The Residential Educational Therapeutic Unit Accompany from Hospital Sant Joan de Déu Barcelona, is a device integrated into the public health network, intended for the comprehensive care of children and adolescents under 18 years of age who suffer from an illness complex mental disorder, at serious risk of becoming chronic and generating significant disabilities at a functional, cognitive and emotional level. It was a result from a joint venture between the Department of Social Rights and the Department of Health. The device was created to respond to the increase in behavioral problems and mental health disorders of children underguardianship.

General Objective

To improve the quality of life in the physical, mental and social spheres of vulnerable children and adolescents with serious complex mental pathology through a biopsychosocial and community care model that integrates health, social, family and educational care and which is aimed at the recovery of the person’s life project.

Specific Objectives

To offer intensive intervention, personalized and in a co-responsible manner, that is to say, that integrates the therapeutic, education, social services and child protection teams.

Promote the community and social reintegration avoiding stigmatization and social exclusion.

Improve the intra-family relationship and the burden perceived by caregivers.

Decrease the number of renunciations of parental authority of a minor.

The unit has a capacity for 28 beds: 23 places for children/adolescents underguardianship of the administration and 5 places for cases that are at risk of family claudication due to their therapeutic and educational needs.

There are 5 coexisting therapeutic units. The apartments are referred as ‘homes’ and their organization is designed to encourage the active participation of residents with the professionals who attend them.

The Unit has a multidisciplinary team made up of the following professionals: Psychyatrists, Nurses, clinical psychologists, Social Workers, Educational worker, nursing assistants, administrative.

- 110 children and adolescents have been taken care, with an average cumulative stay of 13 months. In all cases in which the family had the guardianship of the patient, family claudication has been avoided There is a 36% discharge of those patients under guardian that have returned to their original family home 100% of the cases have been linked to an educational center adapted to their needs or to a training project

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Overall, the care model implemented by the population served in the Acompanya’m unit is positively evaluated. Since it provides an intensive and personalized care, treatment and intervention for children suffering from a serious mental disorder of high complexity. A comprehensive, personalized, interdisciplinary approach is offered, coordinated and co-responsible with educational, protection and social services.

None Declared

Conversion disorder (a term that describes what was previously called hysteria) refers to motor or sensory symptoms, or both, that resemble a neurological disease, but that do not originate from or cannot be explained by a known physical disease.

To find reliable tools that can guide the difficult diagnosis of conversion disorder.

Bibliographic review

The exact prevalence of the disorder is unknown. It is estimated that approximately 5% of referrals to neurology are for this disorder. Approximately one third of patients referred to the neurologist have symptoms that cannot be explained by an organic disease. Involuntary movements are the most common motor manifestations of the conversive syndrome, being tremor one of the most frequent manifestations. The first differential diagnosis of conversion disorder is neurological disease. It is currently not necessary for the diagnosis to assess whether or not the symptoms are produced intentionally, as the assessment of conscious intentionality is unreliable. The neurological examination is the fundamental tool for the diagnostic approach, being even more enlightening than the complementary tests. Hoover’s sign, Babinski’s combined leg flexion, plantar flexion of the ankle, tremor and its distraction and synchronisation manoeuvres, as well as the clinical differences between epileptic seizures and non-epileptic seizures of psychogenic origin, are some of the reliable tools for a correct diagnosis.

The diagnosis of the disease should be one of exclusion. There must be clinical data showing clear evidence of incompatibility with a neurological disease and conversion symptoms do not correspond to known physiological mechanisms and anatomical pathways.

No significant relationships.

The lack of a standardised definition for the concept of TRD and an adequate criteria for therapeutic response make difficult the management of patients with MDD who do not achieve remission with one or more courses of treatment. All classifications suggested to define TRD are arbitrary, partially evidence-based, subordinated to the pharmacological findings of the time in which they are written and with serious inconsistencies, making it difficult to construct a universal and enduring diagnostic system.

Considering that the most important goal in treating a patient with Major Depressive Disorder (MDD) should be remission and return to previous functionality, the search for a standardised, evidence-based classification system will allow timely and effective interventions leading to the reduction of this devastating condition.

Bibliographic review

The proposed therapeutic algorithm arises from the combination of several fundamental principles for the management of treatment-resistant depression: the different classification systems of the concept, as well as the concepts of response, relapse, recurrence and remission; the scientific evidence found in the current literature, routine clinical practice, knowledge of switching and augmentation strategies, the new pharmacological targets and neurobiological hypothesis discovered, without forgetting finally the different clinical profiles of depressive symptomatology and the specific indications of each antidepressant.

Resistant depression is difficult to treat successfully and is not a uniform entity. Recently there has been a move to characterise treatment-resistant depression as ‘difficult-to-treat’ depression on the basis that the former description implies that depression treatments are normally effective and that non-response is therefore somehow abnormal.

No significant relationships.

The use of antipsychotics (APS) is essential. Despite their great efficacy, some of them are associated with an increase in prolactin levels that can lead to hormonal changes needing to be identified and managed [1,2,3]. Hormonal changes use to have clinical implications including hypogonadism, infertility and sexual dysfunction

To evaluate possible hormonal alterations and some clinical implications produced by hyperprolactinemia (HPRL) derived from the use of some antipsychotic compounds.

A complete fasting blood test was performed on a sample of 113 subjects (69 men and 44 women). 54% (n = 61) showed a normal prolactin level and 46% (n = 52) showed hyperprolactinaemia ( >50ng / ml). On the global sample, 39.8% (n = 45) was treated with some hyperprolactinemic drug , mostly risperidone and paliperidone.

Some differences were found depending on the gender of the subjects. A highly significant inverse relationship between the values of prolactin and testosterone was found in males (p=0.020, r=-0.285). In females, increased prolactin level was significantly related to decreased cortisol values.

Antipsychotic-related Hyperprolactinaemia ( mainly risperidone and paliperidone) is related with a decrease in testosterone levels in males and with an increase in cortisol levels in females.

No significant relationships.

Psychiatric illnesses are related with a reduced life expectancy and an increase of mortality rates (around 60%) mainly associated with cardiovascular diseases [1]. The high prevalence of obesity, metabolic syndrome, diabetes mellitus and tobacco use among these patients undoubtelly predispose to the impairment in physical health and mortaility increase. Regular physical activity in the general population is associated with a decrease in cardiovascular risk but litle is know about iss influence in some chronic and severe mental disorders like schizophrenia [2].

To quantify the physical activity performed by a sample of subjects with psychosis, borth males and female, compared to a control group.

A sample composed of 141 patients with schizoprenia was compared to 103 healthy subjects as a control group. The International Physical Activity Questionnaire - Short Form (IPAQ) scale was applied to all participants. The time (minutes) of physical activity performed in a week (METs) was collected by each participant [3].

The differences in the total physical activity Mets for the patients with schizophrenia were highly significant (p = 0.001), showing a lower degree of physical activity compared to the control group. A higher and significant percentage of sedentary lifestyle among the psychiatric group (64.5%), compared to 35.5% in the control group was found.

The group of pateints with Schizophrenia showed a significant higher sedentary lifestile including less physical activity. This finding could be highly related with a higher risk of cardiovascular disease and deterioration of the physical health.

No significant relationships.

Despite high survival after bidirectional cavopulmonary anastomosis, a considerable number of patients suffer significant post-operative morbidities related to prolonged length of stay.

A single-center retrospective cohort study of all consecutive patients undergoing a first-time bidirectional cavopulmonary anastomosis from 2006 to 2019.

Prolonged length of stay was defined as hospital stay greater than the 75th percentile for our cohort. Of 195 patients who met inclusion criteria, the median post-operative length of stay was 8 days (interquartile range, 4-15 days). Prolonged length of stay was defined as greater than 15 days. In multivariate analysis, greater than mild systemic atrioventricular valve regurgitation (odds ratio 3.7, 95% CI 1.05-13.068, p = 0.04), longer length of stay after the initial palliative procedure (odds ratio 1.028, 95% CI 1.004-1.05, p = 0.02), and pre-operative higher superior vena cava oxygen saturation (odds ratio 0.922, 95% CI 0.85-0.99, p = 0.04) maintained statistical significance as independent risk and protective factors for prolonged length of stay. A one-level increase in the severity of pre-operative systemic atrioventricular valve regurgitation was associated with a multiplicative change in the odds ratio of prolonged length of stay of 5.45 (p = 0.005) independent of the severity of systemic ventricular dysfunction.

Pre-operative characteristics with greater than mild systemic atrioventricular valve regurgitation, longer length of stay after the initial palliative procedure, and lower superior vena cava oxygen saturation were associated with prolonged length of stay after a first-time bidirectional cavopulmonary anastomosis.

Recurrent laryngeal nerve injury leading to vocal cord paralysis is a known complication of cardiothoracic surgery. Its occurrence during interventional catheterisation procedures has been documented in case reports, but there have been no studies to determine an incidence.

To establish the incidence of left recurrent laryngeal nerve injury leading to vocal cord paralysis after left pulmonary artery stenting, patent ductus arteriosus device closure and the combination of the procedures either consecutively or simultaneously.

Members of the Congenital Cardiovascular Interventional Study Consortium were asked to perform a retrospective analysis to identify cases of recurrent laryngeal nerve injury after the aforementioned procedures. Twelve institutions participated in the analysis. They also contributed the total number of each procedure performed at their respective institutions for statistical purposes.

Of the 1337 patients who underwent left pulmonary artery stent placement, six patients (0.45%) had confirmed vocal cord paralysis. 4001 patients underwent patent ductus arteriosus device closure, and two patients (0.05%) developed left vocal cord paralysis. Patients who underwent both left pulmonary artery stent placement and patent ductus arteriosus device closure had the highest incidence of vocal cord paralysis which occurred in 4 of the 26 patients (15.4%). Overall, 92% of affected patients in our study population had resolution of symptoms.

Recurrent laryngeal nerve injury is a rare complication of left pulmonary artery stent placement or patent ductus arteriosus device closure. However, the incidence is highest in patients undergoing both procedures either consecutively or simultaneously. Additional research is necessary to determine contributing factors that might reduce the risk of recurrent laryngeal nerve injury.

Borderline personality disorder (BPD) is characterized by instability of interpersonal relationships, self-image, and emotions, and by impulsivity. Although patients with BPD are misdiagnosed, some of them receive mental health treatment. Even if the first-line treatment of this disorder is psycotherapy, the patients with BPD may be highly symptomatic and are often prescribed multiple medications in a manner unsupported by evidence.

The aim of this study is to study the available evidence about the pharmacotherapy for borderline personality disorder.

A review of the available literature about the management of borderline personality disorder and de pharmacotherapy for personality disorders was performed.

First-line treatment of the personality disorders is psycotherapy. The treatment plan for BPD may include individual and group therapy, medication, self-education, specialized substance use disorder treatment, partial hospitalization, or brief hospitalization during times of crises. Medications are generaly used only as adjuncts to psychotherapy and the adjunctive use of symptom targeted medications has been found to be useful. There is limited information to guide pharmacotherapy; preliminary evidence limits the practice of polypharmacy. Sympton-domain focused medication treatment is recommeded by some guidelines: cognitive-perceptual symtoms (low-dose antipsychotic drugs), impulsive-behavioral dyscontrol (mood stabilizers), affective dysregulation (mood stabilizers and low-dose antipsychotic drugs) and self-harm (omega-3 fatty acids).

BPD cause significant distress and impariment of social, occupational and role functioning. The first-line treatment for BPD is psychotherapy; however symptom-focused, medication treatment of BPD is generally considered to be an adjunct to psychotherapy. The data support the efficacy of low dose antipsychotic drugs and mood stabilizers.

The exposure to child maltreatment increases the lifetime risk for many psychopathological symptoms: depression, anxiety disorders, bipolar disorder, schizophrenia, post-traumatic stress disorder, personality disorder and dissociation. Besides, adopted children, especially those with a history of institutional living before adoption, are at greater risk for a range of developmental, behavioral and attachment concerns. The case report is of a 17-year-old male, with reactive attachment disorder (RAD). He suffered child maltreatment in his family of origin before the international adoption.

The aim of this study is to present a case-report illustrating the relationship between chil maltreatment, adopted children and the reactive attachment disorder.

A bibliographic search was performed about reactive attachment disorder. Information regarding the clinical case was obtained by consulting the patient’s file.

A 17-years-old male who was adopted at age of 9 from Spain. According to reports from the orphanage, the patient suffered severe maltreatment by his family of origin, with scars on his back. The patient presents impulse control disorder, with verbal and physical heteroaggressiveness in situations of frustration, hunger and sleep. He stopped attending the institute at the age of 12, with marked isolation and reversal of the sleep-wake cycle. His treatment plan are partial hospitalization, psychotherapy and pharmacotherapy.

Both child maltreatment and adoption are risk factors for the presence of psychopathology during the lifetime. Especially during the pre-adoption process and the first years after adoption, both the family and the child should be able to use specialized Mental Health services.

No significant relationships.

Among medical students the rate of depression varies between 5-32% and it is known that the suicide rate is higher than in the general population.

Clear and current data are needed to design studies for the diagnosis and treatment of students and residents of Medicine with psychological and psychiatric disorders in order to reduce rates of suicidal behavior in this population group.

A systematic search for articles on the UpToDate, PubMed and Mendeley platforms has been conducted with the keywords “suicide”, “suicidal behavior”, “suicidal ideation”, “medicalschool” and “medical students”. We found 435 items from which a total of 42 items were selected.

The prevalence of depression is 27.2%, of which only 15.7% of them are under treatment. Burnout, has a high prevalence of 45-50%. The prevalence of suicidal ideation in the last year is 11.1%. The most commonly used method is medication overdose. Suicidal behavior is greater among students who choose to choose Psychiatry or Family and Community Medicine as a specialty.

The rate of suicidal ideation among medical students is 11.1%. Nearly one out of every three medical students suffers from depression in some degree, and only one in five is treated. The similar prevalence of burnout at all levels supposes poor management of stress from the faculty. Medical schools should reduce the associated stigma and should encourage depressed students to seek treatment.

Electroconvulsive therapy (ECT) is today one of the main treatments available and used in psychiatry for serious mental illnesses. Eighty years after its introduction, the ECT procedure has evolved to become a safe option based on scientific evidence. Nowadays there are no absolute contraindications for ECT, regardless of the type of population and clinical situation.

To illustrate the electroconvulsive therapy in medical comorbidities context with a case report.

Descriptive case study.

We present a 66 years old patient who suffers from a psychiatric decompensation with a diagnosis of major depressive disorder with psychotic symptoms. Due to her cardiological history (prolongation of the QT interval of possible psycopharmacological origin and a 2:1 AV block, that required the implantation of a definitive pacemaker) and partial response to psychotropic medication, the initiation of electroconvulsive therapy is proposed as the best alternative. The pacemaker was previously studied by cardiology for a very complete analysis before the procedure. It was recommended to convert it to fixed rate pacing by using a magnet. To do this, we placed it over the pacemaker during the technique. While waiting for a clinical improvement, no incidence has been produced during the sessions.

ECT should not be postponed as a last resort. Numerous studies conclude that ECT is globally the treatment of choice (70-85% response) in severe depressive conditions, over and above antidepressant drugs. The incidence of relevant cardiac complications on ECT is relatively rare (0.9%). Regarding the use of pacemakers, electroconvulsive therapy represents an effective and safe option for the patient.

No significant relationships.

Telecommuting is defined as “a work practice that involves members of an organization substituting a portion of their typical work hours to work away from a central workplace, using technology to interact with others as needed to conduct work tasks”. The prevalence rate of telecommuting in Sapin in 2019 was 5%, while this rate grew up to 34% during de COVID-19 pandemic.

The purpose of this poster is to make a review about how telecommuting affects the employees’ mental health.

A review os the available literature on employees’ menthal health.

Most employers who offer telecommuting consider it a strategic decision for their businesses: it could reduce the expenses of physically accommodating the employees, and it might help employers to contact their subordinates anytime, if needed. Many articles in the popular press about telecommuting extol the benefits of this practice on employees’ health (work-life balance, reduction of travel expenses). However, only a handful of empirical studies substantiate these claims (job satisfaction, quality of life, and role-related stress). Less discussed is the potential of telecommuting to have a negative impact on employees’ health. It may increase both social and professional isolation, which in turn is associated with higher levels of emotional exhaustion, cynicism, cognitive stress complaints and lower levels of work engagement.

Finally, although it is not as effective as personal contact, organizations may stimulate qualitative virtual interaction with coworkers by providing robust online meeting tools and infrastructure, so users can seamlessly collaborate regardless of their physical location.

We present an open prospective and muti – center study with a follow – up of 2 years in patients with a first psychoses episode. Assessments were made every three months for 2 year. We used a protocol including: PANSS, GAF-EEAG, CGI, Young mania, Hamilton scale for the depression, UKU, OCS, Premorbid Adjustment scale, the Information Subtest and Psychosocial Stress Global Assessment (DSM III R). The assessment of prodromal symptoms was retrospectively. The symptoms were based on the late prodromal style described by McGorry (1). A statistical analysis of data was performed.

Objetives

1. • Evaluate the gender differences in the prodomal state and analyse the prognosis according to them.

231 patients were included (32.5% women). The following symptoms were more frequent in men (p<0.05): isolation, odd behaviour, deterioration of cleanness, language vague, and lack of spontaneity. The outcome after 2 year was worse when patients had the following symptoms in the group of the men: lack of spontaneity, language vague and deterioration of cleanness. However, women have the same outcome independently of prodromal symptoms in the illness onset.

The presence of prodromal symptoms could influence on outcome of men after two years. They have a worse outcome when they have some prodromal symptoms. The intervention on this phase could be an opportunity to improve the outcome of men with first psychosis episode.

To describe validation process of the new apathy scale for institutionalized dementia patients (APADEM-NH).

100 elderly, institutionalized patients with diagnosis of probable Alzheimer Disease (AD) (57%), possible AD (13%), AD with cerebral vascular disease (CVD) (17%), Lewy Bodies Dementia (11%) and Parkinson associated to dementia (PDD) (2%). All stages of the disease severity according to the Global Deterioration Scale (GDS) and Clinical Dementia Rating (CDR) were assessed. The Apathy Inventory (AI), Neuropsychiatric Inventory (NPI), Cornell scale for depression, and the tested scale were applied. Re-test and inter-rater reliability was carried out in 50 patients. The feasibility and acceptability, reliability, validity, and measurement precision were analyzed.

APADEM-NH final version consists of 26 items and 3 dimensions: Deficit of Thinking and Self-Generated behaviors (DT): 13 items, Emotional Blunting (EB): 7 items, and Cognitive Inertia (CI): 6 items. Mean application time was 9.56 minutes and 74% of applications were fully computable. All subscales showed floor and ceiling effect lower than 15%. Internal consistency was excellent for each dimension (Cronbach’s α DT = 0.88, α EB = 0.83, α CI= 0.88);Test-retest reliability for the items was kW=0,48-0,92; Inter-rater reliability reached kW values 0.84-1.00; The APADEM-NH total score showed a low/moderate correlation with apathy scales (Spearman ρ, AI =0.33; NPI-Apathy= 0,31), no correlation with depression scales (NPI-Dementia = -0.003; Cornell= 0,10), and high internal validity (ρ =0.69 0.80).

APADEM-NH is a brief, psychometrically acceptable, and valid scale to assess apathy in patients from mild to severe dementia and discerning between apathy and depression.

Antipsychotic treatment is known to be associated with secondary sexual dysfunction (SD). Recognition and treatment of this adverse effect has received growing attention. Until now, all antipsychotic agents were thought to potentially cause SD mediated by increased prolactin. Our aim was to observe whether aripiprazole modifies SD in patients with schizophrenia after 3 months of treatment.

Multicenter, observational, open-label, prospective, three-month study with single group of aripiprazole treated patients. Sexual activity was assessed using CGI-S and CGI-I for SD; SALSEX scale, validated for Spanish, 3 times after initiating study drug. Patient's clinical status was evaluated by CGI-S and CGI-I for psychotic disorders, and by BPRS Scale.

Result: 42 patients (70% men), 38 completed the study. Incidence of SD at 3 months was null for all patients studied. As period of treatment advanced, the Salsex score decreased, showing a mean overall reduction of –5 points (SD 3.6). Largest reduction was observed in subgroup of patients with SD in baseline visit, who exhibited a mean reduction of –6 points (SD 3.1).

Men with SD in baseline evaluation showed more marked improvement than women at 40 days of treatment (p=0.0447). However, recovery was similar for both groups at 90 days of treatment.

In schizophrenia, SD secondary studies to antipsychotics are important in establishing effectiveness of these agents in chronic treatment. After 3 months of aripiprazole treatment, no SD was observed in patients. Patients who presented SD at study initiation improved over course of 3 months treatment with aripiprazole.

Evaluate the sex differences in first episode psychosis.

We present an open prospective and muti – center study with a follow – up of 2 years in patients with a first psychoses episode. The patients were treated with risperidone and assessments were made in the first month and then every three months for 2 year. Therefore, we used a protocol including the following scales: PANSS, Global Assessment of Functioning scale (GAF-EEAG), CGI, Young mania rating scale, Hamilton scale for the depression, UKU, OCS, Premorbid Adjustment scale (Cannon-Spoor), the Information Subtest (WAIS) and Psychosocial Stress Global Assessment (DSM III R).

231 patients were included (32.5% women). Males have consistently an earlier onset even after controlling the cofounding factors and poorer premorbid functioning. Women have a shorter DUP, and they are more likely to be married than men and to live with their couples or children. Women have also better adherence to treatment than men. Males don't show differences in negative, positive symptoms or cognitive deficits. There was no difference between the sexes in the dose of the prescribed antipsychotic. There are no clear sex differences in family history and obstetric complications. Sex doesn't have influence on the course of illness in middle-term (2 years).

This paper supports the presence of significant differences between schizophrenic males and women, but there aren't differences in the outcome of the disease.