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Factors Associated with Voluntary Discharge in a Hospital Detoxification Unit: An Observational and Descriptive Analysis
- P. Gamboa Lozada, G. Ortega Hernández, R. F. Palma Álvarez, A. Ríos Landeo, J. A. Ramos Quiroga, L. Grau López
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S135-S136
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Introduction
Adherence to treatment for addictive disorders remains a clinical challenge. Despite detoxification admissions being scheduled and initiated voluntarily by the patient, several factors may contribute to treatment discontinuation.1 Understanding these factors will enable the development of specific interventions for a more effective approach.2
ObjectivesTo identify and analyze the relationship between specific clinical factors and voluntary treatment discontinuation.
MethodsAn observational and descriptive study was conducted using a retrospective database of 1146 patients admitted to the “Hospital Universitari Vall d’Hebron” Detoxification Unit between June 2008 and December 2019. Bivariate analysis was conducted to identify individual associations between clinical factors and voluntary discharge. Subsequently, a multivariate analysis was performed to assess the combined influence of these factors while controlling for potential confounding variables.
ResultsA total of 135 patients (11.8%) requested voluntary discharge. Significant differences were found between the voluntary discharge and non-voluntary discharge groups in patients with dual diagnosis (91.1% vs 80.9%, p<0.0001), specifically the presence of psychotic disorder (18.7% vs 12%, p<0.05) and cluster B personality disorder (66.7% vs 31%, p<0.0001). Significant associations were also observed with prior detoxification admissions (64.5% vs 54.1%, p<0.05), heroin as the main admission substance (29.6% vs 13.3%, p<0.0001), lifetime use of more than three substances (65.3% vs 45.3%, p<0.0001), and pre-admission binge-pattern substance use (72.1% vs 51.4%, p<0.0001). A significant relationship was found with therapeutic discharge in the diagnosis of major depressive disorder (14.6% vs. 24.8%, p<0.05), admission for alcohol detoxification (25.9% vs. 42.8%, p<0.0001), and participation in group therapy during admission (27.4% vs. 49.9%, p<0.0001).In the multivariate analysis, it was found that cluster B personality disorder (p<0.0001), heroin as the primary substance of admission (p<0.05), and pre-admission binge-pattern substance use (p<0.05) were independently related to voluntary discharge.
ConclusionsCluster B personality disorder, admission for heroin detoxification, and pre-admission binge-pattern substance use are factors associated with voluntary treatment discontinuation.
Disclosure of InterestNone Declared
A case of steroid induced psychosis in a patient with mediastinal lymphoma
- B. Orgaz Álvarez, M. Velasco Santos, P. Ibáñez Mendoza, Á. de Vicente Blanco, G. García Cepero
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S317
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Introduction
Corticosteroids are a key part of many cancer treatment regimens and neuropsychiatric side effects have long been recognised. Steroid-induced psychosis is a disorder classified under substance or medication-induced psychosis in the Diagnostic and Statistical Manual of Mental Disorder, 5th edition. Management strategies include treatment with antipsychotic medication and reducing corticosteroid dosage.
ObjectivesTo describe the case of steroid induced psychosis in a patient with mediastinal lymphoma and provide a concise literature review.
MethodsClinical case report and brief literature review.
Results27-year-old male with a diagnosis of Stage IV Primary Mediastinal Lymphoma according to the Ann Arbor classification was admitted to the Haematology ward for chemotherapy treatment (R-DA EPOCH). Two days after admission the patient developed acute psychotic symptoms consisting of thought block, kinaesthetic hallucinations, and delusions. Prior to admission, the patient had been on corticosteroid treatment for two months (up to 8mg/day of dexamethasone), with a significant dose increase (up to 200mg/day of prednisone) at the beginning of chemotherapy treatment two days prior to symptom development. The patient had no personal or family history of mental health issues, no substance misuse and had not received any psychopharmacological treatment prior to admission.
Medical evaluations including a cranial CT scan, an MRI, EEG, blood tests and lumber puncture were all within normal parameters, discounting organic or metastatic causes for the symptoms.
Considering a potential episode of steroid-induced psychosis, the patient was started on olanzapine at a dosage of 10mg per day. The patient exhibited a positive response, with symptoms alleviating within 24 hours of the initial dose. In terms of corticosteroid therapy, haematologists adjusted the prednisone regimen to 100mg per day, and due to the encouraging progress, the olanzapine dosage was subsequently reduced to 5mg per day.
ConclusionsThis case underscores the importance of considering the possibility of steroid induced psychosis as a differential diagnosis specially in patients on high dose steroids presenting with psychotic symptoms. A multidisciplinary approach is crucial to ensure optimum treatment and care.
Disclosure of InterestNone Declared
Intranasal esketamine efficacy as a treatment for treatment-resistant depression, case series
- C. Delgado Marmisa, I. Álvarez Correa, H. Vizcaíno Herrezuelo, L. Egüen Recuero, E. Garrido Dobrito, L. Gayubo Moreo, B. Sanz-Aranguez, L. Delgado Tellez, L. Caballero Martínez, R. De Arce Cordón, B. Jiménez-Fernández
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S692
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Introduction
Intranasal esketamine has been approved as a treatment for patients with treatment-resistant depression. We analyzed the results of its efficacy in 15 patients.
ObjectivesTo evaluate the efficacy of intranasal Esketamine as a treatment in patients with treatment-resistant depression
MethodsCase series
ResultsFor the last 8 months, since the treatment with intranasal esketamine was approved for resistant depression, we have treated 14 patients with this drug. Through this process, we followed a standardized method consisting in the following steps:
On the first esketamine session (DAY 1) the patient has to fill a CGI and a MADRS scale.
On the second esketamine session (DAY 7) the patient has to fill a CGI, a MADRS scale, a form about the level of satisfaction with the drug and a last form in which they can include the secondary effects.
On week 6 since the start of the treatment, the patient has to fill again a CGI, a MADRS scale, a form about the level of satisfaction with the drug and a last form in which they can include the secondary effects.
In the 6th month since the start of the treatment, the patient has to fill again a CGI, a MADRS scale, a form about the level of satisfaction with the drug and a last form in which they can include the secondary effects they have perceived.
We analyzed and compared all of the previous data and obtained the following results:
At day 7: 64% of the patients had a response in the form of improvement, of which 66% were feeling “slightly better” and 33% were feeling “better”.
At week 6: 71% of the patients had a response in the form of improvement, of which 50% were feeling “slightly better” and the other 50% were feeling “better”.
At month 6: only 28% of the patients completed the treatment; of which 100% had a response in the form of improvement: 50% were feeling “slightly better”, 25% were feeling “better” and 25% were feeling “far better”.
ConclusionsAlthough our data suggests that intranasal esketamine has been effective in short term depressive symptoms, we have yet no information about its medium and long-term efficacy or secondary effects. Nevertheless, other potential factors should be evaluated as they could affect the results in the long-term such as the difficulty in maintaining the treatment for more than 6 weeks.
In addition, the patients who experienced the most improvement according to our data were patients with a TAB diagnosis, so this could be an interesting research focus.
Disclosure of InterestNone Declared
Alcohol-Induced Psychosis: Beyond Korsakoff. Case report and Literature Review
- Á. De Vicente Blanco, B. Orgaz Álvarez, P. Ibáñez Mendoza, M. Velasco Santos, J. Garde González
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S482
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Introduction
Chronic consumption of alcohol has clear deleterious effects on the nervous system. Among its less-recognized consequences are subacute and chronic alcohol-induced psychotic disorders. Lasègue, Garnier, Magnan, and Michaux provided exhaustive clinical descriptions of different presentations of subacute alcoholic delusional disorder, while Kraepelin, Allamagny, and Neveu defined the characteristics of chronic alcoholic hallucinatory psychosis. Both conditions are characterized by the occurrence of hallucinations and vivid dream-like content in their delusions, along with potential emotional detachment from the symptoms. Presently, both conditions are categorized under the generic term ‘Alcohol-Induced Psychotic Disorder,’ with limited available scientific literature.
ObjectivesOur goal is to bring attention to the existence of subacute and chronic alcohol-induced psychosis in individuals with long-term alcohol users.
MethodsCase report using clinical records and a non-systematic literature review.
ResultsA 63-year-old male, with a forty-year history of chronic alcoholism and no other prior mental health issues, was admitted in the emergency department. He conveyed vague delusional notions regarding his roommate and described vivid morning dreams in which he tried to communicate but couldn’t speak. This led him to believe his roommate harboured harmful intentions. Additionally, he mentioned that for the past two months, he had developed a telepathic connection with his sister and his deceased mother, with whom he felt he communicated without speaking. He described feeling strangement and anxiety concerning these experiences, which he firmly believed to be undeniably real. He reported being able to hear the voices of his mother and sister. He also described short-term memory problems dating back two years. He denied any other psychopathology and exhibited probable ideational and emotional impoverishment secondary to chronic alcohol consumption. Confirmation of the patient’s account was provided by his family members. The prescribed treatment included antipsychotic medication and a recommendation for alcohol abstinence.
ConclusionsDescriptions of chronic and subacute alcohol-induced psychoses are found in early psychiatric textbooks but have been omitted from contemporary classifications. While their incidence is low among chronic alcohol users, they represent a severe clinical entity. These disorders are usually distinguished by the presence of delusions and vivid hallucinations characterized by dream-like content. This distinct symptomatology aids in the accurate differentiation from other psychotic disorders and clinicians should be aware of their existence.
Disclosure of InterestNone Declared
Emotional intelligence in teachers of educational institutions in the department of Magdalena
- K. L. Perez Correa, J. Viloria Escobar, L. P. Pedraza Àlvarez, M. Egea Lavalle
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S822
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Introduction
Psychosocial and mental health-related variables are crucial determinants of individuals’ lives in society and their roles within organizations, especially in educational institutions that are characterized by social complexities. In this regard, this research aims to determine the levels of emotional intelligence among teachers in educational institutions in the Department of Magdalena.
ObjectivesDetermine the levels of emotional intelligence among teachers in educational institutions in the Department of Magdalena
MethodsMethodologically, it is situated within the empirical-analytical paradigm with a quantitative approach, using the descriptive method. A convenience sample of 179 teachers was used, and the TMMS-24 questionnaire was administered.
ResultsThe results revealed that 37.7% of the teachers completely agree, and 30.9% strongly agree with the statement that they pay a lot of attention to their feelings. On the other hand, only 12.2% somewhat agree, and 1.2% strongly disagree with the statement that they normally worry about what they feel.
Additionally, 33.9% agree with the statement that they usually take time to think about their emotions, while 25.6% somewhat agree, and only 1.2% strongly disagree with the statement that it is worth paying attention to their emotions and mood. Furthermore, 6.4% agree, and 5.2% strongly agree with the statement that they let their feelings affect their thoughts.
As for thinking about their mood constantly, 16.7% strongly disagree, and 39.1% somewhat agree. Moreover, 6.9% strongly disagree, and 21.4% somewhat agree with the statement that they pay a lot of attention to what they feel.
Only 1.1% strongly disagree with being able to frequently define their feelings. and only 1.7% strongly disagree, and 10.2% somewhat agree with the expression “I often become aware of my feelings in different situations.” 34.1% strongly agree, and 26.6% completely agree with the statement “I can always tell how I feel.” Finally, 5.1% strongly disagree, and 19.4% somewhat agree with the statement “Sometimes I can tell what my emotions are.”
ConclusionsIn conclusion, the study emphasizes in the importance of teachers’ emotional intelligence and its potential impact on their performance and students’ learning outcomes. It also highlights the need for intervention strategies to strengthen this psychosocial variable in educational institutions in the Department of Magdalena.
Disclosure of InterestNone Declared
Mental Health and Addictions in Pregnancy: Feasibility and Acceptability of a Computerized Clinical Pathway and Prevalence Rates
- R. Carmona Camacho, J. Chamorro Delmo, M. Alvaro Navidad, N. Lopez Carpintero, N. Estrella Sierra, R. Guimaraes de Oliveira, M. Olhaberry Huber, L. Mata Iturralde, R. Álvarez García, E. Baca Garcia
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S66-S67
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Introduction
Mental Health problems and substance misuse during pregnancy constitute a serious social problem due to high maternal-fetal morbidity (Cook et al, 2017; JOCG, 39(10) ,906-915) and low detection and treatment rates (Carmona et al. Adicciones. 2022;34(4):299-308)
ObjectivesOur study aimed to develop and test the feasibility and acceptability of a screening and treatment clinical pathway in pregnancy, based on the combination of e-Health tools with in-person interventions and, secondly, describe the prevalence of mental illness and substance use problems in this population.
Methods1382 pregnant women undergoing her first pregnancy visit were included in a tailored clinical pathway and sent a telematic (App) autoapplied questionnaire with an extensive battery of measures (WHO (Five) Well-Being [WHO-5],Patient Health Questionnaire [PHQ-9], General Anxiety Disorder [GAD-7], Alcohol Use Disorders Identification Test [AUDIT], Drug Abuse Screening Test [DAST], Columbia Suicide Severity Rating Scale [C-SSRS] and specifically designed questions on self-harm and psychopharmacological drugs).
Patients who did not respond to the questionnaire on their own received a counseling call.
Based on the screening results, patients were classified into five groups according to severity (Figure 1) and assigned a specific action pathway (Figure 2) that included a range of intervention intensity that goes from an individual psychiatric appointment to no intervention.
ResultsOf the 1382 women included in the clinical pathway, 565(41%) completed the evaluation questionnaires. Of these, 205 (36%) were screened as positive (Grades III,IV or V. Table 1) and 3(0.5%) were classified as needing urgent care. Of the patients offered on-line groups (100), 40% (40) were enrolled in them.
Table 1: Grade distribution of those screened as positives
Grade III 97 (17,2%) Grade IV 105 (18,6%) Grade V 3 (0,5%) Concerning prevalence rates, 73 (12,9%) patients endorsed at least moderate anxiety according to GAD-7 (≥10), 65 (11,5%) endorsed at least moderate depression according to PHQ-9 (≥ 10), 17 were positive on DAST (3%) and 63 (11%) patients scored above the threshold in AUDIT-C(≥ 3) for alcohol use.
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Image 2:
ConclusionsHigh prevalence rates suggest that effective detection and treatment mechanisms should be integrated into usual care. The use of standardized clinical pathways can help with this aim, allowing better clinical management and referral to treatment, but still face challengues to increase retention. The use of e-health tools offers the opportunity to improve accessibility and therapeutic outcomes through online interventions.
Disclosure of InterestNone Declared
The meaning of work for teachers in educational institutions in the department of magdalena
- K. L. Perez Correa, L. P. Pedraza Àlvarez, J. Viloria Escobar, J. J. Gómez Rangel
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S821
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Introduction
The psychosocial and mental health-oriented variables of people are determinants for their life in society and their roles within organizations, especially educational institutions that are endowed with social complexities.
ObjectivesThe objective of this research was to understand the meaning of work for teachers in educational institutions in the department in order to recognize elements such as the level of importance that work holds for them and the factors that either promote or hinder that centrality.
MethodsThis is a descriptive study with a quantitative methodology, and the sample selection was done for convenience, taking into account ethical aspects such as the handling of confidentiality for both the individuals who participated in this study and the educational institutions involved.
ResultsRegarding the meaning attributed to work by teachers, the results indicate that 29.6% of teachers declare themselves neutral when it comes to the statement that “the most important things in people’s lives are related to work”. 26.8% of teachers are neutral regarding the statement that “the primary function of work is to generate income”, and 17.9% somewhat agree. 20.7% disagree to some extent. 15.6% disagree with the statement that “people’s primary goals in life should be oriented toward work”. 25.1% of teachers are neutral, and 17.9% somewhat agree with the statement that “the main function of work is to enable interesting contacts with other people”. Only 11.7% strongly agree with the statement that “work is, in general, one of the most important things in people’s lives.
ConclusionsIt is concluded that there is a need to implement strategies that contribute to the strengthening of the teaching profession and contribute to improving educational quality
Disclosure of InterestNone Declared
Transcranial Magnetic Stimulation and Dual Pathology: An Integrative Protocol
- A. Moleon, P. Alvarez de Toledo, M. Martín-Bejarano, J. Narbona
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S145
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Introduction
Dual pathology, characterized by the simultaneous presence of substance use disorders and psychiatric disorders, is a topic of growing interest in the scientific community. In particular, obsessive-compulsive disorder (OCD) is a common comorbid psychiatric condition in patients with substance use disorders.
ObjectivesTo evaluate the efficacy of rTMS on comorbid disorder symptoms by applying specific protocols for OCD and substance use disorder in a clinical case of dual pathology.
MethodsCase Description: A 36-year-old male diagnosed with OCD and habitual cocaine use (an average of 6 times per month). Previous unsuccessful attempts to quit substance use. Undergoing psychotherapy and psychopharmacological treatment for OCD since the age of 22 with no significant clinical improvement.
Methodology: The severity of OCD was quantified before and after the intervention using the Yale-Brown Obsessive Compulsive Scale (YBOCS). To assess addictive behavior, the Maudsley Addiction Profile (MAP) was used. During the intervention period, the occurrence of substance use was recorded based on the patient’s and family members’ reports. The intervention involved the administration of an rTMS protocol tailored to the specific case, consisting of the simultaneous application, using a double-cone coil, of rTMS at 20Hz over the right dorsomedial prefrontal cortex (DMPFC) at an intensity of 100% of the resting motor threshold (RMT) to treat OCD symptoms, followed by intermittent theta burst stimulation (TBS) over the left DMPFC at an intensity of 120% of the RMT to address substance addiction. The patient received a total of 30 sessions at a rate of one session per day, five days a week, for six weeks.
ResultsResults: The results showed an improvement in the total score on the YBOCS scale, decreasing from a value of 26 in the pre-intervention assessment to 16 in the post-intervention assessment, representing a reduction of more than 35% from pre- to post-intervention, meeting response criteria. Thus, there was a decrease in both obsessive and compulsive symptoms, with reduced associated distress and increased control. Additionally, throughout the intervention, there was a gradual decrease in substance use, decreasing from an average of 6 monthly instances before treatment initiation to a total of 1 in the month the treatment ended.
ConclusionsConclusions: This unique case study represents a therapeutic window for the treatment of patients with comorbid disorders, demonstrating promising preliminary benefits of the combined rTMS intervention for both conditions, especially in the field of addictions.
Keywords: rTMS, neuromodulation, obsessive-compulsive disorder, addictions
Disclosure of InterestNone Declared
The winners project: neuropsycological changes after a video game-based training program in pediatric cancer survivors. a case report
- C. Gonzalez-Perez, E. Moran, N. Malpica, J. Alvarez-Linera, H. Melero, M. Alonso, M. Esteban, A. Perez-Martinez, E. Fernández-Jiménez
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S649
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Introduction
Children who have undergone an oncological process and have received treatment with chemotherapy or radiotherapy on the central nervous system may have significant neurocognitive sequelae. Some video games have shown neurocognitive benefits in people with impairments in different areas, such as attention or memory.
ObjectivesThis work aims to demonstrate the benefit of a video game-based training program to improve the neurocognitive profile in a child survivor of cancer.
MethodsThe patient is a 9-year-old female who was diagnosed with acute lymphoblastic leukemia at the age of 4 years. She received routine treatment of this disease by chemotherapy, including high-dose chemotherapy (with blood-brain barrier crossing) and intrathecal chemotherapy. She is currently 3 years after the end of treatment.
The Continuous Performance Test 3 (CPT-3) (sustained attention/vigilance) was administered before and after a multifaceted training program consisting of playing 3 video games for 12 weeks, as follows: a brain-training game (4 days per week, 7-12 minutes per day), a skill-training game (2 days per week, 10 minutes per day) and an exergaming game (2 days per week, 10 minutes per day).
ResultsPrior to intervention, the patient had 3 atypical z-scores on the CPT-3 (z scores: mean = 0, S.D. = 1), with a pattern compatible with ADHD (omissions z = 1.2; hit reaction time z = 3.4; hit reaction time block change z = 1.2). After intervention, she had only an atypical z-score (hit reaction time z = 3.6), with a pattern compatible with slowing, without ADHD.
ConclusionsThe neuropsychological evaluation of this patient showed an improvement in his attentional pattern on the CPT-3 after the video game-based training.
Disclosure of InterestNone Declared
The study protocol of the winners project: a randomized and controlled trial using a videogame-based training program in pediatric cancer survivors
- C. Gonzalez-Perez, E. Moran, N. Malpica, J. Alvarez-Linera, H. Melero, M. Alonso, M. Esteban, E. Fernández-Jiménez, A. Perez-Martinez
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S648-S649
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Introduction
Childhood cancer survivors have neurocognitive sequelae that in most survivor follow-up programs are underdiagnosed and for which there is usually no treatment plan.
Video games have demonstrated various psychological and neurocognitive benefits in different subpopulations, such as patients with organic neurological deficits or children with ADHD. However, few studies have been carried out using video games-based interventions in the paediatric oncology population.
ObjectivesThe aim of this work is to present the WINNERS study protocol, the objectives of which are to diagnose the neurological and cognitive sequelae in child cancer survivors, and to demonstrate the benefit in these areas of a training program based on video games.
MethodsA randomized controlled and unblinded trial is presented. Fifty-six patients aged 8 to 17 years stratified into two age groups (8-12 and 13-17) who had received any of the following treatments 1 to 6 years before the enrolment will be selected: high-dose chemotherapy with blood-brain barrier crossing, intrathecal or intraventricular chemotherapy, CNS radiotherapy or hematopoietic stem cell transplantation.
A neuropsychological evaluation will be performed consisting of a battery of neuropsychological tests to assess parameters such as attention, memory, visuospatial ability or speed of response, as well as a neuroimaging evaluation by structural and functional magnetic resonance imaging. The evaluation will be repeated 3 months and 6 months after the enrolment. Patients will be randomized to a treatment group or to a recycled waiting group. Intervention will consist on a 12-week training at home using 3 video games: a brain training game, an exergaming game and a skill training game.
ResultsAccording to the hypotheses of this study, it is expected that the proposed program of videogame-based interventions will improve neurocognitive and other wellbeing parameters in the intervention group.
ConclusionsThis study aims to improve the quality of care for patients who have survived a cancer disease by detecting sequelae that have so far been poorly attended, and by proposing a gamification-based intervention program that is effective and attractive for this population.
Disclosure of InterestNone Declared
Brief Psychotherapeutic and Psychopharmacological Interventions as Facilitators of Bariatric Surgery Success in Patients on the Anxious-Impulsive Spectrum: A Pilot Study
- Í. Alberdi-Páramo, M. Navas Tejedor, M. Paz Otero, J. Sánchez- Rodríguez, D. Gimeno Álvarez
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S491
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Introduction
Patients undergoing bariatric surgery often present with impulsive behavior and symptoms of anxiety. In this context, brief psychotherapeutic interventions such as nutritional education, cognitive restructuring, and behavioral activation have been shown to enhance pre-surgery weight loss and improve the likelihood of successful surgical outcomes. Furthermore, anorexigenic pharmacological treatments involving fluoxetine, bupropion, naltrexone, eslicarbazepine, zonisamide, and topiramate have been associated with increased success rates of the bariatric intervention.
ObjectivesTo assess the impact of brief psychotherapeutic interventions and psychopharmacological treatments on the success of bariatric surgery in anxious-impulsive patients, investigating the effectiveness of combined strategies in enhancing preoperative weight loss and surgical outcomes.
MethodsWithin the framework of a third-level hospital’s Bariatric Surgery Protocol, a total of 63 obese patients were assessed using the MINI International Neuropsychiatric Interview (MINI), Hamilton Anxiety Rating Scale (HARS), and Barratt Impulsiveness Scale (BIS-11) during the pre-surgical evaluation. Patients with Axis I pathologies were excluded, leaving a sample of 56 participants (38 females; BMI: 43.58±8.72 kg/m2; age: 48.5±9.7 years). Individuals displaying mild anxiety (6-14 points on HARS) and moderate/severe anxiety (>14 points on HARS) and/or those with a BIS-11 score exceeding 32.5 were selected for combined psychotherapeutic and psychopharmacological interventions.
ResultsCategorized by anxiety and impulsiveness levels, the patient distribution was as follows:
Mild anxiety without impulsiveness: 19 patients
Mild anxiety with impulsiveness: 31 patients
Moderate/severe anxiety without impulsiveness: 2 patients
Moderate/severe anxiety with impulsiveness: 15 patients
This pilot study explores the potential synergy between brief psychotherapeutic interventions and psychopharmacological approaches in enhancing the outcomes of bariatric surgery for patients within the anxious-impulsive spectrum.
ConclusionsThe results shed light on the feasibility and potential benefits of a combined treatment strategy, contributing to the optimization of bariatric surgery success in this specific patient population. Further research is warranted to confirm and generalize these findings.
Disclosure of InterestNone Declared
Psychiatric brain gain in Switzerland. Competency-based onboarding.
- D. Gurrea Salas, R. F. Palma Álvarez
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S392-S393
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Introduction
In the last 30 years, Switzerland has been established as a destination country for psychiatric trainees. The needed competences for the work as a trainee deviate regarding colleagues from foreign countries though, hindering a viable solid development professional without specific on-boarding program. A similar approach to the figure of tutor anchored in the Spanish postgraduate medical training is still missing in the Swiss medical System. Hereby we performed a survey in the new colleagues who are part from the medical team in an observer status before beginning with the responsibilities as a trainee.
ObjectivesRecognizing competences and needs of the onboarding in current trainees that are still allocating because of the work conditions as stated in the following paper, (Bischof et al. Swiss Arch Neurol Psychiatr Psychother. 2021;172:w03198)
MethodsSurvey with open questions collecting needs and competences expected to fulfil in Switzerland were distributed in 5 different medical colleagues in an observer status between August 2022 and September 2023.
ResultsResponse rate was 62,5 %. Main reasons for the migration were considering better perspectives in education and professional development in the goal country, coming push factors as the current work situation in the original country to the fore. Support regarding the local language and an overview of the interprofessional communication were outlined as the advantage of the internship prior to the duties as a psychiatric trainee.
ConclusionsAn structured on-boarding program is a demand for the newcomers - majority of trainees from foreign countries - to step in better in the Swiss health system. Elements of the Spanish trainee system could be adapted for a suitable allocation and integration process in the goal country.
Disclosure of InterestNone Declared
Crisis resolution teams: are we doing things well?
- J. J. Martínez Jambrina, L. P. Gómez, A. M. G. Alvarez, C. P. Miranda, S. P. Alvarez, N. A. Alvargonzalez, I. F. Arias
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S609-S610
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Introduction
Crisis resolution teams (CRTs) are a crucial component of mental health care, providing timely support to individuals experiencing acute mental health crises. This abstract delves into the concept of crisis and seeks to identify the patients who stand to benefit from these specialized services.
ObjectivesDefining crisis within the context of CRTs can be complex. It encompasses not only immediate emergencies but also broader mental health distress.
Research suggests that suitable candidates for CRT interventions are those facing acute mental health crises : This includes individuals experiencing suicidal ideation, severe agitation, or severe emotional distress.
La “Escala de Evaluación de Resolución de Crisis” (Crisis Resolution Team Assessment Tool, CRTAT) de Sonia Johnson es una herramienta diseñada para para medir la efectividad de los CRT y la duración de la intervención en crisis. Establece un límite de seis semanas como el período máximo durante el cual se debe ofrecer la atención en crisis.
Existen otras escalas de evaluación para medir la eficacia de la resolución de crisis:
1. Escala de Intensidad de Crisis (CIS): se utiliza para medir la gravedad de la crisis y la necesidad de intervención inmediata.
2. Escala de Evaluación de Crisis de Brage Hansen (BCES): se enfoca en la evaluación de crisis suicidas y evalúa la intensidad de la ideación suicida y la urgencia de la intervención.
3. Escala de Evaluación de Crisis de Eriksson (ECAS): Diseñada para evaluar la intensidad de la crisis en pacientes psiquiátricos, la ECAS se centra en la agitación, la ansiedad y la angustia emocional.
Methods- Studies have explored the effectiveness of CRTs and the perspectives of service users. Understanding how patients perceive crisis and CRT services is crucial for tailoring interventions effectively.
ResultsConclusions- CRTs play a vital role in mental health care, offering timely support to individuals experiencing crises. While defining crisis is complex, suitable candidates often include those in acute distress requiring immediate intervention. Understanding the perspectives of service users and the diverse nature of crisis experiences informs effective crisis resolution strategies.
Disclosure of InterestNone Declared
Transcranial Magnetic Stimulation and its Efficacy in Alleviating Depressive Symptoms in Patients with Suicidal Ideation
- A. Moleon, M. Martín-Bejarano, P. Alvarez de Toledo, I. Perez, J. Narbona, M. García-Ferriol, R. Perea, J. M. Oropesa, J. Torres
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S181
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Introduction
Suicide is a global public health issue. According to the latest available data from the National Institute of Statistics, 4,003 people died by suicide in 2021, reaching a new historical high. Approximately 90% of suicide victims suffer from one or more severe psychiatric disorders, and there is a documented 20-fold higher risk of suicide in individuals with affective disorders compared to healthy subjects (Abdelnaim et al., 2020). Repetitive transcranial magnetic stimulation (rTMS) has been established as an effective alternative or complementary treatment option for patients with depressive disorders, but little is known about its effects on suicide risk.
ObjectivesTo assess the efficacy of rTMS in reducing depressive symptoms in patients with suicidal ideation and behaviors.
MethodsPopulation and Methods: A retrospective analysis was conducted on a sample of 28 psychiatric patients (23 females; mean age 49.36 ± 16.23) with suicidal ideation identified by item 3 (suicidality) of the Hamilton Depression Rating Scale (HDRS), who were treated with rTMS. All patients received a minimum of 30 sessions, consisting of the application of a high-frequency (>10Hz) or intermittent theta burst stimulation (TBS) over the left dorsolateral prefrontal cortex (DLPFC) at an intensity of 120% of the resting motor threshold (RMT), and repeated low-frequency pulses (1Hz) or continuous TBS over the right DLPFC with an intensity of 110% of the RMT.
ResultsResults: The results show a statistically significant improvement in depressive symptoms following rTMS intervention (p < 0.001). Furthermore, remission was observed in 46% of the sample (HDRS < 8).
ConclusionsDiscussion: In line with recent studies (Abdelnaim et al., 2020; Hines et al., 2022) and systematic reviews (Cui et al., 2022; Bozzay et al., 2020) on suicidal ideation in the context of psychiatric disorders, the findings of this study demonstrated that rTMS achieved satisfactory results in reducing depressive symptoms and suicidal ideation.
Conclusions: This clinical study indicates preliminary promise for the prevention of suicidal acts and underscores the need for more detailed and specific research on rTMS in the field of suicide.
Keywords: rTMS, neuromodulation, depression, suicide.
Disclosure of InterestNone Declared
Differences in the perception of stigma in schizophrenia between men and women: a brief qualitative approach
- P. Andres-Olivera, B. Arribas-Simon, E. D. Alvarez, B. Bote, C. Martin-Gomez, C. Payo, C. Munaiz, R. Brito, M. Ligero-Argudo
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S805-S806
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Introduction
Men and women with psychosis have different courses and presentations of symptoms. Men with psychosis have an earlier onset of illness, more negative symptoms, and worse premorbid functioning. Women, on the other hand, have better social functioning and less substance abuse. Despite these evident differences, there are few studies that delve into these distinctions, especially from a subjective perspective.
ObjectivesThe aim of this study is to understand the differences in the perception of psychosis between men and women.
MethodsFive women and five men diagnosed with schizophrenia participated in the study. They were matched so that the age difference between them was no more than 5 years, with ages ranging from 40 to 56 years. Participants had not experienced acute decompensation of their underlying illness and had not required admission to an Acute Care Unit in the 6 months prior to inclusion in the study. Data collection was conducted through the Spanish translation of the Indiana Psychiatric Illness Interview, consisting of five parts: a narrative about their life, a narrative about the illness, questions related to how the illness has changed their life and what has not changed, the overall influence of the illness on their life, and lastly, expectations for the future.
ResultsMen expressed more concerns about work (4 men versus 2 women), while women expressed more concerns about not having become mothers (3 out of 5 women, compared to one man). All participants shared experiences of isolation in intimate relationships, including romantic relationships. Regarding stigma, three women believed that people treated them like children and dismissed their opinions. However, two of them viewed this behavior from their loved ones positively. Two women discussed the impact that psychosis and medications had on their bodies and how others had reacted to these changes
ConclusionsThe concerns and stigma associated with mental illness differ between genders. These differences should be taken into account when developing specific biopsychosocial treatment plans.
Disclosure of InterestNone Declared
Clinical features and factors related to suicidal ideation in adult patients with benzodiazepine use disorder
- P. Querol Clares, G. Ortega Fernandez, R.-F. Palma Alvarez, C. Daigre, M. Alijotas Capdevila, J.-A. Ramos Quiroga, L. Grau Lopez
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S135
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Introduction
Benzodiazepine use disorder (BUD) has been associated with the presence of suicidal ideation (SI) in general population. It seems there is an overall increase in the risk of attempting suicide due to the increase of impulsivity, rebound and withdrawal of those who use benzodiazepines(1). However, this association has been scarcely studied.
ObjectivesTo explore the prevalence, clinical features and factors related to lifetime SI in adults with BUD.
MethodsA cross-sectional study was conducted in an outpatient center for addiction treatment between 01/01/2010 and 12/31/2021. Adult patients who met criteria for active BUD were included. Patients with language barriers, cognitive impairments and those who were participating in any clinical trial were excluded. All patients were evaluated with an ad-hoc questionnaire, EuropASI (European Addiction Severity Index), BDI (Beck Depression Inventory) and HRQoL SF-36 (Health-related quality of life according to SF-36). Univariate and bivariate analyses were performed comparing BUD patients with or without SI.
Results554 patients were included (65.2% males; M age 42.6±12.6 years). SI was reported in 57.2% of the patients. Regarding the sociodemographic variables, any type of lifetime abuse was correlated with SI (67.8%, 73.5% and 77.8% of the patients with emotional, physical and sexual abuse respectively). Considering the different psychiatric features studied, having any psychiatric diagnosis increased SI up to 64%. Depressive and cluster B personality disorders were the ones with a higher presence of SI (67.1% and 68.1% respectively). Anxiety and cluster A personality disorders had also higher proportions of SI (56.1% and 58,7% respectively). Regarding the different assessment instruments used, a higher punctuation on BDI score was seen in the group of patients with SI (23.73±12.86). The scores also showed a worse perception of the mental quality of life of those people with SI, measured by HRQoL (13.76 and 36.82±31.93 in patients with SI and no SI respectively). Considering the EuropASI, there was an increased proportion of SI in those patients with a worse familiar situation (0.44±0.30), a higher alcohol consumption (0.26±0.28) and a worse psychological condition (0.48±0.24).
ConclusionsThe prevalence of SI in patients with BUD is significative and is related to several clinical factors. Those factors should be taken into account in daily clinical practice, research, and any health policies on suicide. Further research should be developed.
1. Dodds, T.J. ‘Prescribed benzodiazepines and suicide risk’, The Primary Care Companion For CNS Disorders 2017; 19(2).
Disclosure of InterestNone Declared
“Suicide Clusters: Analysis of a Sample of Completed Suicides in Spain”
- A. M. G. Alvarez, J. J. M. Jambrina, I. F. Arias, L. P. Gómez, N. A. Alvargonzalez, C. P. Miranda
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S777-S778
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Introduction
“Cluster suicides,” also known as “suicide clusters,” refer to a phenomenon in which a series of suicides occur within a specific community, group, or geographic area within a relatively short period of time. These suicides often appear to be interconnected, either through imitation or contagion, and may involve individuals who have some form of social or emotional connection to each other.
Objectives- Understanding the definition and characteristics of cluster suicides.
- Analyzing common risk factors and triggers in cluster suicide cases.
- Evaluating prevention and support strategies for affected individuals and communities.
MethodsWe conduct an analysis of this concept based on a sample of suicides that occurred in a Spanish region over an 8-year period (2015-2022).
We will Analyzethe following aspects:
- Definition and characteristics of cluster suicides.
- Risk factors contributing to the occurrence of cluster suicides.
- Examples of real cases or case studies illustrating this phenomenon.
- The role of imitation and contagion in cluster suicides.
- Prevention and support strategies, including education on warning signs and access to mental health services.
- The impact of media coverage and how it can amplify the contagion effect.
- Measures to reduce access to lethal means of suicide.
ResultsWe will discuss about the results found:
- Definition and characteristics of cluster suicides.
- Risk factors contributing to the occurrence of cluster suicides.
- Examples of real cases or case studies illustrating this phenomenon.
- The role of imitation and contagion in cluster suicides.
- Prevention and support strategies, including education on warning signs and access to mental health services.
- The impact of media coverage and how it can amplify the contagion effect.
- Measures to reduce access to lethal means of suicide.
ConclusionsThe main conclusions of our presentation are :
- The importance of recognizing cluster suicides as a real and concerning phenomenon.
- The need to address specific risk factors and triggers in affected communities.
- The effectiveness of prevention and support strategies in reducing cluster suicide cases.
- The importance of promoting media responsibility in suicide coverage.
BIBLIOGRAPHY
1. Cluster Suicides: A Critical Review and Theoretical Framework” (2019) - Este estudio proporciona una revisión crítica de la literatura sobre cluster suicides y presenta un marco teórico para comprender mejor este fenómeno
2. “Clusters of Suicides and Suicide Attempts: Identification, Prediction, and Prevention” (2016) - Aunque este estudio no se centra exclusivamente en España, ofrece información sobre la identificación y prevención de clusters de suicidio que puede ser relevante.
3. “Epidemiology of Suicide in Spain, 1981–2008” (2012) - Proporciona una visión general de la epidemiología del suicidio en España, lo que podría ayudar a contextualizar los estudios específicos sobre clusters.
Disclosure of InterestNone Declared
A preliminary analysis of clinical characteristics of patient with alcohol use disorder and suicidal ideation
- R. F. Palma-Alvarez, A. Rios-Landeo, G. Ortega-Hernandez, E. Ros-Cucurull, C. Daigre, M. Perea-Ortueta, M. Sorribes, L. Grau-López, J. A. Ramos-Quiroga
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S132-S133
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Introduction
Suicidal behaviors are frequently observed among patients with substance use disorder, including suicidal ideation (SI) (1). Alcohol use disorder (AUD) is one of the most prevalent addictions and may be related to suicidal behaviors (2,3). However, the association between AUD and SI requires a deeper analysis which includes several clinical features observed among AUD patients.
ObjectivesTo analyze the clinical characteristics and features associated with lifetime SI among patients who had AUD.
MethodsThis is a cross-sectional study performed in an outpatient center for addiction treatment in patients seeking for treatment who met the criteria for AUD between 01/01/2010 and 12/31/2021. Patients were evaluated with an ad-hoc questionnaire and the European Addiction Severity Index (EuropASI), SI was evaluated using the item for SI in EuropASI.
ResultsFrom a potential sample of n=3729 patients, only n=1082 (73.8% males; mean age 42.82±12.51) met inclusion criteria and had data for the current analysis. Lifetime SI was present in 50.9% of the AUD patients. Several clinical features were related to SI, including: sex differences, any type of lifetime abuse, polyconsumption, benzodiazepine use disorder, any psychiatric diagnosis aside from SUD, and higher addiction severity according to the EuropASI.
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ConclusionsSI among AUD patients is related to several clinical features which indicate a higher addiction severity, more polyconsumption, and a higher prevalence of psychiatric comorbidities. These findings may contribute to the understanding of suicidal behaviors in AUD patients but it is required further investigations, including longitudinal studies.
REFERENCES
1 Rodríguez-Cintas L, et al. Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res. 2018;262:440-445. doi:10.1016/j.psychres.2017.09.021
2. MacKillop J, et al. Hazardous drinking and alcohol use disorders. Nat Rev Dis Primers. 2022;8(1):80. doi:10.1038/s41572-022-00406-1
3.Darvishi N, et al. Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis [published correction appears in PLoS One. 2020;15(10):e0241874]. PLoS One. 2015;10(5):e0126870. doi:10.1371/journal.pone.0126870
Disclosure of InterestNone Declared
Tolerability of intranasal esketamine, a case series of 15 patients
- I. Álvarez Correa, C. Delgado Marmisa, H. J. Vizcaíno Herrezuelo, L. Egüen Recuero, E. Garrido Dobrito, L. D. Téllez de Cepeda, L. Gayubo Moreo, B. Sanz-Aránguez Ávila, L. Caballero Martínez, R. de Arce Cordón
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S543
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Introduction
Intranasal esketamine has recently been approved for the treatment of treatment-resistant depression in adults, with different studies showing its efficacy and tolerability. However, the real-world tolerability of this treatment is still unclear.
ObjectivesEvaluate the tolerability of intranasal esketamine in a case series of 15 patients.
MethodsOur case series includes 15 patients, who received treatment with intranasal esketamine during 2022-2023. In order to evaluate the tolerability of intranasal esketamine, patients were asked to complete the TSQM and a side effect questionnaire on different moments of the treatment (one week, six weeks and six months after the beginning of the treatment).
ResultsThe most common adverse effects were dissociation, dizziness, and somnolence, which resolved within the hours following the administration. All of them were mild or moderate in severity, having a minor impact on the patient, so none of the patients discontinued the treatment due to adverse effects. Other adverse effects noticed were: transitory increment of blood pressure in several patients, and worsening of obsessions in a patient with previous obsessive-compulsive symptoms.
ConclusionsOur data suggests that intranasal esketamine is well tolerated, with transient and mild adverse effects. In all cases the risk-benefit ratio must be evaluated, but until more studies are done, it seems to be a safe treatment for treatment-resistant depression.
Disclosure of InterestNone Declared
Management of Acute Organic Change of Character cases by Liaison Psychiatry Unit
- E. Cesari, H. Álvarez, H. Andreu, L. Bueno, O. De Juan, J. I. Mena, I. Ochandiano, L. Olivier, S. Salmerón, L. Pintor
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S489-S490
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Introduction
The Acute Organic Change of Character (AOCC) is an organic mental disorder subtype in which perception, thought, mood and personality impairment predominate. It consists in a change in the individual’s general behaviour or attitude, which is shown to be closely associated with or caused by an underlying organic process, and which is rapidly resolved when the organic noxious agent is eliminated (Pintor et al. Journal of Psychiatry and Psychiatric Disorders 4 (2020): 354-358).
ObjectivesTo describe the importance of taking AOCC diagnosis into consideration and the role of liaison psychiatrists in AOCC management by presenting two AOCC cases admitted to the Hospital Clinic of Barcelona.
MethodsWe retrospectively reviewed two AOCC cases in patients followed by our hospital’s liaison psychiatry unit during the summer of 2023. We also searched for previous case reports of AOCC using a PubMed query.
ResultsCase 1: A 50-year-old male who suffered a polytrauma with diffuse axonal injury (DAI). His relatives and the referring medical team observed a change in his behaviour consisting in irritability, suspicion, hostility and impatience. No cognitive impairment nor fluctuation in the described symptoms were observed. At the time of discharge character changes were still present due to DAI slow and unpredictable clinical course. Symptomatic treatment with risperidone 6mg/day and quetiapine 100mg/day was administered achieving a satisfactory clinical response.
Case 2: A 47-year-old woman with type 2 diabetes who suffered an infectious cellulitis that spread causing sepsis. The patient began to appear disruptive with verbose and tangential speech during her admission. No cognitive impairment nor fluctuation in the described symptoms were observed. Symptomatic treatment with risperidone 10mg/day and olanzapine 5mg/day was administered achieving a satisfactory clinical response. At the time of discharge character changes described before were almost resolved.
ConclusionsThe clinical presentation of both cases suggested organic mental disorders in which a change in general behaviour predominates. Liaison psychiatrists play a key role in AOCC management by recognizing the clinical pattern, helping if needed with psychopharmacological treatment and ensuring a good understanding of the disorder both by the referring medical team and the patient’s relatives. To our knowledge, it would be of great importance to achieve a better understanding of this clinical condition which to date we consider to be underdiagnosed.
Disclosure of InterestNone Declared