To determine the rate of healthcare personnel (HCP) glove or gown contamination with methicillin-resistant Staphylococcus aureus (MRSA) and to estimate which patient care interactions and HCP roles are associated with greater contamination.

Multicenter cohort study.

Five Veterans Affairs medical centers in the United States.

Patients with a positive MRSA clinical or surveillance culture within the past 7 days were enrolled. Five HCP in the room were observed for each patient. After completion of tasks and prior to room exit, HCP gloves and gowns were cultured separately.

We enrolled 799 patients and obtained 3,832 glove and gown cultures. Contamination of HCP gloves or gown with MRSA occurred 713 of 3,832 (18.6%) of the time, while 589 of 3,832 (15.4%) of interactions resulted in contamination of gloves, and 319 of 3,831 (8.3%) of interactions resulted in contamination of gowns. The gloves and gowns of physical therapists and occupational therapists were most frequently contaminated. Any interactions that involved touching the patient resulted in glove or gown contamination in 622 of 2,901 (21.4%) of observations, while touching only the environment resulted contamination in 91 of 931 (9.8%) of observations. Rates of glove or gown contamination were similar in the intensive care unit (ICU) and non-ICU.

Contamination of HCP gloves and gowns with MRSA occurs frequently when caring for Veteran patients particularly when there is direct patient contact. Hospitals may consider optimizing contact precautions by using fewer precautions for low-risk interactions and more precautions for high-risk interactions.

Observational studies indicate that higher educational attainment (EA) is associated with a lower risk of many mental health conditions (MHC). We assessed to what extent this association is influenced by genetic nurture and demographic factors (i.e., assortative mating and population structure).

We conducted a within-sibship Mendelian randomization (MR) study. The sample consisted of 61 880 siblings (27 507 sibships) from the Trøndelag Health Study-HUNT (Norway) and UK Biobank (United Kingdom). MHC outcomes included symptom scores for anxiety, depression, and neuroticism, measured using the Hospital Anxiety and Depression Scale, the 7-item Generalized Anxiety Disorder Scale, the 9-item Patient Health Questionnaire, and the Eysenck Personality Questionnaire, along with self-reported psychotropic medication use.

One standard deviation (SD) increase in liability to EA was associated with lower anxiety (−0.20 SD [95% CI: −0.26, −0.14]), depression (−0.11 SD [−0.43, −0.22]), and neuroticism scores (−0.30 SD [−0.53, −0.06]), as well as lower odds of psychotropic medication use (OR: 0.60 [0.52, 0.69]). Within-sibship MR estimates remained consistent with population-based estimates: anxiety (−0.17 SD [−0.33, −0.00]); depression (−0.18 SD [−1.26, 0.89]); neuroticism (−0.29 SD [−0.43, −0.15]); psychotropic medication use (OR, 0.52 [0.34, 0.82]).

Higher EA or genetic liability to education reduces symptoms of anxiety, neuroticism, and psychotropic medication use. These mental health benefits do not seem to be explained by EA-linked genetic nurture or demographic factors. Regarding depression, results were less conclusive due to imprecise estimates, though beneficial effects of genetic liability to higher EA are possible and warrant further investigation.

Suicide involves not only patients but also families and communities, causing long-lasting effects on those who “survive”. The term “second victim” is used to define people who experience significant distress after a patient suicide (PS). For mental health professionals, PS could be considered an “occupational hazard”.

To assess the impact of patient death on psychiatric trainees and early career psychiatrists (ECPs), comparing PS to other causes of death.

Participants completed a socio-demographic section and a section about the experience of PS. Impact of event scale–revised version (IES-R) based on the last 7 days and the 7 days after the most recent patient death, Suicide Knowledge and Skills Questionnaire (SKSQ), the Impact of a Patient’s Suicide on Professional and Personal Lives Scale and the Maslach Burnout Inventory (MBI) were administered.

110 subjects were recruited from 23 European and 1 Asian countries. The mean age was 31.9 (SD=4.7). Most were trainees (66.4%, n=73), worked in a psychiatric ward (61.8%, n=68), and in general adult psychiatry (83.6%, n=92). Patient death was experienced by 51.8 % (n=57) of the participants. 17.3% (n=19) experienced a PS, 12.7% (n=14) experienced multiple PS, 13.6% (n=15) had patients who died both by suicide and other medical conditions, and 8.2% (n=9) had patients who died from other medical conditions. The most reported feelings were sadness, regret, guilt, helplessness and frustration. Among participants who experienced at least one PS, 89.7% (n=35) developed symptoms. The most common were increased awareness of risk (40.4%; n=19), low mood (34.0%; n=16), anxiety (32.6%; n=15) and lack of concentration (26.1%; n=12). 6.5% (n=3) experienced suicidal thoughts/passive death wishes, and 6.5% (n=3) received individual psychotherapy treatment for their symptomatology. Having experienced a patient loss influenced clinical practice in 33.3% (n=19) of the sample, with 10.5% (n=6) reporting the affliction of the ability to carry out clinical duties. 12.7% (n=14) considered changing careers, 10.5% (n=6) took sick leave, 57.8% (n=33) received helpful support from colleagues. However, 52.3% (n=30) felt they needed additional support. According to the total score of IES-R scored on the 7 days after the most recent patient death, 22.9% (n=11) of the sample who experienced at least one PS had a score indicating a risk of PTSD, compared to 22.2% (n=2) of participants who experienced other type of patient death. No difference in all scales was observed in those experienced PS rather than any other kind of patient death (p>0.05).

Our results confirm that PS affects the mental health of ECPs and psychiatric trainees, and impacts their daily lives. A larger sample should be collected to strengthen our results and better characterize the impact of these events.

None Declared

Autoimmune encephalitis is a new and increasingly well-described entity. The most common is encephalitis caused by antibodies against the N-methyl-D-aspartate receptor on the surface of neurons (NMDAR encephalitis). It is a predominant entity in women and young patients and it is often associated with ovarian teratomas, neuroblastomas, Hodgkin’s lymphomas and others.

NMDAR encephalitis can manifest with a diverse range of neurological and psychiatric symptoms (personality change, anxiety, insomnia, confusion, attentional and short-term memory deficits, emotional lability, psychotic symptoms, language impairment, fluctuations in the level of consciousness, seizures and dysautonomia).

Clinical review of Anti-NMDAR Encephalitis for differential diagnosis with Functional Neurologic Disorder.

Clinical case and literature review.

We present the clinical case of a 27-year-old woman with a history of depression and anancastic personality disorder. The patient went to the Emergency Department different days presenting both neurological (facial paresthesias, hypoesthesia, weakness, high-intensity occipital headache, dizziness, loss of consciousness and anterograde amnesia) and psychiatric symptoms (obsessive thoughts, anxiety, visual and auditory hallucinations). She was admitted to the Neurology Unit. Complementary tests were performed: EEG, cranial CT scan, MRI, lumbar puncture, blood tests (including tumour markers) and urinalysis, founding no alterations suggestive of encephalitis or other systemic pathologies. She was also evaluated by the Psychiatry service. The patient described that as a result of a recent change in her job she presented emotional lability, obsessive ruminative ideas and anxiety. Treatment with Sertraline 100mg/day and Lorazepam 1mg/8 hours was started.

After ruling out autoimmune encephalitis, the patient was diagnosed with Functional Neurologic Disorder, given the temporal relationship of the symptoms with the stressful history at work.

Given their growing prevalence autoimmune causes, such as NMDA anti-receptor antibody encephalitis, should always be considered in the cases of neuropsychiatric alterations. It is very important to carry out a correct organic screening prior to the diagnosis of psychiatric pathology. It is also essential an adequate coordination between different medical departments for an accurate and comprehensive approach to the patient.

None Declared

Careful qualitative analysis of medical comorbidities in psychogeriatric patients is frequently overlooked in clinical practice, although these individuals often present with complex clinical pictures where multiple age-related somatic conditions can influence or alter the psycopathological presentation of mental disorders. This interplay can significantly affect both diagnosis and management, complicating the therapeutic approach and influencing prognosis.

We present the case of an 81-year-old male with a history of schizoaffective disorder admitted to our Psychiatry Unit due to an episode of marked motor inhibition and delusions. This case is notable for its complex clinical presentation, requiring a broad differential diagnosis, and serves as a representative example of the challenges in managing psychogeriatric patients with overlapping psychiatric and neurological comorbidities.

1. 1) To describe the clinical particularities of this case, focusing on relevant psychogeriatric comorbidities and related changes in pathoplasticity.

2. 2) To review the available evidence regarding the characteristics and management of comorbid neurological disorders in psychogeriatric patients.

The patient’s clinical history was reviewed, including complementary tests such as brain MRI and PET-CT scans. Additionaly, a literature search was carried out, focusing on psychiatric and neurological comorbidities in elderly patients with a history of psychotic and affective disorders.

The patient’s clinical course reveals a significant change in the presentation of symptoms starting at the age of 70. Prior to this age, episodes were characterized mainly by inhibition, mutism, and delusional guilt. However, from the age of 70, there is a notable shift to more complex presentations with both manic and psychotic symptoms, including persecutory delusions, hyperactivity, and religious ideation, alongside periods of mixed affective states with significant affective lability. The development of probable drug-induced parkinsonism, confirmed by a negative DaTSCAN, and neuroimaging findings suggestive of a neurodegenerative process akin to Alzheimer’s disease further complicated the clinical picture. Therapeutic interventions included psychopharmacological adjustments and electroconvulsive therapy, resulting in partial stabilization.

1. 1. Managing psychogeriatric patients requires addressing comorbidities with a flexible, symptom-based approach.

2. 2. Neurodegenerative processes can alter prognosis by increasing relapse risk and changing symptom patterns.

3. 3. A multidisciplinary approach is crucial for optimizing care in complex psychogeriatric cases.

None Declared

Psychiatric symptoms in vascular dementia occur in up to 95 % of patients. These symptoms can be of a depressive or manic type, among others. For this reason, it is essential to carry out a proper differential diagnosis between vascular dementia and other types of pathology that include psychiatric symptoms.

1. 1) To describe the main psychiatric symptoms that could guide the diagnosis of vascular dementia.

2. 2) To make an appropriate differential diagnosis in order to carry out the most suitable therapeutic approach in each specific case.

A review of the most recent literature related to psychiatric symptomatology in patients with vascular dementia.

Vascular dementia can present with very diverse psychiatric pathology. Depending on the subcortical area affected, a particular symptomatology will predominate. For this reason, it is of vital importance to carry out a proper differential diagnosis. When the brain area affected is the ventromedial prefrontal cortex, the predominant symptomatology is depressive, with a higher percentage of patients with abulia. If the area most affected is the orbitofrontal cortex, disinhibition will predominate. However, if it is the dorsolateral prefrontal area, it will lead to executive dysfunctions.

On the other hand, it should be noted that psychiatric symptomatology due to vascular damage often has an atypical presentation in patients. For example, if what predominates is depressive symptomatology, what might appear relatively frequently would be late onset anxiety, irritability, or excessive somatic preoccupation. However, sadness or crying would not be as representative. If what predominates is the manifest symptomatology, in this case, with a high probability it would manifest itself in the form of behavioural disinhibition.

Because of these peculiarities, it is essential to make a proper screening between vascular dementia, late onset depression or Alzheimer’s disease, as the therapeutic approach to each pathology will be very different, as will be the prognosis.

• - Atypical psychiatric symptomatology may be the key to a diagnosis of vascular dementia.

• - A proper differential diagnosis between vascular dementia, late onset depression and Alzheimer’s disease is essential.

• - There is no clear benefit in the use of ACE inhibitors and NMDA receptor antagonists in cognitive impairment. However, there is evidence of improvement in cognitive function with SSRI antidepressants in patients with and without depression.

None Declared

The worldwide prevalence of Wernicke-Korsakoff syndrome is thought to range from 0-2%. Those at greatest risk include the homeless, the elderly, and psychiatric patients (1). In treatment, typical regimens include high doses of intravenous thiamine, three times daily for at least three days. Electrolyte abnormalities should be corrected and fluids replaced.

We are interested in studying the evolution of a patient with alcohol withdrawal syndrome progressing to wernicke’s encephalopathy.

We conducted a literature review by searching for articles in Pubmed.

A 40-year-old male, with no medical or surgical history of interest, alcohol consumer, was admitted to the hospital ICU for an episode of ataxia and agitation in the context of four days of alcohol abstinence. He was sedated and orotracheal intubation was performed and treatment was started with thiamine, tiapride and diazepam. After hemodynamic and respiratory stability, the patient was transferred to the Internal Medicine ward where he presented clinical symptoms compatible with Wernicke’s Encephalopathy (cerebellar ataxia and nystagmus). Psychiatry was consulted to adjust treatment and to carry out a psychosocial approach for discharge (alcohol withdrawal center).

The patient’s evolution has been favorable with the adjustment of psychopharmacological treatment. In the neurological examination we observed nystagmus and cerebellar ataxia. In the psychopathological examination the suspicious contact, psychomotor restlessness, mild generalized tremor in both MMSS are remarkable. Speech difficult to understand due to language barrier. Traits of impulsivity in the foreground. Unstructured biological rhythms. Partial insight. Intellectual functions and volitional abilities preserved.

In the complementary tests without significant remarkable alterations. In the treatment adjustment, a de-escalation of diazepam has been carried out for discharge. Treatment with pregabalin, tiaprizal, thiamine and vitamins B1-B6-B9 was also prescribed. Recommendation of absolute cessation of alcohol consumption and follow-up by internal medicine, psychiatry and social work.

Wernicke-Korsakoff syndrome is a clinical diagnosis and Wernicke’s encephalopathy should be suspected in any person at risk of thiamine deficiency presenting oculomotor findings, ataxia or confusion (1). Thus, in our patient presenting ataxia and nystagmus in the context of alcohol abstinence and some malnutrition, an early approach with thiamine can be performed to prevent progression to Korsakoff’s syndrome.

Once amnesia and executive deficit are present, Korsakoff’s syndrome should be suspected. The key to good outcomes is therefore to detect Wernicke’s encephalopathy early and treat it with thiamine (1). Severe concomitant infections, including sepsis of unknown origin, are frequent during Wernicke’s phase (2). In our patient there were no complications.

None Declared

Obsessive-compulsive disorder (OCD) has an estimated prevalence of 1-2% and causes a significative reduction in functionality and quality of life with a high socioeconomic impact.

First and second line treatment includes serotonin reuptake inhibitors, clomipramine, antipsychotics augmentation strategy and cognitive behavioural therapy. It is ineffective in 20-60% of patients whose approach may include transcranial magnetic stimulation (TMS).

The aim of this study is to assess the effect of treatment with TMS on obsessive-compulsive, anxious, and depressive symptoms in patients with OCD.

A prospective observational study was conducted including all patients diagnosed with OCD who underwent TMS in our department since March 2023.

Our protocol targets the dorsolateral prefrontal cortex and includes a total of 25 sessions using the Food and Drug Administration approved parameters (20 Hz, 100% of the leg resting motor threshold, 50 trains of 2s duration, inter-train interval 20s, 2000 pulses per session). Before each session, symptom provocation is performed. TMS was performed using the Cool D-B80 coil and a MagPro stimulator.

Symptoms before and after treatment were assessed using the Yale Brown Obsessive-Compulsive Scale (Y-BOCS), the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D).

As of 01/09/2024, 21 individuals with OCD completed TMS treatment, 57% male, with a median age of 37 years (interquartile range (IQR) 17). The median duration of illness was 25 years (IQR 15), with 24% of patients having very severe OCD, 52% severe, and 19% moderate—all refractory to psychotherapeutic and pharmacological treatment.

There was a statistically significant reduction in Y-BOCS scores (pre-TMS median score 29 (IQR 6), post-TMS 21 (IQR 13), p=0.003), with 32% of patients achieving a complete response (Y-BOCS reduction ≥35%) and 5% a partial response (Y-BOCS reduction ≥25%). No correlation was found between the change in Y-BOCS scores and other variables such as age, duration of illness, and pre-TMS scores on Y-BOCS, HAM-A, and HAM-D.

Additionally, a statistically significant reduction was observed in HAM-A scores (pre-TMS median 20 (IQR 18), post-TMS 16 (IQR 11), p=0.026) and HAM-D scores (pre-TMS median 19 (IQR 17), post-TMS 15 (IQR 14), p=0.029).

No severe adverse effects were reported.

This study shows significant reductions in Y-BOCS, HAM-A, and HAM-D scores after TMS treatment, with many patients achieving complete or partial response. These findings align with previous research, suggesting TMS is an effective option for treatment-refractory OCD. The absence of severe adverse effects supports its safety.

In conclusion, this study adds to real-world evidence by demonstrating the efficacy and safety of TMS in a clinical setting. Continued data collection is crucial to identify predictors of response.

None Declared

The proposed research work aims to carry out a review of the data of the Assertive Community Treatment Program of Segovia, analyzing its importance in certain profiles of psychiatric patients.

Review of data from the Segovia Assertive Community Treatment Program from 2020-2024: age, sex, nationality, marital status, level of education, diagnosis, family history, substance use, population, socio-family situation, economic situation, follow-up and admissions in Mental health, social health coordination and disability.

Data from the Segovia Assertive Community Treatment Program from 2020-2024.

The majority of patients participating in the Segovia Assertive Community Treatment Program between 2020-2024 were Spanish men between 20 and 60 years old. All patients were single, except three separated and one married. Approximately half of them lived alone and the other half with their family of origin. Most had basic education and half were employed. Regarding the consumption of toxic substances, most of them smoked tobacco and some also consumed alcohol or cannabis, and a small number cocaine. Many of them received a financial benefit and had social-health coordination.

The most common diagnosis is schizophrenia, followed by schizoaffective disorder and delusional disorder, most with psychiatric family history. Other diagnoses that the patients presented were: bipolar disorder, personality disorder and obsessive-compulsive disorder. Some of them also had disabilities.

It is important to highlight that 94.12% of patients live in rural areas, many of them more than 30 minutes away by car and with faced great difficulties with public transportation. Many of them were more previous admissions to Psychiatry and an irregular follow-up in Mental Health, but very few had readmissions during the Program. The majority of patients had psychopharmacological treatment, and 7.14% of them had injectable antipsychotic treatment.

A large percentage of patients in the Assertive Community Mental Health Treatment Program are people who live in a rural environment, with a long distance from the nearest mental health center and with difficulties using public transportation, which is why this program is very useful. In these patients to achieve clinical stability, since these patients had irregular follow-up in Mental Health consultations and had numerous admissions to Psychiatry.

None Declared

PTSD is a mental disorder that may develop after exposure to threatening or horrifying events. PTSD is characterized by the following: 1) re-experiencing the traumatic event or events in the present in the form of vivid intrusive memories, flashbacks, or nightmares. Re-experiencing may occur via one or multiple sensory modalities and is typically accompanied by strong or overwhelming emotions, particularly fear or horror, and strong physical sensations; 2) avoidance of thoughts and memories of the event or events, activities, situations, or people reminiscent of the event(s); and 3) persistent perceptions of heightened current threat. The symptoms persist for at least several weeks and cause significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.

Some reviewes found that PTSD is prevalent during pregnancy and after birth and may increase during postpartum if not identified and treated. It can affect women, their relationship and birth outcomes aswell as infant emotion regulation and development. The findings indicate that there are links between psychological, traumatic and birth-related risk factors as well as the perceived social support and the possible PTSD following childbirth in mothers and partners.

A case report is presented alongside a review of the relevant literature regarding the prevention, diagnosis, and treatment of PTSD.

We present a case report of a 34-year-old woman with no previous contact with Mental Health Services. She got pregnant unexpectedly in the context of a long stable relationship. At the beginning she was feeling uncertain about carrying on with the pregnancy but finally decided to keep it. She states she felt well throughout the pregnancy. The night after giving birth her baby suffered from a cardiorespiratory arrest, which was noticed by the nursing team but not by the mother. The baby recovered with no medical sequelae but the patient started feeling depressed and presenting anergy, apathy, irritability, flashbacks, and intrusive memories of her sick baby and insomnia, checking every hour during the night that her child was still breathing. Later she developed separation anxiety from her baby, not being able to leave her in the kindergartner nor to leave her alone with other family members (including the father). Guilty feelings were persistantly observed during the therapy sessions.

Psychotherapeutic and pharmacological treatment was started with moderate improvement. Since breastfeeding was a rewarding experience and enforced the mother-daughter bond it was taken in consideration for the therapeutic plan.

The postpartum period is of special vulnerability and early treatment of symptoms in mothers is of great importance. Early diagnosis in maternity services should be a priority.

None Declared

Obsessive-Compulsive Disorder (OCD) and psychotic disorders are traditionally considered distinct entities; however, there is increasing evidence of a spectrum where these conditions overlap. In some cases, OCD presents with poor insight, leading to obsessive thoughts and behaviors that resemble psychotic features. These “schizo-obsessive” phenomena challenge standard diagnostic categories and suggest a continuum between OCD and psychosis, necessitating a more integrated approach to diagnosis and treatment.

We report the case of a 69-year-old male evaluated in the emergency department for severe obsessive symptoms, including intrusive images and compulsive behaviors, accompanied by low insight and depressive symptoms, such as suicidal ideation. Initial management with selective serotonin reuptake inhibitors (SSRIs) led to only partial improvement, highlighting the complexity of distinguishing obsessive from psychotic symptomatology and supporting the concept of a continuum between OCD and psychosis.

1. 1) To describe the clinical presentation and management of a patient with OCD and psychotic features.

2. 2) To review the evidence regarding the clinical characteristics and management of the schizo-obsessive spectrum.

A review of the patient’s clinical history, psychiatric assessments, and treatment responses was conducted. A literature review was also performed to provide an overview of OCD with low insight and schizo-obsessive phenomena.

The schizo-obsessive spectrum concept suggests an overlap between obsessive-compulsive symptoms and psychotic features, particularly when insight is impaired. In OCD with poor insight, obsessions can lose their typical egodystonic quality and appear more like delusions. This challenges traditional diagnostic boundaries and indicates a continuum between OCD and psychosis, where insight fluctuates and symptoms may shift from obsessive to delusional states. Clinical management is complex; combining SSRIs with antipsychotics can be effective, particularly in cases with minimal insight. In our case, the introduction of low-dose aripiprazole led to significant improvement, supporting a combined pharmacological strategy addressing both obsessional and psychotic dimensions and aligning with the schizo-obsessive spectrum framework.

1. 1. This case highlights the difficulty in distinguishing psychotic from obsessive symptoms when insight is poor, emphasizing the need for careful differential diagnosis.

2. 2. The overlap of obsessive and psychotic features in this patient indicates the need for further study of “schizo-obsessive” phenomena.

3. 3. The patient’s positive response to combined SSRIs and antipsychotics suggests this approach may be effective for similar cases with overlapping symptoms.

None Declared

Early childhood is a critical phase where the foundations for many essential skills are established. It is also a crucial time to monitor children’s development for early signs of neurodevelopmental disorders (NDD).

This study aimed to develop a computerized system to help preschool teachers identify risk signs of NDD.

Phase 1: Development and validation of content and checklists - In the first stage, checklists were created to address four NDDs: ADHD, ID, ASD, and SLD. These were based on literature reviews and validated by four experts in neurodevelopmental disorders. The experts evaluated the checklists on two criteria: comprehensiveness and adequacy. Further assessment considered comprehension, objectivity, and precision of the checklist items, ensuring clarity for teachers using the system.

Phase 2: Development of the computerized system - The system was designed to assist early childhood educators in identifying children at risk for NDDs and supporting referral decisions, without diagnosing the disorders. Teachers begin by registering themselves and the child under observation. They then complete a checklist, indicating whether the child displays certain characteristics and the frequency of occurrence. A score of 1 indicates the presence of signs for ADHD, ID, ASD, or SLD, while 0 indicates absence. At the end of the process, the system generates a report with a risk level, which can be saved, edited, or printed for discussion with parents or specialists.

Phase 1 - Content validation showed high scores, particularly for ASD and ADHD (1.00), while SLD scored lower (0.75). The overall Content Validity Index (CVI) for all disorders was 0.91. Experts suggested minor adjustments to the ADHD and SLD sections, especially concerning developmental characteristics that may vary by age. The checklists were further evaluated for reliability, yielding an overall CVI of 0.87.

Phase 2 - The computerized system was built using a RESTful API in Node.js, with the Nest.js framework. The frontend was developed as a Single Page Application (SPA) using Angular, and PostgreSQL was used for data storage. The system includes data validation through the Zod library and user authentication via JWT. It is designed to be a precise, low-cost screening tool for identifying, not diagnosing, NDDs. The system does not differentiate between severity levels or subtypes of disorders, reinforcing its role as a first-line identification tool.

Initial usability tests confirmed that the system is intuitive and suitable for its intended purpose. However, it is crucial to emphasize that the tool is not intended to operate autonomously. It supports, but does not replace, comprehensive clinical evaluations and the expertise of qualified professionals in diagnosing NDDs.

None Declared

Electroconvulsive therapy (ECT) has long been regarded as highly effective in the treatment of Treatment-Resistant Depression (TRD), with remission rates ranging from 50% to 70%. In recent years, esketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has emerged as a novel treatment option for TRD due to its rapid and potent antidepressant effects (1).

This case aims to reflect on the comparative use of esketamine versus ECT in the management of TRD, considering clinical outcomes, side effects, and patient response.

A literature review was conducted using PubMed to gather evidence on the efficacy of esketamine and ECT for TRD. We also present a case study of a 53-year-old female patient with TRD to illustrate the clinical application and response to esketamine.

The patient, a 53-year-old divorced woman with a 31-year-old son, has a history of three psychiatric admissions in 2021 due to major depressive episodes. She was previously treated at a day hospital and continues follow-up care in outpatient settings. Her current psychopharmacological regimen includes Venlafaxine 300 mg and Mirtazapine 30 mg, with Aripiprazole recently discontinued.

The patient presented to the emergency department with a marked deterioration in mood, neglect of daily activities, and increased social isolation. Psychiatric evaluation revealed a depressed appearance, slowed speech, bradypsychia, and passive thoughts of death, though without suicidal ideation. Her biological rhythms were disrupted, and she experienced unquantified weight loss, despite good family support.

The patient received her first intranasal dose of esketamine (56 mg) without complications, followed by six additional doses twice weekly. Mild side effects included nausea and occasional depersonalization and derealization. Over time, the patient showed progressive improvement in both affective symptoms and daily functioning.

This case highlights the rapid antidepressant effects of esketamine in TRD patients, aligning with current literature. Esketamine is noted for its quick action and efficacy compared to second-generation antipsychotics (2, 3). Despite these benefits, ECT remains a more cost-effective option with higher remission rates for TRD, even though it is slightly less expensive than esketamine (1). The patient experienced significant clinical improvement with esketamine, which was well-tolerated with minimal side effects. However, the long-term efficacy and cost-effectiveness of esketamine relative to ECT remain under discussion. Further research is needed to clarify esketamine’s role in TRD treatment and to establish the best approach for long-term management.

None Declared

Lithium is used as a first-line treatment in perinatal bipolar disorder. Lithium is almost exclusively renal eliminated without undergoing metabolization. Renal changes associated with pregnancy are responsible for alterations in lithium pharmacokinetics that may impact lithium efficacy and toxicity in mother. Characterization of the trajectory of lithium disposition during the perinatal period (previous year of pregnancy, pregnancy and first year postpartum) is necessary to monitoring and dose adjustments to prevent bipolar symptom recurrence while minimizing adverse effects.

To characterize the disposition of lithium during the perinatal period ant to evaluate whether changes in serum lithium concentration are consistent with changes in renal function (creatinine).

Women treated with lithium carbonate and referred to the perinatal psychiatry out-patient clinic of a single tertiary university hospital (November 2006 -December 2018), were evaluated for eligibility to participate in this retrospective observational cohort study (HCB/2020/1305). The basis of this study was all samples analysed in the same laboratory for lithium during perinatal period obtained at steady-state and predose. Serum creatinine concentrations measurements were also extracted. Lithium concentrations were determined by means of an AVL 9180 electrolyte analyzer based on the ion- selective electrode (ISE) measurement principle. Detection limit (LoD) was 0.1 mEq/L and limit of quantification (LoQ) 0.2 mEq/L. Serum creatinine concentration was determined by molecular absorption spectrometry. Detection limit (LoD) was 0.10 mg/dL, and the limit of quantification (LoQ) was 0.15 mg/dL Linear mixed models were used to analyze lithium and creatinine serum concentrations.Time points extractions and lithium dose were included as fixed effects, while the individual mother was included as a random effect to account for repeated measurements.

In total, 1260 lithium and 1174 creatinine serum concentration measurements from 109 pregnancies of 95 women were available. Dose-ajusted serum lithium concentrations (C/D ratio) decreased and average of 23.9% and 27.6% during the first and second trimesters respectively, increased slightly in the third trimester but remained 16.9 % below the prconception time (reference period) and increased postpartum 11% . Serum creatinine concentration evidenced a similar longitudinal pattern during pregnancy (decreased 20%, 26.1% and 22.3% in first, second and third trimester respectively) and also decreased postpartum 4.3%.

We recommend monitoring lithium and creatinine serum concentration once every 4 weeks until 34 weeks of pregnancy, then weekly until delivery, followed in postpartum at day 2±1, (bi-)weekly during the first month, monthly until 6 months postpartum and then every 3-4 months to ensure adequate lithium dosing.

None Declared

Genetic research on nicotine dependence has utilized multiple assessments that are in weak agreement.

We conducted a genome-wide association study (GWAS) of nicotine dependence defined using the Diagnostic and Statistical Manual of Mental Disorders (DSM-NicDep) in 61,861 individuals (47,884 of European ancestry [EUR], 10,231 of African ancestry, and 3,746 of East Asian ancestry) and compared the results to other nicotine-related phenotypes.

We replicated the well-known association at the CHRNA5 locus (lead single-nucleotide polymorphism [SNP]: rs147144681, p = 1.27E−11 in EUR; lead SNP = rs2036527, p = 6.49e−13 in cross-ancestry analysis). DSM-NicDep showed strong positive genetic correlations with cannabis use disorder, opioid use disorder, problematic alcohol use, lung cancer, material deprivation, and several psychiatric disorders, and negative correlations with respiratory function and educational attainment. A polygenic score of DSM-NicDep predicted DSM-5 tobacco use disorder criterion count and all 11 individual diagnostic criteria in the independent National Epidemiologic Survey on Alcohol and Related Conditions-III sample. In genomic structural equation models, DSM-NicDep loaded more strongly on a previously identified factor of general addiction liability than a “problematic tobacco use” factor (a combination of cigarettes per day and nicotine dependence defined by the Fagerström Test for Nicotine Dependence). Finally, DSM-NicDep showed a strong genetic correlation with a GWAS of tobacco use disorder as defined in electronic health records (EHRs).

Our results suggest that combining the wide availability of diagnostic EHR data with nuanced criterion-level analyses of DSM tobacco use disorder may produce new insights into the genetics of this disorder.