Age-related vascular changes have long been documented as an etiopathogenic factor of some geriatric depressive syndromes. More recently, it has emerged the concept of “Vascular Depression” recognizing that cardiovascular disease may predispose, precipitate or perpetuate late life depression. This condition was defined by an episode of major depressive disorder within the preceding 12 months in elderly with cardiovascular/cerebrovascular disease, or major cardiovascular risk factors. Vascular Depression isn`t described in DSM-V, and that difficults clinical recognition and affects clinically informed systematic studies.

Regarding a clinical case, we enphasize the clinical impact of Vascular Depression`s hypothesis.

We present a qualitative review of this topic using the Pubmed Central database.

74 years old male patient, with major depressive disorder about ten years. Depressive and cognitive symptoms didn`t respond to antidepressive treatment and his functional state has gradually declined.

Vascular depression develops after the 60 – 65 years in the absence of personal and family history of affective disorder. The key symptoms are low energy, anhedonia, deficits in selfinitiation, psychomotor retardation, reduced processing speed and lack of insight into mood symptoms. Clinical assessment includes a review of history of vascular risk factors or/and disease, but also an imagiological evidence demonstrating subcortical white matter abnormalities. Insidious and chronic course tends to delay its recognition and management. This becomes critical because Vascular Depression is associated with poor response to antidepressant treatment and persistent depressive symptoms. It`s also associated with poor selfmanagement of comorbidities and impairment in daily function. Increased mortality from all causes is widely documented.

Community Advisory Boards (CABs) are typically comprised of adult community members who provide feedback on health-related, adult-focused research. Few, if any, CABs comprised of youth participants exist. In 2019, a Midwest medical center recruited a diverse group of 18 11–17-year-old community members to a Pediatric Advisory Board (PAB) to provide feedback on the recruitment and involvement of minors in research.

Semi-structured interviews with n = 12 PAB members were conducted to understand their experiences and views on participating in the PAB. Parents (n = 7) were interviewed separately to assess the congruence of views on PAB membership between parents and their children. Interview transcripts were qualitatively analyzed to identify iterative themes.

PAB members thought the PAB addressed an unmet need of soliciting feedback from youth to develop age-appropriate study materials and to understand potential concerns of young participants. While PAB members expressed interest in the research topics presented by researchers, a few members indicated barriers to full participation, including lack of self-confidence, anxiety, and discomfort sharing opinions in a group setting. Parents supported their child’s PAB participation and hoped it would help them build confidence in developing and sharing their opinions in ways that were meaningful for them, which PAB members largely reported occurring over their period of involvement.

Findings from a novel Midwest PAB indicated benefits to PAB members. While contributing to pediatric research planning by providing feedback on recruiting youth and improving study protocols, they gained confidence in providing opinions on biomedical research and developed their scientific literacy.

Depressive and anxiety disorders are highly comorbid, which has been theorized to be due to an underlying internalizing vulnerability. We aimed to identify groups of participants with differing vulnerabilities by examining the course of internalizing psychopathology up to age 45.

We used data from 24158 participants (aged 45+) in 23 population-based cross-sectional World Mental Health Surveys. Internalizing disorders were assessed with the Composite International Diagnostic Interview (CIDI). We applied latent class growth analysis (LCGA) and investigated the characteristics of identified classes using logistic or linear regression.

The best-fitting LCGA solution identified eight classes: a healthy class (81.9%), three childhood-onset classes with mild (3.7%), moderate (2.0%), or severe (1.1%) internalizing comorbidity, two puberty-onset classes with mild (4.0%) or moderate (1.4%) comorbidity, and two adult-onset classes with mild comorbidity (2.7% and 3.2%). The childhood-onset severe class had particularly unfavorable sociodemographic outcomes compared to the healthy class, with increased risks of being never or previously married (OR = 2.2 and 2.0, p < 0.001), not being employed (OR = 3.5, p < 0.001), and having a low/low-average income (OR = 2.2, p < 0.001). Moderate or severe (v. mild) comorbidity was associated with 12-month internalizing disorders (OR = 1.9 and 4.8, p < 0.001), disability (B = 1.1–2.3, p < 0.001), and suicidal ideation (OR = 4.2, p < 0.001 for severe comorbidity only). Adult (v. childhood) onset was associated with lower rates of 12-month internalizing disorders (OR = 0.2, p < 0.001).

We identified eight transdiagnostic trajectories of internalizing psychopathology. Unfavorable outcomes were concentrated in the 1% of participants with childhood onset and severe comorbidity. Early identification of this group may offer opportunities for preventive interventions.

Chronic consumption of cocaine can induce transient psychotic symptoms, expressed as paranoia or hallucinations. This is typically prevented by abstinence. The term Cocaine-Induced Psychosis (CIP) has been used to describe this syndrome. Impulsivity has been hypothesised are likked with CIP.

This study examined the relationship between CIP and substance consumption variables and impulsivity disorders including ADHD (Axis I) and Borderline personality disorders (BPD) (Axis II), and attempted to evaluated their link as a risk factors for CIP.

Trained psychiatrists systematically conducted a structured interview in which the conclusions from the psychotic symptoms were summarized. We used the CADDID to evaluate Adult ADHD, SCID II for axis II disorders, and the Barrat Impulsivity Scale (BIS-11).

We evaluated 163 (34,16 yo, 85,80% men) cocaine-dependent patients, according to DSM-IV criteria.

We found statistically significant association between CIP and Early age at onset of cocaine addiction (p = 0,04), cocaine use per day 6 months before starting treatment (p = 0,03), Barrat cognitive impulsivity subscale (p < 0,004), and Adult ADHD (p < 0,041). No relationship between BPD and CIP was found.

We confirm previous findings that Impulsivity disorders as ADHD or high impulsivity trails are liked to CIP. Coinciding with our previous findings, relationship between early age of onset cocaine dependence or high amounts of cocaine use and CIP was found. CIP are related with impulsivity disorders spectrum.

Chronic pain irrespective of its origin can be a major factor of significant distress inducing high levels of anxiety, depression and sleep disturbance. These symptoms can, by their turn, aggravate the perception of pain. The objective of this study is to characterize mood, anxiety and sleep pattern in patients with chronic rheumatic pain.

Patients observed in the Psychosomatic Consultation of Coimbra University Hospitals from January 2008 with chronic rheumatologic pain were included in the study. They were prospectively assessed (twice in average) by a Psychiatrist for mood, anxiety, sleep, general status and levels of pain with standardized rating scales.

Thirty-two female patients were included in the study. Mean age was 51,22±7,37 years. Depression and levels of anxiety both correlated positively with Clinical Global Impression Scale but not with the level of pain reported by the patient. Moreover, although a significant proportion of the patients reported sleep disturbance, especially in the beginning and in the middle of the night, this was not correlated with levels of pain.

This study suggests that chronic pain is not a predictor of depression and anxiety and does not fully explain the distress reported by patients with chronic rheumatic disorders. Assessment of other factors such as personality traits, coping styles and maladaptative health behaviours should be part of the routine intervention in these subjects.

Cocaine induced psychosis (CIP) is common but not developed in all cases. Many risk factors have been linked with CIP. A lifetime diagnosis of ADHD has been associated with the categorical presence of CIP.

The objective of this study is to determinate the relationship between impulsivity and impulsivity-realetd disorders (BPD, BN and ADHD) and CIP.

We study the presence of psychotic symptoms using a clinical interview for psychotic symptoms in a large sample of cocaine-dependent patients. Patients suffering from schizophrenia or bipolar disorders were excluded. Finally we included 287 patients in the study.

A structured interview about psychotic symptoms were systematically conducted. The Structured Clinical Interview for DSM IV Axis I and Axis II disorders were used in order to identify the comorbidity. CAADID-II (Conners’ Adult ADHD Diagnostic Interview for DSM-IV) were used in order to identify ADHD comorbidity. Barrat impulsivity scale were used for evaluate impulsivity.

BIS total were 63.78. We identify a significant association between CIP and BIS cognitive subscale p < 0.003 and BIS total p < 0.021. We also identify a significant association between CIP and adult ADHD in cocaine-dependent patients p < .0.002. We fail to identify association between CIP and BPD and BN.

CIP is related with BIS cognitive subscale and BIS total scores, and with ADHD comorbidity in cocaine-dependent patients. As well these findings could be useful for a clinical approach to the risks of psychotic states in cocaine-dependent patients.

Substance-dependent patients(SDP) have more personality disorders(PD) than general population; and they present more frequent and severe levels of depression and anxiety.

To study cluster C personality disorders in SDP.

We included a clinical sample of 822(621 males) SDP according to the DSM-IV-TR criteria seeking treatment in the Outpatient Drug Clinic Vall d’Hebron in Barcelona, Spain.

The assessment process consisted of three interview sessions conducted by trained psychiatrists and psychologists using SCID I and II, BDI, STAI-R/S. Exclusion criteria were:intoxication at baseline examination, severe somatic disease at baseline examination and low language proficiency.

39.2% of the sample presented at least one PD and 9.55% presented a cluster C PD. Of them the found prevalence were Avoidant(44.9%), Dependt(11.5%), Obssessive-compulsive(37.2%), comorbidity (6.4%). The addiction prevalences that Cluster C PD patients show were: dependent of alcohol 9.4%, benzodiazepines 18.5%, opioids 6.1%, cocaine 9.7 and cannabis 12.3%.

70.5% of the PD cluster C group were men, however differences according to the cluster C PD were found, being higher the proportion of men in Obsessive-compulsive PD (85.7%) and fewer in Dependent PD patients (33.7%)(χ2 =12.19, p = .007).

Cluster C PD patients presented more depressive symptoms and showed higher scores in anxiety-trait than patient with Cluster A or B PD, being this difference statistically significant.

There is a high rate of cluster C personality disorders among addicted patients. Higher levels of anxiety depression are detected in these patients. Clinicians should be check systematically this symptoms and traits in addicted patients.

There is limited understanding of the cognitive profiles of Spanish-speaking children with Attention-Deficit/Hyperactivity Disorder (ADHD). The current study investigated the cognitive cluster profiles of Puerto Rican Spanish-speaking children with ADHD using the Wechsler Intelligence Scales for Children-Fourth Edition Spanish (WISC-IV Spanish) Index scores and examined the association between cognitive cluster profiles with other potentially relevant factors.

Hierarchical cluster analysis was used to identify WISC-IV clusters in a sample of 165 Puerto Rican children who had a primary diagnosis of ADHD. To examine the validity of the ADHD clusters, analysis of variances and chi-square analyses were conducted to compare the clusters across sociodemographics (e.g., age and education), type of ADHD diagnosis (ADHD subtype, Learning Disorder comorbidity), and academic achievement.

Clusters were differentiated by level and pattern of performance. A five-cluster solution was identified as optimal that included (C1) multiple cognitive deficits, (C2) processing speed deficits, (C3) generally average performance, (C4) perceptual reasoning strengths, and (C5) working memory deficits. Among the five clusters, the profile with multiple cognitive deficits was characterized by poorer performance on the four WISC-IV Spanish Indexes and was associated with adverse sociodemographic characteristics.

Results illustrate that there is substantial heterogeneity in cognitive abilities of Puerto Rican Spanish-speaking children with ADHD, and this heterogeneity is associated with a number of relevant outcomes.

In cases of mass-casualty incidents (MCIs), triage represents a fundamental tool for the management of and assistance to the wounded, which helps discriminate not only the priority of attention, but also the priority of referral to the most suitable center.

The objective of this study was to evaluate the capacity of different prehospital triage systems based on physiological parameters (Shock Index [SI], Glasgow-Age-Pressure Score [GAP], Revised Trauma Score [RTS], and National Early Warning Score 2 [NEWS2]) to predict early mortality (within 48 hours) from the index event for use in MCIs.

This was a longitudinal prospective observational multi-center study on patients who were attended by Advanced Life Support (ALS) units and transferred to the emergency department (ED) of their reference hospital. Collected were: demographic, physiological, and clinical variables; main diagnosis; and data on early mortality. The main outcome variable was mortality from any cause within 48 hours.

From April 1, 2018 through February 28, 2019, a total of 1,288 patients were included in this study. Of these, 262 (20.3%) participants required assistance for trauma and injuries by external agents. Early mortality within the first 48 hours due to any cause affected 69 patients (5.4%). The system with the best predictive capacity was the NEWS2 with an area under the curve (AUC) of 0.891 (95% CI, 0.84-0.94); a sensitivity of 79.7% (95% CI, 68.8-87.5); and a specificity of 84.5% (95% CI, 82.4-86.4) for a cut-off point of nine points, with a positive likelihood ratio of 5.14 (95% CI, 4.31-6.14) and a negative predictive value of 98.7% (95% CI, 97.8-99.2).

Prehospital scores of the NEWS2 are easy to obtain and represent a reliable test, which make it an ideal system to help in the initial assessment of high-risk patients, and to determine their level of triage effectively and efficiently. The Prehospital Emergency Medical System (PhEMS) should evaluate the inclusion of the NEWS2 as a triage system, which is especially useful for the second triage (evacuation priority).