As we know antipsychotic drugs are associated with the presence of side effects thar impair adherence, the course of the disease and the patient's functionality. Besides drug efficacy, tolerability is a factor which we consider in the choice of treatment.

Descriptive cross-sectional study of inpatients between June and September 2014 in treatment with paliperidone and with any psychiatric diagnosis according to the diagnostic criteria Statistical Manual of Mental Disorders (DSM-IV). To evaluate the presence of side effects we use the UKU (Udvalg für Kliniske Undersogelser), which is a comprehensive measure of side effects of psychotropic drugs. It consist of 54 items grouped into psychological, neurological, autonomic and other symptoms.

18 patients (12 men and 6 women) were included. The average age was 37 years. 16 patients (88.8%) had a diagnosis of Tr. psychotic and 2 of them (11.1%) Tr. personality. 8 patients had started treatment with oral paliperdione two weeks before evaluation, while the remaining 10 patients had longer treatment (mean 9.4 months).

Symptoms found in the psychic area were astenia, lassitude, fatigability, decreased sleep duration and emotional indifference. No symptoms were described in the neurological area. Among the autonomic effects: increased sweating and inside the area “others”: decreased sexual desire, erectile dysfunction and weight loss. All of them were obtained as slight maximum score.

These data give us guidance on the tolerability profile of oral paliperidone short to medium term. The values obtained in the UKU scale indicate good tolerability of the treatment.

From last March 2011 until now we have implemented in our Acute Mental Health Unit the Law 42/30-12-2010. This law regulates the existence of free-smoke places.

We have collected the data of the smokers patients that began the process of detoxification. We evaluated their level of dependence (Fargestrom's test), their motivation to smoke and the abstinence syndrome intensity. At three months of their hospital discharge we measured the abstinence from smoking in these patients.

A total of 31 patients were assessed, 22 out of them were treated with patches of nicotine (14 men, 8 women) age range 18 -57 years; 9 out of 31 smokers patients did not use substitutive treatment (6 men, 3 women) age range 22 - 48 years.

At three months, only 2 patients kept the tobacco abstinence (6.4%) and another patient more had reduced the consumption approximately to the half. Six month later only one of them kept abstinent.

We understand the necessary promotion and the prevention of the physical health in our patients, avoiding the consumption of toxic substances as far as possible. It is crucial to improve the efficacy of the interventions aimed at to quit tobacco consumption.

However, the abandon of an addiction should have a fundamentally voluntary character. The addictions in our patients are chronic and recurrent, and they should be approached from a longitudinal perspective including in its treatment plan.

Cases of isoniazid-related psychiatric disordersreported in the literature include psychosis, obsessive–compulsive neurosisand mania. Tuberculosis is an endemic issue in our area; so much people receiveprophylactic treatment for tuberculosis. Pyridoxine deficiency may play a rolein the pathogenesis of isoniazid-induced psychosis. Such deficiency states maybe detected indirectly by measuring urinary metabolites of tryptophan.

We performeda retrospective analysis of those patients in the literature and we report acase of isoniazid-induced psychosis in a 42-year-old man with schizophrenia andalcohol dependence. He was abstinent during the last six months.

A 42-year-old man with schizophrenia, in full remission for the last twoyears, presented psychotic symptoms (delusions and hallucinations) suspected tobe related to prophylactic treatment with isoniazid after his brother testedpositive to a tuberculin test. The psychotic symptoms resolved completely afterisoniazid was discontinued. We didn´t change his treatment during the episode(Clopixol 200mg/21 days).

Clinicians should be aware of this adverseeffect of isoniazid and that it may present with a broad clinical picture. As aresult of our findings we coordinated a clinical session with others HospitalDepartments.

1. 1 Isoniazid-Induced Psychosis Ann Pharmacother September 1998 32: 889-891.

2. 2 Vallejo Ruiloba J, Leal Cercos C. Tratado de Psiquiatría. 20. ed. Barcelona: Ars Medica; 2010

“I watch death” it is an English mnemonic acronym for the myriad causes of Delirium. It characterizes for sudden onset, low consciousness, attention and cognition levels. Although its origin is because of different organic disorders, it is usually consulted to the mental health services because of its psychopatology. An early detection and the subjacent cause treatment are fundamental.

We performed a retrospective analysis of those patients visiting the Emergency Services and/or hospitalized in San Agustín's Hospital of Linares and being subsequently diagnosed of delirium by the liaison psychiatry team during the year 2011. We studied the following variables: medical diagnostic, sex, age, comorbidity and psychopatology, A follow-up of the patients was also done.

The 5% of 299 liaison psychiatry consultations corresponded to patients with delirium. Traumatology and General Medicine generated the 72% of the consultations to liaison psychiatry team. All patients were male, 50% of them were under 40 and older than 60 years. They had several comorbid factors such as polytraumatism, post-surgery, previous brain damage, ischemic heart disease, HIV, etc. The most widely used drug treatment for mental symptoms was low-dose of haloperidol, according to clinical guides evidence. A 25% of patients died within two weeks after the consultation to liaison psychiatry team despite treatment of the subjacent cause.

As a result of our findings we coordinated a clinical session with others Hospital Departments to improve clinical care for these patients in order to improve the early diagnostic and intervention.

The migration experience is a complex process that involves a break with the society of origin and an adaptation in the host society. This process involves cognitive and emotional aspects, both conscious and unconscious, of individuals. All of that with the culture and ethnicity influence the mental health of this population.

To observe and describe what these population groups require of mental health care.

Collect data (sex, age, place of origin, work activity, diagnosis, treatment) of immigrant patients referred from Primary Care or Specialty Care Hospital to the Community Mental Health Unit of the North of Granada from 2010 to 2013.

We identified differences between immigrant patients and the remaining patients: younger age (“working-age”), with unskilled labor activity or unemployed, higher prevalence of affective pathology major discontinuity and treatment dropout.

In these groups the prevalence of mental illness is similar to the rest of the population, however, they have limited access to medical services that may be related to increased frequency of disability, social cost and human suffering.

We should pay special attention to these ethnic minorities for a better care and monitoring of mental disorders.

The term, acute and transient psychosis, is comprehended as a heterogeneous group of disorders, which share, as a common feature, the abrupt and brief deployment of typical psychotic behaviour, either polymorph, delusional, or schizophreniform. This diversity of symptoms may also be present in other psychotic disorders, for which, some authors question its reliability.

To analyse the clinical manifestations present in acute and transient psychotic disorders (ATPD), and determine the differences between its different subcategories.

Retrospective chart review study of adult patients admitted in our psychiatric unit between 2011 and 2015, with a mean diagnosis of ATPD at hospital discharge. Diagnostic criteria was according to the International Classification of Diseases (ICD-10). Symptoms were divided under operative procedures, as set out in psychopatologic descriptions. For methodological reasons, statistical analysis was conducted between polymorphic features group (PM) and nonpolymorphic group (NPM). Chi-squared test and Fisher's exact test (as appropriate) were performed, using MedCalc software.

Thirty-nine patients met the inclusion criteria. Acute polymorphic psychotic disorder with and without symptoms of schizophrenia (39%), acute schizophrenia-like psychotic disorder (20%), acute predominantly delusional psychotic disorder (23%), other and NOS (18%). There were statistically significant differences between PM and NPM groups in emotional turmoil (>PM, P = 0.0006), grossly disorganized or abnormal motor behaviour (>PM, P = 0.0038), and type of onset (sudden >PM, P = 0.0145).

Currently, the same concept encompasses two categories (PM and NPM) to be differentiated. The ATPD construct is under review, due its long-term instability.

The authors have not supplied their declaration of competing interest.

Pathological gambling, as behavioural addiction, is always related with psychosocial important problems. In this case, everything is even more difficult due to grave mental disease associated, Paranoid Schizophrenia. Man, 26 years old, single. He was diagnosed of psychotic disease at the beginning due to his grave addiction to THC and others stimulant drugs. His outpatient treatment was complicated and he needed to be hospitalised once (being diagnosed of Schizophrenia). After that, he improved till he got a standardised job. He was able to have his medical treatment (Aripriprazol 15 mgs per day and Biperidene 4 mgs per day) although he kept his isolation. Then, the patient could talk about his pathological gambling. He suffered from slot machine addiction, and he also suffered from depression symptoms closely related to family and economic problems due to pathological gambling. This patient was in contemplation state and he accepted to start with antidepressant (Mirtazapine 15 mgs per day) and psychological treatment. We agreed to make a record of his gambling uses (with regular self-reports). His salary would be administered by his parents and he only could take a little money every week. The treatment was useful; it increased the capacity of economic self-management and the recovery of depression disease related.

In our opinion, he used gambling as filling a need for activity, and as a way of connecting with society/world. These findings suggest the need for improved prevention and treatment efforts related to problem/pathological gambling in individuals with psychotic disorders.

The authors have not supplied their declaration of competing interest.

From a historical perspective, the first data related to the placebo effect on “mental health” date to the 1950s decade, when evidence was first shown of the important percentage of people with a psychiatric pathology that benefited from the consumption of placebos. It is believed that the responses to placebos and nocebos are influenced by the content and the way of informing the patient, which influences in the quality of life and therapy adherence. Among the factors that influence the magnitude of the placebo effect, we find variables related to the patient, with the placebo itself and the therapist.

To determine the relationship between the clinical response of a placebo and the behavior and information on the placebo contributed by the health worker.

Systemic review of the articles published in Medline-PubMed from 2005 to the present.

Being kind, friendly, interested, nice, emphatic, and considerate as well as having a positive attitude toward the patient and the treatment as well as the expectations of the therapist are variables that are associated to a beneficial effect in a placebo situation as well as in active treatment.

The patient's expectations, a product of selective processing of the information that she/he receives about the effect of a placebo or active treatment, and the behavior of the health worker in clinical practice, produces variability in the symptomatic response through its influence on the magnitude of the placebo effect. In the bibliography reviewed, there is a marked lack of attention dedicated to clinical studies in the addressing of this phenomenon.

The authors have not supplied their declaration of competing interest.

In the recent decades, there is a growing interest in gender differences in psychotic disorders. Also, in the field of acute and transient psychosis, according to various studies, women seem to have higher prevalence and long-term diagnostic stability.

To determine whether there are gender differences in clinical features of acute and transient psychotic disorders (ATPD).

Descriptive cross-sectional study in the adult patients with ATPD were admitted between 2011 and 2015 in our acute psychiatric ward. Diagnostic criteria was according to the International Classification of Diseases (ICD-10). Descriptive and inferential statistic procedures for clinical symptoms and diagnostic subcategories were performed, using the MedCalc software, version 15.8.

Thirty-nine patients met the inclusion criteria. Males were (MG) 41%, females (FG) 59%. There were some statistically significant differences between gender in the polymorphic features group (>FG, P = 0.048), and in the presence of acute stress (>FG, P = 0.0277). Length of stay was also different, but without statistical significance (>MG, P = 0.0607). In contrast, symptomatic sets, family history of psychosis, and type of onset (sudden or acute) were similar for both groups.

The gender differences seem to be in favour of a higher prevalence of polymorphic psychotic symptoms, in relation to stressful events in women. Somehow, these factors could be a condition, which would determine a greater diagnostic stability in female patients, even in cases of recurrences.

The authors have not supplied their declaration of competing interest.

To evaluate factors of therapeutic efficacy of paliperidone palmitate, such as the speed of action and its maintenance in patients who experienced a first psychotic episode that led to a hospital admission in the acute unit.

Two-year observational and descriptive study. Patients admitted to the Mental Health Hospital Unit (MHHU) from January 2013 to July 2014, with a first psychotic episode and under paliperidone palmitate treatment. Monitoring and evaluation six months after hospital discharge. They were evaluated using the PANSS and BPRS scales at four different time points of the evolutionary process.

Average scores of the BPRS scale: 39 on admission day, 27 on day of discharge, 23 on the third month and 20 on the sixth month. Average score of PANSS scale: PANSS-PG: 64 on admission day, 48 on day of discharge, 25 on the 3rd month, and 20 on the 6th month. PANSS-P: 41 on admission day, 21 on day of discharge, 12 on the 3rd month, and 10 on the 6th month. PANSS-N: 21 on admission, 11 at discharge, 8 on 3rd month and 7 on 6th month. No clinically significant side effects were observed that would lead to the modification of the doses or the abandonment of the treatment in this period.

The results of this observational study show that the start of the treatment with PAP is associated with an observable clinical response on the 4th day. The evaluation scales at the 3rd and 6th months also suggest the maintenance of efficacy of the treatment.

The authors have not supplied their declaration of competing interest.

Involuntary outpatient treatment (IOT) is a type of non-voluntary treatment applied in the community, which tries to ensure the therapeutic compliance of patients that have a severe mental illness.

In Spain, a specific legal regulation about this matter does not exist; however, it is a fact in clinical practice. The application of IOT is not without controversy, with advocates, who consider it a way of achieving therapeutic compliance, and detractors, who think it is an infringement of the fundamental rights of a person.

An evaluation of the knowledge on IOT in Spain. Analyze the four ethical principles found in this treatment.

The protection of the patient is encompassed in the principle of beneficence. And how could we combine this with the principle of autonomy? The answer should be individualized and based on a determined disorder. Starting with non-maleficence, we ask if IOT would provoke a rejection so that the patient would distance himself further from the therapeutic environment. As for the principle of justice, the high cost by patients that do not comply with the treatment would be diminished if we are able to have them follow the treatment with higher effectiveness. This would allow a greater number of patients to access these resources.

The proposal of IOT should be preceded by a deliberative process. This process should include a psychiatric diagnosis that includes not only psychiatric aspects, but psychological, familial and social as well. This would compel us to create a personalized design of the therapeutic needs of each patient.

The authors have not supplied their declaration of competing interest.

The total costs of schizophrenia increased to 2576 million Euros in 2013 in Spain, or 2.7% of the annual cost of health services. The hospitalizations, along with other intermediate resources, such as Day Hospital, etc., significantly contribute to the increase of economic burden. In Spain, the average hospital stay of schizophrenic patients is 18.24 days, totalling to an average cost of 6,753 Euros/patient (370.23 Euros/patient/day).

The sample selected included patients from both sexes, aged between 18 and 65 years old, with diagnostic criteria of schizophrenia (according to DSM-IV and ICD-10), admitted in the Mental Health Hospital Unit (MHHU), Úbeda between 2012 and 2013, with registered visits of at least 2 outpatient visits or 1 hospitalization related to the schizophrenia diagnosis (n = 48).

After the start of treatment with the injectable antipsychotic drug of prolonged duration, the number of patients that required hospitalization for any psychiatric motive went from 24 patients (49.7%) to 11 patients (22.4%; P < 0.001). The patients who started treatment with PAP during hospitalization had an average stay of 15.7 days, as compared to 18.24 days of average hospital stay due to schizophrenia in Spain. The direct costs of hospitalization stays due to psychiatric reasons decreased from 162,071.88 Euros to 74,282.95 Euros (P < 0.001).

This observational study shows us that the treatment with PAP reduced the average length of the hospital stay, and resulted in a decreased percentage of re-admissions as compared to oral treatments for schizophrenia. These data led to savings of more than 50% of the direct costs of hospitalization.

The authors have not supplied their declaration of competing interest.

The use of PAP is already much extended in general. The recommended doses in the technical specifications of the drugs, as the result of trial studies, differ from the doses administered in habitual clinical practice. Therefore, the justification of this study is to monitor the average doses prescribed, to be able to reach an agreement on the best doses. To retrospectively analyze the first 32 patients in our area of healthcare, who were prescribed PAP, the doses used at the start of treatment and after 3 years.

Two initial doses of PAP were analyzed, maximum and current (outpatient) in 32 patients attended in the area of mental health of North Jaen, who started the treatment with PAP between 2012 and 2013, with an average length of time of 2.55 years (SD 2.02). We evaluated the diagnosis (schizophrenia and related disorders, ICD-10 F20), the number of hospital admissions previous and posterior to the start of the treatment and change in weight.

Average doses: initial: 110.15 mg (SD 32.83), maximum: 165.51 mg (SD 29.76) and maintenance: 146.81 mg (SD 29.59). Average hospital admissions: prior and posterior to the start of treatment: 1.5 and 0.83. An average reduction of 44.06% in admissions was observed.

The data obtained suggests that a dose of 75–200 mg could be effective in the maintenance of patients with schizophrenia and for decreasing the number of new hospital admissions. Fifty percent of the cases can be compensated with long acting peliperidone as a monotherapy.

The authors have not supplied their declaration of competing interest.

The validity and diagnostic stability of acute and transient psychotic disorder (ATPD) has been questioned by several authors, since its introduction in the International Statistical Classification of Diseases (ICD-10).

To determine the overall diagnostic stability of ATPD in scientific literature.

A systematic review and meta-analysis of prospective studies and retrospective chart reviews. Computerized search was performed in MEDLINE/PubMed, EMBASE, and Google Scholar, using the terms: “acute and transient psychotic disorder”, or “acute psychosis”, and “stability”, or “outcome”, or “long-term”, or “follow-up”, or “course”. Search was restricted to works in English published between 1993 and 2015, according to ICD-10 criteria. Opinion articles, individual case reports, researches with less than ten subjects, and overlapping studies were excluded. Data analysis was conducted using MedCalc software, version 15.8. Statistical procedure was calculated for meta-analysis of proportions.

Twenty-six studies met the inclusion criteria (n = 10852). For methodological purposes, a distinction was made between short-term (less than 2 years), medium-term (between 2–7 years), and long-term stability (more than 7 years). For short-term group (k = 5), the overall stability was 60.69% (fixed effects model); Cochran's heterogeneity statistic Q = 14.9, I2 = 73.15%, P = 0.0049. For medium-term group (k = 15), it was 49.99%; Q = 181.6, I2 = 92.29%, P < 0.0001. For long-term group (k = 6), it was 61.86%; Q = 35.12, I2 = 92.29%, P < 0.0001.

The global stability of ATPD indicates at the validity of the construct, but should be redefined in future revisions of ICD, to clarify better diagnostic criteria, and more predictive power.

The authors have not supplied their declaration of competing interest.