In 1990, Latin American countries committed to psychiatric reforms including psychiatric bed removals. Aim of the study was to quantify changes in psychiatric bed numbers and prison population rates after the initiation of psychiatric reforms in Latin America.

We searched primary sources to collect numbers of psychiatric beds and prison population rates across Latin America between the years 1991 and 2017. Changes of psychiatric bed numbers were compared against trends of incarceration rates and tested for associations using fixed-effects regression of panel data. Economic variables were used as covariates. Reliable data were obtained from 17 Latin American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Guatemala, Mexico, Nicaragua, Panama, Paraguay, Peru, El Salvador, Uruguay and Venezuela.

The number of psychiatric beds decreased in 15 out of 17 Latin American countries (median −35%) since 1991. Our findings indicate the total removal of 69 415 psychiatric beds. The prison population increased in all countries (median +181%). Panel data regression analyses showed a significant inverse relationship −2.70 (95% CI −4.28 to −1.11; p = 0.002) indicating that prison populations increased more when and where more psychiatric beds were removed. This relationship held up when introducing per capita income and income inequality as covariates −2.37 (95% CI −3.95 to −0.8; p = 0.006).

Important numbers of psychiatric beds have been removed in Latin America. Removals of psychiatric beds were related to increasing incarceration rates. Minimum numbers of psychiatric beds need to be defined and addressed in national policies.

The aim of this prospective study was to determine the efficacy of DBS using several targets in a pharmacoresistant OCD population with heterogeneous symptoms.

Five patients (3 males) have been included in the study. Patients were classified according to their prominent features as follows: contamination/cleaning, symmetry/checking, exactness/counting and forbidden thoughts.

The entire surgical procedure was performed under general anaesthesia. Direct targeting based on stereotactic MRI without microelectrode recordings was done. A combination of two of the following targets was simultaneously implanted for all patients: subthalamic nucleus, accumbens nucleus and bed nucleus of stria terminalis, limbic globus pallidus internus.

Patients were assessed pre-and postoperatively using the Yale-Brown Obsessive Compulsive Scale.

Mean age at surgery was of 42.6±12.68 years. Mean follow-up with DBS was of 21±14.88 months.

Mean preoperative Y-BOCS scores was 31.6±2.70 and of 11±7.97 (p=0,057, Wilcoxon signed Rank test).

Subthalamic nucleus and accumbens nucleus targets seem to be comparable in alleviating several subtypes of compulsions (checking, cleaning, counting) as well as obsessions. Further investigations are required to assess the role of limbic globus pallidus in improving pharmacoresitant OCD. Implanted system was well accepted without triggering new obsessions.

Present study shows the socio-demographic and clinical profile of patients with severe mental illness in Mancha Centro health area. Furthermore, it is a descriptive approach to the current state of clinical assistance in the area.

Socio-demographic and clinical variables were collected in a sample of 55 patients, 37 men and 18 women with severe mental illness, treated at the Mancha Centro Mental Health Centre. Using SPSS.15, analysis of qualitative and quantitative variables was made.

Average age was 39, 25 years +/− 8, 82; 72, 7% lived with their families and 85, 5% had the support of relatives. Main diagnosis were: psychotic disorder (81,2%) with high proportion of schizoaffective disorder; mood disorders (9,1%), personality disorders (5,5%) and OCD (3,6%). In the last two years, 25, 5% was admitted in a medium-stay psychiatric unit, 15% in a short- time stay psychiatric unit and, in the last six months, 4% came to emergency service. Patients with higher number of admissions and emergency consultations were those with schizophrenia and schizoaffective disorder. The average time of follow up was 10 years (+/− 6, 84), every 49, 45 days (+/− 19,1). 80% receive group therapy, 85,5% family intervention and 54,5% cognitive rehabilitation.

We found a profile of young man with significant family support, low number of admissions and emergency consultations. Results could be in relation to: geographical dispersion, emergency access difficulties and protective socio-cultural factors. Better knowledge about needs would allow a better assistance in the future.

To expose from the clinical and welfare expectation, the experience with injectable Risperidona of long duration with three cases clinical whose principal diagnosis is of Mental Delay Moderated with alteration of the associate behavior.

I marry 1: 14-year-old Teenager of age attended in our CSM for Mental Delay and Disorder of conduct to familiar and school level.

CI = 50. It has received diverse antipsychotic and stabilizing treatments of oral form being the discontinuous capture. For one year in treatment with injectable Risperidona 50 mgr/14 days, answering favorably to the treatment, diminishing the conducts heteroagresivas that he was presenting to the beginning.

I marry 2: 15-year-old Teenager of age late Mental and disorder of the disturbing behavior with episodes d excitation, irritability and loss of control.

Not clinical stabilization with oral treatment for lack of familiar adherence. We introduce injectable Risperidona, 7,5 mgr/14 days, pupil to the family to mint of the importance of the treatment and the facility of administration. It improved the adherence to the center and therefore, clinical improvement.

I marry 3: Preadolescente and 13 years and age with compatible symptoms late Mental Moderates do and autistic features with important estereotipias and autoaggressions. For a few months in treatment with Risperidona inyecable 37,5 mgr/14 days with clinical improvement.

Cognitive strategies have received considerable attention in the field of pain management, together with more traditional approaches based on physical interventions and behavior modification. Distraction is a technique that lately has been often studied.

Distraction is based on an individual's limited attention capacity; it diminishes attention aimed to a painful stimulus with a subsequent pain reduction (Wismeijer & Vingerhoets, 2005).

To study the effect of VR as a distraction technique in an experimental pain task.

37 healthy participants were induced pain through two consecutive immersions using the cold-pressor test. All participants went through two experimental conditions: VR and black screen. The order of conditions was counterbalanced and a design of repetitive measures was used.

A virtual environment “Surreal World” was developed based on distraction techniques designed to surprise participants. The effect of VR as a distraction technique was evaluated using objective measures of pain (threshold, tolerance, pain intensity and time estimation) and other cognitive measures (self-efficacy and catastrophic thinking in vivo).

VR significantly decreased tolerance and pain intensity, influenced participants to underestimate the length of immersion. A higher self-efficacy in VR and a lower rumination and helplessness were registered in the pain experience. Thus, VR may help improve the efficacy of cognitive strategies.

The study shows the relevance of VR as an adjunctive method in the treatment of acute pain and allows studying its efficacy in patients with chronic pain.

Antipsychotic therapy is the cornerstone of the treatment of schizophrenia and other psychoses. Although clinical guidelines tend to recommend the use of antipsychotics in monotherapy, combination of two or more antipsychotics (that is, polytherapy) is a common habit in clinical practice.

To assess differences in antipsychotic combination profile between patients with schizophrenia and patients with other psychoses.

A total of 241 patients (40.2% females, mean age 39.7+/−13.0 years) consecutively admitted during 2009 to a psychiatric inpatient ward with diagnosis of schizophrenia and other psychoses were assessed.

145 (60.2%) patients were diagnosed with schizophrenia while 96 patients (39.8%) were diagnosed with other psychoses (schizoaffective disorder n = 35, delusional disorder n = 8, schizophreniform disorder n = 8, brief psychotic disorder n = 13, psychotic disorder not otherwise specified n = 27, and other psychoses n = 5). Out of the total sample, polytherapy was used in 150 (62.2%) patients. A total of 100 (69.0%) patients with schizophrenia were on polytherapy, compared to 52.1% of those with other psychoses (p = 0.008). After controlling for age and gender, the association between a diagnosis of schizophrenia and being in polytherapy remained significant (p = 0.046).

Patients diagnosed with schizophrenia are more prone to be in polytherapy than those with other psychoses.

Partial or non-adherence to medication is high amongst patients with schizophrenia. Rates of non-adherence of up to 72% have being reported depending on the method used and the patient population. Adherence is essential for optimal long-term patient outcomes in schizophrenia and failure to adhere to medication can have a major impact on the course of illness and treatment outcomes.

The objective of the EMEA (Europe, Middle east and Africa) ADHES survey was to collect psychiatrist's perceptions of the assessment, reasons and management of partial and non-adherence to medication.

The aim of this poster is to present psychiatrist's perceptions collected in the EMEA ADHES survey.

The survey was devised to ascertain psychiatrists’ preferred methods of assessing adherence, their perceptions of the level of adherence, reasons for non-adherence and on strategies to improve adherence.

Psychiatrists estimated that during the previous month more than half of their patients (53%) were partially or non-adherent. They estimated that as few as a third of patients who deteriorated after stopping medication was able to attribute this to their non-adherence. 76% of psychiatrists assessed adherence most frequently by asking their patient explicitly. Use of long-acting treatment was the preferred choice to address adherence problems for 62% of respondents.

This EMEA-wide survey illustrates that while respondents recognised the relevance and importance of partial and non-adherence to medication, there remains a need for more proactive management of treatment adherence of patients with schizophrenia to reduce the frequency and consequences of relapse.

Electroconvulsive Therapy (ECT) is a safe and effective technique widely used in our area. Scientific literature related to the application of this technique is continuously developing, specifically with regard to the placement of the electrodes, the amplitude of the stimulus pulse administered, the initial charge used, and the anesthetic agent involved.

The primary aim of this study was to analyze technical variables associated with the use of ECT in our hospital, and compare them to the guidelines of the protocol developed in our hospital and international standards.

We performed a review of Clinical Histories of the patients that were treated with ECT in the “Hospital 12 de Octubre” (Madrid, Spain), in the period comprised between January 1st, 2008 and December 31st, 2009. We collected data related to the application of the technique, socio-demographic variables and clinical profiles. We used descriptive statistics to analyze our data.

During this period, 602 ECT sessions were applied. Placement of the electrodes was unilateral in 58% of subjects with Affective Disorders and 8% of subjects with Schizophrenia. The amplitude of the stimulus pulse was 1 ms. Mean charge administered in the initial and final session was 236.85 mC and 357.16 mC, respectively. Etomidate was used as anesthetic in 68% of cases.

ECT technical variables applied in our hospital are adjusted to guidelines of our area and international recommendations. Longitudinal studies are warranted in order to objectively assess techinical variables associated to ECT.

Andalusia is the most highly populated (7,849,799 hab.) region of the Spanish State. It has all the sanitary domains under its own Health Service (Consejería de Salud), and it has undertaken a deep reorganization of the psychiatric services, establishing a new model based on the mental health communitarian alternative that is already completely implanted. Rates of readmission are a method to assess the quality of care and an important tool in the planning of services of mental health.

The aim of this study is to establish if readmission rates are influenced by Human Resources in Psychiatric Community Devices.

Part of FIS Project PI05/90061 ‘Patterns of General Hospital Psychiatric Units Overuse’.

MBDS is a system of hospital register that gathers all the discharges produced in the andalusian hospitals. It is totally trustworthy from 1995, and we have processed data up to 2004.

Our Data Set register 101234 hospital admissions of psychiatric patients.

The number of admissions from patients who enter three times or more throughout the year has been: 22.66%(1995); 24.66% (1996); 31.01%(1997); 30.72%(1998); 34.07%(1999); 35.35%(2000); 36.92%(2001); 32.93%(2002); 31.20%(2003) and 29.36%(2004).

On the other hand, it has been an increase in Mental Health Human Resources Rates: 24.23-100.000 inhab-(1998); 24.19 (1999); 26.01(2000); 28.04(2001); 29.83(2002); 29.16(2003); 29.34(2004) and 29.90(2005).

Increasing human resources in psychiatric community devices do not change revolving-door rates in general hospital acute psychiatric units in a community mental health system.

Partial or non-adherence to medication is high amongst patients with schizophrenia. Many and often overlapping factors are considered to impact on treatment adherence, including: patient-related (lack of insight, psychotic, negative or cognitive symptoms), treatment-related (adverse effects, insufficient efficacy), environmental (living situation, negative attitudes of relatives/friends), and physician-related (patient-healthcare professionals relationship) factors.

The objective of the ADHES EMEA (Europe, Middle East and Africa) survey was to collect psychiatrist's perceptions of the assessment, reasons and management of partial and non-adherence to medication.

To present psychiatrist's opinion through EMEA of potential reasons for partial or non-adherence

The ADHES survey comprised 20 questions and was conducted in 36 countries across EMEA (over 4500 psychiatrists treating patients with schizophrenia).

Across EMEA 37% of psychiatrists viewed lack of insight as the most important reason for their patients stopping medication. 23% of psychiatrists viewed patient's feeling better and thinking it unnecessary to take medication as the most important reason for their patients stopping medication. 7% or less of psychiatrists viewed undesirable side effects, insufficient efficacy, cognitive impairment or drug/alcohol abuse as the most important reasons for their patients stopping medication.

In this survey, psychiatrists estimated that patient’s lack of insight and subjective improvement could constitute the main factors explaining poor adherence. Other factors (i.e., side effects, substance abuse) were regarded as less important. Strategies aimed at raising awareness of maintaining treatment, are warranted within EMEA, with the aim of improving clinical outcomes.

Comorbidity has been defined as the coexistence of somatic and psychiatric diseases with diferent physiopatology in the same person, and it can appear simultaneously to the schizophrenia or during the patient's lifetime. There are two types of comorbidity: episodical or taking place during the lifetime of the patient. We can diffferenciate between comorbidity itself (in cluster, dependent or associated) to the so-called pseudo-comorbidity. Besides, comorbidity has been classified as a co-syndrome and it is considered a prognosis indicator of this disease, which can determine an increase in the rates related to relapses, worse response to treatment, less capacity to cope with social situations, and suicide in patients suffering from schizophrenia.

177 schizophrenic patients were assessed for affective symptoms and suicide behaviour. 24.3% were suffered for depression. 35% had a previous record of autolytic attempts. The rate of suicide history were higher among depressed schizophrenics (50%) than non-depressed schizophrenics (20%) (p<0,05).

We point out the clinic importance of suicide in schizophrenic patients suffering from depression. Moreover, the study shows the necessity to carry out longitudinal studies to recognize indicators of depression in advance and establish the diagnosis of depression, and, also, to acknowledge the importance of the gender factor in the depression of schizophrenic patients.

Rates of non-adherence of up to 72% have being reported, in schizophrenia, depending on the method used and the patient population. Rates of approximately 59% over 1 year have been reported for individuals with a first episode. Patients who stop medication are almost five times more likely to experience relapse than adherent patients. Failure to adhere to medication can have a major impact on the course of illness and treatment outcomes.

The EMEA (Europe, Middle East and Africa) ADHES schizophrenia survey was a survey of psychiatrists across the region, treating patients with schizophrenia, designed to canvas their perceptions of assessment, potential reasons and management for partial or non-adherence to medication amongst their patients.

To present methodology and demographics of the EMEA ADHES survey in schizophrenia.

The EMEA ADHES survey comprised 20 questions and was conducted in 36 countries across EMEA. In addition to recording the gender, age and practice setting of the respondents, questions related directly to the issue of partial-/non-adherence in patients with schizophrenia.

The survey was conducted amongst psychiatrists (including neurologists with psychiatric background in Germany) from January - March 2010. Results were obtained from 4722 respondents. Psychiatrists perceived that during the previous month more than half of their patients (53%) were partially or non-adherent across all EMEA regions

The EMEA ADHES schizophrenia survey is a large and geographically broad survey providing insight on psychiatrists’ perceptions of the assessment, causes and management of partial and non-adherence to medication.

El following work tries to show the difficulty of adherence to the treatment of our patients and the factors that influence the same one.

To establish an alliance terapeútica in a patient with diagnosis of paranoid Esuizofrenia submitted to dialysis with void conscience of disease.

Secondary chronicle treats itself about a 49-year-old male diagnosed of paranoid Schizophrenia with a renal disease to a chronic familiar GN in phase V in dialysis nowadays. He does not arouse of mental illness.

Renal chronic insufficiency in daily dialysis. Badly TA’s control and irregular follow-up of the diet. From Nefrología’s consultation they request interconsultation and psychiatric treatment.It is sent for nefróloga for valuation of pharmacological treatment by the aim to improve the adherence to his dialysis. From the first moment it considers to work together with nefrología to adapt treatment, being the mediating one the sister-in-law. We initiate treatment with paliperidona 3mgr/día. We remind that it of the nefróloga every day on having come to dialysis. Later we initiate treatment with injectable Risperidona of long duration 25mgr/14 days in increasing dose up to 75mgr/14días with good response.

Though it keeps small conscience of presenting a mental illness, he accepts the treatment, improving both the psychotic symptomatology and the acceptance of his physical ailments.

The multidisciplinary attention in the psychiatric patient and especially in the mental serious patient it is fundamental to obtain a good alliance and adherence to the treatment, and therefore to improve the forecast.

Attention plays an important rol in pain perception. Focusing attention in pain intensifies the painful experience whereas distraction may decrease its subjective sensation (Eccleston & Crombez, 1999).The purpose of the two studies is to establish the efficacy of distraction by means of VR in the control and reduction of pain using the cold-pressor test. In both studies threshold, tolerance, perceived pain intensity and time estimation were measured.

37 healthy participants were induced pain in two consecutive immersions using the cold-pressor test. The experiment was counterbalanced and all participants went through two experimental conditions: VR (stereoscopic screen) and black screen. A virtual environment “Surreal World” was designed based on distraction of attention techniques. Results showed that VR significantly increased threshold and tolerance, diminished pain intensity and perception of time.

35 healthy participants underwent two consecutive immersions using cold pressor: VR (using the updated version of Surreal World and 3D laptops) and black screen. VR significantly increased the threshold and tolerance, whereas variations in the estimation of time were barely significant.

Differences in the results of the two studies could be accounted for by the immersive effect of the stereoscopic screen. Findings are discussed in relation to previous studies on VR and pain. Results support VR as an adjunctive method in pain treatment and allow proving its efficacy in patients with chronic pain.

Substance-induced psychoses (SIP) are associated with greater conjugal ties, greater substance dependence, homelessness, parental substance abuse, poorer family support and visual hallucinations, while primary psychotic disorders (PP) have greater symptom severity.

To describe differential characteristics between PP and SIP in a dual diagnosis unit.

We collected sociodemographic, employment data, admission reasons, family substance abuse and main drug of abuse.

• • 23 patients were admitted with psychosis (87% males; mean age 35,6±10,1). Two groups were performed: PP (N=12) and SIP (N=11).

• • Mean length of admission was 17,78±13,17 days. Most prevalent co-occurrent diagnoses were psychotic disorders-cocaine use disorders (43,5%).

• • The only significant difference between PP and SIP was shorter length of admission in SIP (days: mean [s.d]) (26,6±14,9 vs. 13,8±7,5; p< 0.05). Other variables studied were: (1) main reasons for admission: hallucinations/delusions (33,3% vs. 90,9%), suicide ideation (33,3% vs. 0%); (2) main drug of abuse: cocaine (50% vs. 45,5%), alcohol (33,3% vs. 0%), psychoestimulants (0% vs. 27,3%), cannabis (8,3% vs. 18,2%); (3) marital status: married/cohabiting (25% vs. 36,4%), divorced (16,7% vs. 0%), single (58,3% vs. 63,6%); (4) employment: employed (33,3% vs. 50%) and unemployed (66,7% vs. 50%); (5) age, years: mean (s.d): 37,8 (10,6) vs 33,2 (9,5); (6) parental substance abuse (65,7% vs. 83,3%).

• • No significant differences were found between both groups (PP vs. SIP) except for shorter length of admission in SIP.

• • The most frequent co-ocurrent diagnosis was psychotic disorder+cocaine use disorder.

Substance-induced psychoses (SIP) are associated with greater conjugal ties, greater substance dependence, homelessness, parental substance abuse, poorer family support and visual hallucinations, while primary psychotic disorders (PP) have greater symptom severity.

To describe differential characteristics between PP and SIP in a dual diagnosis unit.

We collected sociodemographic, employment data, admission reasons, family substance abuse and main drug of abuse.

• • 23 patients were admitted with psychosis (87% males; mean age 35,6±10,1). Two groups were performed: PP (N=12) and SIP (N=11).

• • Mean length of admission was 17,78±13,17 days. Most prevalent co-occurrent diagnoses were psychotic disorders-cocaine use disorders (43,5%).

• • The only significant difference between PP and SIP was shorter length of admission in SIP (days: mean [s.d]) (26,6±14,9 vs. 13,8±7,5; p< 0.05). Other variables studied were: (1) main reasons for admission: hallucinations/delusions (33,3% vs. 90,9%), suicide ideation (33,3% vs. 0%); (2) main drug of abuse: cocaine (50% vs. 45,5%), alcohol (33,3% vs. 0%), psychoestimulants (0% vs. 27,3%), cannabis (8,3% vs. 18,2%); (3) marital status: married/cohabiting (25% vs. 36,4%), divorced (16,7% vs. 0%), single (58,3% vs. 63,6%); (4) employment: employed (33,3% vs. 50%) and unemployed (66,7% vs. 50%); (5) age, years: mean (s.d): 37,8 (10,6) vs 33,2 (9,5); (6) parental substance abuse (65,7% vs. 83,3%).

• • No significant differences were found between both groups (PP vs. SIP) except for shorter length of admission in SIP.

• • The most frequent co-ocurrent diagnosis was psychotic disorder+cocaine use disorder.