The Positive and Negative Syndrome Scale (PANSS) has been used as a universal instrument for clinical assessment of psychopathology in schizophrenia. Different studies have analyzed the factorial structure of this scale and have suggested a five-factor model: positive, negative, excited, depressive, and cognitive/disorganized factors. Two of the most used models are the Marder´s solution and the Wallwork´s one.

The aim of this work was to study the correlations of the two cognitive factors (Marder and Wallwork) with a cognitive assessment performed with a standard cognitive battery, in a sample of patients with first psychotic episode of schizophrenia.

Seventy four patients with first psychotic episode of schizophrenia (26.9, SD:7.8 years old; 70.3% male) were included. The cognitive assessment was performed with the MATRICS Consensus Cognitive Battery (MCCB). The MCCB present seven cognitive domains: Speed of processing, Working memory, Attention/Vigilance, Verbal Learning, Visual Learning, Reasoning and Problem Solving, and Social cognition). Pearson correlations were performed between MCCB scores and Marder´s PANSS cognitive factor (P2, N5, G5, G10, G11, G13, G15) and Wallwork´s one (P2, N5, G11).

Correlation between MCCB scores and cognitive factors of Marder and Wallwork can be seen in the table.

Both PANSS cognition factors show a moderate correlations with Speed of processing, Working memory, Attention/Vigilance and Verbal Learning assessed by MCCB. More discrete correlations were found with Visual Learning, Reasoning and Problem Solving, and with Social cognition (in fact, non-significant correlation with Wallwork´s cognitive factor was found).

Acknowledgements. This study has been funded by Instituto de Salud Carlos III (ISCIII) through the project PI19/00766 and co-funded by the European Union.

None Declared

Intranasal esketamine has recently been approved for the treatment of treatment-resistant depression in adults, with different studies showing its efficacy and tolerability. However, the real-world tolerability of this treatment is still unclear.

Evaluate the tolerability of intranasal esketamine in a case series of 15 patients.

Our case series includes 15 patients, who received treatment with intranasal esketamine during 2022-2023. In order to evaluate the tolerability of intranasal esketamine, patients were asked to complete the TSQM and a side effect questionnaire on different moments of the treatment (one week, six weeks and six months after the beginning of the treatment).

The most common adverse effects were dissociation, dizziness, and somnolence, which resolved within the hours following the administration. All of them were mild or moderate in severity, having a minor impact on the patient, so none of the patients discontinued the treatment due to adverse effects. Other adverse effects noticed were: transitory increment of blood pressure in several patients, and worsening of obsessions in a patient with previous obsessive-compulsive symptoms.

Our data suggests that intranasal esketamine is well tolerated, with transient and mild adverse effects. In all cases the risk-benefit ratio must be evaluated, but until more studies are done, it seems to be a safe treatment for treatment-resistant depression.

None Declared

Schizophrenia (SCH) and bipolar disorder (BD) are severe mental disordes, which have high incidence (Whiteford et al. Lancet 2013; 381 1575-86) and are the main causes of diasibility in young people (WHO 2022; https://www.who.int/news-room/fact-sheets/detail/mental-disorders).

Psycological stress appears in different mental disorders, and this is directly related to oxidative stress (Moller et al. Chem Biol Interact. 1996; 102 17-36)(Pupic-Bakrac et al. 2020; Psychiatr Danub. 32 412-9). Oxidative stress causes reticulum edoplasmic stress (ER stress) and this produces high levels of misfolded proteins. Defective proteins are degraded by the proteasome, but but when the density of misfolded proteins exceeds the capacity of the proteosome, the Unfolded and Misfolded Protein Response (UPR) is triggered through three main pathways: Inositol-requiring enzyme 1α (IRE1α); transcription factor 6 alpha (ATF6α) and protein kinase RNA-Like ER kinase (PERK), trying to recover normal protein synthesis capacity (Bermejo-Millo et al. 2018; Mol Neurobiol. 55 7973-86) (González-Blanco et al. 2022; J Cachexia Sarcopenia Muscle 13 919-31).

Characterizing ER stress and UPR in SCH and BD.

We studied ER stress and UPR in peripheral blood mononuclear cells (PBMC) from 50 patients with SCH and an equal number of patients with BD compared to their corresponding controls in order to achieve our objectives.

Western Blot assay were performed following classical procedure () and the results was normalized to Ponceau as loanding control (Nie et al. 2017; BiochemByophys Resp 12 10-13) (Sander et al. 2019; Anal Biochem 575 44-53). Proteasome activity was assessed using Proteasome Activity Assay Kit (ab107921, Abcam, Cambridge, UK).

ER stress was evaluated with BiP/GRP78. Our results showed significantly increased expression in SCH (p<0,01) and BD (p<0,05), being more increased in SCH. Proteasome activity was increased in SCH and BD, being only statistically significant in SQZ (p<0,05). UPR study showed IRE1a cascade significantly activated in SCH (p<0,001) and only slight increased in BD showed without statistical differences. ATF6a pathway is measured by cleavage to active protein (50-kDa). Results showed higher expression in SCH than in BD and controls (p<0,001). In addition, PERK pathway showed higher statistical levels of p-eIF2a/eiF2a ratio in SCH than in BD and control respectively (p<0,05 and p<0,01).

Our results showed a greater alteration in SCH than in BD at the level of protein synthesis, which implies a greater toxicity at the cellular level and, therefore, a clear risk for the survival of cells in this pathology.

None Declared

Schizophrenia (SCH) and bipolar disorder (BD) are severe mental disorders which lead to psychotic, affective and cognitive symptoms and often cause a progressive functional deterioration of the individual. The current diagnosis of SCH and BD essentially depends on clinical observation that often leads to misdiagnosis and the introduction of non-specific treatments. Therefore, an early detection and intervention are determinant for a better prognosis. Improving outcomes of a First Episode of Psychosis (FEP) depends mainly on the identification of reliable and discriminatory biomarkers between both disorders.

Given that oxidative stress has been tightly involved in multiple metal disorders, the major goal of this work was to characterize oxidative alterations in order to identify potential biomarkers which allow the differential diagnosis in an early stage.

The study was carried out on samples from 49 subjects (14 women and 35 men), divided into four groups: a control group of 10 individuals not previously diagnosed with any serious mental disorder, 17 patients who had presented a FEP, 12 patients diagnosed with SCH and 10 patients diagnosed with BP. Biochemical analysis were conducted in erythrocyte fraction to characterize the cellular oxidative damage by measuring lipid peroxidation (LPO) levels and the antioxidant defense system by the evaluation of catalase (CAT) and superoxide dismutase (SOD) activities.

In the present work, we observed a significant increase in LPO levels in both SCH and BD disorders that was not neutralized by the antioxidant defense. It was found that SCH patients, despite exhibiting greater activities of SOD and CAT compared to BD individuals, also showed significantly higher levels of oxidative damage. The differential oxidative profile observed between SCH and BD individuals allowed to perform an individually analysis of patients diagnosed with FEP. Although it was not possible to identify the type of psychotic disorder of all the patients with FEP, the results obtained showed that while several individuals exhibited an oxidative prolife similar to that observed in SCH patients, other individuals presented a prolife very similar to that found in patients with BD.

The current work reveals that LPO is a potential indicator of worse prognosis after being differentially modified in both SCH and BD. Moreover, SOD and CAT have been identified, by presenting an opposite profile between patients with SCH and BD, as potential preliminary biomarkers for a discriminatory diagnosis in an early stage of the disorder.

None Declared

The objective of this study was to investigate whether glycated hemoglobin (HbA1c) is a valid surrogate for evaluating the effectiveness of antihyperglycemic drugs in diabetes mellitus (DM) trials.

We conducted a systematic review of placebo-controlled randomized clinical trials (RCTs) evaluating the effect of a treatment on HbA1c (mean difference between groups) and clinical outcomes (relative risk of mortality, myocardial infarction, stroke, heart failure, and/or kidney injury) in patients with DM. Then, we investigated the association between treatment effects on HbA1c and clinical outcomes using regression analysis at the trial level. Lastly, we interpreted the correlation coefficients (R) using the cut-off points suggested by the Institute for Quality and Efficiency in Healthcare (IQWiG). HbA1c was considered a valid surrogate if it demonstrated a strong association: lower limit of the 95 percent confidence interval (95 percent CI) of R greater than or equal to .85.

Nineteen RCTs were identified. All studies included adults with type 2 DM. None of the associations evaluated was strong enough to validate HbA1c as a surrogate for any clinical outcome: mortality (R = .34; 95 percent CI −.14 to .69), myocardial infarction (R = .20; −.30 to .61), heart failure (R = .08; −.40 to .53), kidney injury (R = −.04; −.52 to .47), and stroke (R = .81; .54 to .93).

The evidence from multiple placebo-controlled RCTs does not support the use of HbA1c as a surrogate to measure the effectiveness of antihyperglycemic drugs in DM studies.

To investigate potential age, period and birth cohort effects in the prevalence of suicide ideation in European ageing population.

A total of 50 782 community-dwelling adults (aged + 50) from 20 different European countries were collected in the Survey Health Ageing and Retirement study. A multilevel logistic regression model of repeated measures was modelled to assess the effects of age and other variables, including the variability of observations over three levels: birth cohort groups, time period assessment and individual differences.

The larger effect of variability was attributed to individual-level factors (57.8%). Youngest-old people (65–79 years) showed lower suicide ideation than middle-aged people (50–64 years). No significative differences were found for suicide ideation between middle-aged people and oldest-old (80 + years). Only 0.85% and 0.13% of the total variability of suicide ideation accounted for birth cohort and period effects, respectively. Cohorts born between 1941 and 1944 possessed the lowest estimates of suicide ideation. Conversely, suicide ideation started to rise with post-War generations and reached a significant level for people born from 1953–1957 to 1961–1964. Regarding the time period, participants assessed in 2006–2007 showed a lower likelihood of suicide ideation. The rest of the cohorts and period groups did not show any significant effect on the prevalence of suicide ideation.

Our results suggest that age and suicide ideation relationship is not linear in middle and older age. The European Baby boomers born from 50s to mid-60s might report higher suicide ideation than their ancestors. This scenario would imply a greater need for mental healthcare services for older people in the future.

“Rite of passage” is an etnographic concept developed by VanGennep that defines the vital transition of an individual between two different status. It is divided in three stages: separation, liminal/threshold and aggregation. Turner described the liminal phase, and the terms of “communitas” and “liminoid” (structure of a rite without religious/spiritual elements). One widely-known Rite of Passage is the initiation of the shamans.

Study the elements of a rite of passage present in Psychiatric Trainning.

• • Field study (observational, descriptive, non-experimental).

• • Preliminary Sample=10trainees (5man+5women); last year of Psychiatric Trainning.

• • “ad hoc” semi-structured interview (21items subdivided in open questions). 10interviews (average duration=75mins). Permanent register:digital recorder.

• • Summary and analysis of the answers. Review of the literature.

1. - Psychiatric Trainning shared the elements and tri-phasic structure of VanGennep's “rite of passage” concept

2. - Trainees saw themselves as more empathic(7/10) and humanistic(8/10) than other specialties colleagues. Stigma towards mental illness(8/10) and fear of suicide(9/10) were also considered as their distinctives.

3. - The collective behaved as a communitas(10/10)

4. - No spiritual elements(0/10): liminoid process

5. - Resemblances of the ancestral shamans' Initiation: Despite bloody practices were over, suffering was also present(7/10), but was seen as necessary(6/10) and well tolerated(7/10).

6. - Trainees felt that they grew spiritual and mentally(7/10) during the trainning years

Results suggest that Psychiatric Trainning has stable phenomena that:

• • are compatible with the Rite of Passage schema

• • Are considered exclusive of Psychiatry by trainees

• • Have not been systematically studied as a whole, which could help to improve the training.

Most of the studies about Eating Disorders in adolescents have been typically focused on females, only to conclude that the approach should be similar in males. It has been stimated that 5-10% of patients with Anorexia Nervosa are males. Later age of onset and higher prevalence of premorbid overweight are considered among the main differences with female patients.

Analysis of the anthropometric variables of a sample of males with diagnosis of Restrictive Eating Disorder.

Naturalistic, Descriptive and Retrospective study

1. - Sample: 22 male adolescents

2. - Inclusion criteria: males with Restrictive Eating Disorder diagnosis (according to DSM-IV criteria) admitted to an Eating Disorder ward during 2007 and 2008

3. - “ad hoc” questionnaire (15 items)

4. - Analysis: PASW statistics 18

Age range: 7-14years (medium age=14,79±2,50years).11 patients (50%) were older than 16 years-old

1. - Medium BMI (Body Mass Index) at the beginning of the admission was 17,79kg/m2.

medium weight loss: 13,5±7,02kg/m2 (corresponding to a reduction of 22,24±7,52% of the previous weight)

1. - Medium speed of weight loss: 0,92±1,1kg/54

2. - BMI at discharge: 18,69 ±3,43 kg/m2

3. - 19/22 patients (86%) had a premorbid history of overweight

4. - Binge eating: 8 patients (36,4%)

5. - Purgative behaviour: 10 patients (45%)

6. - Laxatives use: 4 patients (18%)

7. - Intense physical exercise: 21 patients (95,5%)

8. - Average duration of current restrictive episode: 13,7 months

In the studied sample we observed:

1. - High prevalence of premobid overweight

2. - Very high frequency of compulsive exercise

3. - Drastic weight loss and loss of a very high percentage of the previous weight, in short periods of time, reaching very low BMI.

analyse GAD impact on clinical and self-perceived health status in outpatients followed in Psychiatric clinics.

Multicentre, cross-sectional study enrolling subjects above 18 years-old with GAD according with ICD-10. Participants were chosen at ramdon by quotes and weighted geographically, but patients were enrolled consecutively. HAM-A and CGI-S were administered to determine clinical status and SF-36 and Sheehan disability scales for health status assessment.

A total of 792 patients; 15.7% naives (GADn), 68.9% women, mean (SD) age of 40.0 (12.9) years were included. Time to effective diagnosis and start up of treatment were, respectively, 2.3 (4.9) and 2.6 (4.7) years. Severe symtoms of anxiety (HAM-A > 24) were presented in 45.2%; 56.9% in GADn vs 43.0% on-treatment (GADt), p<0.001. CGI-S was 3.7 (1.1) in GADn vs. 4.2 (0.8) in GADt, p<0.001. The 77,7% of GADt were receiving 2 or more drugs: 94.1% ansiolytics and/or antidepressants. The 39.3% of subjects showed high/extreme disability for work; 44.4% GADn vs 38.5% GADt, p=0.33, 34.5% for daily-living domestic activities; 39.7% vs 33.7% respectively, p=0.082, and 41.8% for social life; 43.1% vs 41.7% respectively, p=0,145. Mental composite summary of SF-36 was below normal; 30,0 (11,4), much lower in GADn: 25,4 (8,5) vs. 30,8 (11,7), p<0.001. No gender differences were found.

This study showed that a considerable proportion of GAD patients still need for additional medical remedies which should improve the level of disability caused by the diasease and counteract the deteriorated mental health observed in such patients.

analyse the presence of comorbid symtoms as assessed by Hamilton Anxiety scale in outpatients followed in Psychiatric clinics.

Multicentre, cross-sectional study enrolling subjects above 18 years-old with GAD according with ICD-10. Participants were chosen at ramdon by quotes and weighted geographically, but patients were enrolled consecutively. HAM-A and CGI-S were administered to determine clinical status and comorbid symptoms (scoring > 3 in HAM-A). QoL was assessed by SF-36 questionnaire.

A total of 792 patients; 15.7% naives (GADn), 68.9% women, mean (SD) age of 40.0 (12.9) years were included. Symptoms of imsomnia were presented in 30.1% of subjects; 42.3% in GADn vs 27.8% on-treatment (GADt), p=0.001. Symptoms of cognitive function deterioration were showed in 21.1% (25.2% in GADn vs. 20.3% in GADt, p=0.220) and depressive symptoms in 15.5% (15.4% in GADn vs 15.5 in GADt, p=0.991). Moderate to excruciating pain was presented in 46.7% of subjects; 50.5% in GADn vs 46.1% in GADt, p=0.705. Overall, psychic and somatic anxiety symptoms scoring were higher in GADn than in GADt; 26.8 (7.3) vs 22.4 (9.6), p<0.0001, 14.2 (3.6) vs 12.0 (5.0), p<0.0001, and 12.6 (4.5) vs 10.4 (5.2), p<0.0001, respectively. No age or sex differences were found.

Pain, symptoms of depression and cognitive deterioration were comorbid conditions presented in a considerable proportion of GAD patients irrespective of time of evolution, age or sex. Frecuency of insomnia was also high, mainly in naïve patients. This study shows that more attention should be devoted to comorbid condition associated with GAD.

analyse the impact of comorbid depression on clinical and self-perceived health status in outpatients with GAD in Spain.

Multicentre, cross-sectional study enrolling subjects above 18 years-old with GAD according with ICD-10. Participants were chosen at ramdon by quotes and weighted geographically, but patients were enrolled consecutively. HAM-A and CGI-S were administered to determine clinical status and SF-36 and Sheehan disability scales for health status assessment.

Seven-hundred-ninety-two patients; 15.7% naives (GADn), 68.9% women, mean (SD) age of 40.0 (12.9) years were included. Ninety (11,4%) fulfilled criteria for comorbid depression with GAD. Depressive subjects were older [49.5 (11.3) vs. 43.7 (13.2) years, p=0.0001], female (78.7% vs 67.6%, p=0.034) and received lorazepan and lormetazepan more frequently (30.0% vs. 18.5%, p=0.015, and 15.6% vs. 5.0%, p=0.0002, respectively), but not antidepressatns, and received higher number of drugs; 2.3 (0.8) vs. 2.0 (0.8), p=0.011. Overall, psychic and somatic anxiety symptoms scoring (HAM-A) were higher in depressive; 26.4 (8.2) vs 22.7 (9.5), p=0.0003, 14.1 (4.1) vs 12.1 (4.9), p<0.0001, and 12.3 (4.7) vs 10.6 (5.2), p=0.0023, respectively. Depressive showed more severe symptoms of anxiety; 62.2% vs. 43.0%, p=0.0031, and scoring in CGI; 4.2 (0.9) vs 3.7 (1.1), p<0.0001. Depressives also showed higher scoring of disability; 19.7 (6.0) vs. 15.6 (7.0)%, p<0.0001, and lower values in physical and mental summary subscales of SF-36; 38,6 (7,9) vs 43.9 (9.0), p<0.0001, and 26.6 (9.5) vs. 30.4 (11.6), p=0.0008.

Comorbid depression enlarges deterioration in clinical status, level of functioning and quality of life of outpatients with GAD.

Depression is highly recurrent in Bipolar patients, causes more disability than other manifestations of the illness and depressive symptoms predominate over manic and hypomanic symptoms. Our aim is to describe whether in our sample we can find some specific differences from the early course of the illness.

33 patients meeting DSM-IV criteria of Bipolar Disorder I and II whose illness onset was less than 5 years from the first Manic/ hyponamic episode or/and less than 10years from the index depressive episode. Recorded variables included socio-demographic, clinical, treatment characteristics and scales (HRSD, YMRS, BPRS, GAF).Analysis was performed using SPSS Version 12.0.

57.6% were male, 42.4% female, mean age 34.42 years. 2 Patients (6.2%) were depressed when inclusion and 8.8% had had a depressive episode before were included in our Program.

The mean number of depressive episodes was 1.88 (SD 3.58). Only 1 patient had had self-harm intent. 15.2% has first degree family history of Unipolar depressive disorder and 20% of Bipolar disorder. 6.2% were hospitalized because a depressive episode.

We found less rates of depressive episodes than we found in the literature with less sub-syndromal and syndromal depressive symptoms than in routine bipolar population that could be explained by the short course of the illness in our sample. More research should be done to study bipolar depression in early phases to find predictors that help us to decrease the high impact it has in the disorder.

Symptoms of attention-deficit/hyperactivity disorder (ADHD) appear in childhood, but often persist into adulthood. The prodrug lisdexamfetamine dimesylate (LDX) is an effective once-daily treatment for the symptoms of ADHD in children, adolescent and adults.

To evaluate post hoc the impact of ADHD medication history on the efficacy of LDX in adults.

In this phase 4, double-blind, dose-optimized study, patients aged 18–55 with ADHD and impaired executive function were randomized (1:1) to LDX or placebo for 10 weeks. Patients well controlled on current ADHD medication with acceptable tolerability were ineligible. Self-reported, lifetime ADHD medication histories were recorded at screening. Investigator-rated ADHD Rating Scale IV with adult prompts (ADHD-RS-IV-Adult) was a secondary efficacy measure. Primary efficacy and safety outcomes have been published (J Clin Psychiatry 2013;74:694–702).

Baseline characteristics were similar across treatment arms and previous ADHD medication subgroups. Differences between LDX and placebo in mean change from baseline to endpoint in ADHD-RS-IV-Adult total score were observed in the overall study population (n=154; –11.1 [95% confidence interval: –14.96, –7.32]; effect size, 0.9), treatment-naïve patients (n=80; –11.4 [–16.81, –5.96]; 0.9) and patients previously treated with: any ADHD medication (n=74; –10.9 [–16.50, –5.30]; 0.9), methylphenidate (n=40; –9.9 [–17.44, –2.45]; 0.9), amfetamine (n=38; –13.8 [–20.86, –6.75]; 1.3) and atomoxetine (n=21; –8.4 [–21.97, +5.26]; 0.6).

In these post hocanalyses, the response to LDX was similar in the overall study population and subgroups of patients categorized by ADHD medication history.

Study funded by Shire Development LLC.

Although many mental health care systems provide care interventions that are not related to direct health care, little is known about the interfaces between the latter and core health care. ‘Core health care’ refers to services whose explicit aim is direct clinical treatment which is usually provided by health professionals, i.e., physicians, nurses, psychologists. ‘Other care’ is typically provided by other staff and includes accommodation, training, promotion of independence, employment support and social skills. In such a definition, ‘other care’ does not necessarily mean being funded or governed differently. The aims of the study were: (1) using a standard classification system (Description and Evaluation of Services and Directories in Europe for Long Term Care, DESDE-LTC) to identify ‘core health’ and ‘other care’ services provided to adults with mental health problems; and (2) to investigate the balance of care by analysing the types and characteristics of core health and other care services.

The study was conducted in eight selected local areas in eight European countries with different mental health systems. All publicly funded mental health services, regardless of the funding agency, for people over 18 years old were identified and coded. The availability, capacity and the workforce of the local mental health services were described using their functional main activity or ‘Main Types of Care’ (MTC) as the standard for international comparison, following the DESDE-LTC system.

In these European study areas, 822 MTCs were identified as providing core health care and 448 provided other types of care. Even though one-third of mental health services in the selected study areas provided interventions that were coded as ‘other care’, significant variation was found in the typology and characteristics of these services across the eight study areas.

The functional distinction between core health and other care overcomes the traditional division between ‘health’ and ‘social’ sectors based on governance and funding. The overall balance between core health and other care services varied significantly across the European sites. Mental health systems cannot be understood or planned without taking into account the availability and capacity of all services specifically available for this target population, including those outside the health sector.