Anorexia nervosa is an eating behavior disorder that is often related to various personality factors. The relationship between obsessive compulsive disorder and eating Disorders has been highlighted.

To present a clinical case of a patient with eating disorder and gastric bezoar, secondary to compulsive hair ingestion.

Bibliographic review of articles published in relation to the comorbidity of these disorders, based on articles published in the last 5 years in Pubmed.

26-year-old female. Diagnosis of restrictive anorexia nervosa. She was admitted to the hospital on two occasions for nutritional disorders. In the last admission, she reported greater anxiety and significant weight loss. She reports that she has limited her food intake, but she does feel thin and is unable to eat for fear of gaining weight. Ruminative thoughts about her body image. During admission, the patient expressed a sensation of fullness, nausea and vomiting, later observing in abdominal X-ray and gastroscopy, the presence of a gastric trichobezoar, which was finally resolved conservatively.

Trichotillomania is observerd in 1 in 2000 people, trichophagia is even less frequent. According to DSM- V, these disorders are grouped within obsessive-compulsive spectrum disorders. A Trichobezoar is a conglomerate that can be found in the stomach or intestine, composed mainly of hair, previously ingested. Trichotillomania can be associated with anorexia nervosa, especially in patients with obsessive personality traits, which occurs frequently. The gastric slowing that patients with anorexia often present is a factor that favors the formation of the bezoar

No significant relationships.

Electroconvulsive therapy (ECT) is a medical treatment for those patients with high suicide risk or refractory psychiatric disorders. It is currently a safe technique, and its effectiveness has been widely demonstrated.

Presentation of a clinical case about a patient with drug-resistant delusional disorder and high suicide risk, who eventually received ECT treatment.

Bibliographic review including the latest articles in Pubmed about ECT procedure, effects and use.

We present a 45-year-old man, who visited different doctors several times by reporting he had the feeling of “having a brain tumor or a vascular disorder”, so he requested imaging tests (computed tomography and magnetic resonance). These tests were absolutely normal, but he kept thinking something was wrong, and eventually attempted suicide by hanging (his family founded him before it was too late). The patient was admitted to hospital, and started psychopharmacological treatment, with minimal response. He desperately insisted that he had “something inside his head”. At this point, it was proposed to start ECT, and the patient accepted. After 6 bilateral ECT sessions, he was visibly more relaxed and less worried, and he no longer presented autolytic ideation. He was still a little bit suspicious about the feeling of having a neurological disease. Currently, the patient runs a follow-up consultation.

Electroconvulsive therapy is a safe and effective technique for those patients with high suicide risk. It may be useful to perform imaging tests in certain cases, for detecting intracranial pressure, acute hemorrhage, tumors… A follow-up of these patients must be performed

No significant relationships.

The Covid-19 pandemic has had a significant impact on the mental health of adolescents. Several descriptive studies and systematic reviews have shown an increase in suicide rates in this age group.

- To present a literary review on the impact of the Covid-19 pandemic on the mental health and suicidal behavior of adolescents around the world. - To present data on admission rates due to suicidal behavior during the first year of the Covid-19 pandemic in a Spanish child-adolescent psychiatric hospitalization unit.

- We will present a literature review and a retrospective cross-sectional study on admission rates for suicidal behavior in a child-adolescent psychiatric hospitalization unit. - Admission rates for suicidal behavior during the year prior to the pandemic will be compared with rates relative to the first year of the pandemic.

- We have found a significant increase in admission rates for suicidal behavior during the year of the pandemic. Similar results have been found in different studies and meta-analyzes. - The socio-demographic characteristics of the patients are quite similar in the two periods of time analyzed, but the reference to intra-family problems has been more frequent in the year of the pandemic.

Our data is in line with other studies suggesting that the Covid-19 pandemic has had a strong impact on teenage suicidal behavior.

No significant relationships.

Traumatic brain injury (TBI) can cause changes in the personality and behaviors. History of TBI has been associated with violent behavior and substance abuse.

Presentation of a clinical case of a patient with antisocial personality traits who suffered a TBI and abuses alcohol.

We conducted a bibliographic review by searching for articles published the last 5 years in Pubmed

We present the case of a 48-year-old male patient with a history of myoclonic epilepsy, who suffered a TBI in a car crash. During his stay at ICU antisocial and borderline personality traits were found. When he came to consultations, he presented signs of alcohol intoxication (verbiage with hasty and dysarthric speech, and psychomotor incoordination). He acknowledges daily alcohol intake, although he minimizes it. During the interview he is irritable, prone to anger when contradicted and boasts of episodes of heteroaggressiveness and violence that he has carried out in the past. He reports morning sickness and tremors, but does not accept that they may be due to alcohol withdrawal. There is no motivation for change.

It has been determined that history of TBI is more frequent in individuals with antisocial personality. TBI has been linked to violent behaviors, poor inhibitory control, engaging in illegal acts and higher rates of substance abuse. However, the causal relationship between antisocial behavior and TBI has yet to be clarified, as the available evidence does not show which comes first. More research is needed in the future that takes into account the temporal sequence of events.

No significant relationships.

Migrations are a source of stress for patients, which can have repercussions on their Mental Health. We present the case of a native Senegalese patient who presented a first psychotic episode.

Presentation of a clinical case of an immigrant patient with a psychotic disorder.

Bibliographic review on migration and psychosis by searching for articles in Pubmed.

We present the case of a patient of 20 years, a native of Senegal, who has been living in Spain for 3 months in a shelter home. He has no family or relations in Spain, and only speaks Wolof, presenting serious difficulties in communication with healthcare workers. He came to Hospital with his social worker because strange behaviors had been observed. He presented delusional ideation of self-referential and mystical-religious content, related to “the prophet” and “the need to fulfill a mission”. He also presented auditory hallucinations that he identified as of divine origin, and ordered him to perform behaviors such as picking hairs from the ground and various rituals. He acknowledges cannabis and alcohol use in the previous days. Paliperidone treatment was started. Throughout the admission, he begins to show concern for the state of his relatives in Senegal and the need to send them money.

Multiple studies indicate that migrants are at higher risk of psychosis, specially those from countries where the majority of population was black, according to some series. The challenge lies in understanding the mechanisms underlying this increased incidence, taking into account psychosocial factors such as social isolation and trauma.

No significant relationships.

Pregnancy has sociocultural implications that lead to conceiving it depending on the cultural context (Noguera & Rodríguez, 2008). Self-care is a cultural practice associated with the well-being of mother and child during pregnancy (Carmona, Hurtado and Marín 2007). Being relative to culture, self-care varies according to current beliefs. Beliefs are the concretion of a way of thinking about the environment that surrounds us (Peirce, 1903).

Analyze the beliefs of women from a population group in Montería, about pregnancy and its implications regarding self-care in eating.

Qualitative approach. Sources: primary. Sample: due to saturation, 15 pregnant women assigned to the Mocarí neighborhood hospital in Montería. Instrument: semi-structured open interview. The information was processed through AtlasTi, implementing content analysis. Emerging categories: contents, routines in food.

Main belief: food affects the well-being of mother and child. It is adequate or inappropriate depending on categories such as content and routines. The former refer to the food consumed, the latter indicate the times of consumption.

Beliefs about pregnancy operate as generators of mental habits, projected wishes and concrete actions. Therefore, they are an important starting point for the implementation of self-care practices at the institutional level.

No significant relationships.

Brain lesions may induce psychiatric symptoms in some cases. Imaging tests are important to make a differential diagnosis, and therefore initiate an appropriate treatment.

Presentation of a clinical case about a patient with psychiatric symptoms who presented an organic lesion.

Bibliographic review including the latest articles in Pubmed about psychiatric symptoms induced by organic lesions.

We present a 51-year-old male patient, with adequate previous functionality, who attended psychiatric consultations due to changes in his character, with delusional mystical and megalomaniac ideation, verbiage, hypoprosexia, memory loss and insomnia (diagnosed with Bipolar Disorder type II, hypomanic episode). Eventually, a brain computed tomography scan was performed, in which meningioma was visualized. The patient underwent surgery, and he asked to keep a sample of his tumor to always carry it with him on a pendant. Psychiatric symptoms induced by organic lesions are highly variable, depending on the location and size of the lesion, and they may be the first and/or only symptom of a meningioma (up to 21% according to various studies), so it is important to perform imaging tests in some cases. At this time, the patient is under follow-up, he has remained euthymic and stable, and he refuses to take psychopharmacological medication.

Psychiatric symptoms may be the first and/or only manifestation of an organic lesion in some cases. Neuroimaging tests (CT and MR) may be useful in the differential diagnosis. It is important to carry out an indiviualized treatment based on the patient’s pathology, which may include surgery and/or drugs.

No significant relationships.

Megalomanic ideas in a patient with limited intellectual functioning may be due to the psychotic clinic or be the result of their disability.

This case is intended to highlight the importance of a joint approach between psychiatrists and psychologists to assess functionality before and after the psychotic episode.

34-year-old woman with no mental health history. She came to the emergency department for an episode of aggression at home. Her parents report that they have observed strange behaviour, she is more aggressive, speaks alone, changing voices and global insomnia in the last few days. Her language is incoherent and disorganised, with a long response latency. Megalomaniacal and catastrophic delusions. Possible auditory hallucinations and thought control phenomena.

During admission, antipsychotic treatment was introduced with good tolerance and response on the part of the patient. She has been distancing herself from the ideas and has become somewhat critical. A psychological evaluation was carried out with different scales that showed borderline IQ.

It is important to make a good assessment of the patient’s symptoms in order to make a differential diagnosis. In this case, it is advisable to carry out a control and follow-up, as well as a neuropsychological assessment before and after the acute episode. In addition, a multidisciplinary approach with psychologists, psychiatrists and social workers is important.

No significant relationships.

We present the clinical case of a patient where the psychotic clinic coexists with gender dysphoria. This scenario can be the result of a change in gender identity derived from the psychotic process or appear independently of it.

We want to explain the importance of knowing how to act with a patient in whom these two processes coexist.

20-year-old woman, with no history of mental health. She comes to the emergency department for behavioral alteration. The family observes strange behaviors, unmotivated laughter, soliloquies and aggressive episodes. Abandonment of studies, hobbies and radical physical change. Delusions of prejudice and self-referential delusions. Possible phenomena of echo and diffusion of the thought. Auditory hallucinations talking to her in male gender, since then she presents doubts about her sexual identity and manifests her desire to change sex. Altered judgment of reality.

During admission, we started treatment with an antipsychotic with good tolerance and she was referred to mental health team, where psychopharmacological treatment was adjusted with good response. In the following medical appointments the psychotic clinic disappeared at the same time that sexual identification was completely restored and made a critique of the behavior and experiences.

This case highlights the importance of assessing the chronology of symptoms, the patient’s criticality, the response to antipsychotic treatment and the need to exclude the psychotic background of the desire for gender reassignment before making a therapeutic decision.

No significant relationships.

A delusion of parasitosis is defined as the fixed, false belief of infestation by invisible organisms or fibrous material of unknown origin. The differential diagnosis is true infection, substance use disorder, dementia or other neuropsychiatric disease.

Our goal was to characterize delusions of parasitosis, classically named Ekbom syndrome, among individuals attending our emergency department (ED).

Over a four-year period (2017-2020), we carried out a retrospective case-register study of patients with DSM-5 Ekbom syndrome attending an ED that provides mental health services to an area of nearly 450.000 inhabitants in Sabadell (Barcelona, Spain).

There were 13 eligible patients: 7 were diagnosed for the first time and 6 had multiple episodes. Female-to-male ratio was 1.6:1; average age was 56.9. The most common diagnosis was delusional disorder (n=5;8.5%), followed by schizophrenia (n=3;23.1%) and organic disorders (n=2;15.4%). Origin: Africa (n=5;38.5%), South-America (n=4;30.8%) and Spain (n=4;30.8%). Fifty percent showed poor treatment compliance. Antipsychotics used: risperidone (n=8;61.54%), olanzapine (n=4;30.8%). Five patients received antidepressants. Most patients had previously been seen by other medical specialties (internal medicine, dermatology and hematology). ‘’Match box sign’’: 7 patients (53.8%). Cerebral atrophy was present on brain scan in 4 patients. After discharge: acute psychiatric unit (n=7), outpatient appointments (n=4), day hospital (n=1) and 1 to a psychogeriatric unit.

Delusions of parasitosis are rare in our emergency department. The typical patient is a postmenopausal woman, a visitor or immigrant to Spain. Effective treatment requires a focus on cultural, gender, and age aspects, with close cooperation between psychiatry and other relevant specialties.

Day care programs have been extensively used to treat people with acute psychiatric disorders. Day hospitals (DH) can act as an alternative to admission in patients with acute symptoms, shorten the duration of admission, be useful for rehabilitation and maintenance care or enhance treatment in patients with poor adherence to outpatient care. Few research has been conducted in delusional disorder (DD).

To investigate whether DH care increases adherence with psychiatric appointments in patients with DD. To describe functions of partial hospitalization in DD.

Comparative study including DD patients who attended a DH (Group 1:n=12) versus patients who did not receive DH care (Group 2;n=7). Patients attending DH were classified into 3 groups according to the program function at referral. Adherence with outpatient follow-up appointments (primary outcome) and pharmacy refill data (secondary outcome) were assessed after discharge over a 6-month period (DH) and compared with group 2. For statistical analyses, non-parametric tests were performed.

Program function (DH): alternative to admission (n=4); shortening of admission (n=5) and enhancing outpatient treatment (n=3). Patients receiving DH care were more frequently referred from the inpatient unit or emergency department compared to those who did not attend DH (commonly referred from primary care services). No statistically significant differences were found between both groups in adherence to psychiatric appointments. Patients who attended DH showed higher compliance with antipsychotics (89.29% vs.72.62, p<0.05).

DH care may be a useful alternative to increase adherence with antipsychotics in DD patients with poor awareness of illness.

AGR has received honoraria, registration for congresses and/or travel costs from Janssen, Lundbeck-Otsuka and Angelini.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a biological basis overlapped with obsessive compulsive disorders and body dysmorphic disorder (BDD). The combination of pharmacological treatment and psychological interventions have been considered the gold-standard

Our main objective was to present the case of a patient with ASD and comorbid BDD. As a second objective, we reviewed recent works on the common neurobiological substrate and therapeutic options for both conditions.

(1)Clinical case: Patient with ASD and BDD, treated with fluoxetine 60 mg/day and aripiprazole 30 mg/day. (2)Non-systematic narrative review focused on neurobiological substrate and treatment of ASD and BDD. The electronic search was performed by the PubMed database (1990-2020) using the following key terms: “autism spectrum disorder”, “body dysmorphic disorder”, “dysmorphophobia”, “neurobiology”, “pharmacological treatment”, “psychological treatment” and “treatment”.

Our patient is a 31-year-old single male fulfilling DSM-5 criteria for ASD, diagnosed in childhood, and BDD. He received pharmacological treatment and CBT. He also verbalized having been concerned with his lips and mouth for the last 10 years. This discomfort leads to passive ideas of death. Review: All articles (n=4) supported the use of selective serotonin reuptake inhibitors (SSRIs) and CBT in this comorbidity. None of them reported the use of antipsychotics. Oone article described the use of Repetitive transcranial magnetic stimulation (rTMS) and oxytocin.

ASD and BDD share the basis of corticostriatal circuits. ISRS and CBT may be effective in treatment. Other options (oxytocin or rTMS) should be further investigated. Examining this comorbidity could be useful for discovering possible endophenotypes.

Measuring the appropriateness of antibiotic prescribing in nursing homes remains a challenge. The revised McGeer criteria, which are widely used to conduct infection surveillance in nursing homes, were not designed to assess antibiotic appropriateness. The Loeb criteria were explicitly designed for this purpose but are infrequently used outside investigational studies. The extent to which the revised McGeer and Loeb criteria overlap and can be used interchangeably for tracking antibiotic appropriateness in nursing homes remains insufficiently studied.

We conducted a cross-sectional chart review study in 5 Wisconsin nursing homes and applied the revised McGeer and Loeb criteria to all nursing home–initiated antibiotic treatment courses. Kappa (κ) statistics were employed to assess level of agreement overall and by treatment indications.

Overall, 734 eligible antibiotic courses were initiated in participating nursing homes during the study period. Of 734 antibiotic courses, 372 (51%) satisfied the Loeb criteria, while only 211 (29%) of 734 satisfied the revised McGeer criteria. Only 169 (23%) of 734 antibiotic courses satisfied both criteria, and the overall level of agreement between them was fair (κ = 0.35). When stratified by infection type, levels of agreement between the revised McGeer and Loeb criteria were moderate for urinary tract infections (κ = 0.45), fair for skin and soft-tissue infections (0.36), and slight for respiratory tract infections (0.17).

Agreement between the revised McGeer and Loeb criteria is limited, and nursing homes should employ the revised McGeer and Loeb criteria for their intended purposes. Studies to establish the best method for ongoing monitoring of antibiotic appropriateness in nursing homes are needed.

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.