In Spain, consumption of psychotropic drugs is high and benzodiazepines represent 74% of the total. His prescription in primary care is very common and their use continues to grow. They are safe and effective drugs, but patients with prolonged use are elaborating the most adverse effects, particularly the dependency.

Descriptive ans cross-sectional.

Primary Health Care.

We seleted 202 patients treated with benzodiazepines, consecutive sample, belonging to the health center Los Barrio who were seen in consultation during 2009.

We conducted through a questionnaire that cointained the treatment and demographic characteristics.

We detect a frequency of use of benzodiazepines 9% (95% CI 4,7-12,1%). The profile of the consumer responds to middle-aged woman, with primary and housewives. Somatic diseases were associated in 72.6% (CI 67,2-77,5%) and had mental pathology at 59.7% (CI 53,9-65,3%). 35% (95% 29,6-40,6%) of prescribed benzodiazepines were clorazape dipotassium. Consumption was constant for over a year. The prescription from primary care represents 81% (95% 76,3-85,4%) and in 65% (CI 59,3-70,3%) is associated with other psychoactive drug.

In our area, highlights the prescription of benzodiazepines from primary care on demand and consumption during prolonged time. Interventions should be conducted on the prescription of benzodiazepines in medical and other interventions for patient support.

Pegylated-interferon (pegIFN) plus ribavirin (RBV) is for the moment the licensed therapy for chronic hepatitis C. Neuropsychiatric symptoms are frequent side effects due to the treatment with pegIFN, registered in 30 to 80% of instances, with mood rather than psychotic disorders usually observed.

A manic profile with psychotic symptoms in a HCV infected patient receiving pegIFN-RBV is presented to discuss management strategies and outcome.

A 47 year-old male patient, former IDU and alcohol abuser, without past psychiatric history, was under therapy for chronic hepatitis C (genotype 1a, HCV-RNA 6.2 log IU/mL, Child A5). After 14 weeks of pegIFN-RBV treatment the patient attends ER with insomnia, uneasiness, expansive mood, irritability, extravagant and disinhibited behaviour, and detrimental and self-referential delusion.

The patient was admitted at the Psychiatric Unit to receive amisulpride (400 mg/12h) plus lorazepam (1 mg/8h), with psychotic symptoms regressing over following days. It was agreed that psychotropic drugs would be maintained at the same doses until the end pegIFN-RBV therapy, intended for 48 weeks.

Antipsychotic therapy may be effective and allows VHC infected patients with manic symptoms related to pegIFN-RBV therapy to continue their treatment.

The convenience of a dimensional Axis II in the DSM-5 has been discussed, since there is criticism about the current categorical model, such as the high comorbidity or the scarce interrater agreement. Some think that those flaws could be attributed to the lack of an underlying theoretical model. To this respect, there are evidences that show that the personality disorders could be considered as extreme cases of normal personality traits. We try to find out if the factor analysis of a personality disorder scale (MCMI-III) reflects normal personality factors.

Participants and procedure: we analyzed the MCMI-III (Millon, 1998) profiles of 50 Personality Disorders patients and 50 controls. Principal Components Factor Analyses with varimax rotation were computed globally and separately for each sample.

A three factor structure (paranoid introversion, self control and insecurity) was found when analyzing both samples together. The separated samples analysis showed the same structure in controls, while in patients we found a three factor structure: neurotic introversion, hostility and self control. Both structures were basically equivalent, and differences among them could be qualified by a test bias (namely, higher averages for patients in the anxious and psychotic-like disorders).

Factor structures did not reflect the DSM-IV cluster division, and neither did it reflect Millon's classification. Conversely, the factors we found were consistent with personality traits previously described by normal personality models (e.g.: Cattell, 1957; Costa y McCrae, 1990; Eysenck, 1981).

A critical review of current models of clinical staging of depressive disorders and their potential contribution to routine clinical practice will be presented.

The main objective was to establish the correlation between the clinical staging model proposed by Hetrick and McGorry (modified by our group) with the severity of depression, the associated disability and the treatment resistance degree.

It is a descriptive cross-sectional study carried out in a sample of 135 patients, 15 or more years old, with a diagnosis of DSM-IV-Major Depression (single or recurrent episode) that were in contact with the outpatient and inpatient Units of the Institute of Psychiatry of the San Carlos Clínico Hospital in Madrid. Socio-demographic and clinical variables were collected: diagnosis, global impression of illness, severity of depressive symptoms, functionality and disability degrees and resistanceto treatment.

In spite the sample size limitations, it can clearly note that clinical stage model correlates in a statistically significant way with the scores of the Clinical Global Impression (CGI), and especially with the Global Assessment of Function (GAF) and the resistance to treatment degree.

We will discuss the utility of clinical staging model in the clinical practice and the interest to study the correlations between this proposed model and the established biomarkers of Major Depression.

Suicide is a major public health problem, especially in young people. It is one of the most significant causes of mortality and potential years of life lost. Medical students are a vulnerable group presenting mental health problems.

To study the prevalence of common mental illnesses among medical students from the university of Valladolid in order to assess the need for intervention programs.

Cross-sectional study in which, 584 students participated during the academic year 2015–2016 by completing an online self-administered questionnaire. Mental health outcomes were measured by different batteries of depression, anxiety and suicide (BDI, GAD-7 and MINI). Information about possible related risk factors was also obtained. Statistical Chi2 and Student t-tests were applied to estimate associations between socio-demographic, socioeconomic data and clinical results.

We found a prevalence of 15.8% for depression, 11.6% for ideation suicide and 38.5% for anxiety, with gender differences in the latter case. Prevalence rates were higher than those described in general population. Compared to other international studies, prevalence estimates were also higher among our sample.

This study shows for the first time data of these three psychiatric disorders among medical students in Spain. It suggests the urge to implementing preventive activities to alleviate maladaptive behaviors, academic stress, improve the quality of life and adaptation of students to college life. Larger, prospective, multicentre studies are needed to draw conclusions about the causes and consequences of students’ stress, since evidence shows that mental health problems are perpetuated throughout professional performance.

The authors have not supplied their declaration of competing interest.

The pathophysiology of psychosis is not fully discovered yet. However, during the last years many different risk factors are shown to prove to have a strong influence within the development of this pathology. Traumatic brain injury (TBI) is one of them.

Show TBI as a psychosis development risk factor.

Case report. A clinical vignette is presented followed by the results obtained in a bibliographic review.

A young 19-year old immigrant man, who lives with his parents in a social exclusion situation is brought to the hospital after having been observed making estrange religious rituals within a local river. During the anamnese he declares that God is “getting in touch with him” while he shows to be changed, with suspicion about being pursued. He also reveals to have suffered a mild-severe TBI with 8 years, having right ear audition problems since then. During the hospitalization some medical test were done, such as MRI, showing the lack of the inner right ear, as well as white matter abnormalities in his right hemisphere, which could be consequence of the TBI. Those findings make us think that this pathology might have been influenced, within other factors, by the traumatic brain injury.

This bibliographic review shows that traumatic brain injury may increase the risk of developing psychosis up to 65% from healthy controls, with a medium gap of 3.3 years between the TBI and the appearance of psychotic pathology.

The authors have not supplied their declaration of competing interest.

Alcoholic hallucinosis is a rare complication of chronic alcohol abuse, characterized by acoustic verbal hallucinations and delusions, mainly of a menacing content, arising in clear consciousness, that appear during or shortly after a period of heavy alcohol consumption.

To outline the key clinical features of alcoholic hallucinosis in order to improve differential diagnosis with other entities.

We studied the evolution of an outpatient followed in a Mental Health Centre of Valladolid and compared it with present data about the condition, found in a bibliographic search of articles no older than 10 years about the topic.

Partial insight about the experience, along with clear consciousness, was key to discard other psychiatric diagnosis that also present acoustic hallucinations. Neuroimagining and functional tests in our patient showed moderate cognitive impairment and cortical atrophy, which contradicts other studies which claim that an acceptable level of cognition must be present in order to gain the necessary insight to meet the diagnostic criteria.

Alcoholic hallucinosis is a rare form of subacute encephalopathy, secondary to an abrupt stop in a previously chronic and heavy alcohol consumption. Its diagnosis is mainly clinical, and neuroleptics are the most used drug, being abstinence essential for an adequate evolution. The course is usually benign, although the acoustic phenomena may not disappear completely.

The authors have not supplied their declaration of competing interest.

Attachment is an innate programming whereby a child seeks for security. There is scientific and empirical evidence that insecure attachment is usual in eating disorder patients [1].

To highlight the relevance of attachment between child and caregivers, as well as its significance in therapeutic approach.

A 17-year-old girl hospitalized after attending to emergency department due to fainting. BMI: 12.89. She reports restrictive behavior since age 11 that her mother regards as “child issues”. Divorced parents, she grew up with her mother, diagnosed of hypochondria, who mentions not understanding why she is not the one who is hospitalized.

During hospitalization, she turned 18-years-old. Guardianship of her younger siblings was removed to her mother. She had a secure relationship with her 24-year-old sister, so she decided to move in with her. Later on, she had a positive progress, maintaining the gained weight and mood stability, although cognitive distortions persist.

Among developmental and maintaining factors of eating disorders, impaired attachment is becoming increasingly interesting. Even though the main goal of treatment is weight restoration, exploring attachment patterns can facilitate to achieve that aim. This clinical case emphasizes the importance of attachment in eating disorders among child and young adults.

The authors have not supplied their declaration of competing interest.

Smoking is an addictive and chronic disease. Twenty-four percent of the Spanish population in 2012 smoked daily.

To evaluate a smoking cessation program in a Primary Care Center.

Observational, prospective study. We describe an individualized smoking cessation in Plaza del Ejército Health Center (Valladolid). Inclusion criteria: active smoker, ≥ 18 years old and belonging to the Health Center. Exclusion: severe mental illness. Included patients from November 2013 until January2014. Ended in July 2014. Four Medical residents participated, we present the results of one of them. During the first consultation motivational interviewing was conducted, physical examination and treatment was prescribed (cognitive behavioral therapy or drug treatment: varenicline). In subsequent consultations interview and follow-up. Variables: age, gender, pack-years, nicotine dependence (Fagerstrom) and Prochaska and DiClemente phase, weight, treatment used, dropout rate and final withdrawal of snuff.

Eleven patients, mean age 48.18 (13.61), 7 (63.6) women. Comorbidity: 6 (54.5) anxious-depressive pathology, 1 (9.1) dysthymia, 2 (18.2) endocrine pathology and 1 (9.1) respiratory disease. Four (36.4) showed high dependency and 2 (18.2) extreme. Media packages 20.50/year (19,20). Seven (63.6) were in action phase of Prochaska and DiClemente and 2 (18.2) in preparation. Visits range: 1-11. The average was 4.55 (3.64). Three (27.27) patients attended only the first visit. Four (36.4) achieved complete abstinence, 3 (27.27) met maintenance phase. One (9.1) reduced consumption in half. Patients gained average 0.5 kg (2.47).

The results are similar to those reported in other series. Modest dropout rate. No pharmacological treatment was used due to high coexistence of comorbidities, the only patient who used varenicline suffered insomnia. Average age and media packages were superior to other series.

The authors have not supplied their declaration of competing interest.

Suicide is the deliberate act of take off life to itself. According to WHO, more than one million people commit suicide every year.

Compare data of suicide attempts between 1996 and 2014 in the University Hospital of Valladolid. Influence of the economic crisis on suicide data. Expose the risk factors. Provide prevention strategies.

We have performed a study of epidemiological surveillance collecting descriptive data of suicide attempts; using the same methodology as in 1996. The variables studied were: sex, age, day, month, residence, method, personal status, education, employment status, religious believes, family history of suicide, psychiatric history and family and personal psychiatric history.

Increase in the rate of suicide attempts 27%. Distribution by sex is similar, but in 2014, a higher proportion was observed in males. The percentage of women is significantly higher than that of men in the group of teenagers (10–19 years old) (20% women vs. 4.5% of men; P = 0.005); 83.5% have a psychiatric diagnosis (54.2% of them have a depressive disorder). Unemployment and economic problems stand out as environmental stressors in 2014. The main suicide method used in Valladolid is the hanging, and the second method used is the precipitation.

The primary, secondary and tertiary prevention strategies are very important. Suicide is the major cause of mortality in the young age group (15–24 years old). Mortality in the general population has been on a downward trend; but suicide rates per 100,000 population has remained stable over the last decade.

The authors have not supplied their declaration of competing interest.

CADASIL (Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy), the most common form of hereditary stroke disorder, is characterized by headaches, transient ischemic attacks and psychiatric symptoms which include mood changes, behaviour disorders and variable levels of dementia.

To emphasize the necessity of discarding somatic and neurological processes before a psychiatric diagnosis is reached.

We present a case initially followed in psychiatry and derived to neurology, and compare it with articles no older than ten years, found in a bibliographic search in Medline (PubMed), fitting the next keywords: CADASIL, autosomal dominant encephalopathy, psychiatric symptoms.

The most frequent manifestation of CADASIL is the early age onset of cerebrovascular ischemic attacks, nonetheless, a fair percentage of patients debut with insidious psychiatric symptoms, especially mood changes, behavioural disorders and even mutism. Independently of the age of onset, these symptoms are present at some point of the illness in most cases.

Psychiatric symptoms can be found in a vast number of somatic and neurological disorders, even being the first manifestation of such processes. This challenges diagnosis, and given than the line between brain and mind is blurred and not always clear, cooperation among different specialities is of utmost importance in order to correctly treat the illness as a whole, and not just the sum of the parts.

The authors have not supplied their declaration of competing interest.

The main feature of body dysmorphic disorder (BDD) is impairing preoccupation with a physical defect that appears slight to others. Previously, its delusional and nondelusional variants were sorted in two separate categories, but owing to new data suggesting that there are more similitudes than differences between them, DSM-5 now classifies both as levels of insight of the same disorder.

To enunciate the similarities and differences between the two variants of BDD.

To better understand the features and comorbidity of BDD, so as to improve its management and treatment.

Taking DSM-5 and DSM-IV-TR as a reference, we have made a bibliographic search in MEDLINE (PubMed), reviewing articles no older than 5 years that fit into the following keywords: body dysmorphic disorder, delusions, comorbidity, DSM-IV, DSM-5.

Both the delusional and nondelusional form presented many similarities in different validators, which include family and personal history, pathophysiology, core symptoms, comorbidity, course and response to pharmacotherapy.

The new classification of delusional and nondelusional forms of BDD as levels of insight of the same disorder, which places them closer to the obsessive-compulsive spectrum than to the psychotic one, not only improves treatment options, but also reinforces the theory that delusions are not exclusive of psychotic disorders, setting a precedent for the understanding and classification of other disorders with delusional/nondelusional symptoms.

The authors have not supplied their declaration of competing interest.

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

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

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

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

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

Madness and creativity are thought to be related from ancient ages. Nowadays, thanks to new scientific developments and researches we are able to identify common genetic and brain patterns between creativity and psychosis.

Taking the inspiration of a psychotic patient with some shocking drawings, we want to get deep into the actual knowledge about the relation between creativity and psychosis.

Case report and bibliographic review.

A 19-year-old man was brought to the hospital after having been found making strange rituals in the public way. In the anamnese he showed to have experienced mystic delusions and hallucinations. He made some particularly creative drawings.

We made a review which showed that this patients may have a diminished latent inhibition, which could make them experiencing usual live irrelevant stimuli as something very exciting and creative at the same time. Genome wide association studies show also that people having creative jobs and psychotic patients share some genes, which could be linked to this abnormal latent inhibition.

Latent inhibition abnormalities could be related with psychosis and creativity. There are differences within the course of people having this oversensibility, which could be explained due to the presence of protective and risk factors.

The authors have not supplied their declaration of competing interest.

22q11.2 deletion syndrome is a primary immunodeficiency due to micro-deletion on the large arm of chromosome 22. Patients suffer from several anomalies, including metal illness, that such the case we present, mean a warning sign for further study.

Twenty-one years-old male, with psychotic symptoms, typical of schizophrenia, behavioral disorders and mental confusion, plus epileptic episodes and psychomotor agitation. Two previous incomes with the diagnosis of psychotic disorder not otherwise specified. Treated with anti-psychotics at low doses with inter-episode stability.

Prematurity, low birth weight, neonatal asphyxia, generalized seizures, otitis and recurrent urinary tract infections, hypernasal voice, poor academic performance, difficulty relating. Physical examination: hypernasal voice, furred tongue, dysmorphic faces, scoliosis, hipotanía, stereotypes, delusions, auditory hallucinationsd negative symptoms.

We considered the possibility of a neurodevelopmental disorder, with a multidisciplinary approach, resulting in the diagnosis of paranoid schizophrenia and velocardiofacial syndrome, which had gone unnoticed. Mean doses of clozapine, haloperidol and topiramate were used. He accepted psychiatry and other specialties follow-up, since it requires a complex and multidisciplinary approach.

Definition of velocardiofacial Syndrome and lack of consensus on terminology:

– syndrome 22q11.2 DS as genetic subtype of schizophrenia? Opportunity to study the pathogenesis of schizophrenia;

– the importance of a comprehensive approach to early diagnosis, clinical improvement and preventing complications.

The authors have not supplied their declaration of competing interest.