The predictive power of polygenic scores (PGSs) for lithium treatment response in bipolar disorder remains limited.

To enhance the prediction of lithium responsiveness by developing a multi-trait PGS (mt-PGS) combining genetic information from multiple phenotypes implicated in lithium response and/or bipolar disorder aetiology.

We analysed data collected from bipolar disorder patients who had received lithium treatment for at least 6 months and participated in the International Consortium on Lithium Genetics study (N = 2367). The Alda scale was used to assess lithium responsiveness, and treatment outcome was defined as continuous total Alda score (0–10) and categorical outcome (favourable ≥7 versus unfavourable response). PGSs were calculated for 60 phenotypes grouped into 5 clinical–biological clusters: psychiatric and behavioural (#23 phenotypes), cardiometabolic (#17), autoimmune/inflammatory (#5), neurocognitive (#8) and renal function (#7). We applied cross-validated machine learning regression approaches in both outcomes within each cluster, with the selected features from each cluster subsequently combined to construct the final mt-PGS models. Model performance was assessed using explained variance (R2) for the continuous outcome, and both McFadden’s pseudo-R2 and standard classification model parameters for the categorical outcome.

mt-PGS explained between 5.70% (continuous outcome) and 9.11% (categorical outcome) of the interindividual variability in lithium responsiveness. Classification accuracy (area under the curve) for the categorical outcome was 68.24% (95% CI: 64.98–71.66), with a Brier score of 0.257. Of the 5 clusters, the PGSs for psychiatric and behavioural phenotypes were most strongly associated with lithium responsiveness, accounting for 3.67–6.52% of its variability.

By integrating PGSs for multiple relevant phenotypes, predictive accuracy for lithium response improved substantially compared with single-trait methods. Future research incorporating larger, more diverse populations and combining genetic scores with clinical data holds promise for further enhancing prediction and advancing clinical implementation.

Emergency department (ED) urine culture stewardship may reduce low-value testing, but downstream effects on antibiotic use and postdischarge utilization remain uncertain.

We evaluated an intervention in which an infectious diseases physician and microbiologist reviewed pyuric urinalysis-with-reflex encounters, assessed culture indications, and contacted clinicians to recommend cancellation when absent. Adult ED encounters from February–July 2025 to September 2025-February 2026 were included; August was washout. Outcomes were urinalysis with reflex within 24 hours, urine culture within 24 hours, antibiotic days of therapy (DOT) per 100 patient-days, length of stay (LOS), and 30-day ED revisit among ED discharges. We fit biweekly interrupted time series models.

Among 17,621 encounters, the intervention was associated with lower postintervention slopes for urinalysis with reflex within 24 hours (−0.5 percentage points per biweekly period; 95% CI, −0.9 to −0.1) and urine culture within 24 hours (−0.2 percentage points; 95% CI, −0.4 to −0.0). DOT showed no sustained change (postintervention slope change, 0.00; 95% CI, −0.23 to 0.24). LOS showed a lower postintervention slope (−0.05 d; 95% CI, −0.08 to −0.02). Thirty-day ED revisit showed a higher postintervention slope (0.8 percentage points; 95% CI, 0.3 to 1.3).

The intervention reduced urinary testing but did not reduce antibiotic DOT and was associated with increased 30-day ED revisit. Diagnostic stewardship in the ED may need to be paired with antimicrobial stewardship and prospective safety monitoring.

Research suggests that the gender gap in alcohol (Alc.) consumption may be narrowing, with increasing consumption by the female population. For women, the equivalent of 20-25 grams/day is considered harmful consumption. Many of the harmful effects of alcohol consumption occur more rapidly and more severely in women, yet the majority do not seek treatment

To describe the prevalence of harmful use of alcohol in women admitted to hospital for other mental illness.

Retrospective observational study of six months duration. Data was collected from all patients admitted to the hospital during the period of study, with no specific exclusion criteria. Descriptive statistics were performed.

During the study period, 312 patients were admitted to the hospital, 52.8% of whom were women, 21.8% of whom had a harmful use of Alc. The prevalence of harmful Alc. use in the different mental illnesses was: 22.2% in schizophrenia or other psychoses, 13.9% in bipolar affective disorder, 11.1% in depressive disorder, 13.9% in personality disorder, 19.4% in substance use disorder, 13.9% for other diagnoses and a prevalence of 5.56% for those of unknown diagnosis

In recent years, it has been shown that the overall prevalence of harmful alcohol use and alcohol use disorder has increased in women. They tend to seek care in settings where their alcohol problems may not be recognised. They have lower social support for treatment participation and greater barriers to accessing treatment, resulting in even higher rates of co-occurring medical and mental health problems. Prevention strategies and intervention programmes should be adapted to the specific needs of women, taking into account both individual risk factors and socio-cultural contexts

None Declared

Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.

To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.

Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.

Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.

AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.

Up to 45% of individuals who commit suicide contact their Primary Care physician (PCP) the month before. The objective is to study clinical characteristics of patients presenting death and/or suicidal ideation (SI) in Primary Care.

195 patients attending their PCP were evaluated using systematic sampling in three Primary Care Centres. Patients completed the PHQ and a Life Changes Checklist. Demographic data, both psychiatric and medical conditions and treatments, visits to their PCP, and days out of work (last year) were also collected.

24 patients had death or suicidal ideation for the previous two weeks (12,4%; IC95% 8,3-18,8%). Most of them (87,5%) had a mental disease, major depressive disorder (62,5%) and general anxiety disorder (50%). Patients with SI had more somatic symptoms (p<0,001), a greater number and score of recent life changes (p<0,001) and days out of work (last year) ((p=0,028) than the rest of the sample.

Compared to patients with any psychiatric disorder, patients with SI had more depressive symptoms (p<0,001) and a higher score in life changes in the 6-12 month period (p=0,044).

14 (58,3%) patients with SI had no previous psychiatric diagnosis and only 8 (33%) were receiving treatment.

In spite of a greater severity in depressive and other clinical characteristics of patients with SI most of them are not correctly detected and treated. Improving the rate of detection and treatment by the PCP of such patients would probably play a key role in the prevention of suicide.

Chronic insomnia (ChI) is a common condition in Primary Care (PC). Regardless that it's often related to psychiatric morbidity it appears to be a strong predictor of future depression and a disabling disorder by itself. The aim of this study was to measure and compare clinical and psychiatric characteristics of both patients with primary ChI and secondary ChI.

A random sample of 225 subjects older than 18 years old, from 3 PC Centres of the area of Madrid (Spain) was interviewed using the Oviedo Sleep Questionnaire, a semi-structured interview for sleep disorders. The subjects completed the Patient Health Questionnaire. Data about medical conditions, drug treatments, days of work lost (last year) and use of health care services (last 3 months), were also collected. Psychiatric and clinical characteristics between groups (primary vs secondary ChI) were compared.

78 patients fulfilled criteria for ChI and 53 (67.9 %) of them were suffering from any psychiatric disorder (including subtreshold conditions). Patients with primary ChI compared to secondary insomnia patients had no significant differences in age, gender, use of health care resources and days of work lost. However, patients with secondary ChI compared to primary ChI had more somatic and depressive symptoms (U-Mann-Witney test; p=0.002 and p<0.001, respectively).

There is an important group of patients among PC attendees suffering primary ChI. Patients suffering primary ChI are comparable to patients with psychiatric disorders and insomnia in terms of days of work lost and use of health care resources.

Previous data suggest that there is an important group of patients between primary care (PC) attendees suffering a psychiatric disorder that remain undetected. Our aim was to know data about this group of patients compared with patients without psychiatric pathology (PWP) and patients with already known psychiatric pathology (PKP).

A random sample of 225 subjects older than 18 years old, from 3 PC Centres of the area of Madrid (Spain) completed the Patient Health Questionnaire (PHQ). Data about medical and psychiatric conditions, drug treatments, days of work lost (last year) and use of health care services (last 3 months), were also collected. Psychiatric and clinical characteristics between groups were compared.

50 (22,2%) patients were suffering a psychiatric condition according to PHQ but without recognition by their general practioner. This group of patients were younger than PWP and PKP (ANOVA; p=0,021 and p=0,013). They were suffering more depressive symptoms and somatic complaints than PWP (p<0,001 and p<0,001 respectively). In terms of days of work lost and use of health care services did not differ from PWP.

The results suggest that other reasons rather than the symptomathology (depresive symptoms, somatic complaints) may be important in the proccess of detection of mental health problems in PC. Both days of work lost and the number of visits to general practioner appear to be two determinant factors.

Neurocognitive disorders are the only psychiatric disorders which underlying pathogeny can potentially be determined. This has important implications, for it makes possible the use of biomarkers in order to gain better diagnosis, and opens a door to more accurate treatments. Nonetheless, as biomarkers are not exclusive of a single disorder, the lengths of its utility are still unknown.

To understand the values and limitations of biomarkers in differential diagnosis of dementias.

We present three cases followed in the Neurology ward of our hospital, in which they were admitted for diagnosis and treatment of a subacute form of dementia. Medical history, core symptoms, screening tests for cognitive impairment, MRI, EEG and biomarkers in cerebrospinal fluid were used for diagnosis.

Two cases had consistent clinical features and complementary explorations, and they were respectively diagnosed as Creutzfeldt-Jakob Disease and Lewy Body Dementia; however, the last case showed contradictory results between clinic and complementary explorations, particularly 14-3-3 protein, which was positive and led to the initial diagnosis as Creutzfeldt-Jakob Disease, which was proven wrong once necropsy was practiced.

Although complementary explorations, and biomarkers in particular, are of invaluable utility in the accurate diagnosis of multiple psychiatric diseases, they must always be considered within a context given by biography and clinical features, because, when failing to do so, they can lead to misdiagnosis and delay of correct treatment.