Delusional parasitosis, also known as Ekbom syndrome, is the most frequent among the somatic delusions. It may occur at any age but is more common in the elderly, particularly in females. It is a syndrome in which the patient has the false belief that he is infested by some type of insects, lice, worms or other invertebrates, and that they live or grow under their skin or inside their body. Psychiatric interventions are usually rejected by these patients and long-term treatments are frequently abandoned.

A clinical case was followed and reviewed to illustrate the links between somatic delusions, hypochondriasis, somatization and obsessive disorders.

A 58-year-old female presents delusions of infestation. She has a long history of somatization and hypochondria, which can be interpreted as a continuum in the onset of the delusional syndrome. In this case, delusions of infestation are projected onto a third person. Psychophramacological treatment with long acting injectable risperidone was then introduced, as an alternative to drugs previously used.

The effectiveness of pimozide and risperidone for the Ekbom syndrome has been documented in the literature. In our case, we decided to introduce long acting injectable risperidone after several rejections or long-term discontinuation in oral treatments.

Progressive hepatolenticular degeneration or Wilson's disease is a rare autosomal recessive genetic disorder of copper metabolism, which is characterised of hepatic and neurological disorders due to the accumulation of copper in organs such as the liver or the basal ganglia. The manifestations of Wilson's disease are multiple and sometimes insidious, which makes the diagnosis very complicated.

A clinical case was followed and reviewed to illustrate the psychiatric symptoms in Wilson's disease.

A 23-year-old male came to the emergency room presenting insomnia, logorrhea, euphoria, irritability and a slight tremor in the upper limbs. Symptoms started two weeks before. The previous year, he was diagnosed of bipolar disorder after a manic episode which required inpatient treatment with risperidone and lithium. During the actual hospitalization, the tremor increased progressively and affected all four limbs and his head. He was then examined by neurology and an ophthalmology service, who ordered some specific complementary exams. Low levels of ceruloplasmin and serum copper and high levels of urinary copper confirmed the diagnosis of Wilson's disease. Treatment with copper chelants was introduced and the psychiatric symptoms and the analyses got better in several weeks.

Even a typical presentation of a psychiatric syndrome can be part of the spectrum of an organic illness. So an organic etiology should always be considered in the differential diagnosis, as sometimes it is possible to be treated.

Available data does not recommend antipsychotic drug combinations in treatment of psychotic symptoms and monotherapy is nowadays considered the option with the highest scientific evidence. Nevertheless, antipsychotics combination is a common practice in countries such as USA (40-60%), Japan (90%) and Spain (50-70%).

To determine antipsychotic combinations frequency in patients with a diagnosis into the psychotic spectrum admitted in an acute psychiatric unit. to determine the differences among these combinations according to diagnosis. to analyze which are the associations more commonly prescribed as well as the theoretical basis that supports them according to receptorial profiles.

Demographic and clinical data of patients with a psychotic-spectrum diagnosis admitted to the Doctor Peset University Hospital acute unit during 2004-2007 were retrospectively analyzed. We observed the percentage of patients treated with more than one antipsychotic drug, as well as the combinations more frequently prescribed.

Out of 677 analyzed patients, 302 were treated with an antipsychotic combination therapy (45%). the associaton most commonly prescribed was an oral atypical antipsychotic + an intramuscular atypical antipsychotic (121 patients). According to diagnosis, 50% from each diagnostic group was treated with a combination antipsychotic therapy.

There is a high percentage of inpatients treated with more than one antipsychotic. We found no significant differences by diagnosis nor any clearly-defined key according to receptorial profiles.

Comorbidity between Substance Use Disorder (SUD) and other psychiatric disorders, known as Dual Diagnosis, is an issue of growing interest in Mental Health. The high association between Personality Disorders (PD) and substance use is reported in scientific literature. However, not many studies have been published regarding the prevalence of this disorder in a psychiatric unit. AIMSTo determine the prevalence of substance abuse among patients with a Personality Disorder in a psychiatric unit.

A retrospective descriptive study was carried out among all patients admitted to our psychiatric unit during one year. The data collected from the discharge clinical records of patients were: demographic variables, personal psychiatric history and substance use, urine tests and clinical diagnoses at discharge.

We obtained a sample of 334 patients. There was comorbidity between Mental Disorder and SUD in 10.17% of subjects; including 4% diagnosed with Personality Disorder (80% belong to Cluster B). 53.3% of patients with PD substance abuse was reported. Excluding nicotine dependence and benzodiazepines, the most common substances used were cannabis (50%), alcohol (37.5%) and cocaine (25%).

This study shows that Personality Disorder is the Mental Disorder most commonly associated with SUD, among inpatients in our psychiatric unit. In order to detect cases of Dual Diagnosis, we suggest optimize recording in clinical history substance use and systematic urine tests in all patients admitted, which would benefit from specific treatment for their condition.

Antipsychotic therapy is the cornerstone of the treatment of schizophrenia and other psychoses. Although clinical guidelines tend to recommend the use of antipsychotics in monotherapy, combination of two or more antipsychotics (that is, polytherapy) is a common habit in clinical practice.

To assess differences in antipsychotic combination profile between patients with schizophrenia and patients with other psychoses.

A total of 241 patients (40.2% females, mean age 39.7+/−13.0 years) consecutively admitted during 2009 to a psychiatric inpatient ward with diagnosis of schizophrenia and other psychoses were assessed.

145 (60.2%) patients were diagnosed with schizophrenia while 96 patients (39.8%) were diagnosed with other psychoses (schizoaffective disorder n = 35, delusional disorder n = 8, schizophreniform disorder n = 8, brief psychotic disorder n = 13, psychotic disorder not otherwise specified n = 27, and other psychoses n = 5). Out of the total sample, polytherapy was used in 150 (62.2%) patients. A total of 100 (69.0%) patients with schizophrenia were on polytherapy, compared to 52.1% of those with other psychoses (p = 0.008). After controlling for age and gender, the association between a diagnosis of schizophrenia and being in polytherapy remained significant (p = 0.046).

Patients diagnosed with schizophrenia are more prone to be in polytherapy than those with other psychoses.

Despite the increasing use of the Internet to seek medical information, little is known about the web search for mental health information among psychiatric patients. We aimed to identify the patients’ demographic and clinical characteristics that better predict the search for medical information, as well as the most consulted aspects of psychiatric disorders.

Over a one-month period, a consecutive series of patients followed at one Spanish hospital psychiatric outpatient clinic completed a 13-item questionnaire about their personal Internet use.

Among the 144 participating patients (72% women), 61% reported having ever used the Internet, with lower search rates for general health (34%) and mental health (22%) data. There were no differences by sex, but Internet use was more frequent among younger and higher-educated patients, as well as among those with eating disorders and personality disorders. Patients were most interested in diagnosis and treatment facets. A model with age (exp.β=1.05; p=.001) and high-school education (exp.β=5.55; p=.004) predicted searching for general medical information and correctly classified 75% of the sample (R2=0.3; p=0.004). Age was the only variable predicting specific search about mental health (exp.β=1.05; p=.001), and correctly classified 76% of patients (R2=0.2; p=0.001).

The results of this one-site pilot study went in the anticipated direction and suggest that possible differences in the access to Internet according to the diagnostic group merit further research with multi-centre, larger samples.

Psychotic symptoms in depression are indicators of severity and poor prognosis. It usually requires psychopharmacotherapy with antidepressants and antipsychotic agents and it may even require electroconvulsive therapy (ECT).

To review the indications of ECT in major depression through the study of a clinical case of a patient admitted in an indoor psychiatric unit.

A 64-year-old woman diagnosed as bipolar affective disorder 20 years ago. Her first manic episode required hospitalization. Afterwards, she remained clinically stable for 18 years with pharmacotherapy with lithium. Lately she was admitted due to a major depressive episode with psychotic features (injury delusions, ruin and catastrophe). Antidepressant and antipsychotic treatment was added, improving her symptoms. However, she had to be readmitted two months later with severe psychotic symptoms that did not improve with pharmacological treatment. ECT was added to her treatment. She improved after a few sessions. During the last years, she has presented depressive episodes with psychotic symptoms at least once a year, and all of them have required ECT.

ECT is an alternative to pharmacological therapy in depression with psychotic symptoms in patients with no response to drugs. According to studies and clinical practice, ETC has been effective as we see in this case. Therefore, ECT is a technique to consider in major depression, not only in patients who do not respond to drug therapy but also in those who do not tolerate psychopharmacological, who suffer from severe or psychotic symptoms, suicide thoughts or those, psychomotor agitation or stupor.

Since the end of 19th century, mental health professionals have noticed that individuals who have experienced traumatic situations often present dissociative symptoms, such as amnesia or fugue states. Dissociation is a defensive mechanism that allows an individual to separate from conscience the psychological distress produced by the trauma. Our aim was to remark the association between Post-traumatic Stress Disorder (PTSD) and long-term dissociative disorders through the study of a clinical case.

A clinical case was followed and reviewed to illustrate this relationship.

Ten years ago, a 49-year-old man was diagnosed of PTSD after having witnessed several colleagues burnt in a tragic accident at work and having helped the emergency fire brigade to rescue other victims. His symptoms required treatment with antidepressants and psychotherapy, and fully remitted after one year. Nevertheless, during the last year, he has presented two dissociative amnesia episodes lasting for three days each, which were examined by a neurology service. More recently, he has suffered a ten-day episode of dissociative fugue, which required psychiatric hospitalization. Although the patient has been asymptomatic during a decade, it is remarkable that he has presented three dissociative episodes in a short period of time. One of them, the fugue state, is interesting because of its long duration and its relatively low prevalence in the general population.

This clinical case allows us to appreciate the long-term relationships between psychological trauma and dissociation, in addition to the well-known short-term effects.

Obsessive compulsive disorder (OCD) in childhood was first described by Legrand du Saulle in late XIX century, however, a systematic study in pediatric population was not made until 1986, by Rapoport. It is has been documented in scientific literature that younger patients usually hide their symptoms because of shame or that they do not find their obsessions and compulsions excessive, so that they feel them in an egosyntonic way, delaying diagnosis until several years after their first symptoms.

To highlight the specific symptoms in Pediatric OCD and review its treatment and approach through the study of a case report.

A 11-year-old boy was referred by his paediatrician to a child mental outpatient service for behavioural disturbances in the last few months. For the last three years, he had been performing rituals of cleaning, order and checking, increasingly complex and with a significant impact on his life, to the point of not being able to go to school and have other members of his family involved. He also had religious and catastrophic obsessions that generated him important distress. He was treated with high doses of sertraline and low doses of risperidone, and cognitive-behavioral psychotherapy with exposure response prevention and training in relaxation techniques were associated to the treatment. The patient improved partially.

This case illustrates the delay in the diagnosis of Pediatric OCD itself as well as the complexity when treating this disorder.

There is a growing interest in establishing a relationship between several mental disorders and traumatic life events in childhood and adolescence.

It has been seen a high prevalence of these traumatic events when reviewing the clinical history of patients with mental illness.

Measuring the prevalence of traumatic events in a sample of patients with a diagnosis of psychotic disorder.

A retrospective descriptive study was made. The sample comprised 50 patients admitted to our psychiatric inpatient unit. These patients were separated into different categories according to clinical diagnosis and demographic variables. Data was obtained through clinical interview before their hospital discharge. We tried to detect the presence or absence of real or imaginary memories of traumatic events during their childhood or adolescence.

52% of patients had a diagnosis of paranoid schizophrenia. 64% reported a history of substance abuse in their family. 20% referred the experience of having suffered sexual abuse by a member of their family, and up to 44% of them by someone other than family. 22% reported having suffered some kind of physical abuse by their parents, and more than 70% reported having suffered some type of traumatic event in the school environment.

There is an important amount of traumatic events in childhood and adolescence in this sample of patients. However, concluding that such traumatic events could eventually produce severe psychiatric disorders is still quite controversial. In order to understand better the association between childhood trauma and severe mental illnesses more research is needed.

Late-onset psychoses are a heterogeneous group of disorders whose nosology has been controversial throughout history. Several methodological limitations have made difficult the comparison among studies and, as a consequence, the research interest has been little, leading to the absence of late-onset schizophrenia and paraphrenia in current official classifications.

To highlight the specific symptoms of late-onset schizophrenia as well as its differences with other psychoses though the study of a case report.

A 70-year-old woman developed psychotic symptoms during the last seven years, consisting of auditory and olfactory hallucinations, telepathic phenomena and injury delusions, erotomania and thought control, with a high level of systematization and fantasy. She was admitted in an inpatient unit. She was treated with risperidone and the psychotic symptoms got better. At the time of hospital discharge, hallucinations and delusional thoughts had disappeared and no behavioral or emotional disorder was observed. Some weeks later, risperidone had to be substituted by paliperidone due to side effects, such as tremor, sialorrhea and parkinsonism.

Late-onset schizophrenic psychosis is not as exceptional as it has been traditionally considered. One of the main problems is that current classifications do not include specific diagnostic categories for cases of late or very-late-onset psychoses. It would be necessary that future ICD-11 and DSM-V classifications will include different-age criteria when diagnosing mental disorders.

The recent increase of immigrant population in some European countries represents a new social reality demanding an update of psychiatric clinical practice and resources. We aimed to:

1. 1. compare the clinical and demographic profile of immigrant patients admitted to a Spanish acute psychiatric ward with that of native patients, and

2. 2. detect changes over the last years regarding both the profile and the occupation of psychiatric beds.

Demographic and clinical data of immigrant patients admitted to the Doctor Peset University Hospital acute unit during 2005-2007 were retrospectively analyzed. For each case, a non-immigrant patient was assigned as a control. Immigrant subjects hospitalized during 2007 were compared to those admitted during 2000.

Over the three-year period, 38 immigrant individuals needed 45 hospitalizations (2.9-5.1% of total annual psychiatric admissions). Native patients presented similar demographics and produced a similar number of hospital stays, but had significantly more psychiatric (p=.02) and medical (p=.05) comorbid conditions. Immigrant patients hospitalized during 2007 (n= 12) were comparable to those admitted in 2000 (n=6), although the former accounted for a larger proportion of annual admissions (3.44% vs. 1.93%).

During the last seven years, the occupation of psychiatric beds by immigrant population has almost doubled but it is still in the low range. The clinical and demographic profiles of patients admitted to this acute ward were similar, regardless of their geographical origin.

To study the effectiveness of safety devices intended to prevent percutaneous injuries.

Quasi-experimental trial with before-and-after intervention evaluation.

A 350-bed general hospital that has had an ongoing educational program for the prevention of percutaneous injuries since January 2002.

In October 2005, we implemented a program for the use of engineered devices to prevent percutaneous injury in the emergency department and half of the hospital wards during the following procedures: intravascular catheterization, vacuum phlebotomy, blood-gas sampling, finger-stick blood sampling, and intramuscular and subcutaneous injections. The nurses in the wards that participated in the intervention received a 3-hour course on occupationally acquired bloodborne infections, and they had a 2-hour “hands-on” training session with the devices. We studied the percutaneous injury rate and the direct cost during the preintervention period (October 2004 through March 2005) and the intervention period (October 2005 through March 2006).

We observed a 93% reduction in the relative risk of percutaneous injuries in areas where safety devices were used (14 vs 1 percutaneous injury). Specifically, rates decreased from 18.3 injuries (95% confidence interval [CI], 5.9-43.2 injuries) to 0 injuries per 100,000 patients in the emergency department (P = .002) and from 44.0 injuries (95% CI, 20.1-83.6 injuries) to 5.2 injuries (95% CI, 0.1-28.8 injuries) per 100,000 patient-days in hospital wards (P = .007). In the control wards of the hospital (ie, those where the intervention was not implemented), rates remained stable. The direct cost increase was €0.558 (US$0,753) per patient in the emergency department and €0.636 (US$0,858) per patient-day in the hospital wards.

Proper use of engineered devices to prevent percutaneous injury is a highly effective measure to prevent these injuries among healthcare workers. However, education and training are the keys to achieving the greatest preventative effect.