Depressive disorders represent the main cause of disability in the world, due to its prevalence, its impact on the patient’s quality of life and its role as one of the main risk factors for suicide. Current antidepressant treatments can take weeks to take effect and months to achieve response and remission.It is estimated that up to 30% of patients with major depressive disorder (MDD) are resistant to antidepressant treatment, in addition, approximately 30-45% of patients with depression do not achieve an adequate response to the first antidepressant treatment.According to the STAR*D study, the more lines of treatment are required, the lower remission rates are estimated, as well as higher relapse rates during the follow-up phase.With the appearance of intranasal dosage esketamine allows the release directly to the central nervous system, the mechanism of action of esketamine is based on the antagonism of the NMDA receptor, which entails the modulation of the excitatory transmission of glutamate and the release of BDNF,activating neurotrophic signaling and synaptogenesis.

The objective is to expose the response after treatment with intranasal esketamine in a case of resistant depression.

A 55-year-old female patient, diagnosed with resistant recurrent depressive disorder.The patient had undergone treatment with different therapeutic lines with antidepressants, and potentiations with antipsychotics, observing little response in the current episode, for which reason we evaluated the indication of intranasal Esketamine. Scales: MADRS (Montgomery Asberg Depression rating scale) =37, Hamilton Depression Scale=25, PHQ-9=20, indicating severe depression.

After starting treatment with intranasal esketamine, an early response was observed. After the first month of treatment, mild depression was scored at MADRS=10 and moderate depression at Hamilton=14, PHQ-9=12, and at week 14 of treatment, it was scored mild depression in both MADRS and Hamilton. Intranasal 56mg esketamine plus 20mg escitalopram, 30mg mirtazapine and 5mg aripiprazole.

Intranasal esketamine offers a rapid reduction in depressive symptoms maintained over time, reducing the risk of relapse and with a favorable tolerability profile, so its use in depression resistant to treatment presents a great advance.

None Declared

Manic episodes have a multifactorial etiology, with frequent association with genetic factors, comorbidities such as systemic diseases or secondary to infectious diseases, and environmental exposure factors. The prevalence of bipolar disorder is markedly higher in patients with autoimmune disease. The risk of developing bipolar disorder in some studies has been seen to be higher among patients with rheumatoid arthritis, therefore chronic inflammation would be a potential mechanism and could be a modifiable risk factor for bipolar disorder. Growing evidence indicates that Sars-CoV-2 may also trigger the acute onset of mood disorders or psychotic symptoms.

We present the case of a patient who presents symptoms compatible with an acute manic episode after an outbreak of rheumatoid arthritis and comorbid COVID infection.

52-year-old patient. She went to the hospital emergency room presenting affective symptoms compatible with a manic episode and psychomotor agitation. Personal medical history: rheumatoid arthritis, antiphospholipid syndrome. Psychiatric personal history: Depressive disorder under follow-up by a private psychiatrist under treatment with antidepressants. During the interview, the patient presented accelerated speech, with great emotional incontinence. Saltigrade thought and tachypsychia. She verbalizes delusional ideas of megalomaniacal and mystical and religious characteristics. She verbalizes that she is the reincarnation of the holy spirit, that God has taken her body and speaks through her. In the emergency room, a Sars-CoV-2 infection that the patient was unaware of was diagnosed. She is admitted to the hospital in the mental health unit, in the first interviews the patient maintains speech with delusional ideas “I notice the stigmata of Christ on my body”.

The patient recovers after treatment for the COVID infection, remaining asymptomatic. It was decided to start lithium to stabilize mood and the patient presented good tolerance and treatment with antipsychotics. The patient presented a favorable response, remitting the psychotic symptoms of which she was critical and stabilizing the affective symptoms. The patient is diagnosed with Severe Manic Episode with Psychotic Symptoms, as the main diagnosis and we could conclude the diagnosis of Bipolar Disorder since she has presented 2 depressive episodes in the past that have required treatment and follow-up by psychiatry.

Manic episodes have a multifactorial etiology and require an individualized approach, and comorbid medical conditions must always be assessed in order to establish a therapeutic plan with patients.

None Declared

Burnout syndrome or professional exhaustion is defined as feeling burned out, exhausted, overloaded, exhausted. It is a syndrome characterized by emotional exhaustion, depersonalization and low personal fulfillment. This clinical syndrome was first described in 1974 by Herbert Freudenberger, a psychiatrist, who defined burnout as “the depletion of energy experienced by professionals when they feel overwhelmed by the problems of others.” Mental Health is one of the specialties with the greatest emotional exposure due to all the circumstances that surround these professions, to maintain health in its 3 axes: physical, mental and social well-being as defined by the WHO

The objective of the study is to determine the presence of Burnout Syndrome in Mental Health professionals through the Maslach Burnout Inventory (MBI) questionnaire.

An observational, descriptive and cross-sectional study is carried out. The people included in the study were the health personnel of the Mental Health Clinical Management Unit (psychiatrists, administrative personnel, nursing assistants, nursing personnel, social workers and psychologists, and training personnel) who wanted to participate in the study. Carrying out the MBI questionnaire and sociodemographic data.

In our study we have a sample of 59 people. Regarding the sociodemographic data, we have 45 women and 14 men. Regarding the results after correcting the MBI questionnaire, we found that 4 professionals presented Burnout Syndrome (a psychiatrist and a 4th year psychiatry resident intern of psychiatry), 35 professionals presented tendency to suffer from Burnout since one of the three areas measured by the questionnaire was affected and 15 did not suffer from Burnout. Regarding the domains, we obtain that emotional exhaustion is the area, together with low personal achievement, that is most affected in the professionals of the community mental health unit, 23 and 22 professionals, respectively. Depersonalization is present at 12. Professionals with temporary contracts presented greater emotional exhaustion and low personal accomplishment. Professionals with permanent contracts show greater emotional exhaustion. Among the professionals in training, low personal achievement and depersonalization stand out. The 4 professionals who present burnout syndrome are married women and 3 of them with temporary contracts.

The results obtained show the presence of Burnout Syndrome and a high tendency to develop it among the professionals of the Mental Health Unit. In relation to the data, we must reassess the care systems for professionals and prevent the causes that can lead professionals who are starting their professional career to develop burnout in normal situations that can lead to collapse in extraordinary circumstances such as the COVID-19 pandemic.

None Declared

Suicide is currently one of the biggest public health problems, it is the third cause of death in the age group between 15 and 29 years (16.36% of young people who died in 2013). The ‘Werther effect’ refers to the mimetic behavior of the suicidal act, thus making reference to the controversial novel “The Sorrows of Young Werther” by Goethe, in 1774. The population most susceptible to this influence is the most vulnerable and ambivalent, such as they can be adolescents and young people, people with personality disorders and drug use. Durkheim considered that imitation was not due to the contagion effect of making suicides public, but to the social conditions of some places, which were what caused people to commit suicide.

The objective of the case is to expose the vulnerability to the imitation of suicidal behaviors of young people suffering from personality disorder and drug use.

We present the case of 4 young people between 18 and 21 years old (3 women and 1 man) from the same group of friends who, after the death by suicide of a 20-year-old boy, in the following 2 months, carried out suicidal behavior by taking medication they found at home and consumption of different drugs.

The two 21-year-old patients planned for the first month of the anniversary of the friend’s death, the intake of drugs and medication and leave a farewell note explaining the reasons. The patients required hospitalization in an acute mental health unit, one patient developed myocarditis secondary to toxins, during hospitalization they undergo psychotherapeutic treatment and are evaluated, leading to the diagnosis of Borderline Personality Disorder and Multiple Drug Use Disorder. The 20-year-old patient took medication on the anniversary month but did not require hospitalization. He underwent outpatient follow-up at a day hospital. During the therapeutic process, he was diagnosed with schizoid personality disorder. The 18-year-old patient required hospitalization for structured self-injurious ideation with a risk of acting out at 2 months, psychotherapeutic treatment was started and she was diagnosed with borderline personality disorder and harmful drug use. The 4 young people continue outpatient follow-up by both the community mental health unit and the addiction treatment center.

We observe in the series of cases exposed, the vulnerability of young people suffering from personality disorders and drug use to suicidal behavior, so risk factors for their prevention must be identified and continue working on adequate information of suicidal acts, whether completed or not, to avoid imitation phenomena. In all cases, suicide should not be seen as a desirable alternative and strategies to cope with difficulties and emotional management should be offered and promoted, especially in this young population that is still developing and is more vulnerable.

None Declared

Stigma is a complex process and a universal phenomenon that is part of all social groups and that is maintained by its functions related to the establishment of one’s own identity and the facilitation of socialization processes. The stigma of the patient is important to evaluate since it is a subjective experience that can have negative correlations in relation to self-esteem, empowerment and recovery orientation of the patient with mental illness. Hospitalization in mental health takes place at times of mental illness decompensation and is an intervention closely related to the stigma towards mental illness.

The objective of the study is to evaluate the stigma perceived by patients with mental illness hospitalized in an acute mental health unit.

Observational study with 53 patients hospitalized in an acute mental health unit.

Variables collected: Sociodemographic variables (age, sex), clinical diagnosis and stigma is evaluated with the Illness Self-stigma Scale (ISMI).

Sample of 53 patients, 55% women and 44% men, the most frequent diagnoses among those admitted are psychosis spectrum 26.42%, depressive disorders 24.53%, personality disorders 22.64% and bipolar disorders 11.33%. The average age is 41.96 years, between 18 and 72 years. The self-stigma according to the scale (ISMI) we obtain as a total score the patient with the highest stigma scores 100 points and the one with the least scores 44 points. Regarding diagnoses, depressive disorders score 33-72 points, while psychotic disorders score 36-85 points. The highest scores in self-stigma in our study are in personality disorders 49-100 and borderline personality disorder stands out (100 points). In the 5 subscales such as alienation, self-stigma, perceived discrimination, social isolation and resistance to stigma. Higher scores in alienation stand out in all patients.

Patients with personality disorders, especially borderline personality disorder, followed by psychotic disorders, present greater perceived self-stigma in our study than the rest of the patients; it is a very important factor that can affect the evolution of the clinical picture. This factor is important to establish the therapeutic plan and the different interventions, it would be recommended to assess the stigma together with the measures to reduce symptoms.

None Declared

To present a clinical case that reflects the causal relationship between the administration of high-dose corticosteroids and the appearance of maniform-type psychopathology.

Descriptive study of a case report and literature review on the subject.

32-year-old woman with alcohol abuse detected, added Antabus 250 mg / day to her treatment.

After 2 months of treatment, she was admitted to the Digestive Service due to acute hepatitis. After a liver biopsy and autoimmunity study was diagnosed as Autoimmune Hepatitis. Treatment with Antabus was withdrawn, and Prednisone 60 mg/day was prescribed. Seven days after starting treatment with corticosteroids, she presented maniform symptoms (psychomotor restlessness, expansive mood, dysphoria, megalomanic delusions, alteration of biological rhythms with decreased need for sleep and risk behaviors), and she was admitted in a psychiatric hospitalization unit. After considering various differential diagnoses she is diagnosed with Substance-Induced (corticosteroids) Mood Disorder with manic features. Psychiatry agrees with the Digestive Service to start treatment with Paliperidone and progressively lower the dose of corticosteroids until suspending it and prescribe an immunosuppressant. Finally, the maniform symptoms that led to admission remitted completely and control and outpatient treatment were continued.

Its important to always keep in mind the great risk of the appearance of psychiatric disorders that treatment with high doses of corticosteroids entails, especially in susceptible patients or with a psychiatric history or genetic susceptibility. It is necessary to know the possible appearance of these neuropsychiatric adverse effects in order to prevent them, and if it appear, to assess, if possible, the suspension or reduction of corticosteroid treatment.

None Declared

The COVID-19 pandemic and social and mobility restriction measures have had a negative impact on the mental health of the population.

The objective is to demonstrate the impact of the pandemic on mental disorders.

64-year-old man who is taken to the emergency room after a suicide attempt, by hanging with a belt out of concern and measuring the contagion of the COVID-19 virus in the context of long-standing delirious ideas of contamination and hypochondriacal neurosis. Adaptive disorder in relation to previous divorce. Psychopathologically, the patient is anxious and restless, conscious, inattentive and poorly oriented in space and time. Accelerated language with monothematic discourse about the possibility of contagion that has caused isolation behavior to the point of shredding organic waste and throwing it down the toilet so as not to have to go out to throw it out for fear of contagion. Faced with a neighbor’s wake-up call due to a blocked pipe, he suffers a crisis of guilt and anxiety and attempts to commit suicide. COVID-19 PCR=negative. Beck’s Depression Inventory 24=moderate depression. IPDE accentuated obsessive and avoidant personality traits.

Diagnosis: Moderate depressive episode with psychotic symptoms. Hypochondriacal disorder. Ananchastic personality disorder. Treatment: Paliperidone 3mg/24h. Sertraline 100mg/24h

In obsessive personalities and hypochondriacal neuroses, the COVID-19 pandemic has posed an increased risk of decompensation for affective disorders and even suicide attempts. Isolation, lack of treatment and prior monitoring, as well as the difficulty of identifying vital stressors, must be taken into account if an early intervention is to be carried out.

No significant relationships.

Patients with mild cognitive impairment may present deficits in naming, speech production, oral comprehension and written comprehension. In the differential diagnosis, cerebrovascular disease that can lead to cognitive impairment must also be differentiated from endogenous depressive disorder or language impairment.

The aim is to highlight the importance of differential diagnosis in cognitive disorders in relation to a case.

A 68-year-old female patient attended a psychiatric consultation derived from neurology when presenting a language disorder. The husband who accompanies her and the patient indicate that she has problems finding words and substitutes other expressions for them or sometimes does not answer or does so with something different from the topic that is being asked. She refers that she presents repetitive language with memory problems, alteration in the evocation of memories. The patient reports mood swings and irritability and crying with a low tolerance for frustration since she cannot express herself. Cranial MRI: cortical and central involutional changes. Periventricular leukoaraiosis and ischemic gliosis-like lesions in the white matter of both hemispheres. Psychopathological exploration: Conscious, oriented. She smiles at the questions but doesn’t answer them. Repetitive language. Alteration in the articulation of language. Depressed mood reactive to current situation. Some irritability Alteration in recent memory and evocation.

She was diagnosed with organic mental disorder compatible with mild cognitive impairment. Treatment with rehabilitation of the language disorder of vascular etiology is established.

Imaging and neuropsychological tests should always be performed in a patient with language, memory, and mood disorders to study its etiology.

No significant relationships.

Obsessive compulsive disorder (OCD) is a pathology represented by thoughts, images, impulses or feelings that generate great anxiety and discomfort, as well as the development of compulsive acts and rituals that cause great dysfunction.

The comorbidity of different psychiatric disorders with OCD is known, such as impulse control disorder and tic disorder.

The objective of this study is to describe the clinical characteristics, comorbidities and the treatment used in a patient with an OCD diagnosis and motor tics.

Description of a clinical case of motor tics associated with OCD in an adult patient.

A 29-year-old man begins mental health follow-up for presenting, as a result of a choking episode, obsessive thoughts with significant emotional and behavioral repercussions, to the point of restricting his diet and losing several kilos of weight. He also manifested checks and rituals in order to avoid possible choking.Treatment with sertraline and clonazepam was started, without evidence of improvement in symptoms. Months later, bucolingual and guttural tics, difficult to control by the patient and which caused bite lesions in the mouth and tongue, were added to the described clinic. Oral aripiprazole was associated to the treatment and then prolonged- release intramuscular administration was used, achieving improvement in obsessive symptoms and motor tics.

The usefulness of adjuvant treatment with atypical antipsychotics has been demonstrated in adults with OCD who present an insufficient response to an SSRI. Injectable prolonged-release antipsychotics can help improve long-term prognosis by ensuring adherence.

No significant relationships.

People spend a large part of our lives in the workplace. Stress at work, desmotivation and mental exhaustation are consequences derived from stressful situations that can be generated at work.

Detection in hospitals of those workers susceptible to exhaustion, work stress or personal demotivation to avoid a problem in the worker’s mental health, allowing early intervention and health strategies.

A cross-sectional study was carried out that included 84 healthcare workers from Spain in October 2021, through an anonymous, voluntary and multiple response type online survey which included questions about sociodemographic aspects and the Maslach burnout inventory

62% were doctors and 29% were nurses, 3 workers were nursing assistants, 2 orderlies, 1 psychologist and 1 physiotherapist. 13% of workers report having received / thought about requesting care from a mental health team (psychologist / psychiatrist) in the last year. 8% admit to having had suicidal ideas in the last year. 30.6% report being emotionally exhausted from their work always and almost always. 15.3% report that working with patients every day is stressful for them.29.4% report feeling “burned” by work. Only 28.2% say that they are always or almost always with a lot of vitality. 20.2% feel that they are at the limit of their possibilities.

Detection in hospitals of those people susceptible to exhaustion, work stress or personal demotivation to avoid a problem in the worker’s mental health, allowing early intervention and health strategies.

No significant relationships.

Dyskinesias are motor disorders that occur as a side effect to treatment with typical and less frequently with atypical antipsychotic drugs. They are more frequents in child population. Treatment usually consists of decrease the dose of drug or replace it with a better profile tolerability antipsychotic. Clozapine is an antipsychotic drug indicated as second-generation treatment of motor disorders that appear as side effects to treatment with neuroleptics.

Demonstrate the efficacy and tolerability of clozapine in the treatment of dyskinesias in childhood.

The patient 12 year-old boy, has episodes of psychomotor agitation once a month. This will alternate with quiet moments in which dyskinetic movements are observed in upper limbs, without being able to detect any type triggering environmental factor. Personal history: hydrocele, diagnosed at 8 years becomes neurodevelopmental disorder considered. Neurosurgery tracking for Subarachnoid cyst. Psychopathological examination: Child presents psychomotor restlessness, disruptive behavior, impairments in communication, movement disorder, stereotypies and dyskinetic movements in shoulder and neck.

In the patient suffering from an autistic disorder, stereotypies and other motor symptoms were observed, the predominant and most relevant being dyskinetic movements in the shoulder and neck, which appeared one month after starting treatment with risperidone and worsening psychomotor skills. Treatment of dyskinesia with clozapine improved the motor symptoms presented by the patient.

Clozapine should be the treatment of choice in the event of dyskinesias as a secondary effect to other antipsychotic treatments, proving effective in controlling them as well as well tolerated in both adults and children.

No significant relationships.

Immigration entails uprooting and this is always a destabilizing event. It includes disorders in family life and a radical break with culture, values, among others. These events create a situation of uncertainty that exacerbates stress and anxiety.

Within this framework, we wanted to inquire about the state of mental health, and more specifically, about depression, in migrants.

A cross-sectional study was carried out that includes 272 migrants from different countries of the world, during the months of August and September 2020, through an anonymous, voluntary and multiple response type online survey which included questions about sociodemographic aspects and the Beck Depression Inventory. The survey was published through social networks (Facebook and Whatapp) in migrant forums around the world, mostly Spanish-speaking, because the survey was published in Spanish.

Of the 276 immigrants surveyed, an average age of 36.63 is seen. The 30% are single. The 30.79% are unemployed. 0.72% attended an immigrant reception centre. 99.63% have Spanish as mother tongue. 33.33% emigrated alone. The results of Beck’s questionnaire, 28.98% have moderate/severe depression. Of the total respondents, 49.63% have been an immigrant for 1 to 5 years. The 85,14% were in a regular legal-inmigration situation.

The immigrant population can be a group at risk for developing anxiety or depressive symptoms, especially when there is a situation of vulnerability and the necessary adaptation mechanisms for a satisfactory migration process cannot be guaranteed.

In daily clinical practice we use to make diagnoses in first consultations, but sometimes it is more complicated, requiring a cross-sectional study of the evolution of the case.In daily clinical practice we use to make diagnoses in first consultations, but sometimes it is more complicated, requiring a cross-sectional study of the evolution of the case.

44-year-old woman. Married and mother of one child. She has an hospitalization for alcohol dependence in the context of depressive syndrome. The patient attends the consultation regularly, presenting in the foreground alcohol consumption with evasive characteristics due to hypothymic mood. Many pharmacological approaches are tried with poor tolerance, as well as referral to an alcohol cessation unit. After that, it requires new income where partial disorientation is observed.

A CT scan is performed and is reported as normal.

In admissions, family-type interventions are performed to reduce accompanying family dysfunction. The evolution is torpid, with the appearance of dysfunctional hysteromorphic personality traits, with childish demands and refusal to go to prescribed consultations. Tendency to confabulation and demonstrative attitudes in the family context, which yield with hospitalization, presenting an absence of disruptive behaviors in the hospital context, but it does seem to present brain alterations due to alcoholism. It is sent home with appropriate indications.

Sometimes, a detailed investigation and follow-up of a case, in this case by way of admission, may result in a different diagnosis than the previous one, which entails a different management.

No significant relationships.

Stigma has been associated with various groups, based on certain attributes or characteristics, such as; Race or health status is a complex and dynamic process, a universal phenomenon that is part of all social groups and is maintained by its functions related to the establishment of one’s own identity and the facilitation of socialization processes. Many societies throughout history have identified people with a mental health problem as part of a minority group considered inferior to the rest. What has made this population an object of social stigma. With the beginning of community psychiatry, and with the need to integrate people with a serious mental disorder into it, it becomes even more valuable to be able to assess the social stigma towards mental illness in the community.

The goal is to examine community attitudes towards people with mental illness.

Cross-sectional study of 228 people through an anonymous online survey. Sociodemographic variables and questionnaires were collected, such as the Community Attitudes Questionnaire towards people with Mental Illness (CAMI).

65% of respondents are women and 35% men. 74% have university studies. 18% do not agree that mental illness is an illness like any other. 1% believe that not all people can develop a mental illness. 7% of those surveyed are afraid that people with mental illness reside in their neighborhood and 14% believe that they are more dangerous people than the general population.

Given the results obtained, we observe that the stigma towards people with mental illness is still present in society.

The COVID-19 pandemic presents symptomatic heterogeneity, so the differential diagnosis is even more relevant and more in patients with mental disorders. COVID-19 is a new disease that is under study and affects people over 65 with the greatest severity worldwide. The most frequent psychiatric symptoms are behavioral disturbances and confusional syndrome among those affected.

The objective is to demonstrate the importance of differential diagnosis in patients with psychiatric symptoms and covid-19.

Patients aged 71 and 77, admitted to psychiatry. They present drowsiness that alternates with episodes of psychomotor agitation in which they verbalize fear of the coronavirus. Personal history: bipolar disorder and schizoaffective disorder. Psychopathological exploration: Spatial-temporal disorientation, uncooperative, fluctuating state of consciousness, verborrheic, salty and incoherent speech at times. Dysphoric mood. Psychomotor restlessness predominantly at night, verbal heteroaggressiveness. Negative to ingestion due to odynophagia. Sensory-perceptual alterations and nihilistic delusions “the virus has killed me, I’m already dead.” Upon admission, they present a cough and fever and are treated with azithromycin and dexamethasone for suspected COVID-19. Complementary tests: chest X-ray bilateral pleural effusion. Cranial CT: Diffuse cortical and subcortical brain parenchyma retraction pattern. PCR positive coronavirus.

After overcoming the infection and with psychopharmacological treatment the confusional syndrome remitted.

Confusional syndrome can present with different psychiatric symptoms, so the differential diagnosis is very important and even more so in patients older than 65 years who present somatic pathologies or acute infections. The differential diagnosis of confusional syndrome is key to adequate treatment and favor the prognosis.

Porencephaly is a neurological condition that can develop before or after birth, characterized by cysts located in any place inside the brain parenchyma, which generally are covered by plain walls and encircled by an atrophic crust. It generates a very variable clinic appearance, with severe cases of high disability and slight cases with a light neurological involvement, which also can go unnoticed until adulthood. The prevalence is unknow and the inheritance is autosomal dominant Male patient of 45 years diagnosed with porencephaly with cerebral palsy that affects left half and cognitive disability. His father reports an emerging defiant behavior, mutism and decrease of appetite from a week ago. No triggering stress factors are reported.

Show the importance of include in the differential diagnose hypoactive confusional syndrome.

On urgent medical visit, male comes with ataxic gates which wasn’t shown before. Inhibited attitude, semiflexed staring at floor, with sparing and monosyllabic speech answers, verbalizing discomfort and personal concern. Sleep-wake rhythm disruptions.

Blood tests and drug screening shows no abnormalities Cranial CT: Without acute lesion Urinary infection observed.

It is important to make complementary test to exclude organic frames which could justify acute-subacute psychopathology. In this case, diagnosis was acute confusional syndrome, however, most known presentation is the hyperactive one which include motor hyperactivity, inappropriate behavior or disorganization and alterations of sensory perception. Hypoactive must always be considered, which is the concluding diagnosis in this case.

No significant relationships.

It reveals a case that occurred in a patient with no previous history whose first manifestation was kinesthetic allucinations, subsequently appearing other psychopathological alterations

24-year-old male. Truck driver by profession. No prior mental health story. Good operation prior to the consultation. He comes accompanied by his parents for having a sensation of having bugs under his skin. It has come to throw gasoline on top to eliminate the possible infection.

Exploration: He is concius, oriented, with scratching lesions. He wears a cap soaked in gasoline to ward off critters. He does not present in the foreground other psychopathological alterations. CT with normal results, thyroid hormones, and normal biochemistry are requested. Treatment with aripiprazole is initiated in ascending doses, as it presents in the beginning a torpid evolution with the appearance of delusions of injury to its boss.

After that, he is currently psychopathologically stable and has returned to work with his father in the field.

Although not the most common, psychotic disorders can occur at the beginning with cenesthetic alterations. Organic screening should be performed and results treated accordingly.

No significant relationships.

Excessive daytime sleepiness, hypnagogic-hypnopompic hallucinations, sleep paralysis, and cataplexy are symptoms associated with narcolepsy. It is not uncommon to occur co-morbidly between narcolepsy and psychiatric disorders. This association is poorly understood. Recent findings indicate that anxiety disorders also are associated with typical symptoms of narcolepsy.

Study of the comorbidity between narcolepsy and psychiatric disorders, like anxiety, through a clinical case.

A 21-year-old female patient with no psychiatric history who consulted due to anxiety and panic attacks related to poor narcolepsy control. Debut of the neurological disease during adolescence with frequent cataplexy attacks that condition their daily activity and generate avoidance behaviors and agoraphobia.

The patient complained of poor quality of sleep and reported a large number of different types of situations (eg, surprise, embarrassment) associated with cataplectic events. Treatment with SSRIs first and bupropion with pregabalin later was partially effective. Recent studies suggest efficacy of vagus nerve stimulation.

Anxiety disorders, especially panic attacks and social phobias, often affect patients with narcolepsy. Anxiety and mood symptoms could be secondary complications of the chronic symptoms of narcolepsy. Recent studies have shown that narcolepsy is caused by defective hypocretin signaling. As hypocretin neurotransmission is also involved in stress regulation and addiction, this raises the possibility that mood and anxiety symptoms are primary disease phenomena in narcolepsy. Recent studies suggest that vagus nerve stimulation could be potentially useful in the treatment of resistant depressive and anxiety disorder and it is not a contraindication in patients with narcolepsy.

No significant relationships.

Pregnancy is a special risk factor for suicide attempts among females (Andrew E. Czeizel et al. 2011). Situational factors such as the novel coronavirus (COVID-19) have also been reported to impact on individual’s mental health.

Examine the effect of COVID-19 and its association with mental health and attempt suicide risk in pregnant population.

A cross-sectional study that includes 113 pregnant women from Spain, through an anonymous, voluntary and multiple response type online survey which included questions about socio demographic aspects, COVID-19’s aspects and mental health.

Of the 112 pregnant patients surveyed, only 2 reported suicidal ideation. The age of the respondents was 32 and 33 years, both of whom were in the 2nd trimester of pregnancy. Both report that it was the first pregnancy and affirm a worsening of their economic situation since the beginning of the COVID-19 pandemic. One of them did not have a partner / marriage and was living with a relative, in turn this respondent was unemployed. Both responded that they were “always” worried about the possible outcome of the COVID-19 pandemic and that their fears had increased, being difficult to control and let them pass. It is very relevant that both agree that they “never” felt that the professionals who carried out the pregnancy controls asked or inquired about their current state of mental health.

Antepartum suicidal ideation is an important and common complication of pregnancy, specially in COVID-19’s times, healthcare professionals who follow pregnancy should detect high-risk suicidal patients and be able to carry out a suicide prevention program.

Suicide is a global health problem. The elderly is the range with the highest suicide rate and suicidal behaviors are more lethal, with greater planning and less possibility of rescue. In the elderly, Major Depressive Disorder is the diagnosis most frequently associated with suicidal behavior. 15% of the elderly with a depressive picture commit suicide. Loneliness, the main cause of suicides in the elderly population.

The objective of the clinical case presented is to address the risk factors for suicide in the elderly.

80-year-old patient, widower who makes a suicide attempt by ingesting glyphosate. Personal history: Acute myocardial infarction 1 month ago. Not mental illness. Family stressors: illness of his granddaughter, loss of his son’s job. Personal stressors: Loss of autonomy due to ischemic heart disease. The patient was admitted to the Intensive Care Unit with acute pulmonary edema secondary to the suicide attempt. Psychopathological exploration: Conscious, oriented and collaborative. Depressive mood in relation to the stressors presented. Makes partial criticism of the suicide attempt, recognizes its seriousness and planning.

Diagnosis: Moderate depressive episode. SAD PERSONS scale: 9 High risk.

The risk factors for suicide in older people can be medical, psychiatric, psychological, family environment and social - environmental factors. There are hardly any specific action protocols that allow early intervention and suicide prevention in the elderly. As social health professionals, we must work on the elaboration and application of these, since consummated suicide represents a major public health problem throughout the world.