Self-perceived health (SPH) is an epidemiologically used variable, recognized as a subjective yet predictive indicator of mortality (Bopp et al. Plos One 2012; 7:e30795) SPH, among other subjective indicators, such as quality of life, contributes to understanding an individual’s overall experience and well-being. While health information, including medical diagnoses given by physicians, forms a substantial part of an individual’s subjective health (Falconer & Quesnel-Vallée, 2017; 190 227-236) the World Health Organization (WHO, 2014) defines health not only by the absence of somatic diseases but also encompasses components of social and mental well-being.

This study aims to explore factors associated with a poorer level of self-perceived health in inpatients due to non-psychiatric conditions with a focus on mental health and substance use-related factors.

We recruited 800 patients during their hospital stay for various pathologies in cardiology, pneumology, internal medicine, and gastroenterology units. Self-reported sociodemographic variables and well-being-related variables, such as SPH, were collected during admission. The MINI Neuropsychiatric Interview was administered to screen for psychiatric conditions, the ASSIST scale assessed the risk related to the use of various substances. Data on the frequency and quantity of substance use, in the three months prior to admission, were also recorded by timeline follow-back. Information on the severity of somatic comorbidity was gathered using the Charlson Comorbidity Index. Non-parametric tests compared SPH in different groups, and variables showing significant differences were included in a multivariate linear regression analysis. This study obtained approval from the ethics committee.

Significant and clinically relevant differences were found in the SPH of patients with anxiety disorders, depressive disorders, and bipolar disorders. These patients reported lower SPH than those without these comorbidities. Patients scoring medium or high risk on the ASSIST scale for tobacco, alcohol, and cannabis also demonstrated lower SPH compared to those with low-risk scores. In the multivariate analysis, accounting for confounding factors, including comorbidity severity, patients with depressive disorders maintained statistically significant lower levels of SPH (ß = -13.391, p < 0.001), as did those with bipolar disorders (ß = -6.096, p = 0.019).

Patients with anxiety, depressive, or bipolar disorders, as well as those with higher-risk use of tobacco, alcohol, and cannabis, exhibited lower SPH. After adjusting for other relevant factors, such as diagnosed somatic pathology, patients with affective disorders continued to score lower in SPH levels. Proper attention and management of psychiatric comorbidities and substance use are crucial in medical hospital settings.

M. Pons-Cabrera Employee of: This work has been funded by Contractes Clínic de Recerca “Emili Letang - Josep Font” 2021 granted by Hospital Clínic of Barcelona, E. Caballería-Lamora: None Declared, L. Navarro-Cortés: None Declared, M. Balcells-Oliveró: None Declared, L. Pintor-Pérez: None Declared, H. López-Pelayo: None Declared

Cannabis use poses a significant risk to the psychological wellbeing of youth, affecting academic performance and potentially triggering the onset of mental health issues. Providing young people with comprehensive information about patterns of cannabis use and specific factors that increase an individual’s health risks is crucial. The ability to critically assimilate this information is known as health literacy (HL).

To design a psychoeducational intervention to increase HL on risky cannabis use among students aged 16-25, and to assess its usability and feasibility.

We designed a psychoeducational intervention based on the outcomes of a 3-hour co-creation session involving healthcare professionals and students. 29 university students and 25 high-school students completed this intervention and assessed its usability and feasibility with the SUS (System Usability Scale), PSSUQ (Post-Study System Usability Questionnaire) and additional open questions regarding the most and less-liked aspects of the intervention.

The design phase resulted in an informative website (http://www.cahlyclinic.cat/) and a 1-hour structured onsite educator-facilitated session, comprising 3 group activities (completed on paper or online) addressing three dimensions of cannabis HL: searching for, interpreting and applying reliable information. Usability of the intervention was rated as excellent (SUS mean score>80). PSSUQ results indicate that students were satisfied with the intervention; found the HL information clear, relevant, and adequate for their needs; found the interface of the digital version pleasant and usable without support; and would recommend it to other students.

We propose an innovative structured and usable intervention, designed using a participatory approach, which aims to disseminate information on risky cannabis use to a key target population, namely young people.

None Declared

No significant relationships.

Wernicke-Korsakoff (W-K) syndrome is a neuropsychiatric disorder resulting from thiamine deficiency, which is associated with significant morbidity and mortality. According to autopsy-based studies, it is still greatly underdiagnosed. In this case study and review, we focus on late diagnosed W-K related with alcohol misuse, and we give a short review about the topic focusing on its prompt diagnosis and adequate treatment.

We intend to underline that W-K syndrome, a preventable neurological condition and even treatable in its early phase if suspected, is underdiagnosed, with critical consequences for the patient's prognosis.

Using a case-report format, we describe three cases of W-K syndrome which were initially misdiagnosed in different general hospitals. We summarize complementary explorations, therapeutic management and evolution, and after that we shortly review the topic.

The three patients were diagnosed of W-K syndrome in the psychiatry unit, weeks after being visited in the emergency facilities, where it was not suspected nor detected or prevented. All of them ended up with cognitive disabilities of a different degree, always with a remarkable impact in their functioning. One of them achieved some amelioration with thiamine in high doses, despite its late detection.

W-K can be prevented and treated if early detected, but it is underdiagnosed, with severe consequences for the patients. We suggest some measures that could enhance its detection and prevention, like modifying emergency room protocols, both diagnostic and therapeutic.

While illegal drug abuse has been recently stabilized in western countries, iatrogenic opiod dependence is increasing. In EEUU, opioids abuse is more prevalent than other legal or illegal drug abuse. Prevention actions and strategies to optimize short and long term treatments need to be outlined.

Learning to prevent, diagnose and treat iatrogenic opioid dependence.

We review 9 cases of iatrogenic opioid dependence hospitalized in the Psychiatric department of a general hospital, considering demographic and personal data, treatment patterns and strategies followed. Pubmed bibliographic search was performed.

Patients came from different clinical resources (44,4% from pain center, 33,3% from emergency department, 22,22% scheduled admission).

N°1:48-year-old man with dependence to oral codeine (1200 mg/day). Maximum methadone dose required (MMR): 30 mg/day.

N°2:43-year-old woman with dependence to oral fentanyl (3000 mcg/day). MMR:25 mg/day.

N°3:50-year-old woman with dependence to fentanyl patches (2,25) and oral tramadol (300 g/day). MMR:20 mg/day.

N°4:55-year-old woman with dependence to oral oxicodone (60 mg/day). MMR:20mg/day.

N°5:39-year-old woman with dependence to subcutaneous meperidine (600 mg/day). MMR:25 mg/day.

N°6:61-year-old woman with dependence to oral codeine (600 mg/day). MMR:15 mg/day.

N°7:45-year-old man with dependence to transmucous fentanyl (600 mcg/day). MMR:90 mg/day.

N°8:49-year-old man with dependence to oral tramadol (450 mg/day). Progressive tramadol withdrawal until suppression.

N°9:38-year-old woman with dependence to transmucous fentanyl (2400 mcg/day). MMR:22,5 mg/day.

Classically, methadone has been the main opioid dependence treatment, as shown in almost all cases exposed. However, new treatments are being developed, e.g. monthly parenteral naltrexone. Opioid dependence treatment must be combined with other substances abuse/dependence or psychiatric comorbidities treatment and psycotherapeutical intervention.

While illicit drug abuse has been recently stabilized in western countries, prescription opioids addiction is increasing to an epidemic level. Few studies exist regarding its treatment options and efficacy. Although buprenorphine has been the mainstay so far, other treatment options might be considered, such as methadone.

We conducted a single arm, retrospective cohort study. Patients admitted to a psychiatry ward for prescription opioid detoxification using methadone between 2010 and 2013 were selected. After discharge, patients completed the study period in a day hospital, specialized in the aftercare of addictions. A follow-up period of three months was established. Sociodemographic and treatment variables, as well as abstinence rates were collected.

Ten patients met the inclusion criteria. The sample consisted mainly of women (81.8%), with a median age of 50 years. The median duration of dependence in years was 8. Dependence to other substances, as well as psychiatric comorbidities were high. Eight patients completed the study period. Of these, 7 (87,5%) were abstinent after three months. The median duration of methadone treamtent was 77 days.

Although several limitations apply to this study, the results indicate that methadone, a well-known and effective treatment for illicit opioid dependence, could be a valid, efficacious option for the detoxification of prescription opioid dependent patients.

Perampanel (PER) is a new selective, non-competitive AMPA glutamate receptor antagonist. PER is generally well tolerated, with dizziness, somnolence, headache, and fatigue as the most common treatment-emergent adverse events, however neuropsychiatric adverse reactions; particularly irritability and aggressiveness can be expected.

We describe a patient who developed and acute confusional state presumably related to treatment with PER.

At the conclusion, the participants should be able to remember that PER is associated with psychiatric side effects.

Collect the data of the clinical history of the patient, who was admitted in the acute psychiatry ward of our hospital.

A 32-year-old woman diagnosed with pharmacoresistant juvenile myoclonic epilepsy, was referred to the emergency department because of severe behavioral disturbances, insomnia, irritability and aggressivity after increasing the dose of PER from 6 to 12 mg. Physical exploration, drug screen and blood tests were all normal. No abnormalities were found in CT, EEG and MRI, and then she was referred to psychiatric ward. At her admission, she presented fluctuations of her mental state and level of consciousness. She was diagnosed with acute confusional syndrome induced by PER, and consequently PER was stopped and risperidone was initiated. In the 4th week symptomatology remitted.

Anti-epileptic drug's (AEDs) are associated with psychiatric side effects. Patients with epilepsy have higher risk develop psychiatric symptoms and behavioral disturbances. There is evidence to suggest that AMPA receptors are involved in the pathogenesis of psychiatric conditions. Such mechanisms could be responsible of the psychiatric symptoms observed. Neuropsychological profiles of AEDs are important considerations for treatment selection, particularly in children and adolescents.

The authors have not supplied their declaration of competing interest.

The relation between alcohol dependence and suicidal behavior is well known and alcohol consumption is a risk factor to take in consideration in order to prevent suicidal attempts. Wernicke encephalopathy (WE) is a common acute neurological disorder caused by thiamine deficiency frequently associated with alcohol use disorder and often infra-diagnosed. Just few cases are reported about the possible correlation between suicidal behaviour and Wernicke encephalopathy.

To describe the possible association between suicidal attempts and Wernicke encephalopathy.

We report the case of a 57 year old man, with past diagnosis of disthymia and amphetamine abuse disorder, and a history of bariatric surgery, who was hospitalized in the intensive care unit (ICU) of hospital clinic for a suicidal attempt by mean of metro railway precipitation. He presented two episodes of psychomotor agitation in the context of an abstinence syndrome that reverted with midazolam continuous perfusion and clonazepam 8 mg per day. Consequently to medical improvement, he was moved to Psychiatry Unit of Addictive Behavior and finally diagnosed with alcohol use disorder.

In the physical exam, bilateral nystagmus and cerebellar ataxia were observed. Signs of malnutrition were detected in the blood analysis. In a brain magnetic resonance image, volume deficits in the mammillary bodies, thalamus, cortex and corpus callosum, as well as peri-aqueductal altered signal were observed, all signs compatible with Wernicke encephalopathy diagnoses.

Wernicke encephalopathy is a frequent concomitant condition in patients with alcohol use disorder. The consequent cognitive decline could represent an independent added risk factor for suicidal behavior.

The authors have not supplied their declaration of competing interest.

Cannabis use and misuse have become a public health problem. There is a need for reliable screening and assessment tools to identify harmful cannabis use at an early stage. We conducted a systematic review of published instruments used to screen and assess cannabis use disorders.

We included papers published until January 2013 from seven different databases, following the PRISMA guidelines and a predetermined set of criteria for article selection. Only tools including a quantification of cannabis use and/or a measurement of the severity of dependence were considered.

We identified 34 studies, of which 25 included instruments that met our inclusion criteria: 10 scales to assess cannabis use disorders, seven structured interviews, and eight tools to quantify cannabis use. Both cannabis and substance use scales showed good reliability and were validated in specific populations. Structured interviews were also reliable and showed good validity parameters. Common limitations were inadequate time-frames for screening, lack of brevity, undemonstrated validity for some populations (e.g. psychiatric patients, female gender, adolescents), and lack of relevant information that would enable routine use (e.g. risky use, regular users). Instruments to quantify consumption did not measure grams of the psychoactive compounds, which hampered comparability among different countries or regions where tetrahydrocannabinol concentrations may differ.

Current instruments available for assessing cannabis use disorders need to be further improved. A standard cannabis unit should be studied and existing instruments should be adapted to this standard unit in order to improve cannabis use assessment.