The SARS-CoV-2 pandemic situation forced the Spanish Government to declare a home confinement that was prolonged for three months. The Health System had to focus almost entirely on the treatment of patients with Covid-19 infection and vulnerable populations such as people with severe mental illness were overlooked. In this context, mental health home care as an alternative to hospitalization became a first-line approachment for patients with an acute mental health disorder.

The aim of this study is to describe the professional practice and the patients characteristics attended by a mental health team in Catalonia during the home confinement due to the SARS-CoV-2 pandemic.

This study includes the period between March 15, 2020 and June 21, 2020. Sociodemographic, clinical and team functioning variables were described. The patient data was obtained from medical history whereas the rest of information was collected through the creation of a database by the members of the assistencial team.

Team’s structure was changed with the creation of two mirror teams. Psychological attention was expanded and the weekend coverage was reorganized.During that period 40 patients were treated with a mean age of 47 years. There were no differences regarding the gender (50% were men and 50% were women). 87% of the patients lived with their family. 75% of referrals were made by the hospital and 90% were referred to community services upon discharge. Regarding diagnoses, 57.5% of the patients were diagnosed with a psychotic disorder (10% being reactive to Covid-19). A total of 482 visits were made, of which 51% were conducted in a telematic form. The mean time between the referral and the admission was 37.98h. The team accepted 97% of the referred patients with an occupancy rate of 112.4%.

The re-organisation of a home treatment team during the domiciliary lockdown allowed to increase the occupancy rate and offered a rapid response to patients, avoiding the need of conventional hospitalization and providing a proper care plan.

None Declared

Major depressive disorder (MDD) is a complex disorder with a significant public health burden. Depression remission is often associated with weight gain, a major risk factor for metabolic syndrome (MetS). The primary objective of our study was to assess prospectively the impact of response to antidepressant treatment on developing MetS in a sample of MDD patients with a current major depressive episode (MDE) and who are newly initiating their treatment.

In the 6-month prospective METADAP cohort, non-overweight patients, body mass index <25 kg/m2, with MDD and a current MDE were assessed for treatment response after 3 months of treatment, and incidence of MetS after 3 and 6 months of treatment. Outcome variables were MetS, number of MetS criteria, and each MetS criterion (high waist circumference, high blood pressure, high triglyceridemia, low high-density lipoprotein-cholesterolemia, and high fasting plasma glucose).

In total, 98/169 patients (58%) responded to treatment after 3 months. A total of 2.7% (1/38) developed MetS out of which 12.7% (10/79) (p value < 0.001) had responded to treatment after 3 months. The fixed-effect regression models showed that those who responded to treatment after 3 months of follow-up had an 8.6 times higher odds of developing MetS (odds ratio = 8.58, 95% confidence interval 3.89–18.93, p value < 0.001).

Compared to non-responders, non-overweight patients who responded to treatment after 3 months of antidepressant treatment had a significantly higher risk of developing MetS during the 6 months of treatment. Psychiatrists and nurses should closely monitor the metabolic profile of their patients, especially those who respond to treatment.

There have been over 900,000 deaths from COVID-19, with more than 3 million people bereaved. These deaths are associated with factors leading to poor bereavement outcomes, and distress in frontline-staff

to (i)present the rapid implementation of an intervention for bereavement support; (ii)characterize first calls and follow-up.

We recruited a multidisciplinary team and prepared a structure called “SIB” (Support and Intervention for Bereavement) in a matter of days. There were three steps for the support (Screening, First-line intervention, Second-line intervention (short follow-up). We collected data screening risk factors for complicated grief (CG).

Between March 24th-May 14th (lockdown, March 16th-May 13th), the hotline received nineteen calls for an intervention. The hospital contacts were various, including mortuary. Fifteen relatives were followed, among them thirteen bereaved for ten deaths (on 52 deaths=19.23%). Dead persons were young (m=59.68 years-old, SD=15.25). All contacts reported several risk factors for a CG (no “goodbye” (100%), no funeral rituals (82.35%)). Six relatives were addressed for short follow-up.

The actual pandemic is at high risk for complicated grief and may until 2021. We hope that all hospitals would implement basic bereavement outreach programs to prepare families for the death and to support them afterwards, as well as provide basic support to frontline staff.

No significant relationships.

The tryptophan pathway along with its two branches of metabolism to serotonin and kynurenine seems to be affected in major depression. In depressed patients, peripheral levels of tryptophan, serotonin, kynurenine and their metabolite remain unclear.

Therefore, peripheral tryptophan and metabolites of serotonin and kynurenine were investigated extensively in 173 patients suffering from a current major depressive episode (MDE) and compared to 214 healthy controls (HC).

Fasting plasma levels of 11 peripheral metabolites were quantified: tryptophan, serotonin pathway (serotonin, its precursor 5-hydroxy-tryptophan and its metabolite the 5-hydroxy-indole acetic acid), and kynurenine pathway (kynurenine and six of its metabolites including anthranilic acid, kynurenic acid, nicotinamide, picolinic acid, xanthurenic acid and 3-hydroxy-anthranilic acid).

60 (34.7%) patients were antidepressant drug free. Tryptophan levels did not differ between MDE patients and HC. Serotonin and its precursor (5-hydroxy-tryptophan) levels were lower in MDE patients than HC. Whereas, its metabolite (5-hydroxy-indole acetic acid) levels were within the standard range. Kynurenine and four of its metabolites (kynurenic acid, nicotinamide, picolinic acid and xanthurenic acid) were lower in MDE patients.

This study uses the largest ever sample of MDE patients, with an extensive assessment of peripheral tryptophan metabolism in plasma. These findings provide new insights into the peripheral signature of MDE. The reasons for these changes should be further investigated. These results might suggest a better stratification of patients and different therapeutic strategies therapeutic strategies.

Nitric oxide synthase (NOS) activity, an enzyme potentially involved in the major depressive episodes (MDE), could be indirectly measured by the L-Citrulline/L-Arginine ratio (L-Cit/L-Arg). The aim of this study was: (1) to compare the NOS activity of patients with a MDE to that of healthy controls (HC); (2) to assess its change after antidepressant treatment.

A total of 460 patients with a current MDE in a context of major depressive disorder (MDD) were compared to 895 HC for NOS activity (L-Cit/L-Arg plasma ratio). L-Arg and L-Cit plasma levels were measured using a MS-based liquid chromatography method. Depressed patients were assessed at baseline, and after 3 and 6 months of antidepressant treatment for depression severity and clinical response.

Depressed patients had a lower NOS activity than HC at baseline [0.31 ± 0.09 v. 0.38 ± 0.12; 95% confidence interval (CI) −0.084 to −0.062, p < 0.0001]. Lower NOS activity at baseline predicted a higher response rate [odds ratio (OR) = 29.20; 95% CI 1.58–536.37; p = 0.023]. NOS activity in depressed patients increased significantly up to 0.34 ± 0.08 after antidepressant treatment (Est = 0.0034; 95% CI 0.0002–0.0067; p = 0.03).

Depressed patients have a decreased NOS activity that improves after antidepressant treatment and predicts drug response. NOS activity may be a promising biomarker for MDE in a context of MDD.

Depression is the most prevalent mental disorder in Primary Care (PC), with 60% of depressed patients receiving treatment in PC Units. Suicide is the most serious consequence of depression. The European Commission funded the European Alliance Against Depression (EAAD), a preventive program on depression and suicide that has been applied in 18 European countries. In Spain, this program has been implemented in Catalonia and the Balearic Islands (Majorca and Menorca).

To present the results obtained in the program implementation in Majorca.

This program was applied in June 2009 within the urban area of Palma (222,100 inhabitants). Phase 1 entailed data collection of suicide, suicide attempts and antidepressant consumption since 2006. Phase 2 implied the development of specific training courses for General Practitioners on suicide prevention in high-risk population, and the launch of a public advertising campaign with the collaboration of mass media.

Based on data collected since 2006, there are nearly 300 suicide attempts in the Balearic Islands every year. Within the area of intervention suicide attempts decreased a 24.8% between 2009 and 2010. Conversely, antidepressant prescription and consumption increased from a frequent 2–3% per year to a 5%.

Obtained results are consistent with findings in other areas where this program has been applied. Data available next years about number of suicides will help to assess the final impact of this program. It is important to continue designing and implementing preventive programs aimed to reduce suicide risk including specific training for health care providers.