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Does intensive home treatment change treatment trajectories of psychiatric disorders?
- A. Martín-Blanco, A. González-Fernández, A. Farré, S. Vieira, P. Alvaro, C. Isern, D. Giménez, C. Torres, V. de la Cruz, C. Martín, N. Moll, O. Castro, M. Sagué-Vilavella
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S167-S168
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Introduction
Intensive home treatment (IHT) for people experiencing a mental health crisis has been progressively established in many western countries as an alternative to in-ward admission. But is this a real alternative? We previously reported that patients treated in our IHT unit only differ from those voluntarily admitted to hospital in suicidal risk and severe behaviour disorders (not in other factors such as clinical severity) (Martín-Blanco et al., Rev Psiquiatr Salud Ment 2022;15:213-5). Now we are interested in disentangle if those patients who used to require inward management can be successfully treated at home.
ObjectivesTo describe subsequent treatment trajectories of the first 1000 admissions to our IHT unit and to compare clinical characteristics among the different groups of trajectories.
MethodsRetrospective cohort study. Subsequent treatment trajectories were collected from December 2016 to October 2022 and classified: absence, hospital, IHT, and mixed (hospital and IHT). Statistical significance was tested by means of ANOVA or Kruskal-Wallis test for quantitative variables (corrected for multiple comparisons) and chi-square tests for qualitative variables.
ResultsTables 1 shows the characteristics of the whole sample. Of the 1000 IHT admissions, 12.1% needed subsequent hospital admission(s), 12.7% IHT admission(s), and 9.3% mixed admission(s). There were no differences among these groups in median severity at IHT admission, but there were differences in the number of previous admissions (p=0.0001): the group with no subsequent admissions had less previous admissions than the other groups (pBonf<0.0001), and the group with subsequent IHT admissions had less than the group with mixed admissions (pBonf=0.0123). There were differences between groups regarding distribution of diagnoses (p<0.0001) (Fig. 1). When considering subsequent admissions by diagnosis, there were differences in severity at IHT admission (p=0.0068) and in number of previous hospitalizations (p<0.0001) (Fig. 2).
Table 1. Clinical characteristics of the whole sample (N=1000) mean SD Age (years) 47.07 17.02 CGI-s at admission * 5 4-5 N % Sex (female) 548 54.8% Psychotic disorders 463 46.3% Affective disorder 257 25.7% Bipolar disorder 128 12.8% Other disorders 152 15.2% Hospital admission in the previous 5 years 313 31.3% CGI-s: clinical global impression - severity. * median and IQR
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ConclusionsPatients that used to require inward management can now be treated at home when suffering an acute episode. Therefore, IHT has changed treatment trajectories for some patients with psychiatric disorders.
Disclosure of InterestNone Declared
A tale of excess: the curious case of the woman with 1447 emergency visits
- M. Sagué Vilavella, A. Giménez Palomo, A. Àvila-Parcet, T. Fernández Plaza, L. Navarro Cortés, G. Oretega Hernández, M. Pons Cabrera, L. Tardón Senabre, M. Vázquez
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S286
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Introduction
Frequent attenders to emergency services are challenging and costly. We report the case of a woman in her mid-twenties who stands out for a total of 1447 emergency visits.
ObjectivesOur primary objective was to describe the emergency visits of our patient. Secondary objectives were to assess her use of other healthcare services and to calculate her health expenditure.
MethodsThis is a clinical case report. We reviewed the patient’s electronic medical records for sociodemographic and clinical data. We obtained detailed information of psychiatric ED visits (length, most frequent times and days) regarding the second most-visited hospital. We assessed the efficacy of hospitalizations in reducing ED visits with a paired samples t Test, comparing the number of visits 30 days pre- and post-hospitalization. We estimated the health expenditure using the regional public health system prices, including three direct costs: emergency visits, hospitalizations and ambulance transportation. We obtained written informed consent from the patient’s legal guardian.
ResultsA 26-year-old woman from Barcelona (Catalonia, Spain), diagnosed with mild intellectual disability, made 1447 emergency visits between 2009 and 2021 (figure 1). 946 visits (65%) took place in psychiatric emergency departments (EDs), whilst 353 (24%) in non-psychiatric EDs and 148 (10%) in urgent primary care. She attended 24 hospitals (ranking number one the closest to the patient’s home, with 387 visits) and seven primary care centers, distributed across 17 cities in Catalonia. Most visits were self-referred, being the main presenting problems anxiety and instrumental suicidal behaviour. Saturday was her favorite day for hospital visits (24,1%), while she seeked care on Tuesdays much less often (4.5%). She made 73.5% of consultations between 1pm and 6pm, with a median length per visit of 2.8 hours (range 0.33-20.9 hours). Regarding other therapeutic approaches, she attended day hospitals, psychiatric rehabilitation programs and family therapy, among others (figure 2), for which she showed low adherence and scarce benefit. She had ten acute hospitalizations, interventions that did not reduce ED visits (t=-0.9835, p=0.36). Health expenditure reached 410.035€.
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ConclusionsThe most common definition of frequent attendance is a patient who has five or more visits per year. Many times, but not always, repeat visits are also inappropriate. The case we report is a grotesque example of both frequent and inappropriate attendance, which has been resistant to all kinds of interventions and has quality-of-care, financial and ethical implications. As of today, it is still a pending case. Maybe it is worth considering residential treatment?
Disclosure of InterestNone Declared
Consultation trends in patients admitted to a Psychiatric Emergency Service before and during COVID-19 pandemic
- M. Gomez Ramiro, A. Gimenez, G. Fico, M. Sague Vilavella, M. Valenti, M. Vazquez
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S591-S592
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Introduction
The COVID-19 outbreak had significant implications worldwide, including mental health. Consultations in the Emergency Service of the Hospital Clínic of Barcelona varied in terms of reasons for consultations, psychopathology, and other aspects, before and during the pandemic.
ObjectivesThis study aims to assess differences in the profile of patients admitted within the last three years to the Psychiatric Emergency Service of a third-level hospital, in order to analyze variations in the number of patients visited, diagnoses and admissions throughout the different seasons.
MethodsAll adults admitted from 2019 to 2021 to the Psychiatric Emergency Service of Hospital Clínic of Barcelona, Spain, were retrospectively included for analysis and divided into three groups depending on the year they attended the Emergency Service. SPSS v25.0 and R statistics were used in order to compare differences between groups.
ResultsA total of 13677 adult individuals who attended the psychiatric emergency service of Hospital Clínic of Barcelona between 2019 and 2021 were included in the analysis. 4814 patients were visited in 2019, 4007 in 2020 and 4856 in 2021. The majority of patients were male (50.1%), with a mean age of 40.47 years (SD 15.83). In terms of acute admission rates, 24.6% of the total sample were hospitalized in an acute psychiatric unit, whereas in the spring of 2020, 34.3% of patients attending the Emergency Service were hospitalized. This revealed significant differences when compared with spring of 2019 and 2021 and with the rest of seasons (p<0.05). With regard to suicide attempts and intentional poisonings, significant differences were only observed between winter of 2019, with the lowest rate, and autumn of 2020, with the highest proportion. In spring of 2019, the lowest rate of patients attending with suicidal ideation was observed, which showed significant differences compared to winter of 2020, spring of 2021, summer of 2021 and autumn of 2021 (p<0.05). Also, statistically significant differences between winter of 2019 and summer of 2021 and also between summer of 2019 and summer of 2021 were observed, with the highest rate in the last one. No significant differences were observed in rates of patients with severe mental disorders visited.
ConclusionsThe COVID-19 pandemic and the situation of lockdown lead to an overall reduction in the overall consultations to the Emergency Service, being this reduction non-significant in patients with severe mental disorders, such as psychotic disorders. In addition, our study shows a decrease in consultations with suicidal ideation in summer of 2019 and a significant increase in summer of 2021. In contrast, an increased tendency in suicide attempts was not observed.
Disclosure of InterestNone Declared
Bioenergetic changes and mitochondrial dysfunction in mania versus euthymia in bipolar disorder type I
- A. Giménez-Palomo, M. Guitart-Mampel, G. Garrabou, X. Alsina-Restoy, A. Meseguer, L. Colomer, G. Roqué, F. J. García-García, E. Tobías, J. Moisés, M. Valentí, E. Vieta, I. Pacchiarotti
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S692-S693
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Introduction
Current evidence has hypothesized the involvement of mitochondrial dysfunction during the acute episodes of BD compared to symptomatic remission. So far, no studies have compared mitochondrial and bioenergetic functions both in-vivo (respiratory parameters) and ex-vivo (cellular respiration) in different phases of the disease in the same individuals.
ObjectivesThis multidisciplinary pilot study aims at assessing bioenergetic and mitochondrial intra-individual differences between manic and euthymic states.
MethodsFour patients with a manic episode admitted to our acute psychiatric ward were recruited. Bioenergetic parameters were measured at admission (T0) and after symptomatic remission (T1).
At admission (T0) and before discharge (T1), HAMD and YMRS total scores were obtained. For the assessment of cellular respiration, polymorphonuclear cells were obtained by a Ficoll density gradient centrifugation procedure. To determine oxygen consumption (at T0 and T1), a million of living peripheral blood mononuclear cells (PBMC) were used. High-resolution respirometry was performed at 37°C by polarographic oxygen sensors in a two-chamber Oxygraph-2k system.
Specific oxygen uptakes (Routine: basal oxygen consumption; Proton Leak: oxygen consumption not coupled to ATP synthesis; and ETC: maximal capacity of the electron transport chain) rates were obtained using mitochondrial chain inhibitors and uncouplers. Oxygen consumption was normalized for protein concentration. Results are expressed as picomoles of oxygen per millilitre (pmol O2/s*μg prot).
Also, a constant work rate exercise test was performed on a cycle ergometer and basal and effort respiratory variables were measured.
Statistical analysis was performed with the SPSS v. 25.0 and GraphPad. Results were expressed as means and SD. Nonparametric tests (Mann–Whitney, Pearson) were used to determine differences (significant at p value <0.05).
ResultsOne patient was a man and three patients were women, with a mean age of 28 years old. HAMD initial and final mean scores were 11.0 and 7.0, and mean YMRS scores were 21.5 and 7.0 respectively.
Results from mitochondrial oxygen consumption revealed that mean basal oxygen consumption tended to be higher in T1 (0.98±0.45) than in T0, and maximal respiratory capacity was significantly increased in T1 (2.26±0.33; p=0.028) compared to T0.
Mean lactate levels and pH levels were similar in T0 and T1. Scales scores were not correlated to different pH or lactate changes after the effort task. Higher initial oxygen consumption was significantly correlated to higher maximal capacity (p<0.05) in T0 and T1.
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ConclusionsOur preliminary results suggest that mania could imply lower oxygen consumption capacity, which should be confirmed in future studies. A bigger study is planned to determine changes in bioenergetic patterns and capacity for aerobic response in manic and depressive episodes.
Disclosure of InterestNone Declared
Changing trends of suicide mortality from 2011 to 2019: an analysis of 38 European Countries
- G. Fico, A. Gimenez-Palomo, R. Andra Bursan, C. R. Ionescu, F. Kraxner, P. Rolland, S. Gomes-Rodrigues, M. Batković, E. Metaj, S. Tanyeri Kayahan, A. Mamikonyan, P. Paribello, A. K. Sikora, C. M. Platsa, M. Spasic Stojakovic, A. H. Halt, M. Az, N. Ovelian, K. Melamud, M. Janusz, K. Hinkov, C. Gramaglia, J. Beezhold, J. L. Castroman, C. Hanon, D. Eraslan, E. Olie
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S85-S86
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Introduction
Suicide is a serious public health problem since it accounts for nearly 900,000 deaths each year worldwide. Globally in 2019, 10.7 persons out of 100,000 died by suicide. Psychiatric disorders are related to an overwhelming proportion of these cases. In the last years, several specific interventions and action plans for suicide prevention have been implemented in a number of European countries.
ObjectivesOur aim was to analyze recent epidemiologic trends of suicide mortality rates in Europe.
MethodsAnnual national statistics of suicide mortality rates derived from Eurostat public databases from 2011 to 2019 were analyzed for 38 European countries. The suicide mortality rate was estimated per year/100,000 population. Linear regression models were used to study temporal trends of suicidal mortality. Analyses were performed using RStudio.
ResultsAvailable data show a statistically significant reduction in suicide mortality rates from 2011 to 2019 in 15 European countries, and a significant increase for Turkey (ES=0.32, SD=0.06, p=0.037) (Fig 1). The greatest significant decrease was reported in Lithuania (ES=-1.42, SD=0.02, p=0.02), followed by Hungary (ES=-1.13, SD=0.11, p=0.0007), Latvia (ES=-0.76, SD=0.11, p=0.007), and Poland (ES=-0.73, SD=0.10, p=0.001). Italy reported the lowest significant reduction in suicide mortality rates (ES=-0.13, SD=0.018, p=0.003). The remaining 16 countries showed no significant changes in suicide mortality trends.
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ConclusionsIn the last years, Europe registered an overall reduction in reported suicide rates. However, more recent data (i.e., suicide rates after COVID-19 pandemic, age and sex-related effect on suicide rates) should be analyzed and used to implement future recommendations. Current and future suicide prevention strategies aim to contribute to a greater reduction of suicide rates in the different European countries.
Disclosure of InterestNone Declared
A family history of suicide in bipolar disorders: powerful, powerless
- M. Sagué Vilavella, G. Fico, G. Anmella, A. Giménez, M. Gómez Ramiro, M. T. Pons Cabrera, S. Madero, A. Murru, E. Vieta
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S387
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Introduction
When completing the medical record of a patient with bipolar disoder (BD), hardly anything is more impacting than a family history of completed suicide (FHS). In fact, FHS is a main risk factor for personal suicide attempts and death in this population. There are few modifiable protective factors against suicide in BD, such as lithium treatment and absence of substance abuse.
ObjectivesWe aimed to explore the relationship between a FHS and clinical characteristics in patients with BD. Given the impact that FHS has on the individual and on healthcare professionals, we hypothesized that it would modify behaviors towards a higher prevalence of the modifiable protective factors against suicide, namely more treatment with lithium and less drug addiction.
MethodsThis is a cross-sectional study that included all patients with BD that were followed up in a specialised unit between 1998 and 2020. Only subjects with complete information on FHS were retained for the analysis. We assessed sociodemographic and clinical data and described it with measures of frequency, central tendency and dispersion. Differences between subjects with and without FHS were calculated with χ², Fisher’s exact test and Student’s t-test as appropriate. We set the significance level at p≤0.05. All tests were two-tailed.
ResultsThe sample consisted of 480 subjects with a mean age of 45.9 years (standard deviation 14.4, range 18-88), of which 54.4% (n=261) were women. 69.2% (n=332) had a diagnosis of BD type I and 30.8% (n=148) of BD type II. 77 subjects (16%) had a FHS. Regarding differences between groups, those with relatives who had committed suicide did not show statistically significant differences in terms of sociodemographic variables (age, gender, civil status, employment) or key clinical features (type of BD, illness duration, psychotic features, predominant polarity, rapid cycling, number of lifetime manic and depressive episodes, comorbid personality disorder), neither did they have a higher use of lithium (55.8% vs 59.3%, p=0.572) nor lower substance use disorder (10.9% vs 15.5%, p=0.34). Predictably, people with FHS had a higher prevalence of family history of mental and affective disorders (96.1% vs 70.9%, p<0.001; 86.3% vs 56.3%, p<0.001) and of stressful life events (71.6% vs 58.9%, p=0.05). Personal lifetime suicide attempts also tended to be higher (36.4% vs 26.7%, p=0.088).
ConclusionsContrary to our hypothesis, in our sample of subjects with BD a FHS was not associated with a higher prevalence of the modifiable protective factors against suicide. Therefore, although suicide has a major impact both in families and healthcare professionals, our results suggest it does not modify attitudes towards prevention in a real-life scenario. The main limitation of our study is its cross-sectional design, which does not allow for causal inference. In conclusion, there is room for improvement in the fight against suicide.
Disclosure of InterestNone Declared
Psychotropic drug repurposing for COVID-19: a systematic review
- U. Isayeva, G. Fico, S. Gomes-Da-Costa, M. Sagué Villavella, A. Gimenez, M. Manchia, A. Murru
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S337
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Introduction
Recently, several antidepressants, mood stabilizers, and antipsychotics have been suggested to have favorable effects in the treatment of COVID-19.
ObjectivesThe aim of this systematic review was to collect evidence from preclinical and clinical studies concerning the scientific evidence for the repurposing of psychotropic drugs in COVID-19 treatment.
MethodsTwo independent authors searched PubMed-MEDLINE, Scopus, PsycInfo, Clinical Trial Registration Site US (ClinicalTrials.gov) databases, and reviewed the reference lists of articles for eligible articles published up to May 31st, 2021. All preclinical and clinical studies on the effect of any psychotropic drug on Sars-CoV-2 or patients with COVID-19 were included. The Newcastle-Ottawa scale was used for the quality assessment of clinical studies. This systematic review adheres to the PRISMA guidelines.
Results22 studies were included in the synthesis: 9 clinical studies, 9 preclinical studies, and 4 computational studies. The use of antidepressants, both SSRI and non-SSRI, was associated with a reduced risk of severe complications of COVID-19. Several antipsychotics showed an increased risk for both Sars-CoV-2 infection and severe complications during COVID-19.
ConclusionsThe current evidence supports a potential anti-SARS-CoV-2 role for several antidepressants, while the evidence on mood stabilizers or antipsychotics remains controversial. Drug repurposing proved highly successful in response to the current pandemic and psychotropic medications are widely used in clinical practice with well-known safety and tolerability profiles, showing antiviral, immunomodulatory, and anti-inflammatory properties, being perfect candidates for possible treatment of COVID-19. Further research will deliver optimized and specific therapeutic tools that will increase the preparedness of health systems for possible future epidemics.
DisclosureNo significant relationships.
Emergency Psychiatry before and during COVID-19 pandemia
- A. Giménez-Palomo, M. Sagué, G. Fico, M. Gómez-Ramiro, M. Vázquez
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S277
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Introduction
The COVID-19 pandemic had a significant impact worldwide. Consultations in the Emergency Service of the Hospital Clínic of Barcelona varied in terms of reasons for consultations, psychopathology, and other aspects, before and after the pandemic.
ObjectivesTo examine changes in the profile of patients admitted before and during the COVID-19 pandemic to our Psychiatric Emergency Service.
MethodsAll children, adolescent and adult psychiatric inpatients admitted from December 4th 2019 to March 31st 2021 to the Psychiatric Emergency Service of Hospital Clínic of Barcelona, Spain, were retrospectively included for analysis and divided into two groups –groups 1 or 2- including the first one all patients who attended before lockdown and the second group those who attended during the pandemic.
ResultsA total of 1991 patients were included -1224 in the first group and 767 in the second group. The majority of patients were male (52.08%), with a mean age of 41.21 years (SD 16.53). A proportion significantly higher of men was found in the second group (p<0.05). The proportion of patients consulting with substance use disorders was significantly higher in the second group (p<0.05). Patients from the second group presented a significantly higher proportion of admissions in an acute psychiatric ward (p<0.05), and also a significantly higher proportion of consultations of patients with dementia (p<0.05).
ConclusionsThe COVID-19 pandemic lead to a significant reduction in the overall consultations, with a higher proportion of severe cases. The lack of availability of caregivers and telework might have influenced the increase in consultations of patients with dementia.
DisclosureAG has received travel and financial support from Janssen, Otsuka-Lundbeck and Angelini, and research support from Instituto de Salud Carlos III, and declares no support related with the subject of this presentation.
Bipolar disorders and suicide: stumbling twice with the same stone?
- M. Sagué-Vilavella, G. Fico, G. Anmella, A. Giménez-Palomo, M. Gómez-Ramiro, M. Pons Cabrera, S. Madero, E. Vieta, A. Murru
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S222-S223
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Introduction
Suicide is the most terrible outcome of bipolar disorders (BD). It impacts families and healthcare professionals deeply. Family history of suicide (FHS) is one of its main risk factors, whereas lithium treatment and absence of substance use disorders (SUD) are two of its few modifiable protective factors.
ObjectivesTo explore the relationship between FHS and clinical characteristics in BD. We hypothesized that FHS would be associated with less SUD, higher rates of lithium treatment and shorter duration of untreated illness (DUI).
MethodsCross-sectional analysis of subjects with BD followed-up in a specialised outpatient unit (Barcelona, October’08-March’18). We described data with measures of frequency, central tendency and dispersion, and we used χ², Fisher’s test and t-tests for comparisons.
ResultsThe sample consisted of 83 subjects, 56.6% males, mean age 41.9 years (SD 12.7). 74.7% (n=62) had a diagnosis of BD-I and 25.3% (n=21) of BD-II. 11 subjects (13.3%) had FHS. Those with FHS did not show significant differences in sociodemographic data, DUI (58.5+/-60.4 vs 38.19+/-84.9 months, p=0.341), lithium use (72.7% vs 73.6%, p=0.95) or SUD (27.3% vs 23.6%, p=0.79). There were differences in terms of lifetime suicide attempts (54.5% vs 20.8%, p=0.026), family history of mental disorders (100% vs 69.4%, n=0.032).
ConclusionsContrary to our hypothesis, FHS was not associated with the modifiable protective factors against suicide (namely, less SUD and more lithium prescription). Similarly, we did not find an association with earlier access to mental health services at symptom onset (DUP as proxy). Therefore, our results suggest FHS does not modify attitudes towards prevention.
DisclosureNo significant relationships.
Dietary diversity and depression: cross-sectional and longitudinal analyses in Spanish adult population with metabolic syndrome. Findings from PREDIMED-Plus trial
- Naomi Cano-Ibáñez, Lluis Serra-Majem, Sandra Martín-Peláez, Miguel Ángel Martínez-González, Jordi Salas-Salvadó, Dolores Corella, Camille Lassale, Jose Alfredo Martínez, Ángel M Alonso-Gómez, Julia Wärnberg, Jesús Vioque, Dora Romaguera, José López-Miranda, Ramon Estruch, Ana María Gómez-Pérez, José Lapetra, Fernando Fernández-Aranda, Aurora Bueno-Cavanillas, Josep A Tur, Naiara Cubelos, Xavier Pintó, José Juan Gaforio, Pilar Matía-Martín, Josep Vidal, Cristina Calderón, Lidia Daimiel, Emilio Ros, Alfredo Gea, Nancy Babio, Ignacio Manuel Gimenez-Alba, María Dolores Zomeño-Fajardo, Itziar Abete, Lucas Tojal Sierra, Rita P Romero-Galisteo, Manoli García de la Hera, Marian Martín-Padillo, Antonio García-Ríos, Rosa M Casas, JC Fernández-García, José Manuel Santos-Lozano, Estefanía Toledo, Nerea Becerra-Tomas, Jose V Sorli, Helmut Schröder, María A Zulet, Carolina Sorto-Sánchez, Javier Diez-Espino, Carlos Gómez-Martínez, Montse Fitó, Almudena Sánchez-Villegas
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- Public Health Nutrition / Volume 26 / Issue 3 / March 2023
- Published online by Cambridge University Press:
- 19 July 2022, pp. 598-610
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To examine the cross-sectional and longitudinal (2-year follow-up) associations between dietary diversity (DD) and depressive symptoms.
Design:An energy-adjusted dietary diversity score (DDS) was assessed using a validated FFQ and was categorised into quartiles (Q). The variety in each food group was classified into four categories of diversity (C). Depressive symptoms were assessed with Beck Depression Inventory-II (Beck II) questionnaire and depression cases defined as physician-diagnosed or Beck II >= 18. Linear and logistic regression models were used.
Setting:Spanish older adults with metabolic syndrome (MetS).
Participants:A total of 6625 adults aged 55–75 years from the PREDIMED-Plus study with overweight or obesity and MetS.
Results:Total DDS was inversely and statistically significantly associated with depression in the cross-sectional analysis conducted; OR Q4 v. Q1 = 0·76 (95 % CI (0·64, 0·90)). This was driven by high diversity compared to low diversity (C3 v. C1) of vegetables (OR = 0·75, 95 % CI (0·57, 0·93)), cereals (OR = 0·72 (95 % CI (0·56, 0·94)) and proteins (OR = 0·27, 95 % CI (0·11, 0·62)). In the longitudinal analysis, there was no significant association between the baseline DDS and changes in depressive symptoms after 2 years of follow-up, except for DD in vegetables C4 v. C1 = (β = 0·70, 95 % CI (0·05, 1·35)).
Conclusions:According to our results, DD is inversely associated with depressive symptoms, but eating more diverse does not seem to reduce the risk of future depression. Additional longitudinal studies (with longer follow-up) are needed to confirm these findings.
Clinical profile of patients admitted in an acute psychiatric ward before and during the COVID-19 lockdown
- A. Giménez Palomo, N. Baldaquí, L. Colomer, F. Gutiérrez, E. Pujal, P. Barrio, M. Bioque, E. Vieta, I. Pacchiarotti
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- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S102
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Introduction
The COVID-19 pandemic entailed several changes in health and medical assistance, economy, and lifestyle. In the Acute Psychiatric Ward of the Hospital Clínic of Barcelona, the implementation of restrictive measures was necessary in order to ensure patients’ safety.
ObjectivesTo compare clinical profiles and course of hospitalization of patients admitted before and during the COVID-19 lockdown in our Acute Psychiatric Ward.
MethodsAll patients admitted from January 7th to February 25th and from March 19th to May 7th of 2020 in the Acute Psychiatric Hospitalization Unit of Hospital Clínic of Barcelona, Spain, were retrospectively included for analysis and divided into two groups according to the period when they were admitted. Statistical analyses were performed using SPSS, 23.0 version.
ResultsA total of 117 inpatients were included (73 admitted before lockdown and 44 during lockdown), being 50.4% male, with a mean age of 42.4 (SD 15.73). Patients from the first group presented a significantly higher proportion of antidepressants prescription at discharge (p<0.05) and more substance use disorders (p<0.05). Regarding the lockdown group, 51% of patients manifested COVID-19-related stress. Time of hospitalization was significantly lower in the lockdown group (p<0.05), even though a significantly higher proportion of patients were discharged at home (p<0.05) compared with the first group.
ConclusionsThe situation of lockdown led to a series of changes in our unit and also in the profile of patients admitted, having shorter admissions, lower prescription of antidepressants, and often COVID-related stress. These differences should be considered in future situations in which restrictive measures may be necessary.
DisclosureNo significant relationships.
Can stress predict delivery date?: Role of chronic and acute stress to the threatened preterm labor as predictors of delivery date
- J. Buesa Lorenzo, A. García-Blanco, M. Vento, A. Moreno-Giménez, L. Campos Berga, V. Diago, D. Hervás, C. Cháfer-Pericás, P. Sáenz González
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- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S607
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Introduction
Threatened preterm labor (TPL) is a traumatic event during pregnancy that involves a threat to the physical integrity of the upcoming baby. Despite biomarkers would be the strongest delivery date predictors, an assessment of chronic and acute stress response to TPL diagnosis may improve this prediction.
ObjectivesThe objective is to predict delivery date in women with TPL based on their response to this diagnosis and chronic stressors, along with relevant obstetric variables.
MethodsA prospective cohort study was conducted with a sample was formed by 157 pregnant women with TPL diagnosis between 24 and 31 weeks. Determination of salivary cortisol, α-amylase levels, along with anxiety and depression symptoms were measured to estimate stress response to TPL. Cumulative life stressors as traumas, social and familiar functioning were also registered. To examine the effect of the possible predictor variables of delivery date, linear regression models were used.
ResultsA correlation was found between the variables of response to chronic stress and between the variables of psychological response to stress. The main predictors of preterm delivery were low family adaptation, higher BMI, higher cortisol levels, and the week of diagnosis of TPL (<29 weeks of gestation).
ConclusionsThe best predictor of delivery date was the combination of the stress response to the diagnosis of TPL measured by cortisol in saliva, cumulative life stressors (mainly family adaptation) and obstetric factors (week TPL and BMI). Through psychosocial therapeutic intervention programs, it is possible to influence this modifiable predictive factors of preterm birth in symptomatic women.
An eye-tracking study for measuring the attentional characteristics towards emotional scenes in children with autism spectrum condition
- M. Lizarán, R. Sahuquillo-Leal, P. Navalón, A. Moreno-Giménez, B. Almansa, M. Vento, A. García-Blanco
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, pp. S226-S227
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Introduction
The difficulties in social interaction present in individuals with autism spectrum conditions may are related with the abnormal attentional processing of emotional information. Specifically, it has been hypothesized that the hypersensibility to threat shown by individuals with autism may explain an avoidance behaviour. However, this hypothesis is not supported by research and the underlying psychological mechanisms of social interaction in autism still unclear.
ObjectivesThe aim of the present study was to examine attentional processing biases by administering a computer-based attentional task in a sample of 27 children with autism spectrum conditions and 25 typically developed participants (age 11-15 years).
MethodsThe initial orienting of attention, the attention al engagement, and the attentional maintenance to different emotional scenes in competition (i.e. happy, neutral, threatening and sad) were measured by recording the eye movements during a 20 seconds free-viewing task.
ResultsThe main findings were: i) children with autism spectrum conditions showed an initial orientating bias towards threatening stimuli; and ii) while typically developed children revealed an attentional engagement and attentional maintenance bias towards threatening stimuli, children with autism spectrum conditions did not.
ConclusionsThe findings of the present study are consistent with the affective information processing theories and shed light on the underlying mechanisms of social disturbances in autism spectrum conditions.
Does maternal age or related factors influence the appearance of psychopathology in children?
- J. Buesa Lorenzo, A. García-Blanco, A. Moreno-Giménez, L. Campos Berga, R. Sahuquillo-Leal, A. Nowak, D. Hervás, V. Diago, M. Vento
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S146
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Introduction
Maternal age and related factors, such as social vulnerability, are associated with neurodevelopmental and behavioral disorders in offspring.
ObjectivesTo examine the influence of maternal age and its related factors on the appearance of autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), alterations in executive functions and behavioral syndromes of the offspring.
MethodsA prospective study was conducted, consisting of 131 healthy pregnant women aged 20 to 41 years, recruited at 38 weeks’ gestation. Their offspring were followed up to 2 years after birth, when psychopatology was assessed. Maternal age and possible related factors were considered predictors. Bayesian ordinal regression models were performed for each outcome variable.
ResultsSymptoms of ASD in children were associated with an older maternal age (OR = 0.188; 95% CI[1.062, 1.401]) and a lower educational level of the parents (OR = -0.879; 95% CI[0.202, 0.832]), meanwhile poor social support predicted most ADHD symptoms OR = -0.086; 95% CI[0.838, 1]) and executive dysfunctions OR = -0.661; 95% CI[0.313, 0.845]. Lower parental education predicted both externalizing and internalizing behavior.
ConclusionsMaternal age-related factors were the main predictors of neurodevelopmental disorders in offspring, rather than maternal age. The performance of prenatal interventions in pregnant women with advanced age and anxious depressive symptoms or adverse social situation, is crucial to reduce the risk of neurodevelopmental disorders in the offspring. Likewise, being able to carry out an early detection of childhood psychopathology would allow the implementation of resources that improve their long-term prognosis.
DisclosureNo significant relationships.
An antisaccade task for measuring the attentional characteristics of social information processing in children with autism spectrum conditions
- M. Lizarán, R. Sahuquillo-Leal, M. Perea, A. Moreno-Giménez, L. Salmerón, S. Simó, M. Vento, A. García-Blanco
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S227
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Introduction
Autistic Spectrum Condition is often characterized by the presence of deficits in social interaction. An abnormal attentional processing may explain these difficulties, as it has been suggested that individuals with autism spectrum conditions may have problems with orienting attention to socially relevant stimuli and/or inhibiting their attentional responses to irrelevant ones.
ObjectivesThe aim of the current study is to shed light on this issue by the assessment of the attentional orienting and inhibitory control to emotional stimuli (angry, happy, and neutral faces).
MethodsAn antisaccade task (with both prosaccade and antisaccade blocks) was applied to a final sample of 29 children with autism spectrum conditions and 27 children with typical development.
ResultsThe main findings were: i) children with autism spectrum condition committed more antisaccade error when seeing angry faces than happy or neutral faces, while children with typical development committed more antisaccade errors when seeing happy faces than neutral faces, and ii) latencies in the prosaccade and antisaccade blocks were associated with the severity of autism symptoms.
ConclusionsThese results suggest that children with autism spectrum conditions show an impaired inhibitory control when angry faces are presented. This bias to negative high-arousal information is congruent with affective information-processing theories suggesting that threatening stimuli induce an overwhelming response in autism. From a clinical perspective, therapeutic strategies that focus on shifting attention to emotional stimuli may improve autism symptomatology and their socials functioning.
Differential inhibition of egg hatching in Aedes aegypti populations from localities with different winter conditions
- Raúl E. Campos, Gabriela Zanotti, Cristian M. Di Battista, Javier O. Gimenez, Sylvia Fischer
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- Journal:
- Bulletin of Entomological Research / Volume 111 / Issue 3 / June 2021
- Published online by Cambridge University Press:
- 27 November 2020, pp. 323-330
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In Argentina, the mosquito Aedes aegypti (L.) (Diptera: Culicidae) is distributed from subtropical to temperate climates. Here, we hypothesized that the expansion of Ae. aegypti into colder regions is favoured by high-phenotypic plasticity and an adaptive inhibition of egg hatching at low temperatures. Thus, we investigated the hatching response of eggs of three populations: one from a subtropical region (Resistencia) and two from temperate regions (Buenos Aires City and San Bernardo) of Argentina. Eggs collected in the field were raised in three experimental colonies. F1 eggs were acclimated for 7 days prior to immersion at 7.6 or 22°C (control eggs). Five immersion temperatures were tested: 7.6, 10.3, 11.8, 14.1 and 16°C (range of mean winter temperatures of the three localities). A second immersion at 22°C was performed 2 weeks later to assess the inhibition to hatch under favourable conditions. After the first immersion, we compared the proportions of hatched eggs and dead larvae among treatment levels, whereas after the second immersion we compared the hatching response among the three populations. The factors that most influenced the egg hatching response were the geographical origin of the populations and the immersion temperature, but not the acclimation temperature. The proportions of hatching and larval mortality at low temperatures were higher for Resistencia than for Buenos Aires and San Bernardo, whereas the hatching response at ambient temperature was lower for San Bernardo than for Buenos Aires and Resistencia. The results support the hypothesis that populations from colder regions show an adaptive inhibition of egg hatching.
Inhibitory effect of positional syllable frequency in Spanish 2nd and 4th grade readers
- J. L. Luque, C. J. Álvarez, S. Bordoy, A. Giménez, P. J. López-Pérez, M. López-Zamora
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- Applied Psycholinguistics / Volume 42 / Issue 1 / January 2021
- Published online by Cambridge University Press:
- 26 November 2020, pp. 1-17
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The inhibitory effect of positional syllable frequency is a well-known phenomenon in visual word recognition: words with high-frequency syllables require extra time for deactivating the lexical syllabic neighbors. The inhibitory effect implies that a connection exists between graphemes, phonemes, the first syllable, and the phonological lexicon. However, experimental results of the first developmental stages of occurrence are scarce and inconclusive. A second- and fourth-grade sample of typical school readers participated in a lexical decision task containing high/low frequency words and high/low syllable frequency words. Our primary hypothesis was that the inhibitory effect would be found on both school grade groups. We did not predict significant differences in magnitude of effect between second- and fourth-grade participants. A general inhibitory effect was found, and separate analyses by school grade groups also indicated significant inhibitory effects. Furthermore, second- and fourth-grade children showed small sizes of the inhibitory effect, resembling the sizes found in adult normal readers. Our results suggest that Spanish readers reach a functional connection between syllables and words at an early stage. The straightforward theoretical implication is that the inhibitory effect relies heavily on the structural properties of the lexical access system that are acquired at an early age.
438 - Nigerian women are more susceptible to the impact of diabetes-and-dementia: State-of-art, Future perspectives and Directions
- L Giménez-Llort, EK Oghagbon, F Dogo, M Ogiator, J Prieto-Pino
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- International Psychogeriatrics / Volume 32 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 04 November 2020, p. 156
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Among the preventable complications of diseases that require urgent effective health literacy programs in sub-Saharan Africa, crosstalk between diabetes and dementia stands out for women's health. Type 2 diabetes mellitus (DM2) in midlife is a recognised risk factor for dementia. This crosstalk is more significant in persons of African ancestry. Globally, the prevalence of DM will increase dramatically in the next few years with 75% of cases living in low-to-middle-income countries. Some major risk factors for DM2 accelerates the development of dementia in Africa-Americans, thus leading to higher prevalence of dementia compared to Caucasians. It is known that 58% of the global 46.8 million dementia subjects lives in economically developing countries. This proportion may reach 63% and 68% in 12 and 32 years' time, respectively. Females are 1.5 times likely to develop dementia, but sub-Saharan Africa women have a disproportionately two-to-eight fold increased dementia risk. In the eye of this storm is Nigeria which is home to the highest number of diabetics in Africa. Diabetes prevalence in the country is rising parallel to increased incidence of obesity, hypertension and rising population age. The socioeconomic impact of increasing prevalence of DM2 and dementia will be unsustainable for Nigeria healthcare system, given the experiences in developed economies. This study analyses the current situation of women's health in Nigeria, and explore future policy directions. The complex interplay of factors involved in the DM2-dementia crosstalk in Nigerian women include those due to biological processes (metabolic syndrome, vascular damage, inflammation, oxidative stress, insulin resistance and anaemia), nutritional habits and sedentary lifestyles. Other factors that predisposes Nigerian diabetic women to dementia are, restricted resources, lack of visibility and poor health management. They add up to increase the burden of disease in the Nigerian woman, irrespective of age. We advise urgent implementation of heath policies and actions that will increase ratio of mental health professionals / number of patients, especially in rural areas and the establishment of proactive primary healthcare centres. Importantly, interventions targeting adolescents and adult women, and others specific to mother- child interactions, are strongly needed in Nigeria and the sub-region for mitigating dementia in women.
470 - Improving homeostatic systems and healthy longevity by intergenerational relationships: Evidences from a translational neuroscience approach
- Díaz-Del Cerro E, Ceprián N, Félix J, Gimenez-Llort L, De la Fuente M
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- International Psychogeriatrics / Volume 32 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 04 November 2020, p. 192
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The aging process is associated with a deterioration of the physiological systems, especially the homeostatic (nervous, immune and endocrine) systems with the consequent increase in morbidity and mortality. With the aging population, increasing number of studies focus on lifestyle interventions to slow down these aging derangements. Here, animal models can be useful to assess their long-term effects and potential value taking into advantage their shorter life span. In a previous work, old animals beneficed of 2 months of continuous cohabitation with adult, with improvements on behaviour, immune function and redox state as well as a higher longevity. However, their adult counterparts showed impairments in these parameters. In the present study, this social strategy was modified with the aim to improve the homeostatic systems in both the old and the adult animals.) Animals of the experimental group with “two old ICR-CD1 female mice cohabiting 15 minutes each day for 2 months with five adult mic” were studied and compared to adult and old controls. After this time, mice were submitted to a behavioural battery of tests to analyse their sensorimotor abilities, anxiety-like behaviours, and exploratory capacities. Peritoneal leukocytes were collected and several immune functions, oxidative and inflammatory stress parameters as well as catecholamine concentrations were assessed. When the adult mice reached old age the same parameters were again analysed. The life span of each animal was also recorded. Several mice of each group were sacrificed to obtain plasma and the hormone oxytocin was evaluated. The results show that old mice presented an improvement of behavioural capacities, immune functions and lower oxidative and inflammatory stress after the two months of social interaction with adult animals, and consequently they exhibited an extended life span. Adult mice, in general, did not show any changes after social interaction, but when they achieved old age an improvement of all the parameters studied and of longevity was observed in comparison with those mice that never had a social interaction with old animals. In conclusion, a short social interaction between old and adult individuals can be an excellent strategy for improving in both the health state and longevity.
Prevalence of ADHD in chronic fatigue syndrome
- N. Sáez Francàs, J. Alegre, N. Calvo Piñero, J.A. Ramos Quiroga, E. Ruiz, B. Olivares, E. García Gíménez, M. Casas
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- European Psychiatry / Volume 26 / Issue S2 / March 2011
- Published online by Cambridge University Press:
- 16 April 2020, p. 1574
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Introduction
Chronic Fatigue Syndrome (CFS) is characterized by severe fatigue associated with pain, sleep disturbance, attentional impairment and headaches. Evidence points towards a prominent role for Central Nervous System in its pathogenesis, and alterations in serotoninergic and dopaminergic neurotransmission have been described.
Attention-deficit Hyperactivity Disorder (ADHD) courses with inattention, impulsivity, and hyperactivity. It affects children and persists into adulthood in 50% of patients. Dopamine transporter abnormalities lead to impaired neurotransmission of catecholaminergic frontal-subcortical-cerebellar circuits.
ObjectivesTo describe the prevalence of ADHD in a sample of CFS patients, and the clinical implications of the association.
AimsTo study the relationship between CFS and ADHD.
MethodsThe initial sample consisted of 142 patients, of whom 9 were excluded because of severe psychopathology or incomplete evaluation. All the patients (age 49 ± 87; 94,7 women) received CFS diagnoses according to Fukuda criteria. ADHD was assessed with a diagnostic interview (CAADID), ADHD Rating Scale and the scale WURS, for childhood diagnose. The scales FIS-40, HAD, STAI and Pluthik Risk of Suicide (RS) were administrated.
Results38 patients (28,8%) were diagnosed of childhood ADHD (4 combined, 22 hyperactive-impulsive, 12 inattentive) and persisted into adulthood in 28 (21,1%; 5 combined, 4 hyperactive-impulsive, 19 inattentive). There were no differences in Fukuda criteria profile and FIS-40 between groups. ADHD patients scored higher in HAD-Anxiety (9,88 ± 4,82 vs. 12,57 ± 3,49; p = 0,007), HAD-Depression (9,69 ± 4,84 vs. 12,04 ± 4,53; p = 0,023), STAI-E (30,55 ± 14,53 vs. 38,41 ± 11,35; p = 0,012), and RS (6,13 ± 3,48 vs. 8,49 ± 3,07; p = 0,002).
ConclusionsADHD is frequent in CFS patients and it is associated with more severe clinical profile.