The Positive and Negative Syndrome Scale (PANSS) has been used as a universal instrument for clinical assessment of psychopathology in schizophrenia. Different studies have analyzed the factorial structure of this scale and have suggested a five-factor model: positive, negative, excited, depressive, and cognitive/disorganized factors. Two of the most used models are the Marder´s solution and the Wallwork´s one.

The aim of this work was to study the correlations of the two cognitive factors (Marder and Wallwork) with a cognitive assessment performed with a standard cognitive battery, in a sample of patients with first psychotic episode of schizophrenia.

Seventy four patients with first psychotic episode of schizophrenia (26.9, SD:7.8 years old; 70.3% male) were included. The cognitive assessment was performed with the MATRICS Consensus Cognitive Battery (MCCB). The MCCB present seven cognitive domains: Speed of processing, Working memory, Attention/Vigilance, Verbal Learning, Visual Learning, Reasoning and Problem Solving, and Social cognition). Pearson correlations were performed between MCCB scores and Marder´s PANSS cognitive factor (P2, N5, G5, G10, G11, G13, G15) and Wallwork´s one (P2, N5, G11).

Correlation between MCCB scores and cognitive factors of Marder and Wallwork can be seen in the table.

Both PANSS cognition factors show a moderate correlations with Speed of processing, Working memory, Attention/Vigilance and Verbal Learning assessed by MCCB. More discrete correlations were found with Visual Learning, Reasoning and Problem Solving, and with Social cognition (in fact, non-significant correlation with Wallwork´s cognitive factor was found).

Acknowledgements. This study has been funded by Instituto de Salud Carlos III (ISCIII) through the project PI19/00766 and co-funded by the European Union.

None Declared

This study aimed to analyze stress, anxiety, depression, and self-efficacy levels among Spanish out-of-hospital emergency medical professionals from February 1, 2021, to April 30, 2021.

A nationwide survey was completed by 1666 Emergency Medical Services (EMS) workers. The Depression, Anxiety, and Stress Scale (DASS-21) and the General Self-Efficacy Scale (GSE) were used. Data analysis used chi-squared, análisis of variance (ANOVA), and logistic regressions.

The sample comprised 833 (50%) men, with an average age of 44.3 ± 9.9 y (range: 19-67 y). Occupational distribution included 453 (27.2%) physicians, 474 (28.4%) nurses, and 739 (44.4%) emergency medical technicians (EMTs). EMTs exhibited higher odds of severe or extremely severe depression compared with physicians (odds ratio [OR]: 1.569; 95% confidenceinterval [95% CI]: 1.213-2.030) and nurses (OR: 1.561; 95% CI: 1.211-2.012). EMTs also displayed higher probabilities of severe or extremely severe anxiety compared with nurses (OR: 1.944; 95% CI: 1.529-2.701). Furthermore, EMTs demonstrated elevated probabilities of severe or extremely severe stress compared with physicians (OR: 1.387; 95% CI: 1.088-1.770). However, no significant differences were found in self-efficacy, with a median value of 73 [20].

Out-of-hospital EMS workers experienced mental health challenges, showing varying levels of depression, stress, and anxiety across different occupational groups. EMTs were particularly affected.

Schizophrenia (SCH) and bipolar disorder (BD) are severe mental disordes, which have high incidence (Whiteford et al. Lancet 2013; 381 1575-86) and are the main causes of diasibility in young people (WHO 2022; https://www.who.int/news-room/fact-sheets/detail/mental-disorders).

Psycological stress appears in different mental disorders, and this is directly related to oxidative stress (Moller et al. Chem Biol Interact. 1996; 102 17-36)(Pupic-Bakrac et al. 2020; Psychiatr Danub. 32 412-9). Oxidative stress causes reticulum edoplasmic stress (ER stress) and this produces high levels of misfolded proteins. Defective proteins are degraded by the proteasome, but but when the density of misfolded proteins exceeds the capacity of the proteosome, the Unfolded and Misfolded Protein Response (UPR) is triggered through three main pathways: Inositol-requiring enzyme 1α (IRE1α); transcription factor 6 alpha (ATF6α) and protein kinase RNA-Like ER kinase (PERK), trying to recover normal protein synthesis capacity (Bermejo-Millo et al. 2018; Mol Neurobiol. 55 7973-86) (González-Blanco et al. 2022; J Cachexia Sarcopenia Muscle 13 919-31).

Characterizing ER stress and UPR in SCH and BD.

We studied ER stress and UPR in peripheral blood mononuclear cells (PBMC) from 50 patients with SCH and an equal number of patients with BD compared to their corresponding controls in order to achieve our objectives.

Western Blot assay were performed following classical procedure () and the results was normalized to Ponceau as loanding control (Nie et al. 2017; BiochemByophys Resp 12 10-13) (Sander et al. 2019; Anal Biochem 575 44-53). Proteasome activity was assessed using Proteasome Activity Assay Kit (ab107921, Abcam, Cambridge, UK).

ER stress was evaluated with BiP/GRP78. Our results showed significantly increased expression in SCH (p<0,01) and BD (p<0,05), being more increased in SCH. Proteasome activity was increased in SCH and BD, being only statistically significant in SQZ (p<0,05). UPR study showed IRE1a cascade significantly activated in SCH (p<0,001) and only slight increased in BD showed without statistical differences. ATF6a pathway is measured by cleavage to active protein (50-kDa). Results showed higher expression in SCH than in BD and controls (p<0,001). In addition, PERK pathway showed higher statistical levels of p-eIF2a/eiF2a ratio in SCH than in BD and control respectively (p<0,05 and p<0,01).

Our results showed a greater alteration in SCH than in BD at the level of protein synthesis, which implies a greater toxicity at the cellular level and, therefore, a clear risk for the survival of cells in this pathology.

None Declared

Schizophrenia (SCH) and bipolar disorder (BD) are severe mental disorders which lead to psychotic, affective and cognitive symptoms and often cause a progressive functional deterioration of the individual. The current diagnosis of SCH and BD essentially depends on clinical observation that often leads to misdiagnosis and the introduction of non-specific treatments. Therefore, an early detection and intervention are determinant for a better prognosis. Improving outcomes of a First Episode of Psychosis (FEP) depends mainly on the identification of reliable and discriminatory biomarkers between both disorders.

Given that oxidative stress has been tightly involved in multiple metal disorders, the major goal of this work was to characterize oxidative alterations in order to identify potential biomarkers which allow the differential diagnosis in an early stage.

The study was carried out on samples from 49 subjects (14 women and 35 men), divided into four groups: a control group of 10 individuals not previously diagnosed with any serious mental disorder, 17 patients who had presented a FEP, 12 patients diagnosed with SCH and 10 patients diagnosed with BP. Biochemical analysis were conducted in erythrocyte fraction to characterize the cellular oxidative damage by measuring lipid peroxidation (LPO) levels and the antioxidant defense system by the evaluation of catalase (CAT) and superoxide dismutase (SOD) activities.

In the present work, we observed a significant increase in LPO levels in both SCH and BD disorders that was not neutralized by the antioxidant defense. It was found that SCH patients, despite exhibiting greater activities of SOD and CAT compared to BD individuals, also showed significantly higher levels of oxidative damage. The differential oxidative profile observed between SCH and BD individuals allowed to perform an individually analysis of patients diagnosed with FEP. Although it was not possible to identify the type of psychotic disorder of all the patients with FEP, the results obtained showed that while several individuals exhibited an oxidative prolife similar to that observed in SCH patients, other individuals presented a prolife very similar to that found in patients with BD.

The current work reveals that LPO is a potential indicator of worse prognosis after being differentially modified in both SCH and BD. Moreover, SOD and CAT have been identified, by presenting an opposite profile between patients with SCH and BD, as potential preliminary biomarkers for a discriminatory diagnosis in an early stage of the disorder.

None Declared

Informed consent forms (ICFs) and practices vary widely across institutions. This project expands on previous work at the University of Arkansas for Medical Sciences (UAMS) Center for Health Literacy to develop a plain language ICF template. Our interdisciplinary team of researchers, comprised of biomedical informaticists, health literacy experts, and stakeholders in the Institutional Review Board (IRB) process, has developed the ICF Navigator, a novel tool to facilitate the creation of plain language ICFs that comply with all relevant regulatory requirements.

Our team first developed requirements for the ICF Navigator tool. The tool was then implemented by a technical team of informaticists and software developers, in consultation with an informed consent legal expert. We developed and formalized a detailed knowledge map modeling regulatory requirements for ICFs, which drives workflows within the tool.

The ICF Navigator is a web-based tool that guides researchers through creating an ICF as they answer questions about their project. The navigator uses those responses to produce a clear and compliant ICF, displaying a real-time preview of the final form as content is added. Versioning and edits can be tracked to facilitate collaborative revisions by the research team and communication with the IRB. The navigator helps guide the creation of study-specific language, ensures compliance with regulatory requirements, and ensures that the resulting ICF is easy to read and understand.

The ICF Navigator is an innovative, customizable, open-source software tool that helps researchers produce custom readable and compliant ICFs for research studies involving human subjects.

The objective of this study was to investigate whether glycated hemoglobin (HbA1c) is a valid surrogate for evaluating the effectiveness of antihyperglycemic drugs in diabetes mellitus (DM) trials.

We conducted a systematic review of placebo-controlled randomized clinical trials (RCTs) evaluating the effect of a treatment on HbA1c (mean difference between groups) and clinical outcomes (relative risk of mortality, myocardial infarction, stroke, heart failure, and/or kidney injury) in patients with DM. Then, we investigated the association between treatment effects on HbA1c and clinical outcomes using regression analysis at the trial level. Lastly, we interpreted the correlation coefficients (R) using the cut-off points suggested by the Institute for Quality and Efficiency in Healthcare (IQWiG). HbA1c was considered a valid surrogate if it demonstrated a strong association: lower limit of the 95 percent confidence interval (95 percent CI) of R greater than or equal to .85.

Nineteen RCTs were identified. All studies included adults with type 2 DM. None of the associations evaluated was strong enough to validate HbA1c as a surrogate for any clinical outcome: mortality (R = .34; 95 percent CI −.14 to .69), myocardial infarction (R = .20; −.30 to .61), heart failure (R = .08; −.40 to .53), kidney injury (R = −.04; −.52 to .47), and stroke (R = .81; .54 to .93).

The evidence from multiple placebo-controlled RCTs does not support the use of HbA1c as a surrogate to measure the effectiveness of antihyperglycemic drugs in DM studies.

To investigate potential age, period and birth cohort effects in the prevalence of suicide ideation in European ageing population.

A total of 50 782 community-dwelling adults (aged + 50) from 20 different European countries were collected in the Survey Health Ageing and Retirement study. A multilevel logistic regression model of repeated measures was modelled to assess the effects of age and other variables, including the variability of observations over three levels: birth cohort groups, time period assessment and individual differences.

The larger effect of variability was attributed to individual-level factors (57.8%). Youngest-old people (65–79 years) showed lower suicide ideation than middle-aged people (50–64 years). No significative differences were found for suicide ideation between middle-aged people and oldest-old (80 + years). Only 0.85% and 0.13% of the total variability of suicide ideation accounted for birth cohort and period effects, respectively. Cohorts born between 1941 and 1944 possessed the lowest estimates of suicide ideation. Conversely, suicide ideation started to rise with post-War generations and reached a significant level for people born from 1953–1957 to 1961–1964. Regarding the time period, participants assessed in 2006–2007 showed a lower likelihood of suicide ideation. The rest of the cohorts and period groups did not show any significant effect on the prevalence of suicide ideation.

Our results suggest that age and suicide ideation relationship is not linear in middle and older age. The European Baby boomers born from 50s to mid-60s might report higher suicide ideation than their ancestors. This scenario would imply a greater need for mental healthcare services for older people in the future.

“Rite of passage” is an etnographic concept developed by VanGennep that defines the vital transition of an individual between two different status. It is divided in three stages: separation, liminal/threshold and aggregation. Turner described the liminal phase, and the terms of “communitas” and “liminoid” (structure of a rite without religious/spiritual elements). One widely-known Rite of Passage is the initiation of the shamans.

Study the elements of a rite of passage present in Psychiatric Trainning.

• • Field study (observational, descriptive, non-experimental).

• • Preliminary Sample=10trainees (5man+5women); last year of Psychiatric Trainning.

• • “ad hoc” semi-structured interview (21items subdivided in open questions). 10interviews (average duration=75mins). Permanent register:digital recorder.

• • Summary and analysis of the answers. Review of the literature.

1. - Psychiatric Trainning shared the elements and tri-phasic structure of VanGennep's “rite of passage” concept

2. - Trainees saw themselves as more empathic(7/10) and humanistic(8/10) than other specialties colleagues. Stigma towards mental illness(8/10) and fear of suicide(9/10) were also considered as their distinctives.

3. - The collective behaved as a communitas(10/10)

4. - No spiritual elements(0/10): liminoid process

5. - Resemblances of the ancestral shamans' Initiation: Despite bloody practices were over, suffering was also present(7/10), but was seen as necessary(6/10) and well tolerated(7/10).

6. - Trainees felt that they grew spiritual and mentally(7/10) during the trainning years

Results suggest that Psychiatric Trainning has stable phenomena that:

• • are compatible with the Rite of Passage schema

• • Are considered exclusive of Psychiatry by trainees

• • Have not been systematically studied as a whole, which could help to improve the training.

Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent psychiatric disorders in children (5.29%) worldwide, and highly comorbid with other psychiatric disorders.

To evaluate ADHD symptoms prevalence/frequency in young ambulatory patients diagnosed with other psychiatric disorders.

Non-interventional, multicentre, and cross-sectional, retrospective study. Patients aged 15-24 having a primary diagnosis of: Substance Use (SUD), Borderline personality (BPD), Anxiety (AD), Affective, Antisocial Personality (APD), or Conduct Disorders(CD) or Bulimia, giving inform consent were included (not previously treated/diagnosed with ADHD). ADHD symptoms prevalence was captured following DSM-IV criteria and moderate ADHD symptoms was considered as scoring >24 in the ADHD RS (DuPaul).

795 patients meeting in- and exclusion criteria were analyzed in the study. Mean age was 21.12 (SD: 2.64), and the majority were men (57.5%).A probable ADHD diagnosis (6 or more DSMIV symptoms and ADHD RS moderate symptoms) was apparent in: 40.3% of SUD patients, 23.7% of AD, 21.7% of Affective Disorders, 30.3% of Bulimia, 48.3% of BPD, 41.7% of CD and 57.1% of APD. Moreover, patients with SUD (ODD: 1.54) and BPD (ODD: 2.2) had significantly more risk vs. rest of population studied of having moderate ADHD symptoms. Also, patients having a probable ADHD diagnosis were significantly rated more severe in the GCI-Severity scale than the rest of population studied.

This cross-sectional study showed that ADHD symptoms are highly prevalent in young ambulatory patients diagnosed primarily with other psychiatric disorders, what seems to worse patient outcome if not diagnosed/managed on time. ADHD comorbidity risk varied significantly depending on the primary diagnosis.

Most of the studies about Eating Disorders in adolescents have been typically focused on females, only to conclude that the approach should be similar in males. It has been stimated that 5-10% of patients with Anorexia Nervosa are males. Later age of onset and higher prevalence of premorbid overweight are considered among the main differences with female patients.

Analysis of the anthropometric variables of a sample of males with diagnosis of Restrictive Eating Disorder.

Naturalistic, Descriptive and Retrospective study

1. - Sample: 22 male adolescents

2. - Inclusion criteria: males with Restrictive Eating Disorder diagnosis (according to DSM-IV criteria) admitted to an Eating Disorder ward during 2007 and 2008

3. - “ad hoc” questionnaire (15 items)

4. - Analysis: PASW statistics 18

Age range: 7-14years (medium age=14,79±2,50years).11 patients (50%) were older than 16 years-old

1. - Medium BMI (Body Mass Index) at the beginning of the admission was 17,79kg/m2.

medium weight loss: 13,5±7,02kg/m2 (corresponding to a reduction of 22,24±7,52% of the previous weight)

1. - Medium speed of weight loss: 0,92±1,1kg/54

2. - BMI at discharge: 18,69 ±3,43 kg/m2

3. - 19/22 patients (86%) had a premorbid history of overweight

4. - Binge eating: 8 patients (36,4%)

5. - Purgative behaviour: 10 patients (45%)

6. - Laxatives use: 4 patients (18%)

7. - Intense physical exercise: 21 patients (95,5%)

8. - Average duration of current restrictive episode: 13,7 months

In the studied sample we observed:

1. - High prevalence of premobid overweight

2. - Very high frequency of compulsive exercise

3. - Drastic weight loss and loss of a very high percentage of the previous weight, in short periods of time, reaching very low BMI.

Fiction films offer unexplored support for rehabilitation in patients with schizophrenia and other psychoses. Schizophrenia produces deficits and distortions in perception and understanding of reality, also expressed in the perception and comprehension of films. After two years of experience “ad hoc” we have designed an experimental case-control study in order to study the effectiveness of the proposed technique compared with conventional “cinema-forum”

20 patients treated at the Psychiatric Day Hospital in Puerta de Hierro Hospital (Majadahonda) will participate in the study. Initially, the researcher will collect information on socio-demographic and clinical data of all participants, as well as a written informed consent. There will be an initial assessment using the following instruments:

1. - SCID

2. - PANSS

3. - SCIP (schizophrenia cognitive screening)

4. - Scale GEOPTE (social cognition in schizophrenia)

5. - Social Functioning Scale (SOFAS, PSP)

6. - Scale of disease awareness

7. - IPDE (TP)

8. - Hamilton Scale (anxiety-depression)

The material used will be the 12 chapters of the first season of TV series “The Sopranos” by David Chase (2004). Specific techniques of cognitive and affective work are compared against a “cinema-forum”. For the evaluation of the effectiveness of the proposed technique, it will be used a measurement tool designed specifically for the activity, which includes:

1. 1. 60 item-Scale, specific on each chapter, evaluating:

1. - Attention

2. - Concentration

3. - Memory

4. - Comprehension of the main plot

5. - Comprehension of subplots

6. - Dialogues

7. - Other

8. - Self-identification of deficiencies or errors

• 2. Heteroapplied analogical scales

• 3. Semi-structured qualitative interview

analyse GAD impact on clinical and self-perceived health status in outpatients followed in Psychiatric clinics.

Multicentre, cross-sectional study enrolling subjects above 18 years-old with GAD according with ICD-10. Participants were chosen at ramdon by quotes and weighted geographically, but patients were enrolled consecutively. HAM-A and CGI-S were administered to determine clinical status and SF-36 and Sheehan disability scales for health status assessment.

A total of 792 patients; 15.7% naives (GADn), 68.9% women, mean (SD) age of 40.0 (12.9) years were included. Time to effective diagnosis and start up of treatment were, respectively, 2.3 (4.9) and 2.6 (4.7) years. Severe symtoms of anxiety (HAM-A > 24) were presented in 45.2%; 56.9% in GADn vs 43.0% on-treatment (GADt), p<0.001. CGI-S was 3.7 (1.1) in GADn vs. 4.2 (0.8) in GADt, p<0.001. The 77,7% of GADt were receiving 2 or more drugs: 94.1% ansiolytics and/or antidepressants. The 39.3% of subjects showed high/extreme disability for work; 44.4% GADn vs 38.5% GADt, p=0.33, 34.5% for daily-living domestic activities; 39.7% vs 33.7% respectively, p=0.082, and 41.8% for social life; 43.1% vs 41.7% respectively, p=0,145. Mental composite summary of SF-36 was below normal; 30,0 (11,4), much lower in GADn: 25,4 (8,5) vs. 30,8 (11,7), p<0.001. No gender differences were found.

This study showed that a considerable proportion of GAD patients still need for additional medical remedies which should improve the level of disability caused by the diasease and counteract the deteriorated mental health observed in such patients.