The Residential Educational Therapeutic Unit Accompany from Hospital Sant Joan de Déu Barcelona, is a device integrated into the public health network, intended for the comprehensive care of children and adolescents under 18 years of age who suffer from an illness complex mental disorder, at serious risk of becoming chronic and generating significant disabilities at a functional, cognitive and emotional level. It was a result from a joint venture between the Department of Social Rights and the Department of Health. The device was created to respond to the increase in behavioral problems and mental health disorders of children underguardianship.

General Objective

To improve the quality of life in the physical, mental and social spheres of vulnerable children and adolescents with serious complex mental pathology through a biopsychosocial and community care model that integrates health, social, family and educational care and which is aimed at the recovery of the person’s life project.

Specific Objectives

To offer intensive intervention, personalized and in a co-responsible manner, that is to say, that integrates the therapeutic, education, social services and child protection teams.

Promote the community and social reintegration avoiding stigmatization and social exclusion.

Improve the intra-family relationship and the burden perceived by caregivers.

Decrease the number of renunciations of parental authority of a minor.

The unit has a capacity for 28 beds: 23 places for children/adolescents underguardianship of the administration and 5 places for cases that are at risk of family claudication due to their therapeutic and educational needs.

There are 5 coexisting therapeutic units. The apartments are referred as ‘homes’ and their organization is designed to encourage the active participation of residents with the professionals who attend them.

The Unit has a multidisciplinary team made up of the following professionals: Psychyatrists, Nurses, clinical psychologists, Social Workers, Educational worker, nursing assistants, administrative.

- 110 children and adolescents have been taken care, with an average cumulative stay of 13 months. In all cases in which the family had the guardianship of the patient, family claudication has been avoided There is a 36% discharge of those patients under guardian that have returned to their original family home 100% of the cases have been linked to an educational center adapted to their needs or to a training project

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Overall, the care model implemented by the population served in the Acompanya’m unit is positively evaluated. Since it provides an intensive and personalized care, treatment and intervention for children suffering from a serious mental disorder of high complexity. A comprehensive, personalized, interdisciplinary approach is offered, coordinated and co-responsible with educational, protection and social services.

None Declared

Discrimination on the basis of race, gender identity, and age, among others, has been associated with negative cognitive outcomes. However, the mechanisms by which perceived discrimination impacts cognition are not yet well understood. Discrimination can lead to chronic stress, which disrupts glucocorticoid pathways and induces susceptibility to metabolic dysregulation. On the basis of this prior work, and the known associations between metabolic syndrome and cognition, the current study examined the hypothesis that metabolic syndrome mediates the relationship between discrimination and cognition.

1,063 adults (Mean age = 54.92 years, SD = 11.68) who participated in the Midlife in the United States project were included. Confirmatory factor analysis was used to examine the acceptability of a bifactor model of metabolic syndrome using four subfactors (insulin resistance, adiposity, dyslipidemia, and blood pressure). The mediating effect of the metabolic syndrome latent factor on the association between discrimination and cognition was tested using PROCESS (Hayes, 2013). Exploratory analyses were conducted to examine which cognitive domains and which metabolic syndrome subfactors were driving these relationships. Mediation analyses adjusted for age, race, sex, and education.

The three most frequently reported reasons for discrimination were gender (n = 209), age (n = 174), and race (n = 129). The CFA of metabolic symptoms was deemed acceptable based on previously outlined goodness of fit criteria (CFI = 0.986, TLI = 0.976, RMSEA = 0.040, SRMR = 0.034). Results of the mediation analysis indicated a significant indirect effect of major events discrimination on the total cognition composite through the general metabolic syndrome factor (B = -0.0029, 95% CI [-0.0016, -0.0066]). Further examination revealed that this relationship was driven through an indirect path of metabolic syndrome on the relationship between discrimination and executive functioning (B = -0.0024, 95% CI -0.0059, -0.0001]). We examined which subfactors were driving these relationships and found that there were significant indirect effects of major events discrimination on total cognition through the insulin resistance (B = -0.0028, 95% CI -0.0065, -0.0003]) and dyslipidemia factors (B = -0.0026, 95% CI -0.0064, -0.0002]).

Our findings provide evidence that metabolic syndrome can help explain differences in cognitive functioning based on experiences of discrimination, even after adjusting for relevant demographic factors. Results from this study suggest that understanding the impact of perceived discrimination on metabolic syndrome and developing lifestyle interventions that can improve metabolic syndrome may be helpful in reducing stress-related cognitive disparities.

The reform of mental health care is a key health policy target. Mental health care provision in Spain is designed with national and regional strategies that stablish the objectives to develop. The Castilla y Leon regional strategy 2022-2026 aim to stabilsh the priorities for objectives and actions with stakeholders from th eregional society.

To evaluate priorities in the implementation of a Mental Health strategy with the consensus of professionals and society.

An initial consensus was achieved with the regional health goverment and local mental health representatives, considering the 2022-2026 national strategy and other mental health plans from nearby regions. Lines in the strategy included transversal lines (part of all the mental health scope) and action lines (priorities focused in one relevant field)

Priorities were stablished by different representatives from mental health and other healthcare professionals, social and educational stakeholders, scientific societies, people with mental health disorders and families. After agreeing to participate in the process, they had to answer an online survey. For each line, they have to score from 0 to 10.

500 subjects participated (44% Healthcare workers, 5.8% education or social services, 3.8% Justice, 8,6% workers for associations, 14% Mental Health Care users). All the lines were highly appreciated (mean score >7). Within the transversal lines, the highest score was for the Humanization line (8.81±1.43) and the lowest for the Digitalization line (7.18±1.92). In the Action Lines, the highest score was for Suicide (9.03±11.5) and the lowest for Elder people (8.04±1.94).

Prevention line had higher scores by Education, Justice, Associations and Healthcare professionals and the lowest was for users (F: 2.754; p=0.012). In the Digitalization line the higher scores were in the health professionals and scientific societies and the lowest in the users (F:4.665; p<0.001). In the research, innovation and Training line, the higher scores were for professionals, societies and users and the lowest in the education and justice groups. The only differences found in the Action lines was for the Addiction line, with higher scores for societies, social services, professionals and users and lower in Associations and Justice (F:2.219; p=0,040)

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Highest transversal priority for the MH Strategy was Humanization of Mental Health Services, and the most critical action was Suicide prevention. Professionals, Scientific societies and Users considered more important research, innovation and training compared with other society groups, whereas the less important areas for the users were digitalization and prevention users. These priorities will help to design the implementation and schedule for the lines of the Mental Health Strategy in Castilla y León.

None Declared

Humanization in Mental Health is a concept that treat to conceal in the last decades the quality, efficiency and safety of care of complex diseases and conditions with individual values, needs and preferences and involves the patient and society in the decision-making priority.

to stablish and evaluate the priorities of different groups of interest in the development of a new humanization plan for mental health

During 2022 a Humanization plan for the Spanish region of Castilla y Leon (2.400.000 habs) was developed with a Delphi model. Participants included 36 stakeholders including mental health services, administration, social services, associations, patients and families. They stablished 32 objectives distributed in 7 strategic lines: 1. “People First” (Rights, Autonomy and Information); 2. “From People to Services” (Participation of users in mental heal services); 3. “Person-Centered-Assistance” 4. “Processes sensible to change” (reduction of coercion); 5. “Human ambient” (Improvement of units, psychosocial interventions). 6. Innovation, training and climate (not evaluated here). 7. “People without marks” (battle against stigma).

Priorities in the lines were stablished by representatives from mental health and other healthcare professionals, social and educational stakeholders, scientific societies, patients and families. After agreeing to participate in the process, they had to answer an online survey. For each line, they have to score it from 0 to 10.

500 subjects participated (38.6% Healthcare workers, 14% Mental Health Care users, 9.8% Social Services, 8.8% Associations, 7.8% Drug Services 6% Management of Health System, 5.8% Education Services, 3.8 Justice). Humanization was the most appreciated plan within the mental health plan 2022-2026 in Castilla y Leon (8.81±1.43).

The Highest priority score was given to the Rights (8.68 + 1.54), Information (8.44 + 1.60) and Stigma (8.43 + 1.89) lines and the lowest were the evaluation of satisfaction (7.62 + 1.90) and Reduction of Coercion (7.29 + 2.12). Differences were found between groups. Scores in Rights and Autonomy (F:3.474; p<0.001) were highest in the Associations (9.32 +1.01) and lowest in the Justice group (7.68 + 1.67). In the information line the highest score (F:2.431; p=0,014) was in the Education Services (9.03 +0,94) compared to Scientific Societies (7,65 + 2,13). Highest score for Participation of Users (F:2,968; p=0,003) was in Social Services (8.76 +1.48) compared to Justice (7.47 +1.95). There were differences in the coercion reduction line (F:2.165; p=0,029) but no pairwise differences were found

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Humanization approaches are well appreciated by different stakeholders. Priorities in our region start with rights, information and integration and mental health users in the health system and society

None Declared

Conversion disorder (a term that describes what was previously called hysteria) refers to motor or sensory symptoms, or both, that resemble a neurological disease, but that do not originate from or cannot be explained by a known physical disease.

To find reliable tools that can guide the difficult diagnosis of conversion disorder.

Bibliographic review

The exact prevalence of the disorder is unknown. It is estimated that approximately 5% of referrals to neurology are for this disorder. Approximately one third of patients referred to the neurologist have symptoms that cannot be explained by an organic disease. Involuntary movements are the most common motor manifestations of the conversive syndrome, being tremor one of the most frequent manifestations. The first differential diagnosis of conversion disorder is neurological disease. It is currently not necessary for the diagnosis to assess whether or not the symptoms are produced intentionally, as the assessment of conscious intentionality is unreliable. The neurological examination is the fundamental tool for the diagnostic approach, being even more enlightening than the complementary tests. Hoover’s sign, Babinski’s combined leg flexion, plantar flexion of the ankle, tremor and its distraction and synchronisation manoeuvres, as well as the clinical differences between epileptic seizures and non-epileptic seizures of psychogenic origin, are some of the reliable tools for a correct diagnosis.

The diagnosis of the disease should be one of exclusion. There must be clinical data showing clear evidence of incompatibility with a neurological disease and conversion symptoms do not correspond to known physiological mechanisms and anatomical pathways.

No significant relationships.

The lack of a standardised definition for the concept of TRD and an adequate criteria for therapeutic response make difficult the management of patients with MDD who do not achieve remission with one or more courses of treatment. All classifications suggested to define TRD are arbitrary, partially evidence-based, subordinated to the pharmacological findings of the time in which they are written and with serious inconsistencies, making it difficult to construct a universal and enduring diagnostic system.

Considering that the most important goal in treating a patient with Major Depressive Disorder (MDD) should be remission and return to previous functionality, the search for a standardised, evidence-based classification system will allow timely and effective interventions leading to the reduction of this devastating condition.

Bibliographic review

The proposed therapeutic algorithm arises from the combination of several fundamental principles for the management of treatment-resistant depression: the different classification systems of the concept, as well as the concepts of response, relapse, recurrence and remission; the scientific evidence found in the current literature, routine clinical practice, knowledge of switching and augmentation strategies, the new pharmacological targets and neurobiological hypothesis discovered, without forgetting finally the different clinical profiles of depressive symptomatology and the specific indications of each antidepressant.

Resistant depression is difficult to treat successfully and is not a uniform entity. Recently there has been a move to characterise treatment-resistant depression as ‘difficult-to-treat’ depression on the basis that the former description implies that depression treatments are normally effective and that non-response is therefore somehow abnormal.

No significant relationships.

Psychiatric illnesses are related with a reduced life expectancy and an increase of mortality rates (around 60%) mainly associated with cardiovascular diseases [1]. The high prevalence of obesity, metabolic syndrome, diabetes mellitus and tobacco use among these patients undoubtelly predispose to the impairment in physical health and mortaility increase. Regular physical activity in the general population is associated with a decrease in cardiovascular risk but litle is know about iss influence in some chronic and severe mental disorders like schizophrenia [2].

To quantify the physical activity performed by a sample of subjects with psychosis, borth males and female, compared to a control group.

A sample composed of 141 patients with schizoprenia was compared to 103 healthy subjects as a control group. The International Physical Activity Questionnaire - Short Form (IPAQ) scale was applied to all participants. The time (minutes) of physical activity performed in a week (METs) was collected by each participant [3].

The differences in the total physical activity Mets for the patients with schizophrenia were highly significant (p = 0.001), showing a lower degree of physical activity compared to the control group. A higher and significant percentage of sedentary lifestyle among the psychiatric group (64.5%), compared to 35.5% in the control group was found.

The group of pateints with Schizophrenia showed a significant higher sedentary lifestile including less physical activity. This finding could be highly related with a higher risk of cardiovascular disease and deterioration of the physical health.

No significant relationships.

Patients with bipolar disorder (BD) have an increased risk for cardiovascular morbimortality. Clinical risk factors, specifically for arrhythmias and sudden cardiac death remain understudied.

This study was conducted to assess differences in cardiac conduction among BD patients.

We included patients with BD in a cross-sectional design, confirmed by structured interview, age 18 through 80. Clinical characteristics were obtained using a structured questionnaire or medical records review. ECG intervals duration and morphology were manually assessed by cardiologists and compared among clinical subgroups using Chi-square, Mann-Whitney, and Kruskall-Wallis tests. Exploratory multivariable linear and logistic regression models were fitted to adjust for potential confounders.

We included 117 patients (60.7% women, 76.9% bipolar I, 50% history of psychosis, 22.6% suicide attempts). We found a significantly longer QTc interval in BD patients with hypertension (difference: 9.5 ms, p=0.006), obesity (difference: 25 ms, p=0.001), and metabolic syndrome (difference: 13 ms, p=0.007). Hypertension remained a significant predictor of longer QTc after adjusting for age, gender, and antipsychotic use (estimate 17.718, p=0.018). We observed a significantly shorter PR interval in women (difference: 6 ms, p=0.029), early age of onset (difference 6 ms, p=0.025), non-users of lithium (difference 4 ms, p=0.002), and early trauma (difference 4 ms, p=0.038). Finally, we identified significant correlations between symptom severity, blood glucose and PR interval (r=0.298, p=0.001; r=0.278, p=0.003; respectively).

Patients with BD and hypertension may have an increased risk for QTc prolongation. Careful cardiovascular monitoring may be warranted.

No significant relationships.

To present the process evaluation of a curricular Cross-curricular Unit on Portion Size (CUPS) program that integrates nutrition and mathematics, describing teacher and student perspectives on the intervention.

Semi-structured interviews and focus groups were conducted following the implementation of the CUPS program during a pilot randomised controlled trial designed to evaluate efficacy for improved portion size estimation. Lessons involved experiential learning using food models and mathematics cubes and focussed on portion size, food groups, volume and capacity. Data were collected immediately post-intervention and analysed using an inductive thematic approach.

Primary schools in Newcastle, Australia.

Year 3 and/or 4 teachers (n 3) and their students (n 15).

Teachers believed the programme supported the learning of nutrition concepts, with the majority of students enjoying the lessons, cubes and food models. Teachers indicated most students were engaged and became more aware of healthy eating and serve size recommendation. Although teachers enjoyed and valued the lessons, they suggested that the integration of volume and capacity should be further improved in order to address the time barrier for teaching nutrition.

The process evaluation reports on challenges and successes of implementing an integrative nutrition programme. This teaching approach could be useful and successful when aligned with teacher’ and student’ needs. Based on participant feedback, lessons could be refined to enhance integration of mathematics content and to support student learning.

Recurrent laryngeal nerve injury leading to vocal cord paralysis is a known complication of cardiothoracic surgery. Its occurrence during interventional catheterisation procedures has been documented in case reports, but there have been no studies to determine an incidence.

To establish the incidence of left recurrent laryngeal nerve injury leading to vocal cord paralysis after left pulmonary artery stenting, patent ductus arteriosus device closure and the combination of the procedures either consecutively or simultaneously.

Members of the Congenital Cardiovascular Interventional Study Consortium were asked to perform a retrospective analysis to identify cases of recurrent laryngeal nerve injury after the aforementioned procedures. Twelve institutions participated in the analysis. They also contributed the total number of each procedure performed at their respective institutions for statistical purposes.

Of the 1337 patients who underwent left pulmonary artery stent placement, six patients (0.45%) had confirmed vocal cord paralysis. 4001 patients underwent patent ductus arteriosus device closure, and two patients (0.05%) developed left vocal cord paralysis. Patients who underwent both left pulmonary artery stent placement and patent ductus arteriosus device closure had the highest incidence of vocal cord paralysis which occurred in 4 of the 26 patients (15.4%). Overall, 92% of affected patients in our study population had resolution of symptoms.

Recurrent laryngeal nerve injury is a rare complication of left pulmonary artery stent placement or patent ductus arteriosus device closure. However, the incidence is highest in patients undergoing both procedures either consecutively or simultaneously. Additional research is necessary to determine contributing factors that might reduce the risk of recurrent laryngeal nerve injury.

Borderline personality disorder (BPD) is characterized by instability of interpersonal relationships, self-image, and emotions, and by impulsivity. Although patients with BPD are misdiagnosed, some of them receive mental health treatment. Even if the first-line treatment of this disorder is psycotherapy, the patients with BPD may be highly symptomatic and are often prescribed multiple medications in a manner unsupported by evidence.

The aim of this study is to study the available evidence about the pharmacotherapy for borderline personality disorder.

A review of the available literature about the management of borderline personality disorder and de pharmacotherapy for personality disorders was performed.

First-line treatment of the personality disorders is psycotherapy. The treatment plan for BPD may include individual and group therapy, medication, self-education, specialized substance use disorder treatment, partial hospitalization, or brief hospitalization during times of crises. Medications are generaly used only as adjuncts to psychotherapy and the adjunctive use of symptom targeted medications has been found to be useful. There is limited information to guide pharmacotherapy; preliminary evidence limits the practice of polypharmacy. Sympton-domain focused medication treatment is recommeded by some guidelines: cognitive-perceptual symtoms (low-dose antipsychotic drugs), impulsive-behavioral dyscontrol (mood stabilizers), affective dysregulation (mood stabilizers and low-dose antipsychotic drugs) and self-harm (omega-3 fatty acids).

BPD cause significant distress and impariment of social, occupational and role functioning. The first-line treatment for BPD is psychotherapy; however symptom-focused, medication treatment of BPD is generally considered to be an adjunct to psychotherapy. The data support the efficacy of low dose antipsychotic drugs and mood stabilizers.

The exposure to child maltreatment increases the lifetime risk for many psychopathological symptoms: depression, anxiety disorders, bipolar disorder, schizophrenia, post-traumatic stress disorder, personality disorder and dissociation. Besides, adopted children, especially those with a history of institutional living before adoption, are at greater risk for a range of developmental, behavioral and attachment concerns. The case report is of a 17-year-old male, with reactive attachment disorder (RAD). He suffered child maltreatment in his family of origin before the international adoption.

The aim of this study is to present a case-report illustrating the relationship between chil maltreatment, adopted children and the reactive attachment disorder.

A bibliographic search was performed about reactive attachment disorder. Information regarding the clinical case was obtained by consulting the patient’s file.

A 17-years-old male who was adopted at age of 9 from Spain. According to reports from the orphanage, the patient suffered severe maltreatment by his family of origin, with scars on his back. The patient presents impulse control disorder, with verbal and physical heteroaggressiveness in situations of frustration, hunger and sleep. He stopped attending the institute at the age of 12, with marked isolation and reversal of the sleep-wake cycle. His treatment plan are partial hospitalization, psychotherapy and pharmacotherapy.

Both child maltreatment and adoption are risk factors for the presence of psychopathology during the lifetime. Especially during the pre-adoption process and the first years after adoption, both the family and the child should be able to use specialized Mental Health services.

No significant relationships.

Among medical students the rate of depression varies between 5-32% and it is known that the suicide rate is higher than in the general population.

Clear and current data are needed to design studies for the diagnosis and treatment of students and residents of Medicine with psychological and psychiatric disorders in order to reduce rates of suicidal behavior in this population group.

A systematic search for articles on the UpToDate, PubMed and Mendeley platforms has been conducted with the keywords “suicide”, “suicidal behavior”, “suicidal ideation”, “medicalschool” and “medical students”. We found 435 items from which a total of 42 items were selected.

The prevalence of depression is 27.2%, of which only 15.7% of them are under treatment. Burnout, has a high prevalence of 45-50%. The prevalence of suicidal ideation in the last year is 11.1%. The most commonly used method is medication overdose. Suicidal behavior is greater among students who choose to choose Psychiatry or Family and Community Medicine as a specialty.

The rate of suicidal ideation among medical students is 11.1%. Nearly one out of every three medical students suffers from depression in some degree, and only one in five is treated. The similar prevalence of burnout at all levels supposes poor management of stress from the faculty. Medical schools should reduce the associated stigma and should encourage depressed students to seek treatment.

Electroconvulsive therapy (ECT) is today one of the main treatments available and used in psychiatry for serious mental illnesses. Eighty years after its introduction, the ECT procedure has evolved to become a safe option based on scientific evidence. Nowadays there are no absolute contraindications for ECT, regardless of the type of population and clinical situation.

To illustrate the electroconvulsive therapy in medical comorbidities context with a case report.

Descriptive case study.

We present a 66 years old patient who suffers from a psychiatric decompensation with a diagnosis of major depressive disorder with psychotic symptoms. Due to her cardiological history (prolongation of the QT interval of possible psycopharmacological origin and a 2:1 AV block, that required the implantation of a definitive pacemaker) and partial response to psychotropic medication, the initiation of electroconvulsive therapy is proposed as the best alternative. The pacemaker was previously studied by cardiology for a very complete analysis before the procedure. It was recommended to convert it to fixed rate pacing by using a magnet. To do this, we placed it over the pacemaker during the technique. While waiting for a clinical improvement, no incidence has been produced during the sessions.

ECT should not be postponed as a last resort. Numerous studies conclude that ECT is globally the treatment of choice (70-85% response) in severe depressive conditions, over and above antidepressant drugs. The incidence of relevant cardiac complications on ECT is relatively rare (0.9%). Regarding the use of pacemakers, electroconvulsive therapy represents an effective and safe option for the patient.

No significant relationships.

Telecommuting is defined as “a work practice that involves members of an organization substituting a portion of their typical work hours to work away from a central workplace, using technology to interact with others as needed to conduct work tasks”. The prevalence rate of telecommuting in Sapin in 2019 was 5%, while this rate grew up to 34% during de COVID-19 pandemic.

The purpose of this poster is to make a review about how telecommuting affects the employees’ mental health.

A review os the available literature on employees’ menthal health.

Most employers who offer telecommuting consider it a strategic decision for their businesses: it could reduce the expenses of physically accommodating the employees, and it might help employers to contact their subordinates anytime, if needed. Many articles in the popular press about telecommuting extol the benefits of this practice on employees’ health (work-life balance, reduction of travel expenses). However, only a handful of empirical studies substantiate these claims (job satisfaction, quality of life, and role-related stress). Less discussed is the potential of telecommuting to have a negative impact on employees’ health. It may increase both social and professional isolation, which in turn is associated with higher levels of emotional exhaustion, cynicism, cognitive stress complaints and lower levels of work engagement.

Finally, although it is not as effective as personal contact, organizations may stimulate qualitative virtual interaction with coworkers by providing robust online meeting tools and infrastructure, so users can seamlessly collaborate regardless of their physical location.