Almost nine months after the start of the war between Russia and Ukraine, millions of people have been affected physically, economically and mainly mentally. Those who have stayed in their homeland, and the ones that have chosen to emigrate to a safer place.

The objective of this article is to assess the importance of social stressors in the onset of a brief psychotic episode, even in the absence of substance abuse or previous illnesses.

The case of a 45-year-old woman is described, known by the Pediatric Emergency Service, for being the tutor of a patient who suffered from anxiety attacks, having emigrated without her parents from Ukraine together with her 5 brothers. The psychotic episode begins when our patient gets notified that she must abandon the custody of the girl, because she will have to go to Turkey with her legal guardians. The family explains the behavioral changes that the patient made and how the clinical picture worsened.

She was admitted at the Hospital’s Psychiatry Service and antipsychotics treatment started. After 5 days, the episode had completely been solved.

In conclusion, we highlight the importance of social problems in the development of a psychiatric pathology and the necessary elements to prevent it: family support network, fast and efficient care services and availability of hospital and pharmaceutical resources.

None Declared

Steroids are a necessary treatment for hypoxic respiratory failure; however there are many side effects that should be taken into account. A 44- year-old-woman with asthma and no past psychiatric history was admitted due to COVID-19 pneumonia and Respiratory syncytial virus (RSV) infection, presenting hypoxic respiratory failure. After two days of intravenous methylprednisolone administration, the patient presented acute psychosis and agitation.

It has been previously described that steroid use can cause effects such as mania, anxiety, agitation, delirium and psychosis amongst other. However they are a necessary treatment in respiratory illnesses and are sometimes unavoidable.

The aim was to examine the appropriate medical response to steroid induced psychosis in patients with acute hypoxic failure.

A bibliographical review was done in PubMed database searching recent cases of steroid induced psychosis using the words (“Steroid”, “Psychosis” and “COVID-19”).

According to literature, it has been shown that partial or complete reduction of steroid use and/or use of psychotropic has been successfully used to treat steroid induced psychosis. Following the research it was decided to reduce intravenous methylprednisolone dose from 20mg/ 8h to 20mg/12h and start oral haloperidol 5mg/8h the first 24h and reducing the dose progressively as the patient recovered. After the first 24 hours the patient presented adequate response to steroids as well as partial response to antipsychotic treatment; presenting no further agitation, absence of hallucinations and partial persistence of the persecutory delusion. A couple of days later there was complete remission of the psychotic symptoms and the patient was on the way to recovery from COVID-19 and RSV.

There is evidence that suggests that medications such as steroids used to treat COVID-19 and other respiratory illnesses can lead to psychotic episodes. It is very important to pay attention to possible side effects when treating with steroids and evaluate the patient history as well as suggest having a follow up visit after the hospital discharge.

None Declared

Multiple Sclerosis (MS) is an autoimmune inflammatory disease that affects 1 in 1000 people. Given the association of MS to many affective disorders and specifically with Bipolar Disorder (BD), it is possible that a manic episode and an acute episode of MS may appear together. In these cases, it is difficult to decide whether it is necessary to start a corticosteroid regimen as treatment for the acute episode of MS, since it may worsen manic symptoms.

The aim is to carry out a review of the existing information in relation to the comorbidity prevalence of MS and TB as well as the joint treatment of both illnesses, and to expose the details of a clinical case, regarding the treatment that was used in the acute psychiatry unit.

First, a search was done in PubMed database reviewing recent cases of steroid induced psychosis using the words (Multiple Sclerosis) AND (Bipolar Disorder). Subsequently, we describe the case of a 41-year-old patient who was admitted to the acute care unit from the emergency department presenting manic symptoms (megalomania, sensation of increased capacities and ideas of mystical content) associated to episodes of muscle weakness and gait disturbances. A screening Magnetic Resonance was performed in which lesions with inflammatory-demyelinating characteristics were detected, and was therefore catalogued as MS debut.

After carrying out a bibliographical review, we can conclude that studies recommend the inclusion of MS within the differential diagnosis of a first manic episode (1), performing neurological examinations, complete anamnesis and imaging tests, given that there is a high prevalence ratio of the comorbidity (2.95%) (2). It has been described that the use of lithium has a calming and neuroprotective agent that may be useful (3).

We consider it of interest to describe the therapeutic approach to the case. After the introduction of Aripiprazole and Lithium, a short regimen of methylprednisolone in high doses was administered to treat the MS episode. When the treatment started, the patient presented a progressive improvement of the manic episode and motor symptoms. We observed that corticosteroid therapy did not worsen the manic symptoms or the patient’s evolution in this case. We intend to contribute by providing information on the joint management of these pathologies and we consider that it is necessary to continue studying this matter to be able to manage these cases in the most appropriate way.

None Declared

The use of hallucinogens has accompanied the human being throughout history. In the 1970s, studies focused on the therapeutic potential of hallucinogens were blocked due to their misuse in the young population. At present, psilocybin is re-emerging as the center of attention due to its possible therapeutic potential in different psychiatric pathologies such as depression, anxiety or substance use.

The main objective of this work has been to review recent studies on the therapeutic potential of psilocybin in drug-resistant depressive disorder.

For the search for articles, the search strategy “psilocybin AND depression” was established in PUBMED. Regarding the inclusion criteria, it was established that they were recent articles, in Spanish or English and that the full text was freely accessible. On the other hand, those articles whose studies did not focus on humans and resistant depressive disorder were excluded. A total of 19 articles were obtained to review.

Focusing on Drug-Resistant Depressive Disorder, multiple studies have agreed that the administration of one or two microdoses (10-25mg) of psilocybin accompanied by psychotherapy improves the clinical picture for at least 6 months. These results make us feel optimistic in the search for new treatments in the field of mental health.

Psilocybin microdoses associated with psychotherapy improves depressive symptoms in a patient resistant to common antidepressants.

The psilocybin response in terms of improvement of the depressive symptoms persists after 6 months of evolution.

One or, in some two cases, two microdoses of psilocybin (10-25mg) are enough to obtain statistically significant results in the improvement of the depressive symptoms.

None Declared

This instrumental work aims to replicate the exploratory factor analysis about the Referential Thinking Scale (REF scale) already developed by Lenzenweger et al. (1997) to examine its multidimensionality.

Participants: The analyzed sample consisted of 193 participants (67.36% women, mean 28.36 years old, SD = 10.35), of whom 131 were patients.

Design, materials and procedure: We used the REF-scale (Lenzenweger et al., 1997) adapted to Spanish language. This questionnaire consists of 34 items that assess the frequency of referential thinking on a dichotomic scale (true/false). We used SPSS 15.0 to conduct a principal-components factor analysis with a varimax and oblimin rotation.

The principal-components factor analysis method led to 5 factors that explain 37.35% of variance for the rotated solution. Because of inter-factors correlations are small, we considered these factors as being independent. The five factors were labeled as: Laughter, Commentaries (it accounted for 8.92% of variance); Guilt (it accounted for 8.77% of variance); Causal Explanations (it accounted for 7.17% of variance); Songs, Newspapers, Books (it accounted for 6.44% of variance); and Attention, Appearance (it accounted for 6.04% of variance).

It's obtained the five factors isolated in previous studies (Lenzenweger et al., 1997; Rodríguez-Testal et al., 2001). However, the multidimensionality of the REF scale must be viewed with caution because of a small percentage of explained variance.

Kernberg's classification of personality disorders (1987) differentiates psychic organization according to the severity: neurotic, borderline and psychotic. Lenzenweger et al. (2001) used a reduced version of IPO with 57 items developed by Kernberg and Clarkin (1995).

IPO was applied in a sample of patients and a control group. We expected to find an adequate reliability and validity of the inventory. Scales adequately distinguish content borderline, neurotic and psychotic.

Participants: 288 subjects (64.9% women), 116 patients attended to private clinical practice from February 2007 to September 2009. 172 control subjects matched by sex, social class and sincerity (EPI).

Transversal design, a measure collective in the comparison group and individual in patients ones. A group of patients was selected for the retest (n = 88).

Instruments. We applied IPO, the BPRS, MCMI-II and MIPS. Diagnoses according to DSM-IV-TR.

Internal consistency (Cronbach) was adequate for the three scales: .83; .90 and .89. The testretest reliability was correct for a mean interval of 44 days (.78; .81; .78). The validity analyses differed between diagnostic groups in Axis I (p< .05), but not in the clusters of personality (p>.05). No differences in BPRS with scale of borderline, but yes with neurotic and psychotic ones. The MCMI-II was properly differentiated by the three scales of the IPO.

The IPO is an useful scale with reliability and validity. The main drawback concerns certain aspects of the borderline scale.

In this study we intended to analyse if the REF Scale is a good indicator to differentiate the two subtypes of paranoia “Bad Me” and “Poor Me” (Trower & Chadwick, 1995).

Participants: We analyzed data from a different sample of previous studies with 326 participants (64.11% women, mean age 30.8, SD = 10.84), of whom 212 were patients.

Design, materials and procedure: We used the REF-scale (Lenzenweger et al., 1997) adapted to Spanish language, of which we deleted two items because of psychometric criteria, resulting 32 dichotomic items. We used SPSS 15.0 to conduct a principal-components factor analysis with a varimax and oblimin rotation, retaining two factors.

Two factors explained 31.32% of the variance (rotated solution). We interpreted factor through factor loadings higher than .42. Factor 1 accounted for 18.28% of the variance and it's associated with referential laughter, commentaries and guilt. Factor 2 accounted for 13.05% of the variance and it's associated with referential concerns related to the media.

Since the inter-factor correlation is moderate (.44) and there are no relevant clinical differences about the content between the two factors, the REF scale is a one-dimensional measure. Therefore, two big factors don’t emerge from the REF scale related to referential concerns about laughter-commentaries and guilt that correspond to “Poor Me” and “Bad Me”, respectively.

In previous works we demonstrated the utility of the REF scale for the assessment referential thinking (Rodríguez-Testal et al., 2001) although it wasn't specific for patients with psychotic disorder (Rodríguez-Testal et al., 2008).

We analyzed the psychometric properties of reliability and validity of the REF scale. We compared the differences in referential thinking between subjects with and without psychopathology. In the patient group we will not obtain differences in referential-thinking between diagnosis types of Axis I, Axis II, or patients with diagnoses on both axes.

Participants: 120 subjects, 70 patients attending a private center of clinic psychology, 64.3 % women, mean age = 35.21 (SD = 10.5) and 50 controls selected from the normal population, 54 % women, mean age = 33.48 (SD = 10.83).

It was applied a cross design for a correlation method of comparison between groups. All the analysis were accepted at p< .05.

We reached adequate internal consistency (Cronbach's alpha= .90, split-half reliability= .83 and .82). The test-restest reliability was significant (mean interval of 44 days). There are significant differences in referential thinking between subjects with and without psychopathology (t=3.8; p=.001). There are significant differences in referential thinking between types of diagnoses (F=3.99; p=.001).

The REF scale has adequate psychometric properties (reliability and validity). It discriminated between patients and no-patients, and between the different types of diagnoses, especially for those who suffer psychotic disorders.

In previous works we used the REF scale of referential thinking as criterion of therapeutic evolution (Benítez-Hernández et al., 2006; Rodríguez-Testal et al., 2009).

We designed a group therapy of social skills for monitoring and modification of the referential thinking. We predict a decrease of referential thinking (frequency and intensity) both in pretest and posttest measures for each session, as in the progress of the all sessions as a whole.

Participants: 5 women from 24 to 38 years old with the diagnoses: Panic Disorder with Agoraphobia and history of Sexual Abuse; generalized Social Phobia; Avoidance Personality Disorder; Bipolar I Disorder; Obsessive-Compulsive Disorder and Avoidance Personality Disorder. It's employed a longitudinal design (brief time-series) of REF measurement (frequency and intensity) at a weekly interval. C Young (p < 0.01) was used for the statistical analysis of the data, t (paired samples) and the method of least squares to obtain the trend line.

• #1: frequency-posttest (p=.01).

• #2: intensity-pretest (p =.01); intensity-posttest, C =.663 (p< .01).

• #3: intensity-pretest, C =.772 (p< .01), intensity-posttest, C =.681 (p< .01).

• #4: frequency-pretest, C =.695 (p< .01), frequency- posttest, C =.74 (p< .01).

• #5: frequency-pretest and frequency-posttest (p>.01).

Preliminary analysis indicates an improvement of referential thinking in the frequency and intensity both intra and inter-sessions. More therapy sessions are needed to reflect a change statistically significant.

In this study we assess the sensitivity of REF scale to detect the disorganization of patient's mental state longitudinally.

Participants: It's a 35-year-old man diagnosed with Schizotypal Personality Disorder. He had a psychotic breakdown and he is being treated with haloperidol. The psychological intervention is cognitive type.

Design, materials and procedure: We used an experimental adaptation of the REF-scale. This self-applied scale consists of 34 items that evaluate the referential thinking in Likert format. We employed a longitudinal design (brief time-series). C Young (p < 0.01) was used for the statistical analysis of the data and the method of least squares to obtain the trend line. We included 103 measures registered at an interval of 3 days.

It's observed a significant declining trend in the whole of the measures both intensity and frequency from the beginning of therapy. However, we observed a significant declining trend in intensity but not in frequency when we analyzed the data from the 50th measurement, which was the period during which the patient got worse.

It's confirmed again that the REF-scale is a stable and reliable measure. It's able to detect changes in the patient's evolution of the referential thinking from the beginning of therapy. In addition, the REF-scale is sensitive detecting decompensations in patients. Therefore, we conclude REF scale is a useful measure for the subsequent decision-making therapeutic.

We created an experimental adaptation of the REF scale (Lenzenweger et al., 1997), in a Likert format for discriminate between frequency and intensity of referential thinking (Rodríguez-Testal et al., 2008).

We try to verify if the Likert format of the REF discriminates between controls and patients, and also in patients with different diagnoses. We predict that there will be differences in frequency and intensity between patients and controls.

Participants: 108 subjects, 40 patients from a private center of clinical psychology, 55% women, mean age = 35.70 (SD = 12.42) and 68 controls selected from the normal population, 50% women, mean age = 36.35 (SD = 12.99).

It was applied a cross design for a correlation method of comparison between groups. All the analysis were accepted at p< .05.

No differences in referential thinking between patients and controls with Likert format in frequency (t = 1.496, P = 1.14), although there were differences in intensity (t = 2.30, p =.023). No significant differences in referential thinking between types of diagnoses with the Likert format (X2 = 6.63, p =. 249).

The Likert format of the REF scale adequately discriminates between patients and controls in intensity but not in frequency. This format doesn't discriminate between different diagnoses. The Likert format induces and overestimates the response.

In previous works, referential thinking was predicted by clinical and dispositional variables such as social anxiety or vulnerability to depression (Rodríguez-Testal, Senín-Calderón & Fernández-Jiménez, submitted to revision).

We propose to find personality variables to characterize the emergence of referential thinking. We predict a greater referential thinking in subjects with a high sensitivity to punishment and higher scores on social anxiety.

Participants: 366 subjects selected from the general population, 66.6% women, mean age = 33.18 (SD = 12.79).

We used the REF-scale (Lenzenweger et al., 1997) adapted to Spanish language, GHQ-28 (Goldberg, 1996), SPSRQ (Torrubia et al., 2001) and The Revised Self-Consciousness Scale (Scheier & Carver, 1985).

It was applied a cross-sectional design and a correlation method. All the analysis were accepted at p < .05.

The multiple linear regression analysis showed the importance of the clinical variable of depression, public self-consciousness, and sensitivity to reward and punishment as predictors of referential thinking (34% of the variance explained). The discriminant analysis according to scores in referential thinking was significant (Lambda = .87, p = .001). The combination of the above variables correctly classified 85.1% of cases.

Subjects more concerned about how they are perceived by others tend to a greater presence of self-references, although they don’t show a high score in social anxiety. Susceptibility to reward and high vulnerable to punishment are the personality variables that best predicted referential thinking.

Anorexia nervosa has the highest suicide mortality ratio of psychiatric disorders, suicide being associated with many factors. We assessed the first lifetime occurrence of these factors taking into account their possible overlap.

Three hundred and four in- and out-patients with anorexia nervosa (DSM-IV) were systematically recruited in three hospitals of Paris suburbs, between December 1999 and January 2003. Patients were assessed by a face-to-face interview (DIGS). Current eating disorder dimensions were measured, and patients interviewed by a trained clinician to assess minimal BMI and, retrospectively, the age at which anorexia nervosa, major depressive disorder, anxiety disorders and switch to bingeing/purging type occurred for the first time, if applicable.

Major depressive disorder (p < 0.001) and subtype switch from the restrictive to the bingeing/purging type (p < 0.001) were the two factors significantly more frequently occurring before suicidal attempts, and remained involved when a multivariate analysis is performed, whether syndromic or dimensional measures are being used. Taking into account lifetime occurrence with a survival analysis, the switch to bingeing/purging type of anorexia appears as a major predictive factor, with a large increase of the frequency of suicidal attempts (OR = 15) when compared to patients with neither major depressive disorder nor bingeing/purging type.

Bingeing/purging type of anorexia nervosa is largely associated with suicidal attempts, and may deserve specific attention. If confirmed on a prospectively designed study, these results would argue for early detection and/or more intensive and specific therapeutic intervention on this aspect of bingeing and purging behaviors.

The aim of this study was to examine the temperament and character profile as risk factors of interferon and ribavirin (IFN+RBV) induced psychopathology in chronic hepatitis C patients. According to the Cloninger's biosocial model (TCI), the temperament dimension harm avoidance (HA) is suggested to indicate central serotonergic turnover, which is further correlated with depressive/anxiety states.

198 patients with chronic hepatitis C in treatment with IFN+RBV were evaluated at baseline and 4, 12 and 24 weeks of treatment. All subjects were assessed by the Patient Health Questionnaire (PHQ), the Hospital Scale of Anxiety and Depression (HADS) and the Temperament and Character Inventory-revised (TCI-R) questionnaire (at basal level).

At baseline, 32 patients had a psychiatric syndrome (16.1%). During the first six months of IFN+RBV treatment the incidence of depression/anxiety syndromes was 37.9% (n=63/166). The personality factors associated (p<0.001, corrected) were: HA dimension; fatigability subscale (HA4), anticipatory worry subscale (HA1); self-directedness dimension (SD); congruent subscale (SD5); and; social acceptance subscale (C1). By logistic regression analysis the independent variables that most predict the induced cases (PHQ+) (dependent variable) were: previous history of mood disorder (p<0.001; Exp(b)=5.655), and both HA4 (p<0.001; Exp(b)=1,104) and C1 (p<0.001; Exp(b)=0.845) subscales.

The assessment of personality traits (HA, C) and previous history of psychiatric disorders before start the IFN+RBV treatment in chronic hepatitis C patients might identify the patients at risk of induced depression/anxiety disorders during the treatment.

This study has been done in part with grants: Instituto-Carlos III (G03/02) (Red-Hepatología) and (GO3/184) (Red-Genotipación/Psiquiatría Genética).

In a previous study (Senín-Calderón et al., 2010) we observed that the REF scale of referential thinking (Lenzenweger et al., 1997) didn’t discriminate among different mental disorders.

We try to verify if self-references in various disorders are related to the severity of psychopathology (patients from public hospital and a private clinical). We predict that there will be differences between patients and controls, but not between the clinical samples. Psychotic disorders will be characterized by a significantly greater presence of self-references.

Participants: 287 subjects, 47 patients from a private clinical center, 57.4% women (mean age = 35.02, SD = 12.69), 30 patients from a public hospital, 53.3% women (38.36 years, SD = 9.53), and 210 controls selected from the general population, 50.5% women (33.80 years, SD = 11.79). Cross-sectional design, correlation method. All analysis were accepted at p < .05.

There are significant differences in self-references between patients and controls in frequency (t (285) = 2.33, p = . 021) and intensity (t (83.98) = 3.59, p = . 001). No significant differences between patients groups (p>.05) (REF-intensity without homogeneity, p < .05). No significant differences in self-references between types of diagnoses except psychotic patients versus adjustment disorder (frequency and intensity).

Self-references are highlighted in psychosis but, with the exception of adjustment disorders, doesn’t discriminate between personality, mood or anxiety disorders. Differences are more related to the clinical severity (BPRS) than with referential thinking.

Despite the high prevalence of obsessive-compulsive symptoms located around 2-3% of the population, there continue to be cases where the characteristics of the patient or the circumstances of their environment, they fall short queries mental health or when they do not for the disorder itself, but for another reason obsessional symptoms worsen.

Expose using clinical case, the existence of patients with obsessive pathology whose characteristics do not seek mental health consultation, until this is associated with a new disease that interferes significantly in vital organization.

We report the case of a man of 88 years old, married at 60, was admitted to the psychiatric consultation at the request of his wife 29 years his junior, for behavioral disorders several years of evolution and history of obsessive symptoms compulsive, which did not interfere with their daily lives by the lack of insight and poor social environment

OCD is included in anxiety disorders.

It is characterized by the presence of obsessions and compulsions that interfere with personal, work and / or patient's social.

There are cases that own personality traits of the patient, this disorder is not diagnosed early and choose to go only when associated with worsening cognitive impairment rituals and interfere with family life.