The coronavirus disease 2019 (COVID-19) has serious physiological and psychological consequences. The long-term (>12 weeks post-infection) impact of COVID-19 on mental health, specifically in older adults, is unclear. We longitudinally assessed the association of COVID-19 with depression symptomatology in community-dwelling older adults with metabolic syndrome within the framework of the PREDIMED-Plus cohort.

Participants (n = 5486) aged 55–75 years were included in this longitudinal cohort. COVID-19 status (positive/negative) determined by tests (e.g. polymerase chain reaction severe acute respiratory syndrome coronavirus 2, IgG) was confirmed via event adjudication (410 cases). Pre- and post-COVID-19 depressive symptomatology was ascertained from annual assessments conducted using a validated 21-item Spanish Beck Depression Inventory-II (BDI-II). Multivariable linear and logistic regression models assessed the association between COVID-19 and depression symptomatology.

COVID-19 in older adults was associated with higher post-COVID-19 BDI-II scores measured at a median (interquartile range) of 29 (15–40) weeks post-infection [fully adjusted β = 0.65 points, 95% confidence interval (CI) 0.15–1.15; p = 0.011]. This association was particularly prominent in women (β = 1.38 points, 95% CI 0.44–2.33, p = 0.004). COVID-19 was associated with 62% increased odds of elevated depression risk (BDI-II ≥ 14) post-COVID-19 when adjusted for confounders (odds ratio; 95% CI 1.13–2.30, p = 0.008).

COVID-19 was associated with long-term depression risk in older adults with overweight/obesity and metabolic syndrome, particularly in women. Thus, long-term evaluations of the impact of COVID-19 on mental health and preventive public health initiatives are warranted in older adults.

According to 2008 data, there are 80.000 patients undergoing replacement opiate programs (RMP) in Spain. However, the clinical therapeutic management and the psychiatric and medical comorbidities have not been well described.

To describe the current therapeutic management and psychiatric comorbilities of opiate-dependent patients undergoing a RMP in Spain.

We carried out an observational, cross-sectional, multicenter study from September 2008 to February 2009. Patients > 18 years, with written informed consent, with a opiate-dependence according to DSM-IV-TR criteria and currently scheduled in a RMP in Spain were included.

624 patients (38.89±7.95 y.o.,84% men) were included in the study from 74 centers.

Psychiatric comorbidities were clinically detected in 68% of all valuable patients, most frequently anxiety (53%), mood (48%) and sleep disorders (41%). Patients receiving buprenorphine-naloxone suffered less sleep disorders (19% vs. 43%; p=0.0327) The proportion of patients with at least one psychiatric comorbidity was directly related to methadone dose (p=0.0066).

The most frequent replacement therapy was methadone (94%), usually in ≤ 40 mg/day (38%) and 40-80 mg/day doses (40%); mean follow up period being 45.88±51.86 months. Significant differences were found between methadone doses and retention. Patients with HIV and HCV infection received higher doses of methadone (HIV+ patients (p=0.0024) and HCV+/ HIV+ patients (p=0.0250) due to ARV treatment; and showed less PMM retention.

Patients present high rates of dual diagnosis, and infectious and non-infectious comorbidities, expecting higher doses of methadone than found (54.04±47.26 mg/day) in the study to assure a proper retention in the maintenance programs.

To explore maintenance of effect with OROS MPH in adults with ADHD.

Multicenter study randomizing adult subjects with ADHD who completed open-label (OL) treatment with OROS MPH (18-90mg/day) for at least 52-week and consented to a 4-week, randomized, double-blind (DB), placebo-controlled (PLC) withdrawal period. Efficacy measures included total CAARS score, CAARS-S:S, GAE, CGI-S and CGI-C. Endpoint analyses were performed using LOCF.

99/155 patients completed the OL OROS MPH treatment phase, only 45/99 patients consented to double-blind randomization. At DB baseline, mean ± SD TCS was 12.1±5.34 (n=23) in the continued OROS MPH group and 16.5±7.49 (n=22) in the placebo group. CAARS changed from DB baseline to DB endpoint by 4.0±7.61 and 6.5±7.82, respectively (p = 0.2586 between groups). CGI-C scores indicated more worsening of symptoms in the placebo group compared to the continued PR OROS MPH (p = 0.0422). Median (range) GAE scores at endpoint were 2.0 (0-3) and 0.5 (0-3), respectively (p=0.0254). Other efficacy endpoints were numerically in favor of OROS MPH. The randomized withdrawal phase may have been underpowered to show statistical significance between treatment groups for the primary outcome. The incidence of treatment-emergent AEs during the DB phase was comparable between groups.

The results indicate that treatment discontinuation after long-term exposure of adults with ADHD to OROS MPH is associated with worsening of clinical symptoms. Statistical significance for several outcomes was not reached, possibly due to study limitations.

There are 80.000 patients undergoing replacement opiate programs in Spain, mainly methadone. Gender differences and the ratio of dual diagnosis in this population are unknown.

To describe gender differences in the current therapeutic management of opiate-dependent patients undergoing a replacement therapy program in Spain.

624 patients from 74 centers in Spain were included between September 2008 and February 2009 in an observational, cross-sectional, multicenter study. Patients were ≥ 18 years, had a diagnosis of opiate dependence according to DSM-IV-TR criteria, were currently scheduled in a replacement therapy program in Spain and were given written informed consent.

Only 16% of patients were female. Methadone average doses were significantly higher in man (57,59mg ± (SD 46,77) vs 52,81mg ± (SD 50,81) (p< 0.05)). Most women were caretaken by their partner (56.8% vs 34,2%) and man by their parents (61,6% vs 37,8) p< 0,05.Women were found to have significantly more sexual disorders than men (6% versus 2%; p=0.0316); but less delirium, dementia, amnesic and other cognitive disorders (none versus 6%; p=0.0486); schizophrenia and other psychotic disorders (3% versus 13%; p=0.0226); and adaptive disorders (2% versus 9%; 0.0427). No significant differences were found between sexes for other psychiatric comorbidities.

The ratio between men and women was close to 5/1, being bigger than that in the general opiate dependent Spanish population. Dual diagnosis rates vary by gender, but not in the number of diagnosis in Axis I or II. Gender differences must be considered when planning dependence services as women.

To explore the relationship between symptomatic and functional outcomes in a five week, double blind, fixed dose, placebo controlled study in adults (age 18-65 years) with ADHD.

Post hoc-analysis of a five-week, double-blind (DB), parallel arm, placebo-controlled trial in adult subjects with ADHD (DSM-IV) and a Conners’ Adult ADHD Rating Scale (CAARS) score >= 24 at baseline. Subjects were randomized to OROS-MPH (18mg, 36mg, 72 mg/day) or placebo. Symptomatic outcomes were assessed by total CAARS score (TCS). Functional outcomes were assessed by Sheehan Disability Scale (SDS) total score and subscales (work, social life and family life), quality of life by Q-LES-Q total score. The relationship of CAARS with SDS and Q-LES-Q was assessed by Pearson's partial correlation analysis, with adjustment for baseline scores of CAARS, SDS, Q-LES-Q, CGI-S, age, sex, and randomization group.

401 subjects were enrolled (54.4% male, mean (SD) age 34 (10.24) yrs). There was a significant treatment effect as measured in TCS at DB endpoint for all OROS MPH treatment groups compared to placebo (P< 0.05). The absolute value of partial correlations of symptomatic outcome with functional outcomes and quality of life varied between 0.54 and 0.36; all correlations were significant (p< 0.0001). These correlations were compared between the functional and quality of life measures, but none differed significantly.

Subjects’ symptomatic improvements during treatment with PR OROS MPH are reflected in improvements in their vocational and social function as measured by the SDS, and quality of life.

To explore the relationship between symptomatic and functional outcomes in adults (age 18-65 years) with ADHD during open label treatment with PR OROS MPH.

Post hoc analyses of a 7-week open-label extension (OLE) (N=370) of a 5 week, placebo controlled double-blind study (DB) which explored safety, efficacy, functional and quality of life outcomes in subjects with a diagnosis of ADHD (DSM-IV). Medication was flexibly dosed (18-90 mg/day) and adjusted individually to best effect during OLE. Regression analyses were performed on the change from DB baseline at OL endpoint in functionality and quality of life as measured by the Sheehan Disability Scale (SDS) and Quality of Life (Q-LES-Q). Baseline score, country, randomization group, sex, change from baseline in CAARS Hyperactivity / Impulsivity, CAARS Inattention and CGI-S at DB endpoint were included as covariates in the analyses.

337 / 370 patients completed the 7-week open label treatment. Improvement on CAARS Hyperactivity / Impulsivity at DB endpoint was significantly related with improvement in SDS “work”, “social life”, “family life” (at least p< 0.005) and “total score” as well as quality of life (p< 0.05) at the end of open label treatment. Change in CGI-S and CAARS Inattention at DB endpoint vs. DB baseline were not related with improvements in any of the functional or quality of life scales at OL endpoint (p>0.05).

These results indicate that improvement in daily functioning and QOL under active treatment may be particularly related to improvement in hyperactivity symptoms.

There are few studies about the characteristics of Substance Use Disorder patients that relapse, defined by restart of the substance use that motivated the intake, after discharge from a Detoxification Unit.

To analyze the percentage of patients who had a relapse in the following 3 months after discharge and to describe their sociodemographic, clinical and therapeutical characteristics.

We prospectively studied drug dependents patients admitted to our Detoxification Unit from June 2008 to August 2009. Data was gathered at admission on demographic (gender, age), clinical (main abused drug, psychiatric comorbidities, polydrug users) and therapeutical variables (hospitalisation duration, prescribed treatment). Patients were followed up for 3 months and assessed for relapse at 1 and 3 months by clinical interview, alcohol screening test and/or urinalysis. Results from patients with and without relapses were compared.

The study sample included 103 patients (77,7% men, average age 38,31±9). At month 3, 57,3% of the patients had relapsed. We found significant differences between the relapse and the non-relapse group on the percentage of polydrug users (68,6% vs 31,4%, p=0,05), on heroine as main drug of abuse (76% vs 24%, p=0,05) and psychiatric comorbidities (60,8% vs 39,2%, p=0,04), being psychotic disorders the most frequent. No significant differences were found between the 2 groups concerning therapeutical variables.

More than half of the patients that ended the detoxification process relapsed in the first 3 months. Polydrug use, opiate dependence and having a psychiatric comorbidity might be considered as risk factors for relapse.

Chronic Fatigue Syndrome (CFS) is characterized by severe fatigue associated with pain, sleep disturbance, attentional impairment and headaches. Evidence points towards a prominent role for Central Nervous System in its pathogenesis, and alterations in serotoninergic and dopaminergic neurotransmission have been described.

Attention-deficit Hyperactivity Disorder (ADHD) courses with inattention, impulsivity, and hyperactivity. It affects children and persists into adulthood in 50% of patients. Dopamine transporter abnormalities lead to impaired neurotransmission of catecholaminergic frontal-subcortical-cerebellar circuits.

To describe the prevalence of ADHD in a sample of CFS patients, and the clinical implications of the association.

To study the relationship between CFS and ADHD.

The initial sample consisted of 142 patients, of whom 9 were excluded because of severe psychopathology or incomplete evaluation. All the patients (age 49 ± 87; 94,7 women) received CFS diagnoses according to Fukuda criteria. ADHD was assessed with a diagnostic interview (CAADID), ADHD Rating Scale and the scale WURS, for childhood diagnose. The scales FIS-40, HAD, STAI and Pluthik Risk of Suicide (RS) were administrated.

38 patients (28,8%) were diagnosed of childhood ADHD (4 combined, 22 hyperactive-impulsive, 12 inattentive) and persisted into adulthood in 28 (21,1%; 5 combined, 4 hyperactive-impulsive, 19 inattentive). There were no differences in Fukuda criteria profile and FIS-40 between groups. ADHD patients scored higher in HAD-Anxiety (9,88 ± 4,82 vs. 12,57 ± 3,49; p = 0,007), HAD-Depression (9,69 ± 4,84 vs. 12,04 ± 4,53; p = 0,023), STAI-E (30,55 ± 14,53 vs. 38,41 ± 11,35; p = 0,012), and RS (6,13 ± 3,48 vs. 8,49 ± 3,07; p = 0,002).

ADHD is frequent in CFS patients and it is associated with more severe clinical profile.

Cocaine dependence disorder has been widely described. However, differences due to gender remain unknown.

To compare clinical gender differences in a large sample of cocaine-dependent patients.

We performed a cross-sectional, observational study in 902 patients (35.47 yo, 21.3% women) with a cocaine dependence according DSM-IV criteria, seeking treatment during 2005 to 2013. Sociodemographic and clinical variables were collected The SCID-I, SCID–II, BIS and a structured interview about cocaine-induced psychosis were performed. Simple descriptive statistics were carried out for demographic and clinical data. Bivariate analysis was made to compare the main variables by sex using SPSSvs18.0.

No differences in age of dependence onset, other clinical variables or cocaine-induced psychosis were detected. However, less cocaine used in the last month (2.12 vs 3.37g) (p < 0.009), more impulsivity (67.2 vs 63.03) (p < 0.040), and more sedative dependence (21.2% % vs 8.3%)(p< 0.00) were detected in women than in men. Affective disorders lifetime were the most prevalent (57,4%) in women. More comorbidity with anxiety disorders (p< 0.025) eating disorders (p< 0.000) and personality disorders (p< 0.039) were detected in women than in men.

Sedative dependence and anxiety disorders should be investigated in cocaine-dependent women in order to treat these conditions. Surprisingly high impulsivity level was detected and could moderate cocaine consumption. However, no difference have been found previously in studies about gender differences in cocaine-dependent patients, so this finding should be confirm in new studies.

The objective of our study is to describe the prevalence of insomnia during active consumption and hospitalisation for detoxification, and its influence on relapses at 3 and 6 months in drug-dependent patients.

We conducted a prospective study of drug-dependence inpatients admitted to the hospital detoxification unit between June 2008 and November 2012, and performed psychiatric follow-up on an outpatient basis over the six months following discharge. Insomnia prior to admission was measured by clinical interview from the patient concerning sleep habits, and during hospital stay using a sleep log filled out by nurse team. Demographic, clinical and diagnostic variables were recorded and a structured clinical interview (SCID) was conducted to assess psychiatric diagnoses. Relapse was deemed to be renewed use of the substance that brought about admission, which was assessed by alcohol testing and/or urinalysis.

We included 434 patients. Insomnia during consumption was reported by 64.3% of patients and 66.1% reported insomnia during hospital stay. Of the patients with preadmission insomnia, 68.3% relapsed at 3 months from discharge, as did 71% of patients with insomnia during hospital stay. Patients who relapsed at 3 months of follow-up showed significantly greater sleep initiation dysfunction prior to and during hospitalisation. Of the patients with preadmission insomnia, 69.2% had relapsed at 6 months from discharge. Patients who relapsed at 6 months of follow-up showed significantly greater sleep initiation dysfunction and global insomnia prior to and during hospitalisation.

Sleep disorders should be study as a prognostic factor in drugdependent patients.

Little is known about medical students’ interest in their training on drug addiction, their personal experience of consumption and whether these aspects influence the detection of addiction in patients.

To study the interest of medical students enrolled on the psychiatry course in the area of addictions, and evaluate the influence of such interest, a history of personal consumption and gender on the detection of addiction in patients.

Voluntary participation was offered to all students from academic years 2008–2009 to 2012–2013. Of the 505 potential students, 336 questionnaires were collected, of which 71.13% were female.

Of the respondents, 88.5% considered that drug dependence issues are important to their professional future and 63% that the approach to drug-related diseases is important. A total of 34% of the students had already assessed addicted patients in their previous clinical training. The students report consuming alcohol(69%), cigarettes(19.5%) and illegal drugs(15.8%). The female students consumed fewer illegal drugs than the men(p0.022) and more frequently considered that the list of topics to be covered was appropriate(p0.021). The male students consumed more illegal drugs more frequently(p 0.005), knew more consumers(p 0.023), and those who drink alcohol consumed more illegal drugs than women(p < 0.005). However, the men seemed to have assessed fewer addicted patients in their previous clinical experience(p0.094).

Consumption among medical students may have a normalizing role on consumption and prevent the detection of addicts. It is important to educate and raise awareness on drugs, as this may influence detection. The focus should be particularly on the male group.

In order to improve global functioning in psychotic patients is necessary to know the kind of variables influencing those.

To research that of a clinical and epidemiological variables group which of them are associated to a better outcome in global functioning in patients affected by psychosis.

A total of 73 psychotic patients were included in this study. All of them were evaluated through a battery of tests including GAF and SIX, PANSS, S-GPTS and a comprehensive questionnaire for clinical and epidemiological variables. A binary logistic regression analysis was applied to the data set of global functioning scores divided by the median in two halves: better and worse global functioning. The model included the following variables: positive, negative and general psychopatology PANSS subscales, PANSS subtype, first or second generation antipsychotic, stimulants drugs use, tobacco use, sex, age, onset age, number of psychotic episodes and S-GPTS score.

Treatment with second generation antipsychotics and lesser scoring in S-GPTS scale were associated with a better outcomes in global functioning. We found an association between lesser negative symptoms and lesser number of psychotic episodes with a better functioning which showed a marginal statistical significance.

We raise the question about preferential use of second generation of antipsychotics as opposed to older antipsychotics and the necessity of improving adherence to treatment for breaking the vicious cycle between psychotic episodes and a worse global functioning. Further studies with greater sample are needed to explain these and another questions.

Alcohol dependence disorder has been widely described. However, differences due to gender remain unknown.

To compare clinical gender differences in an alcohol dependent outpatient sample.

Alcohol dependent outpatients from the centre for addiction treatment of the Vall d’Hebron University Hospital following treatment during 2005 to 2011 were evaluated. We included patients with an alcohol dependence following DSM-IV criteria. Sociodemographic and clinical variables were collected. Simple descriptive statistics were carried out for demographic and clinical data. Bivariate analysis was made to compare the main variables by sex using SPSSvs15.0.

149 patients were included, 83.2% were men. No gender differences were found in the mean age of the sample. Time of first alcohol use to regular consumption was significantly shorter in men (7.9 ± 6.9 year vs 13.95 ± 8.9 years). Significantly more women (68%) compared with men (44.4%) had comorbid psychiatric disorders. 52% of women and 28.2% of men had depressive symptoms. No gender differences were observed for psychotic, anxiety neither personality disorders. Comorbidity with nicotine dependence was high in men and in women (75.4% vs 73.9%). Significantly more women had sedatives dependence (16% vs 5.3%) and opiate dependence (8.3% vs 3.5%) without observing gender differences in the other drugs. the 71.4% of women consume alone compared with the 38.7% of men.

Alcoholic women tend to consume alone. They have more comorbid mental disorders, being depression the most prevalent. Besides alcohol dependence, women also had more sedatives and opiate dependence than men.

Since the early description of paranoia, nosology of delusional disorder has always been controversial. The idea of ??unitary psychosis is old but has now taken on new value from the dimensional continuum model of psychosis.

1. To study the psychopathological dimensions of the schizophrenia spectrum. 2. To explore the relationship between the dimensions obtained and the categorical diagnoses. 3 To compare the different diagnoses of the psychosis from a psychopathological and functional point of view.

an observational study with 550 patients was conducted. 373 patients with schizophrenia, 137 patients with delusional disorder, 40 patients with schizoaffective disorder. PANSS was used to assess the psychopathology and GAF for global functioning. Exploratory and confirmatory factor analysis of the PANSS items was performed in order to obtain a dimensional model. The relationship between diagnostic categories and dimensions was subsequently studied with ANOVA tests.

5 Factors,-manic, negative symptoms, depression, positive symptoms and cognition-, similar in composition to other models were obtained. The model yielded the 57.27% of the total variance. The dimensional model obtained was able to explain the differences and similarities between the different categories of the schizophrenia spectrum and the validity of the categories was questioned. The value of the model in order to help establish the diagnosis, prognosis and treatment decision-making was postulated.

The relationship between neuropsychological and overall performance in people with schizophrenia is known. Smoking and stimulant drugs use can improve neuropsychological outcomes, however the existence of drugs use may be a more severe illness marker.

The purpose of this study is to investigate which clinical and epidemiological variables, including stimulant drugs use and smoking, influence on neuropsychological performance in patients with psychosis.

92 patients with different psychosis were assessed with a battery that included SCIP, to assess neuropsychological performance, PANSS, to evaluate psychotalogy, GAF and SIX as global performance measures. We also explore clinic and sociodemographic data. A binary logistic regresion model was applied on scores on the task ‘words’ of the SCIP (memory and learning), dichotomized at the median. The model included: sex, age, onset age, family history, negative scale, positive scale, global psychopatology and PANSS subtypes, estimated premorbid IQ using Barona Index, stimulant drugs use, smoking and funcionality.

The absence of stimulating drugs use and smoking (trials 2 and 3 of SCIP), was associated with better memory and learning in patients with psychosis. Younger age (trials 1-4 and total of words), higher functionality (trials 1,2 and total of words) and premorbid IQ (trials 2 and 4) were also positively associated with better neuropsychological performance.

Stimulant drugs use and smoking could be markers of poorer previous neuropsychological function in psychotic patients. It is necessary to do longitudinal studies evaluating these variables as markers, risk or protective factors of cognitive performance

Ahe adult patients with attention deficit hyperactivity disorder (ADHD) are characterized by an increased vulnerability to daily life stressors. Cortisol awakening response (CAR) can be used as an index of the adrenocortical activity that relates to chronic stress. Although gender differences in cortisol response have been explored in children with ADHD, there is a lack of gender studies in adults with this disorder.

The aim of the present study is to evaluate possible gender differences in CAR in adults with ADHD.

A total of 50 patients (22 female, age 37.00±8.62 years, and 28 male, age 33.86±9.57 years), with ADHD were recruited from the program for adults with ADHD in the Department of Psychiatry of the Hospital Universitari Vall d’Hebron. Patients fulfilled current DSM-IV diagnostic criteria for ADHD. Psychiatric and organic comorbid disorders were excluded and all the patients were naïve to psychostimulant treatment. Four salivary cortisol samples were collected at 0, 30, 45 and 60 minutes after awakening (work days).

Mean increase in CAR was 10.39±8.68 nmols/l for men and 10.29±9.13 nmols/l for women. T-test comparisons showed no significant gender differences in CAR in adults with ADHD (t= 0.033, z=0.974).

As reported in children, adults with ADHD show no differences in CAR. Albeit these results are still preliminary, they suggest some gender differences in CAR between adults with ADHD and cortisol response in general population.