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Group psychotherapy for patients with first-episode psychosis: Effect on the clinical status and use of resources
- P. Herrero Ortega, A. Oliva Lozano, J. Garde González, C. Bayón-Pérez, R. Mediavilla, M. P. Vidal-Villegas, B. Rodríguez-Vega, S. Cebolla, E. Román, E. V. Pérez Pérez, M. F. Bravo-Ortiz, O. B. O. AGES-Mind Group
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S635-S636
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Introduction
Psychotic disorders carry several economical, psychological and social consequences, both at individual and community levels. Early intervention programs after first-episode psychosis which combine pharmacological and psychosocial strategies are aimed at reducing symptoms, lowering costs in the use of health and non-health care resources and improving overall functioning. AGES-Mind study is based on manualized psychotherapeutic interventions for people with first-psychosis episodes.
ObjectivesThe aim of the study was to evaluate the effect of a group psychotherapeutic intervention on the clinical status and use of clinical resources in a sample of patients with first-episode psychosis at 12 and 24 months after the beginning of the intervention. This cohort will be compared to patients with first-psychosis episodes without group psychotherapeutic intervention.
MethodsLongitudinal, observational, retrospective study on a cohort of N=46 patients with first-episode psychosis within the last 5 years. Two groups of 23 patients each were formed. The participants of one of those groups received group psychotherapy in the context of the AGES-Mind study and the other group received treatment as usual without group intervention. Non-exposed patients were matched by age, gender and time elapsed since first-episode psychosis with those exposed to the intervention. Sociodemographic data, clinical status and use of clinical resources outcome variables were assessed.
ResultsNo significant differences were found in clinical status and use of resources between participants and non-participants in the psychotherapeutic group intervention after 12 and 24 months.
ConclusionsAfter controlling for potentially confounding variables as sociodemographic, age and time since first-episode, participating in a group psychotherapeutic program does not seem to improve clinical variables or use of resources. Further studies with larger samples would be necessary to explore other variables, such as symptoms, satisfaction with the intervention or social functioning.
Disclosure of InterestNone Declared
The use of Polygenic Scores in a family design of First Episode Psychosis
- N. Murillo-Garcia, S. Papiol, S. Barrio-Martínez, M. Sevilla-Ramos, R. Magdaleno-Herrero, Á. Yorca-Ruiz, V. Ortíz-García de la Foz, M. Miguel-Corredera, M. Fatjó-Vilas, R. Ayesa-Arriola
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S631
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Introduction
A wide variety of traits is heritable and has genetic loading, including schizophrenia spectrum disorders (SSDs) and its associated neurocognitive features. The genetic architecture of SSDs is polygenic, with the contribution of thousands of single nucleotide polymorphisms of small effect with an estimated SNP-heritability of 24%. The same occurs with neurocognitive phenotypes such as intelligence or educational attainment. Therefore, the method of polygenic risk scores (PRS) is useful in estimating the genetic burden of such traits. Moreover, the use of PRS in a sample of genetically related individuals would allow analyzing the contribution of genetic and environmental factors involved in the development of the disorder and its candidate endophenotypes.
ObjectivesTo estimate PRS for schizophrenia, and polygenic scores for intelligence and educational attainment in patients with First Episode Psychosis (FEP), their first-degree relatives (siblings and parents), and a group of healthy controls.
MethodsThe sample is comprised of 579 participants of the PAFIP-FAMILIAS project in Santander, Spain (133 FEP patients, their 244 first-degree relatives, and 202 healthy controls). All provided sociodemographic information and completed the same neuropsychological battery. Participants’ DNA was extracted from venous blood samples, and genotyping was performed at the Centro Nacional de Investigaciones Oncológicas (CeGen) by the Global Screening Array v.3.0 panel (Illumina). Data quality control, imputation, calculation of PRS, and genetic association analysis are being performed using PLINK, SHAPEIT, IMPUTE2, SPSS and R.
ResultsData analysis is currently in progress, at the quality analysis stage, in collaboration with the Institute of Psychiatric Phenomics and Genomics (IPPG) in Munich, Germany. We expect to find higher PRS for schizophrenia in FEP patients, while their first-degree relatives will potentially show intermediate risk scores between patients and healthy controls. A similar finding is expected regarding intelligence and educational attainment, as FEP patients may show more genetic burden for low intelligence and education.
ConclusionsThe estimation of PRS has demonstrated to be valuable in studying complex traits such as schizophrenia. We believe that by applying this method in a family design can provide interesting insights on the development of SSDs and its potential endophenotypes, and potentially useful in their prevention.
Disclosure of InterestNone Declared
AGESMind clinical trial: SocialMIND® results at 16 weeks
- M. P. Vidal-Villegas, A. Abad Pérez, P. Herrero Ortega, A. Oliva Lozano, J. Garde González, J. Andreo-Jover, A. Muñoz-Sanjosé, R. Mediavilla, B. Rodríguez-Vega, G. Lahera, Á. Palao-Tarrero, C. Bayón-Pérez, M. F. Bravo-Ortiz
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S480-S481
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Introduction
Early intervention on a first psychotic episode is fundamental for a more favorable prognosis, and it usually combines pharmacological treatment, which mainly affects positive psychotic symptoms, with interventions that can improve the rest of the symptoms and associated problems such as deterioration in social functioning (Harvey & Penn, 2010; Fusar-Poli, McGorry & Kane, 2017). While Mindfulness is gaining more and more prominence in the field of psychotherapy (Chan et al., 2019; Cillesen et al., 2019), social cognition and social functioning are being researched as key targets on which to intervene after a first psychotic episode (Green, Horan & Lee, 2015).
SocialMIND® is a mindfulness-based social cognition training tailor-made to improve social functioning in people who have suffered a first psychotic episode within the last five years. It is currently being compared with a group Psychoeducational Multicomponent Intervention (PMI) in a Randomized Controlled Trial (RCT) (Mediavilla et al., 2019). Both group psychotherapies include 17 sessions delivered over a 9 month period: 8 weekly sessions, 4 biweekly sessions and 5 monthly sessions.
The results of SocialMIND® at 8 weeks showed improvements in social cognition and social functioning, specifically on affective social cognition and self-care (Mediavilla et al., 2021).
ObjectivesTo evaluate the efficacy of SocialMIND® in improving social functioning, measured by the Personal and Social Functioning (PSP) scale 16 weeks after starting the intervention, in people who have suffered a first psychotic episode in the last 5 years.
MethodsRandomized, controlled pilot trial (use of a psychoeducational multicomponent intervention or PMI as active comparator) of two parallel groups (SocialMIND® and PMI) with a 1:1 ratio using a blind evaluator.
ResultsNo statistically significant differences were found in the social functioning variable between the two treatment arms. Intragroup differences are observed in other secondary variables studied (social cognition) 16 weeks after starting the interventions.
ConclusionsSocialMIND® has not been shown to be more effective than a PMI in improving social functioning at 16 weeks after starting the intervention in people who have suffered a first psychotic episode in the five years prior to being included in the study.
Disclosure of InterestNone Declared
Euthanasia and psychiatric patients: a Spanish glance to the Dutch experience
- P. Albarracin, F. Mayor, M. Aparicio, E. Herrero
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S874
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Introduction
The recent approval of euthanasia in the Spanish legal code and its posible extension to psychiatric patients opens an unprecedented scenario in the Iberian country. We analize the experience of the Netherlands, a country where euthanasia has been in practice for over two decades, in order to foresee epidemiological trends that could be replicated in Spain.
ObjectivesTo review the legislation on euthanasia in Spain and the Netherlands, as well as the epidemiological data regarding euthanasia applicants affected by mental health conditions in the Netherlands, to predict future epidemiological trends in a similar population in Spain.
MethodsWe studied the legislation on euthanasia in Spain and the Netherlands, as well as the directives of the Regional Commisions for Euthanasia in the Netherlands to analize differences and similarities between the legal codes on both countries. We also sought epidemiological data regarding the application of euthanasia on psychiatric patients in the Netherlands, gathering data from seven articles in English language obtained through a search in PubMed using the MeSH terms “Euthanasia” AND “Netherlands” and “Psychiatry”.
ResultsEuthanasia on psychiatric patients in the Netherlands has been a practice on the rise during the last decade, despite the elevated proportion of rejected applications and the high survival rate of this patients in later longitudinal studies. Affective disorders and personality disorders stand out as major psychiatric causes between the applicants. The Spanish legislation bears important resemblance to its Dutch predecessor, but also significant differences.
ConclusionsThe available data on the application of euthanasia on mental health patients in the Netherlands show an in increasing trend regarding the execution of this practice, specially on patients who gather distinct clinical features. The data provided by the Dutch experience could have some replication in Spain, as well as anticipate possible future ethical conflicts regarding the application of this service.
Disclosure of InterestNone Declared
Superior mesenteric artery syndrome: when vomiting are not voluntary
- M. A. Morillas Romerosa, A. Oliva Lozano, P. Herrero Ortega, J. Garde Gonzalez
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S851
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Introduction
Superior mesenteric artery syndrome is a gastro-vascular disorder in which the third and final portion of the duodenum is compressed between the abdominal aorta and the overlying superior mesenteric artery. This rare, potentially life-threatening syndrome is typically caused by an angle of 6°–25° between the abdominal aorta and the superior mesenteric artery, in comparison to the normal range of 38°–56°, due to a lack of retroperitoneal and visceral fat (mesenteric fat). In addition, the aortomesenteric distance is 2–8 millimeters, as opposed to the typical 10–20. However, a narrow superior mesenteric artery angle alone is not enough to make a diagnosis with no symptoms.
Symptoms are fullness and epigastric tightness after meals, nausea and vomiting (often bilious) and pain in the middle of the abdomen that improves with the prone or knees flexed to the chest. The diagnosis is supported by imaging tests (esophagogastroduodenal transit or CT) showing dilation and stasis proximal to AMS in the third duodenal portion.
Relief from vomiting with feeding through a enteral probe placed beyond the obstruction to the proximal jejunum supports diagnosis.
Precipitating factors should be corrected first, whenever possible. Acute symptoms can be resolved with gastric decompression and intravenous fluids. Therefore, surgical correction should only be done in well-studied patients with chronic recurrent episodes of AMS syndrome. The most recommended surgical technique is a laparoscopic proximal duodenojejunostomy
ObjectivesTo describe a case of superior mesenteric artery syndrome and review in literature the organic complications and associated psychopathology of this disorder
MethodsClinical case report and brief review of literatura
Results17-year-old woman with a diagnosis of anorexia nervosa. Admitted for behavioral disorder, repeated self-harm and low mood. Presents a BMI of 16.6. Irregular rules. Progressive diet is started to which nutritional supplements are added with good initial tolerance. It presents a loss of 2kg and begins with nausea, vomiting and postprandial epigastralgia. Oral panendoscopy and abdominal ultrasound are performed showing possible mesenteric aortic clamp so naso-jejunal probe and exclusive enteral feeding is prescribed. She received enteral jejunal nutrition progressively with feedback syndrome prophylaxis that included parenteral vitamin B1. After a few days, oral supplementation began. He remained hemodynamically stable, with no signs of heart failure. It gained 3kg of weight up to 43.2kg, starting before discharge from the hospital successfully oral tolerance.
ConclusionsSuperior mesenteric artery syndrome is a serious complication in anorexia nervosa with a low incidence and an estimated mortality of 33%. A multidisplinar approach that addresses both the medical and psychological needs of these patients throughout their hospital stay is necessary.
Disclosure of InterestNone Declared
“Social functioning and use of rehabilitation resources in a group of people who experienced a first episode of psychosis and participated in a psychotherapeutic group program versus a control group”
- A. Oliva Lozano, J. Garde Gonzalez, P. Herrero Ortega, A. Muñoz-Sanjosé, Á. Palao-Tarrero, M. P. Vidal-Villegas, R. Mediavilla, P. Tarín Garrón, J. M. Pastor-Haro, Á. De Diego Gómez-Cornejo, M. F. Bravo-Ortiz, O. B. O. A.-M. Group
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S185
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Introduction
Psychotic disorders have a huge impact on social functioning, which is the ability to stablish and maintain social activities such as interpersonal relationships and self-care activities of daily living. Research data support that the early intervention in people who have experienced a first episode of psychosis (FEP) -based on a multidisciplinary treatment including both psychopharmacological and psychosocial treatments-, has a relevant role in a favorable evolution. AGES-Mind study is based on manualized psychotherapeutic interventions for people with first-psychosis episodes.
ObjectivesTo describe the use of rehabilitation resources and social functioning in a group of people with FEP who were included in a psychotherapeutic group program versus a control group, at 12 and 24 months since the beginning of the intervention.
MethodsLongitudinal, analytical, observational, retrospective study on a cohort of 46 patients with first-episode psychosis within the last 5 years. 23 patients received group psychotherapy in the context of the AGES-Mind study and they were compared with 23 control patients who did not receive a group intervention (treatment as usual). Controls were matched by age, gender and time elapsed since the first episode of psychosis with those exposed to the intervention. Sociodemographic data, social functioning (self-care, social activities, social relationships, and behavior) and use of rehabilitation resources outcome variables were assessed.
ResultsSignificant differences were found regarding participation in social activities in the intervention group versus control group at 24 months. No significant differences were found in other dimensions of social functioning or in the use of rehabilitation resources.
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ConclusionsFurther studies with larger sample sizes are needed in order to determine if the participation in group therapy leads to an improvement in social functioning and use of rehabilitation resources for people who have experienced a first episode of psychosis.
Disclosure of InterestNone Declared
A look back: Coenesthetic schizophrenia. A literature review.
- R. Galerón Guzmán, M. Huete Naval, E. Herrero Pellón, P. Albarracín Marcos, A. García Recio
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1084
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Introduction
We present the case of a 19-year-old patient who experienced a nonexisting moving sensation, increasing size and painful sensation on tongue, jaw and skull bones. Likewise, the patient showed high anguish, psychomotor restlessness and low mood, in relation to somatic symptomatology; which severely interfered in his life, dropping his university studies and his social life. He also presented thoughts of being victim of a complot of his classmates.
ObjectivesTo present a case report and to review the literature of coenesthetic schizophrenia.
MethodsLiterature review of scientific articles searching in EMBASE and Pubmed. We considered articles in English and Spanish.
ResultsTreatment with oral aripiprazole and sertraline was started, with progressive clinical improvement, decreasing somatic sensations until they disappeared, as well as mood improvement and remission of anxiety and psychomotor restlessness.
Coenesthetic schizophrenia was first described in 1957 by Gerd Huber. It is characterized by bodily sensations often combined with affective disturbances. Other symptoms that occur frequently are affective, vegetative, motor and sensory alterations. Typical schizophrenic symptoms are limited to brief psychotic episodes.
ConclusionsWe consider knowledge of this entity important, given the differential clinical characteristics regarding to other presentations of schizophrenia, as well as the need to do a differential diagnosis with other disorders such as body dysmorphic disorder or hypochondriasis.
Disclosure of InterestNone Declared
“Unspecified organic personality and behavioral disorder due to brain damage from HHV-6 encephalitis in child. case report and literature review”
- A. Oliva Lozano, M. A. Morillas Romerosa, P. Herrero Ortega, J. Garde Gonzalez, B. Orgaz Álvarez, J. Curto Ramos, M. Alcamí Pertejo
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S143-S144
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Introduction
We present a case of a 15 year-old boy diagnosed with Unspecified Personality and Beheavioral Disorder Due to Brain Damage from a Human Herpes Virus-6 Encephalitis.
ObjectivesTo describe a case of an Unspecified Organic Personality and Behavioral Disorder secondary to brain damage from Human Herpes Virus-6 (HHV-6) Encephalitis in an 11 year-old childand to review recent literature, in order to improve clinical practice.
MethodsClinical case report and brief review of literature. A bibliographic research was made in the database PubMed, using the terms “Viral Encephalitis” AND “Neuropsychiatric symptoms”; “Viral Encephalitis” AND “Behavioral Disorder”; “Long-Term Neurological Morbidity” AND “Viral Encephalitis”.
Results15 year-old boy diagnosed with Unspecified Personality and Beheavioral Disorder Due to Brain Damage from a Human Herpes Virus-6 Encephalitis, secondary to immunosupression in the context of haematopoietic progenitor transplantation (HPT) at 11 years old. MRI showed supratentorial ventriculomegaly, atrophic changes in encephalon and right hippocampus with subcortical retraction secondary to previous encephalitis. Clinically, main changes appeared in behavior, presenting a serious frontal syndrome with high disinhibition, what implied severe social and academic difficulties. During the outpatient follow-up, the behavioural disorder is being pharmacologically treated with Risperidone 1,5mg per day with a partially favorable evolution. The patient presented intolerance to olanzapine, with an episode of low level of conciuosness after taking it.
Bibliographic research results indicate that the gold standard treatment for behavioral disturbances are antipsychotics. Risperdidone is proven save for treatment in children. Results point out also the importance of an early multidisciplinar intervention, involving family training, rehabilitation resources and curricular adaptations.
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ConclusionsViral encephalitis may have serious neuropsychiatric consequences, especially during childhood while the brain development is not finished. When the neurological damage affects the frontal lobes of the brain, behavioural and personality disturbances are expected and an early multidisciplinar intervention should be considered. Antypsichotics are the gold standard pharmacological treatment for behavioural disturbances. During the scholar period, special curricular adaptations should be done in order to reduce study-related stress.
Disclosure of InterestNone Declared
Virtual self-conversation to support people living with obesity when starting their change process towards a healthier lifestyle: Preliminary results of a longitudinal study
- P. Lusilla, D. Anastasiadou, P. Herrero, J. Vazquez, B. Spanlang, M. Slater, J. A. Ramos, G. Parramon, A. Ciudin, M. Comas
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S110
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Introduction
People living with obesity (PLWO) often experience ambivalence when starting their change process towards a healthier lifestyle. Psychological treatments for obesity should resolve this ambivalence and help PLWO to explore their own reasons for change in line with their needs and values, as well as promote self-efficacy. Following the Motivational Interviewing (MI) principles, the SOCRATES project proposes a “virtual self-conversation” to help PLWO to address some of the psychological aspects associated with obesity, such as the lack of awareness about their condition, the impact of the internalization of weight stigma, and the lack of self-efficacy.
ObjectivesWith the current longitudinal study, we aim to explore how the participants’ process of lifestyle change, and how their eating habits and dysfunctional eating patterns change before and after the virtual intervention.
MethodsForty-eight patients with obesity from the Vall d’Hebron University Hospital (Mean age = 19.7 years) were assigned to 3 groups. The Experimental Group 1 (EG1) (N = 21), after completing an intensive training on MI, received a virtual intervention using the “motivational self-conversation” technique. The Experimental Group 2 (EG2) (N = 17) underwent a virtual intervention with a pre-registered psychoeducational dialogue, and the Control Group (CG) (N = 10) followed treatment-as-usual. All participants completed self-reported questionnaires on their motivation to change lifestyle [(Readiness Rulers (RR), Processes of Change questionnaire in weight management (P-W)], eating habits (Habits questionnaire) and dysfunctional eating patterns (Three Factor Eating Questionnaire-18) at baseline (T0), post-intervention (T1), and 4 weeks follow-up (T2). Repeated measures ANOVA was performed for all the questionnaires.
ResultsStatistically significant results were shown regarding motivation to change through the RR and the “evaluation of the consequences of their weight” subscale of P-W across time for the EG1 (p < .05). These results suggest that participants’ motivation to eat healthier and do more exercise, as well as self-awareness about the negative consequences of their condition increased after the virtual intervention.
ConclusionsThe present study showed that this novel virtual intervention might be an effective tool in helping PLWO resolve their ambivalence to change lifestyle and acquire self-awareness about their condition. However, the intervention did not lead to significant changes in other psychological variables, such as lifestyle habits or dysfunctional eating patterns; domains that may be less sensitive to changes over the time, and which may take place once motivation is well-established.
Disclosure of InterestNone Declared
Suicide in Schizophrenia: A literature review
- M. Huete Naval, R. Galerón Guzmán, E. Herrero Pellón, P. Albarracín Marcos, B. Serván Rendoluna
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1112
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Introduction
More than 90 percent of patients who attempt suicide have a psychiatric disorder. The diagnosis of schizophrenia is associated with a decrease in life expectancy of about 10 years, with suicide being the most important related factor. Literature suggests that the risk of suicide death in this population has been found to be 10 to 20 times higher than that in the general population
ObjectivesTo present a case report of a patient with a first psychotic episode and suicide attempt focusing on clinical features and risk factors.
MethodsPresentation of a clinical case supported by a non-systematic review of literature containing the key-words “suicide”, “Suicidal ideation”, “psychosis” and “schizophrenia”.
ResultsThis is a case report of a male 28-year-old patient, with no known psychiatric history, admitted to our inpatient service after a suicide attempt by precipitation. In a first evaluation, the patient presented psychotic symptoms consisting of paranoid delusions, auditory hallucinations, tendency to social isolation and the appearance of self-harming ideation in the days prior to the episode. After initiation of antipsychotic medication, a significant improvement in positive symptoms was observed. The patient has since had no delusions or hallucinations and is living independently at home.
Contemporary research studies indicate that the lifetime rate of completed suicide in individuals with schizophrenia is between 4% and 13%. Several specific risk factors have been described in the schizophrenia population, such as early stage of the illness, lack of adherence to treatment, recurrent relapses, comorbid depression and the paranoid subtype. The antipsychotic treatments with the most scientific evidence are clozapine, risperidone, olanzapine and quetiapine. Within psychotherapy, cognitive behavioral therapy appears to be the most effective.
Conclusions- It is important to know the risk factors that are associated with an increased risk of suicide in patients diagnosed with schizophrenia.
- An early intervention and specific treatment can improve prognosis of this population.
Disclosure of InterestNone Declared
Sociodemographic and clinical characteristics of the population with a first psychotic episode attended in the mental health services of area 5 of Madrid (Spain)
- J. Garde González, P. Herrero Ortega, A. Oliva Lozano, I. I. Louzao Rojas, M. P. Vidal-Villegas, A. Muñoz-Sanjosé, M. P. Sánchez-Castro, G. Lahera, S. Sánchez Quílez, M. F. Bravo-Ortiz, O. B. O. A.-M. Group
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S443
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Introduction
Risk of functional impairment and progression to chronic illness in people with a first episode of psychosis (FEP) has motivated early intervention programs, showing promising results. Defining the characteristics of people with FEP at local level enables the clinicians to adjust interventional models to the reality of the population. The area 5 of Madrid (Spain) is referred to La Paz University Hospital and it serves a catchment area of roughly 527,000 people.
ObjectivesWe aim to identify sociodemographic and clinical characteristics of patients in the area 5 of Madrid (Spain) who meet the criteria of FEP.
MethodsA descriptive retrospective study including 179 people (age range 18-40 years) who were attended in mental health services of La Paz University Hospital (area 5 of Madrid, Spain), between January 2019 and May 2020, having suffered a psychotic episode in the last five years.
ResultsThe average age of people with FEP was 29.32 years, with a higher proportion of men (62%). The mean duration of untreated psychosis (DUP) was 3.64 months and 47% of patients consume cannabis. We found disparities in DUP among the different districts in the area and we also observed differences depending on the district for inclusion in rehabilitation programs or psychotherapy. The following averages were obtained for the aggregate sample: 1.01 hospitalization/year, 1.42 emergency room visits/year, 1.81 years of illness and a mean dosage equivalent to olanzapine 6.75 mg/day. The incidence of psychosis in our area has been 7.01 cases per 100000 inhabitants/year.
ConclusionsThe incidence of psychosis has been as expected according to data recorded at previous studies in Spain. The results obtained in our sample have included a lower DUP and a higher use of cannabis than those described in the literature. We have also found differences when observing the inclusion of patients in different treatments (psychotherapy, rehabilitation), which may be related to the differences in the DUP by districts. Further exploration in this field is needed to draw causal conclusions.
Disclosure of InterestNone Declared
Reviewing the consistency of Dissociative Identity Disorder: a case report.
- E. Herrero Pellón, P. Albarracín Marcos, M. Huete Naval, R. Galerón Guzmán, F. Mayor Sanabria, A. Montes Montero
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S969
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Introduction
We present the case of a 22-year-old patient who has been followed up in a daytime hospital for personality disorders since June 2022. Of note is the presence of multiple personalities (in total of more than 20 have been identified), each of which has distinct physical and psychological characteristics.
ObjectivesThe objective is to present a clinical case of dissociative identity disorder and to review the existence of scientific evidence supporting this diagnosis.
MethodsLiterature review of scientific papers over the last years and classic textbooks on the issue. We included references in English and Spanish languages.
ResultsNumerous studies support that dissociative disorders are the result of psychological traumas that generally begin in childhood. This is a difficult category to diagnose, since they present symptoms that also appear in other disorders such as those of the schizophrenic spectrum.
One or more dissociative parts of the subject’s personality avoid the traumatic memories while others become fixed to these traumatic experiences and manifest symptoms. In the case of our patient, there are dissociative episodes with subsequent amnesia and auditory, visual and olfactory hallucinations, as well as impulsive behaviors in the form of self-injury and a flattened affect, with significant emotional distancing.
Conclusions- The prevalence of dissociative identity disorder is higher than traditionally thought.
- Some theories develop how trauma essentially produces a degree of dissociation of the psychobiological systems that constitute the subject’s personality.
Disclosure of InterestNone Declared
PSYCHOLOGICAL IMPACT OF COVID-19 LOCKDOWN ON A POPULATION WITH SERIOUS MENTAL DISORDER: DIAGNOSTIC GROUP ANALYSIS
- B. Pedruzo, C. Aymerich, A. Catalan, M. Pacho, M. Bordenave, O. Estevez, J. Herrero, M. Laborda, G. Mancebo, J. L. Perez, M. A. Gonzalez Torres
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S779
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Introduction
Since its emergence at the end of 2019, the COVID-19 virus has spread worldwide. In Spain, mandatory home confinement was established on March 15, 2020, and lasted 99 days. Previous studies on events that required isolation situations suggest a worsening in the mental health of general population, and in particular, of especially vulnerable groups such as individuals with severe mental disorder (SMD).
ObjectivesThe aim of this study is to evaluate the psychological effect (anxiety and depression) of confinement in patients with SMD and to study the dissimilarities among the different diagnostic groups.
MethodsIn this study, assessments were performed using the IDER and STAI questionnaires, in order to evaluate symptoms of depression and anxiety, respectively. The evaluations were carried out in patients who had required at least one admission to the Psychiatric Hospitalization Unit of the University Hospital of Basurto. The Shapiro-Wilk test was used to verify the normality of the sample. ANOVA test was used to study differences among diagnostic groups. Posteriorly, Bonferroni correction was performed.
Results95 participants completed the IDER questionnaire, obtaining a mean score of 24.56 (SD=8.18) for the state and 23.57 (SD=8.14) for the trait. In the STAI questionnaire, a mean score of 27.86 (SD=15.19) was obtained for the state and 30.49 (SD=14.71) for the trait. ANOVA test indicated presence of differences among groups. However, differences did not persist after Bonferroni correction.
ConclusionsIncreased levels of anxiety and depression were found in the sample studied with respect to the general population.No statistically significant differences were found among different disgnostic groups. Further studies should be performed in order to increase the knowledge around this research area.
Disclosure of InterestNone Declared
Non-schizophrenic psychotic disorders: Cycloid psychosis. Case report and literature review
- P. Herrero Ortega, J. Garde González, M. A. Morillas Romerosa, A. Oliva Lozano, J. Curto Ramos
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S636
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Introduction
Cycloid psychosis is a clinical entity with defining traits which emerged from the Wernicke-Kleist-Leonhard school of psychiatry and has a long history in Europe. Leonhard distinguished three clinical forms: anxiety-happiness, confusion and motility psychosis. It is a condition with high clinical heterogeneity and favorable prognosis.
ObjectivesTo describe a case of cycloid psychosis and review in literature the heterogeneity of this phenomena and its clinical management.
MethodsClinical case report and brief review of literature.
Results57-year old male with previous diagnosis of paranoid schizophrenia and severe congenital hearing loss. Preserved autonomy and adequate real-life and interpersonal functioning. Along the past few years the patient has presented episodes of a significant clinical global worsening in context of mainly somatic symptoms (intestinal obstruction and volvulus) and minor stressful life events. On this occasion he appears in the emergency room with a new episode of abdominal pain and is admitted to Internal Medicine with presumptive diagnosis of intestinal volvulus. The patient gathered heterogeneous symptoms including disorientation, confusion, generalized tremor, gait disorder, profuse sweating, regressive and oppositional behaviors (refusal to eat or drink liquids) and sudden behavioral oscillations (from agitation to prostration). From the psychic point of view he showed thought blocking, mutism, significant anxiety, fear of death, delusional prejudice ideas and sensoperceptive disturbance which seemed otherwise related to previous sensorial problems. We introduced treatment with Olanzapine 30 mg and after 4 weeks, the patient suddenly showed a significant clinical improvement until the complete remission of the symptoms and restitution of his previous state. In coordination with his regular psychiatrist was proposed the controversial diagnosis of cycloid psychosis. Cycloid psychosis gather a few clinical features which differentiate it from other entities: acute onset, polymorphic symptomatology, global disturbance of psychic life, remitting and recurrent course and favorable prognosis. Regarding its clinical management no controlled studies have been conducted to this date of the treatment of this phenomena. According to literature ECT seems to be an effective treatment as well as low-doses of atypical antipsychotics. Some authors propose pharmacological maintenance treatment with mood stabilizers.
ConclusionsThe diagnosis of cycloid psychosis can be useful as well as necessary to describe certain patients with similar clinical features, recurrent course and favorable prognosis. Future studies on pharmacological approach would be useful to ensure the appropriate clinical management of these patients.
Disclosure of InterestNone Declared
Relationship between elimination disorders and internalizing-externalizing problems in children: A systematic review and meta-analysis
- C. Aymerich, B. Pedruzo, M. Pacho, M. Laborda, J. Herrero, M. Bordenave, G. Salazar de Pablo, E. Sesma, A. Fernandez-Rivas, A. Catalan, M. Á. González-Torres
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S328-S330
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Introduction
Elimination disorders (ED) include enuresis, defined as wetting from 5 years, and encopresis, defined as soiling from 4 years onwards after organic causes are excluded. They are highly prevalent in childhood and often associated with clinically relevant comorbid psychological disorders. However, no systematic review or meta-analysis examines their co-occurrence with internalizing and externalizing problems in children.
ObjectivesThe aim of this study is to determine if, and to what extent, children with ED show higher internalizing and externalizing problems than their healthy peers.
MethodsA multistep literature search was performed from database inception until May 1st, 2022. PRISMA/MOOSE-compliant systematic review (PROSPERO: CRD42022303555) were used to identify studies reporting on internalizing and/or externalizing symptoms in children with an ED and a healthy control (HC) group. First, a systematic review was provided. Second, where data allowed for it, a quantitative meta-analysis using random effects model was conducted to analyze the differences between the ED and the HC groups for internalizing and externalizing symptoms. Effect size was standardized mean difference. Meta-regression analyses were conducted to examine the effect of sex, age, and study quality. Funnel plots were used to detect a publication bias. Where found, the trim and fill method was used to correct it.
Results36 articles were included, 32 of them reporting on enuresis (n=3244; mean age=9.4; SD=3.4; 43.84% female) and 7 of them on encopresis (n=214; mean age=8.6; SD=2.3; 36.24% female) [Image 1]. The ED group presented significantly lower self-concept (ES:0.42; 95%CI: [0.08;9.76]; p=0.017) and higher symptom scores for thought problems (ES:-0.26; 95%CI: [-0.43;-0.09]; p=0.003), externalizing symptoms (ES:-0.20; 95%CI: [-0.37;-0.03]; p=0.020), attention problems (ES:-0.37; 95%CI: [-0.51;-0.22]; p=0.0001), aggressive behaviour (ES:-0.33; 95%CI: [-0.62;-0.04]; p=0.025) and social problems (ES: 0.39; 95%CI: [-0.58;-0.21]; p=0.0001) [Image 2]. Significant publication biases were found across several of the studied domains [Image 3]. No significant effect of sex, age or quality of the study score was found.
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ConclusionsChildren with an elimination disorder may have significant internalizing and externalizing problems, as well as impaired self-concept. It is recommendable to screen for them in children with ED and provide interventions as appropriate.
Disclosure of InterestNone Declared
Clinical characteristics of chemsex users attended in a ngo in madrid
- J. Curto Ramos, L. Ibarguchi, P. Barrio, A. García, M. A. Morillas Romerosa, P. Herrero, H. Dolengevich Segal
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S644
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Introduction
The intentional use of drugs before or during sexual intercourse (chemsex) is a phenomenon of special importance in the MSM (men who have sex with men) population due to its impact on mental, physical and sexual health.
ObjectivesThe objective of this study was to describe the sociodemographic and medical characteristics, psychoactive substances use of a sample of users with sexualized drug use (chemsex) attended by the non-govenrmental organization Apoyo Positivo in the program “Sex, Drugs and You”.
MethodsA cross-sectional descriptive analysis of a sample of users attended by the non-govenrmental organization Apoyo Positivo in the program “Sex, Drugs and You” was performed.
Results230 participants were included. Most common drugs used during sexual intercourse were: mephedrone, cocaine, poppers, GHB and methamphetamine. The frequencies of substances consumed during sex were: mephedrone (95%), methamphetamine (80%), GHB (92.2%), ketamine (52%), poppers (alkyl nitrites) (95%), cocaine (89 .7%), speed (amphetamine sulfate) (49.6%) and drugs for erectile dysfunction (86%). 61.3% reported having practiced slamsex intravenous substance use at some time in their life, being a habitual practice at the time of collecting information for 50.7%. The most frequent genitally transmitted infections were: syphilis, chlamydia and gonorrhea. Users reported having been diagnosed with the following genitally transmitted infections: hepatitis B virus (7.4%), hepatitis A virus (18.6%), syphilis (69.6%), human papillomavirus (16 %), herpes (9.4%), chlamydia (43%), gonorrhea (60.5%) and candidiasis (9.7%).
ConclusionsSlamsex and STIs are usually reported in our sample. Interventions for chemsex users must include a colaborative model which includes professionals from different areas, including internists and emergency physicians, psychiatrists, psychologists, nurses, social workers and sexologists.
Disclosure of InterestNone Declared
Impulsive traits and dual pathology in patients with depression and alcohol dependence, a case report
- M. Huete Naval, L. Reyes Molón, C. Regueiro Martín-Albo, R. Galerón, E. Herrero Pellón, P. Albarracin
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S464
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Introduction
Alcohol dependence is one of the most frequent comorbidities in depression. Multiple environmental and neurobiological factors are directly involved in these diseases. In particular, impulsivity is present in many patients with dual pathology and may play a relevant role in its causes, clinical manifestations and prognosis.
ObjectivesTo review the relationship between impulsive traits and dual pathology in patients with depression and alcohol dependence.
MethodsPresentation of a clinical case supported by a non- systematic review of literature containing the key-words “impulsivity”, “depression” and “alcohol dependence”.
ResultsThis is a case report of a 43-year-old male with a known history of alcohol dependence and recurrent depression. Interestingly, the patient has a family history of bipolar disorder and alcohol abuse disorder on the paternal side, and frontotemporal dementia on the maternal side. He currently presents a depressive episode associates associated with a significant increase in alcohol consumption. The patient has presented prominent impulsive traits since adolescence that have been aggravated in recent years. This lack of impulse control is described as one of the most relevant factors in relapses in alcohol consumption. Multiple studies correlate the lack of impulse control with a worse prognosis in both alcohol dependence (greater probability of relapses and resistance to treatment) and depression (increased suicide risk). Likewise, an increase in cognitive impulsivity has been observed during depressive episodes, characterized by an inability to inhibit behaviors that have already begun and poor planning capacity, which could lead to a worsening of alcohol abuse.
ConclusionsImpulsivity traits are related to a worse prognosis in dual pathology due to alcohol and depression, and may present common etiopathogenic mechanisms.
DisclosureNo significant relationships.
Alternative starting regimen with aripiprazole long-acting treatments, a case report
- M. Huete Naval, B. Serván, M.E. Expósito Durán, P. Albarracin, E. Herrero Pellón, R. Galerón
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S723
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Introduction
Aripiprazole long-acting treatments can significantly control symptom, improve adherence and reduce the risk of relapse compared to oral drugs. An alternative start-up guideline has recently been approved in several countries that simplifies its administration.
ObjectivesTo present a case report of a patient with schizophrenia treated with alternative starting regimen of aripiprazole long-acting treatment.
MethodsPresentation of a clinical case supported by a non-systematic review of literature.
ResultsWe present the case of a 22-year-old patient diagnosed with schizophrenia, whose symptoms started after the birth of her son, 2 years ago. She has presented a poor clinical evolution, requiring several admissions to our inpatient service after discontinuation of her medication. The patient has taken different antipsychotics, including olanzapine and paliperidone long-acting treatment, which were suspended due to side effects (weight gain and increased prolactin levels). A switch to oral aripiprazole 20mg was made, which showed good response and tolerance. Given the persistence of irregular intake, it was decided to switch to aripiprazole long-acting treatment, applying an alternative initial regime consisting of two doses of aripiprazole long-acting treatments 400mg and one oral aripiprazole 20mg. The patient has since had no delusions or hallucinations and is living independently at home.
ConclusionsThe administration of a simplified initial regime with aripiprazole long-acting treatments could improve therapeutic adherence while maintaining the same effectiveness and similar side effects.
DisclosureNo significant relationships.
Aripirazole-Long Acting Injectable in Pregnant Women with Schizophrenia: A Case Series
- B. Fernández-Abascal, M. Recio-Barbero, M. Saenz-Herrero, R. Segarra
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S129-S130
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Introduction
Long-acting injectable antipsychotics (LAIs) have emerged as a new therapeutic option to treat patients suffering a psychotic disorder. To date, there is a lack of studies regarding safety and clinical use pattern of LAIs in pregnant women.
ObjectivesProvide evidence and real world clinical data of pregnant women with schizophrenia who have been treated with long-acting aripiprazole monohydrate (aripiprazole once monthly [AOM] condition) during their pregnancy.
MethodsDescriptive real-world clinical experiences of pregnant women in treatment with AOM. The information was obtained by reviewing electronic medical records and by direct clinical observation management.
ResultsThe first six case-series describing the pregnancy course of women with schizophrenia treated with AOM. All of them remained psychopathologically stable through pregnancy, and their infants became healthy with normal developmental milestones (Table 1).
Table 1. Clinical characteristics of six case-reports.
Mothers 1 2 3 4 5 6 Maternal/Pregnancy outcomes Age(years) 35 29 35 31 38 30 Diagnosis Schizophrenia Schizophrenia Schizophrenia Schizophrenia Schizophrenia Schizophrenia AOM(mg/days) 400-300 400-300 400-300 160 300 400 Type of delivery Eutocic. Eutocic, preterm Eutocic Eutocic Eutocic Eutocic Neonatal outcomes Weight(grams) 3300 1800 3140 3102 2940 3400 Gender Female Female Male Male Male Male Developmental Abnormalities(years) No(3) No(2) No( 0.17) No(2) No(2) No(1.5) ConclusionsThe favorable results in this case-series suggest that despite the lack of evidence on reproductive safety and treatment with AOM during pregnancy, this therapeutic option should be considered in pregnant women with schizophrenia. However, further research on the use of long-acting antipsychotics in pregnant women is needed.
DisclosureNo significant relationships.
Reviewing the complex link between puerperium and psychosis: a case report
- E. Herrero Pellón, P. Albarracin, M. Huete Naval, R. Galerón, A. García Recio
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S857
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Introduction
We present the case of a 23-year old woman with a history of two hospitalizations in the psychiatric ward of our hospital in the last 8 months. Prior to this age our patient had not required assistance from mental health professionals. The wide variety of symptoms shown by the patient included auditive hallucinations and persecution delusions that led to behavioral alteration and depressive symptoms.
ObjectivesTo present a case report of a puerperal psychosis and to review the different kind of psyquiatric disorders that may arise in the puerperium.
MethodsLiterature review of scientific papers over the last years and classic textbooks on the issue. We included references in English and Spanish languages.
ResultsDuring pregnancy and the puerperium there are biochemical, hormonal, psychological and social changes that cause a vulnerability in women for the appearance of mental disorders. The differential diagnosis of puerperal psychoses must first be made with organic diseases. Once this has been discarded, several studies indicate that there is a high probability that after the onset of puerperal psychosis a cyclical mood disorder is found.
Conclusions- One of the main characteristics of puerperal psychoses is the great variety of its symptomatic manifestations. They can present characteristics of both mood disorders and schizophreniform disorders. - Deep confusion and delusions are often the most prominent symptoms of psychosis in the puerperal period.
DisclosureNo significant relationships.