A 60-year-old patient with no relevant medical history who had been working until three months ago (currently on medical leave). He is married and has two children. There is no history of psychiatric or psychological follow-up, and he has never received psychiatric treatment.

He denies any substance use. He presents to the Emergency Department referred for rapidly emerging behavioral disturbances (over the past 3 months) with no clear precipitating factor, characterized by disinhibition, excessive spending, and inappropriate language. The patient lacks insight into the changes he has experienced and their impact on his functioning and daily life.

To establish a possible causal relationship between the altered brain structure seen on neuroimaging and the patient’s clinical presentation.

To determine whether the neuroimaging findings are the result of a chronic or acute process.

In the Emergency Department, blood and urine tests were normal. A CT scan (Images 1 and 2) revealed a right frontal lesion compatible with encephalomalacia or a porencephalic cyst, with no signs of acute change. No previous neuroimaging was available. Lumbar puncture and EEG results were normal.

Psychopathological evaluation showed the patient to be alert and oriented, with slightly expansive mood not reaching mania. Speech was coherent, with some paranoid ideation and suspiciousness. Disinhibition and excessive spending were observed, though without frank aggression. No anxiety, suicidal thoughts, or psychotic features were noted. Circadian rhythms were disrupted.

A provisional diagnosis of organic personality disorder was made. The patient was admitted to psychiatry and started on Olanzapine 10 mg

Clinical evolution has been poor despite joint psychiatric and neurological care. Neurology was consulted; no acute neurological condition was identified. The abrupt onset suggests a possible organic cause, but the lesion appears chronic on imaging. After two months of treatment, the patient remains clinically unchanged, with improved sleep as the only notable progress.Image 1:Image 2:

Organic findings on neuroimaging often guide diagnosis. In this case, disinhibition aligns with a frontal lesion. However, the timing of onset suggests the symptoms may be unrelated to the imaging, which suggests a longstanding lesion. The patient was functioning normally until three months ago, and the cause of symptom onset remains unclear.

None Declared

Alopecia in adolescence often has a strong psychological component and may act as both a trigger and a perpetuating factor of psychiatric symptoms. The psychosocial burden of visible hair loss is particularly pronounced during adolescence, when body image, self-esteem, and social integration are highly vulnerable. This case highlights the interaction between dermatological symptoms and psychiatric manifestations in a young woman whose alopecia was closely linked to anxiety and depressive symptomatology

To evaluate the clinical course and multidisciplinary management of a patient with alopecia and comorbid anxiety and depressive disorder, emphasizing the importance of an integrative approach

Case report based on retrospective review of psychiatric and dermatological records, complemented by clinical observation and long-term follow-up

We present the case of a 22-year-old woman, in psychiatric follow up since the age of 15 for reactive anxiety and depressive symptoms secondary to alopecia. Dermatological evaluation revealed no organic causes or significant trichological abnormalities, and multiple treatment attempts failed to improve hair loss. Psychological assessment identified relevant stressors including family conflict, religious pressure, and lack of peer relationships. At age 17, she attempted suicide following family rejection of her partner, in the context of academic underperformance. Notably, partial hair regrowth was observed during periods of family stability and school holidays.

Family history revealed a paternal uncle who died by suicide, several maternal aunts under psychiatric care for depression, and a younger brother presenting alopecic plaques. On examination, the patient showed depressive mood, emotional lability, irritability, apathy, anhedonia, and somatic and cognitive anxiety with frequent rumination on physical appearance. Personality traits included high self-demand and anankastic features. No psychotic symptoms or current suicidal ideation were detected.

Treatment with paroxetine (20 mg/day) and lorazepam (1 mg/12 h, with additional doses as needed) was initiated. After three months, significant improvement in anxiety and depressive symptoms was noted, without new alopecic plaques. At six months, a sustained favorable evolution allowed dermatology to discharge the patient.

Alopecia may function as both a trigger and a perpetuating factor of anxiety and depressive symptoms in adolescence, significantly affecting self-esteem and social Multidisciplinary management is essential in cases where organic, psychological, and family factors converge. Combined psychopharmacological treatment, psychotherapy, and improvement of family dynamics contributed to both psychiatric stabilization and dermatological recovery

None Declared

Behavioral disturbances in patients with Attention-Deficit/Hyperactivity Disorder (ADHD) and borderline intellectual functioning represent a significant clinical challenge. The presence of anxiety symptoms, disorganized thought patterns, poor functional autonomy, and limited insight complicates therapeutic approaches. Comorbidity with agoraphobia, paranoid ideation, and distrust toward support figures, combined with poor social support, can lead to prolonged hospitalizations and the need for structured rehabilitation.

To present the case of a patient diagnosed with ADHD, agoraphobia, and borderline functioning, with progressive functional deterioration, behavioral alterations, and social isolation, requiring involuntary psychiatric hospitalization and comprehensive evaluation for referral to rehabilitation services.

We describe the clinical follow-up during her admission to a psychiatric inpatient unit, including structured interviews with the patient and family, additional tests (EEG, psychological evaluation), daily clinical observations by the multidisciplinary team, and pharmacological adjustments. The case presentation details the initial symptoms, response to hospitalization, clinical and functional evolution, and the rationale for referral to a rehabilitation unit.

We present the case of a 39-year-old woman with a history of ADHD, agoraphobia, borderline IQ, progressive isolation, and growing distrust towards her family and healthcare providers. She presented with marked anxiety, emotional lability, disorganized speech, suspicion, and poor insight. Upon admission, she was highly demanding, psychomotor agitated, repetitive in speech, and showed impaired reality testing, though without suicidal or aggressive ideation.

During hospitalization, under pharmacological treatment and environmental containment, she gradually improved: anxiety levels decreased, tolerance to frustration increased, speech became more coherent and goal-directed, and she began to accept both the admission and the need for help. Various pharmacological adjustments were implemented, notably the introduction of paroxetine and aripiprazole, progressive reduction of benzodiazepines, and as-needed antipsychotic medication for agitation. The patient accepted referral to a rehabilitation unit to continue structured intervention and improve her functionality.

This case highlights the challenges of managing patients with complex psychiatric conditions, poor insight, and significant social vulnerability. A multidisciplinary approach and structured environment enabled clinical stabilization and the beginning of awareness and recovery. Rehabilitation referral was essential for promoting autonomy and long-term prognosis.

None Declared

We present the case of a 23 year-old woman with no previous psychiatric history admitted to nephrology to study the chronic renal disease she presents, related to untreated nephronophthisis. She abruptly begins with psychotic symptoms aproximately two weeks before admission, in the form of visual hallucinations and persecutory delusions. She also presents with involuntary movements and vague fears and worries. Speech is coherent at all times.

Liaison psychiatry is called upon during her stay for the differential diagnosis between primary or secondary psychotic symptoms in relation with CRD and a possible encephalopathy. During her hospitalisation she is evaluated by psychiatry, and low doses of antiphychotic are prescribed. On par with the stabilisation of renal function her psychotic symptoms also disappear, remaining completely asymptomatic at the time of this poster, even without antipsychotics.

We analyse the existing literature regarding psychotic symptoms in relation with chronic renal disease, in search of possible associations between the two.

There is little literature regarding the association of chronic renal disease with psychiatric symptoms, and it is mostly focused on anxiety and sleep disturbances. We could not find any establishing a link between chronic renal disease and psychotic symptoms.

We study the case of a young woman presenting with both chronic renal disease and psychotic symptoms. Both are treated during her hospital stay, achieving stabilisation or remission of symptoms. Despite searching the existing literature, we could not find a direct link between the two, pointing towards primary psychotic break.

None Declared

Obsessive–compulsive disorder (OCD) carries a markedly higher risk of suicidal thoughts and behaviors than the general population. Risk is amplified by affective and anxiety comorbidities, childhood trauma, persistent psychological distress, and certain symptom dimensions. Despite these insights, no reliable strategy exists to predict suicide risk in OCD. Machine-learning approaches are emerging as powerful tools for risk prediction in psychiatry and have shown promise in OCD populations.

To develop and validate a machine-learning predictive model of suicide risk in OCD using routinely collected clinical and sociodemographic variables.

Longitudinal study of 199 OCD patients (mean follow-up 17.8 years). Input variables: sociodemographic data (age at onset/diagnosis, years untreated, sex), psychiatric comorbidities, substance use (alcohol, cannabis, stimulants, benzodiazepines, opioids; tobacco excluded), family history of OCD and suicide, medical comorbidities, childhood trauma (Childhood Trauma Questionnaire subscales), and OCD severity (Yale–Brown Obsessive Compulsive Scale).

Target variable: suicide risk classified into three categories—(1) no suicidal behavior, (2) suicidal ideation or thoughts of death, (3) suicide attempt or completed suicide.

Suicidal behaviors were identified through clinical interviews and confirmed in psychiatric records. Supervised machine-learning models (linear discriminant analysis, naive Bayes) were trained with leave-one-out cross-validation. Performance was assessed with Cohen’s kappa, sensitivity, specificity, F1-score, and AUC.

The optimal model identified three key predictors: family history of suicide, affective comorbidity, and substance use (excluding tobacco). This combination achieved κ = 26.8 %, sensitivity 71.4 %, specificity 74.4 %, F1 = 62.7 %, and AUC = 0.80, indicating moderate predictive capability. Neither OCD severity (Y-BOCS) nor childhood trauma improved accuracy. In the cohort, 25 % experienced suicidal ideation or behavior and 2.5 % (5 patients) died by suicide.Image 1:

A straightforward machine-learning model based on standard clinical data predicts suicide risk in OCD with moderate accuracy. The three predictors are routinely assessed, showing that data-driven modeling validates traditional evaluation for early detection and preventive monitoring.

Machine-learning analysis confirms and strengthens standard psychiatric assessment. The presence of family history of suicide, affective comorbidity, and substance use provides sufficient information for a moderate-accuracy estimate of suicide risk in OCD, proving that careful routine evaluation remains the cornerstone of early detection and targeted prevention.

None Declared

Dissociative Identity Disorder (DID) is characterized by the presence of two or more distinct identities or personality states, accompanied by amnesia and behavioral disturbances. Bipolar disorder, on the other hand, is defined by the alternation between episodes of mania or hypomania and major depression, with variability in the duration and intensity of episodes. However, an increasing number of cases of rapid-cycling bipolar disorder have recently been described, whose symptoms may overlap with or be mistaken for those of DID.

The aim of this report is to describe the clinical course of a patient initially presenting with dissociative symptoms, later re-evaluated as a case of rapid-cycling Bipolar II Disorder, and to highlight the diagnostic challenges between dissociative and affective disorders.

We present the case of a 67-year-old woman living with her husband and son. Her psychiatric history began at the age of 30 with an anxious-depressive episode. She had two previous short hospital admissions (2 days each) due to dissociative episodes. During a third admission, she presented with another dissociative episode showing clinical features that overlapped with a hypomanic episode.

On mental status examination at admission, the patient was conscious, oriented, partially approachable, and partially cooperative. Psychomotor restlessness was noted, along with mild suspiciousness and hypervigilance. Speech was accelerated, pressured but interruptible, and she became vociferous when confronted with her symptoms. She displayed a slightly hyperthymic mood with inappropriate/unmotivated laughter. There were no abnormalities in the course or content of thought, nor in perception. No suicidal ideation was present.

Given the coexistence of dissociative symptoms and mood instability, the differential diagnosis was reconsidered. The possibility of rapid-cycling Bipolar II Disorder with hypomanic episodes was proposed. Following the introduction of a mood stabilizer in addition to her usual treatment, the patient has remained clinically stable, with no further dissociative or hypomanic episodes reported to date.

This case illustrates the diagnostic complexity in differentiating dissociative presentations from affective disorders, particularly in the context of rapid-cycling Bipolar II Disorder. Careful longitudinal assessment and therapeutic adjustment are crucial to achieve clinical stability and prevent misdiagnosis.

None Declared

The Generalized Anxiety Disorder 7-Item Scale (GAD-7) is a brief self-reported measure for screening for anxiety symptoms. However, the evidence about its cross-cultural validity is fragmentary and usually focused on specific settings. Therefore, we aimed to critically review and synthesize the existing evidence about the cross-cultural validity of the GAD-7.

We conducted a systematic review of studies assessing the cross-cultural validity of the GAD-7 in following the PRISMA guidelines. Additionally, the quality of the studies was assessed following the COSMIN guidelines, and the quality of the evidence was assessed with the GRADE. Data were synthesized narratively.

Out of 1,965 unique records, 9 unique studies were deemed eligible for the COSMIN appraisal and the narrative synthesis (total sample: 11,894, 53.7% females and 20 different cultural groups). Most studies (7) had adequate quality and showed evidenced of the unitary structure of the GAD-7 across cultural groups. In 4 studies also assessing possible cultural bias, the effect on the general score was deemed negligible.

The evidence about the cross-cultural validity of the GAD-7 is very limited. Although more research is needed, the evidence available shows that the GAD-7 could be a cross-culturally valid tool for the assessment of anxiety symptoms in clinical contexts and epidemiological studies. Until new high-quality evidence will be available, these results would constitute a key first step for supporting the use of the GAD-7 in multi-cultural clinical settings and to inform clinical, public health and global health decision making in relation to anxiety.

Psychiatric hospitalization to manage acute symptoms of mental disorders in children and adolescents may be necessary, although there is a growing concern about the clinical and economic effectiveness of psychiatric admission in this population. This suggests the need for the implementation of new intensive family and community care models that would reduce hospitalization.

Home hospitalization provides an opportunity to offer the child or adolescent with intensive treatment within the infrastructure of their home and the supervision of their family or primary caregivers. It therefore requires fewer resources than traditional inpatient treatment while allowing the patient‘s immediate environment to be involved in the treatment, potentially reducing the risk of a failed transition to the home once the patient is discharged.

The main objective is to analyze the cost-effectiveness of two Mental Health Home Hospitalization interventions for adolescents as an alternative to traditional hospitalization in two hospitals in Madrid, Spain (La Paz University Hospital and Principe de Asturias University Hospital).

This is a quasi-experimental pre-post intervention study that examines two models of Mental Health Home Hospitalization as an alternative to full hospitalization. It will analyze various outcome variables, including clinical, functioning, satisfaction, quality of life, and costs /use of clinical resources.

Participants must be adolescents and young adults aged 12 to 18 years (inclusive), who present a psychiatric decompensation requiring an intensity of care similar to that provided in the hospital. Assessments, including CGI, HoNOSCA, C-SSRS, CSQ-8, EQ-5D-Y, will be conducted at the baseline visit, and at the end of the treatment. Resource use and costs will be recorded at the baseline and six months after the treatment.

Home-based mental health hospitalization for adolescents is an emerging area of interest in the treatment of acute symptoms of mental disorders in this population, but there are not standard protocols for such interventions. Several issues remain to be clarified, including the care pathways for adolescents in crisis who require hospital care and whether organizational differences between interventions impact the outcomes.

None Declared

Depression is a prevalent disease and 30% of affected patients are resistant to pharmacological treatment. Home-Based transcranial Direct Current Stimulation (HB-tDCS) has been proposed as a treatment option due to its low cost, minimal invasiveness, and scalability.

We present preliminary results on safety, feasibility and efficacy of a remotely supervised HB-tDCS intervention in patients with treatment-resistant depression.

7 patients (5 women, age =55.67 ± 6.93) underwent a psychiatric evaluation, pre and post stimulation, that included the Montgomery-Asberg Depression Rating Scale (MADRS), the Beck Depression Inventory (BDI), and the Quick Inventory of Depressive Symptomatology (QIDS). HB-tDCS intervention consisted of 42 daily sessions administered through the Sooma tDCS™ device by a patients’ companion, trained by the research team. The anode was placed on the left prefrontal cortex, the cathode on the right prefrontal cortex, and 2mA current was delivered for 30 minutes.

After each session participants fulfilled an on-line survey for monitoring safety and feasibility.

86.73% of the sessions were completed. Due to impedance 7.84% of the sessions could not start on the first attempt, while 7.45% of the session were temporarily interrupted. Adverse effects included headaches (9.67%), sensations under electrodes (24.89%), and scalp dryness (7.88%).

We observed a significant reduction in depressive symptomatology as measured by the MADRS (-33.56%; t=-7.99, p<0.001). All patients showed partial response (>25%), and two a relevant response (>50%).

Self-reported scales indicated a reduction in symptomatology (QIDS:-21.66; t=-3.139, p=0.010; BDI:-13.92%; t=-1.780, p=0.063).

In line with previous studies, these results indicate that HB-tDCS is a feasible, safe, and potentially effective intervention for treatment of resistant depression.

None Declared

Suicide is one of the leading causes of preventable death.

The PRISURE program is developed with a series of objectives and actions aligned with the Mental Health Strategy of the National Health System - (Spain), Strategic Plan for Mental Health and Addictions of the Community of Madrid 2022-2024 and the Prevention Plan suicide in the community of Madrid 2022-2026, based on the experience of the suicide risk prevention program developed between 2014 and 2023 at the Retiro Mental Health Center (CSM) of the Institute of Psychiatry and Mental Health of the General University Hospital Gregorio Marañón.

Presentation of a secondary suicide prevention program in the Community of Madrid with 10 years of implementation and reinforcement of the therapeutic team in the last year.

Treatment outcomes, assessment of patients’ suicide risk progression during follow-up, referral to patient discharge, and outcome indicators in the past year are measured.

Description of the functioning of the PRISURE program and descriptive study of sociodemographic and clinical characteristics, suicidal crises, evolution and discharge referrals, of all patients treated in PRISURE. The program’s performance indicators, as well as its results, are evaluated over one year from its implementation.

Sociodemographic and clinical characteristics are analyzed, including psychometric evaluation at baseline, 3, 6, 9, and 12 months after referral to PRISURE from August/2023 to August/2024. The suicide risk profile, treatment adherence, program implementation indicators and initial results are evaluated.

PRISURE is a comprehensive care process that includes the prevention, intervention and postvention of suicidal behavior.

It includes interventions indicated for the prevention of suicidal behavior aimed at people in whom relevant signs or symptoms that anticipate the development of a mental disorder, or biological or psychological markers that indicate a high suicidal risk, have been identified.

PRISURE encompasses a set of activities aimed at early detection and indicated prevention, support and care of suicidal behavior, as well as research and promotion of mental health.

None Declared

Bullying, deliberate aggression by a peer or group of peers in a power imbalance that favors the aggressor, is a frequent and preventable traumatic event during adolescence (Abregú-Crespo R et al. The Lancet Child & Adolescent Health 2024; 8:122–134). Mitigating its impact could be a viable strategy for psychosis prevention (Fraguas, D. et al. JAMA Pediatrics 2021; 175, 44–55). A better understanding of its influence on brain development during adolescence could be crucial for implementing effective interventions.

To study the relationship between bullying exposure (BE), distressing psychotic-like experiences (DPLEs), and multi-scale functional network connectivity (msFNC) in the developing brains of 12-year-old adolescents.

We used cross-sectional data from 12-year-old adolescents from the Adolescent Brain Cognitive Development Study, which recruited a representative sample of healthy adolescents from across the United States. We fitted a linear mixed model to predict DPLEs (Prodromal Questionnaire-Brief Child Version) with BE (Peer Experience Questionnaire) as a predictor (n=10,388). We analyzed functional magnetic resonance imaging data with reference-informed independent component analysis and a canonical and replicable multi-scale intrinsic connectivity network template to extract whole-brain 5460 msFNC features (Iraji, A. et al. Hum Brain Mapp 2023 44, 5729–5748). We fitted 5460 linear mixed models to predict DPLEs with BE as a predictor and analyzed the mediation effect of each of the 5460 FNC features (n=5,409). All models were fitted with family and site as random effects, adjusted for covariates (age, sex, race, ethnicity, pubertal development, and family income), and corrected for multiple comparisons.

BE was significantly associated with DPLEs (β=0.39, CI[0.37, 0.41], t(10362) = 41.00, p<.001, R2=0.36, p<.000) (Fig.1). DPLEs were associated with msFNC predominantly between cerebellar, paralimbic, somatomotor, insulotemporal, frontal, temporoparietal, and central executive networks (Fig.2). The association between DPLEs and BE was primarily mediated by msFNC between the paralimbic, somatomotor, insulotemporal, frontal, and temporoparietal networks (Fig.3).

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Bullying exposure may represent a modifiable risk factor for the development of DPLEs during adolescence. It may influence DPLEs through its effects on relevant functional brain networks. The implementation of targeted interventions to prevent BE during adolescence could serve as a viable strategy to mitigate potential functional brain alterations and reduce the risk of psychosis.

None Declared

Functional neurological disorders (FND) are defined as neurological symptoms that are inconsistent and incongruent with classic neurological disorders. Over the past two decades, an interest in the potential underlying mechanisms of these disorders has occurred and a new pathophysiological framework based on current neurobiological theories about global brain function such as the predictive coding theory has emerged. Within this framework, abnormal or erroneous beliefs about symptoms, mediated by attention, are hypothesized to modulate perception and movements, ultimately leading to FND. Previous studies have evaluated cognitive biases such as the jumping to conclusion reasoning style in patients with functional movement disorders (FMD) and it has been suggested that they may play a role in symptoms production. In this study, we evaluated the behavior of patients with FMD when confronted with evidence that contradicts their beliefs through the “Bias Against Disconfirmatory Evidence” (BADE) and their tendency to accept implausible interpretations through the “Liberal Acceptance Bias” (LA).

To evaluate whether patients with FMD have greater difficulty integrating information based on disconfirming evidence than the general population.

Observational case-control study in which the presence of BADE and LA biases were assessed in a sample matched by sex and age using Woodward’s BADE task. Clinical and demographic characteristics of the participants were recorded (such as “Mini Mental State Examination” (MMSE) or “Peters et al. Delusions Inventory” (PDI -21), level of education, employment situation and marital status and cohabitation situation). The BADE test analyses the scores that the patient provides at 3 points in time on the plausibility of 24 scenarios after increasing the information received.

Twenty patients (median age 50.5 years, 75% female) and twenty people from the control group (median age 52.50 years, 75% female) were included. No differences were found on demographic features, MMSE or PDI -21 scores. When compared to healthy controls, FMD patients scored significantly lower in BADE (median 3.35, p=0.03) and significantly higher in LA (median 3.08, p=0.017). Also, when the maximum information was provided, patients scored significantly higher in implausible situations (p=0.01) and lower in true situations (p=0.02) than the control group.

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Patients with FMD have greater difficulty in modifying their beliefs when confronted with disconfirming evidence and a greater tendency to accept less plausible options. These cognitive biases, among other factors, may facilitate the adoption of fixed beliefs, regardless of their plausibility, early and with little evidence. Our results may also explain why some patients with FMD remain with erroneous beliefs despite the explanation of the diagnosis.

None Declared

Registry-based studies are efficient to investigate population mental health and suicide risk, but are largely absent in Europe outside of Scandinavia and the UK.

To investigate suicide risk associated with mental disorders in the Catalan population (7.6 million), stratified by gender and history of psychiatric hospitalization.

Population-representative retrospective registry-based cohort study including 764,938 Catalan residents in the period 2014-2019. Data sources included suicide mortality, electronic health registries from five healthcare settings, and administrative data. Suicide deaths were identified through judicial death registers using ICD-10 codes X60-X84. ICD-9CM and ICD10CM codes from all inpatient and outpatient healthcare contacts were used to categorize 109 mental disorders. Age-sex standardized mortality ratios (SMRs) were calculated using indirect standardization, with expected deaths based on official general population mortality rates in Catalonia.

Suicide risk was significantly elevated among Catalan residents diagnosed with any mental disorder (SMR [95%CI] = 1.6 [1.3-1.9] for females; SMR = 1.8 [1.6-2.0] for males). In females, suicide risk was highest for sedative or hypnotic abuse (SMR = 46.1 [3.7-88.5]), cocaine abuse (SMR = 42.8 [9.0-76.6]), borderline personality disorder (SMR = 33.0 [10.7-55.3]), polysubstance abuse (SMR = 32.9 [2.1-63.8]), and mental disorder not otherwise specified (SMR = 24.9 [11.7-38.1]). In males, risk was highest for obsessive-compulsive disorder (SMR = 20.2 [10.7-29.8]), acute and transient psychotic disorders (SMR = 17.9 [1.1-34.8]), mental disorder not otherwise specified (SMR = 17.2 [10.1-24.3]), paranoid schizophrenia (SMR = 16.8 [9.4-24.1]), and opioid abuse (SMR = 16.1 [1.6-30.6]). Suicide risk was substantially elevated in individuals with a history of psychiatric hospitalization (SMR = 18.3 [15.5-21.2]] for females; SMR = 13.4 [12.0-14.8] for males). In females with psychiatric hospitalization history, risk was highest for dependence on stimulants other than cocaine (SMR = 105.4 [11.6-199.3]), attention deficit hyperactivity disorder (SMR = 86.2 [19.2-153.2]), polysubstance abuse (SMR = 66.0 [33.6-98.3]), opioid abuse (SMR = 60.1 [2.1-118.1]), and cocaine abuse (SMR = 57.2 [32.6-81.8]). In males with psychiatric hospitalization history, risk was highest for obsessive-compulsive disorder (SMR = 45.7 [30.6-60.8]), schizoid personality disorder (SMR = 36.9 [13.5-60.2]), unspecified disorders of adult personality and behaviour (SMR = 35.0 [9.6-60.3]), schizotypal disorder (SMR = 34.3 [6.7-61.9]), and histrionic personality disorder (SMR = 32.5 [1.2-63.9]).

Risk of suicide in the Catalan population varies substantially by mental disorder type, gender, and psychiatric hospitalization history, highlighting the need for targeted and diversified prevention strategies.

P. Mortier Grant / Research support from: Miguel Servet CP21/00078 (ISCIII co-funded by the ESF+); project 202220-30-31 (Fundació la Marató de TV3); PI22/00107 (ISCIII, cofunded by the European Union); AC22/00006 (ISCIII and the European Union NextGenerationEU, Mecanismo Para la Recuperación y la Resiliencia), L. Latorre-Moreno: None Declared, F. Amigo: None Declared, M. López: None Declared, A. Portillo-Van Diest Grant / Research support from: PFIS FI23/00004 (ISCIII co-funded by the ESF+), L. Ballester: None Declared, J. Alonso Grant / Research support from: AGAUR 2021 SGR 00624; CB06/02/0046 (CIBERESP - ISCIII), G. Vilagut: None Declared

The study assessed the interactions and the impact of specialist mobile community care teams (assertive outreach teams or AOTs) implemented in the mental health (MH) system of Bizkaia (Spain) using a methodology derived from an ecosystem perspective.

First, the experts assessed the system’s services and codified them according to an international classification system. Second, following an iterative methodology for expert-knowledge elicitation, a clients’ flow diagram showing the inter-dependencies of the system’s components was developed. It included variables and their relationships represented in a causal model. Third, the system elements where the AOTs had a major impact (stress nodes) were identified. Fourth, three scenarios (variable combinations representing the ‘stress points’ of the system) were modelled to assess its relative technical efficiency (technical performance indicator).

The classification system identified the lack of fidelity of the AOTs to the original assertive community treatment model, categorizing them as non-acute low-intensity mobile care. The causal model identified the following elements of the system as ‘stress nodes’ in relation to AOT: users’ families; social services (outside of the healthcare system); acute hospitals; non-acute residential facilities and, to a lesser extent, acute hospital day care services. When the stress nodes inside the healthcare system were modelled separately, acute and non-acute hospital care services resulted in a large deterioration in the system performance, while acute day hospital care had only a small impact.

The development of the expert-knowledge-based causal model from an ecosystem perspective was helpful in combining information from different levels, from nano to macro, to identify the components in the system likely to be most affected by a potential policy intervention, such as the closure of AOTs. It was also able to illustrate the interaction between the MH system components over time and the impact of the potential changes on the technical performance of the system. Such approaches have potential future application in assisting with service planning and decision-making in other health systems and socio-economic contexts.

Clostridioides difficile infection (CDI) may be misdiagnosed if testing is performed in the absence of signs or symptoms of disease. This study sought to support appropriate testing by estimating the impact of signs, symptoms, and healthcare exposures on pre-test likelihood of CDI.

A panel of fifteen experts in infectious diseases participated in a modified UCLA/RAND Delphi study to estimate likelihood of CDI. Consensus, defined as agreement by >70% of panelists, was assessed via a REDCap survey. Items without consensus were discussed in a virtual meeting followed by a second survey.

All fifteen panelists completed both surveys (100% response rate). In the initial survey, consensus was present on 6 of 15 (40%) items related to risk of CDI. After panel discussion and clarification of questions, consensus (>70% agreement) was reached on all remaining items in the second survey. Antibiotics were identified as the primary risk factor for CDI and grouped into three categories: high-risk (likelihood ratio [LR] 7, 93% agreement among panelists in first survey), low-risk (LR 3, 87% agreement in first survey), and minimal-risk (LR 1, 71% agreement in first survey). Other major factors included new or unexplained severe diarrhea (e.g., ≥ 10 liquid bowel movements per day; LR 5, 100% agreement in second survey) and severe immunosuppression (LR 5, 87% agreement in second survey).

Infectious disease experts concurred on the importance of signs, symptoms, and healthcare exposures for diagnosing CDI. The resulting risk estimates can be used by clinicians to optimize CDI testing and treatment.