Late-life depression has been associated with volume changes of the hippocampus. However, little is known about its association with specific hippocampal subfields over time.

We investigated whether hippocampal subfield volumes were associated with prevalence, course and incidence of depressive symptoms.

We extracted 12 hippocampal subfield volumes per hemisphere with FreeSurfer v6.0 using T1-weighted and fluid-attenuated inversion recovery 3T magnetic resonance images. Depressive symptoms were assessed at baseline and annually over 7 years of follow-up (9-item Patient Health Questionnaire). We used negative binominal, logistic, and Cox regression analyses, corrected for multiple comparisons, and adjusted for demographic, cardiovascular and lifestyle factors.

A total of n = 4174 participants were included (mean age 60.0 years, s.d. = 8.6, 51.8% female). Larger right hippocampal fissure volume was associated with prevalent depressive symptoms (odds ratio (OR) = 1.26, 95% CI 1.08–1.48). Larger bilateral hippocampal fissure (OR = 1.37–1.40, 95% CI 1.14–1.71), larger right molecular layer (OR = 1.51, 95% CI 1.14–2.00) and smaller right cornu ammonis (CA)3 volumes (OR = 0.61, 95% CI 0.48–0.79) were associated with prevalent depressive symptoms with a chronic course. No associations of hippocampal subfield volumes with incident depressive symptoms were found. Yet, lower left hippocampal amygdala transition area (HATA) volume was associated with incident depressive symptoms with chronic course (hazard ratio = 0.70, 95% CI 0.55–0.89).

Differences in hippocampal fissure, molecular layer and CA volumes might co-occur or follow the onset of depressive symptoms, in particular with a chronic course. Smaller HATA was associated with an increased risk of incident (chronic) depression. Our results could capture a biological foundation for the development of chronic depressive symptoms, and stresses the need to discriminate subtypes of depression to unravel its biological underpinnings.

Transcranial Magnetic Stimulation is a non invasive brain stimulation technique used for several neuropsychiatric conditions. The treatment of Acute Lymphoblastic Leukaemia (ALL) involves many cytotoxic drugs that inhibit the rapid growth of cancer cells, but also damage healthy cells, resulting in a wide range of adverse effects (Śliwa-Tytko et al., 2022). Studies have shown that approximately 10-30% of paediatric ALL patients suffer from psychiatric disorders. Therefore, new therapeutic tools are needed, and repetitive transcranial magnetic stimulation (rTMS) has demonstrated tolerability, effectiveness and safety in children (Allen et al., 2017).

We discuss the first case of a 9-year-old girl diagnosed with acute lymphoblastic leukaemia B in who underwent Continuous Theta-Burst Stimulation

Case Presentation. In this study, we describe a case of a 9-year-old girl diagnosed with acute lymphoblastic leukaemia B in November 2016 who completed treatment in July 2019. Since April 2018 she presented symptoms of intracranial hypertension and encephalopathy with behavioural alterations, attention deficit secondary to toxicity. Psychotic outbreaks after toxicity from different treatments was also present. Since starting pericyazine (July 2022) there has been a slight improvement, but her symptoms continue to have a severe impact in her daily functioning. Baseline developmental profile assessed with the Battelle Inventory was significantly below the expected level in all developmental areas except for gross motor skills. Treatment. The TMS intervention consisted of the application on right DLPFC (F4), inhibitory cTBS protocol (5Hz bursts and 3 pulses of 50 Hz each). The protocol consisted in delivering 2 sessions per day for 15 days (separated by 55 minutes), 4 minutes per session (3600 pulses/session), 30 sessions in total. An intensity of 100% of resting motor threshold (C4). TMS was performed with the Magventure Magpro X100 MagOption equipment, Cool DB-80 double cone coil. The Child Behaviour Checklist (CBCL) for parents was used to assess intervention effects.

CBCL results reflect improvements in both internalising and externalising total scores after treatment. Specifically, the patient presents clinically significant decreases in several dimensions such as anxious/depressed symptoms, somatic complaints, and social problems. No adverse effects have been reported since the beginning of the intervention.

Internalising and externalising behaviours severity were reduced after 30 TMS sessions. In accordance with the latest systematic reviews on the safety of TMS in the paediatric patient (Zewdie et al, 2020) we propose the development of paediatric guidelines to offer this technique to patients with a history of intolerability or poor drug response.

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Mental health awareness campaigns in the past few years have vastly improved how medical professionals treat mental health patients. However, prejudices and ignorance still interfere in medical practice. In this context, with the case presented we can see that even in presumed mental health diagnoses along with cultural factors (race, language…), the best medical assistance is not ensured.

Review how different intersectional factors can determine the treatment patients receive at hospitals.

Presentation of a patient’s case and review of existing literature, in regards to the influence of race, language barriers and mental health diagnoses when attending patients.

The patient is presumed to suffer from a mental health condition after a battery of initial tests with inconclusive results do not demonstrate an organic origin. Instead of continuing with the medical study, the patient is disregarded as psychiatric even though his profile doesn´t fit beforehand of a fictitious or conversion disorder. The fact that there are also cultural factors in play (race and language) probably unconsciously influence how the medical team treats this patient’s case. Cultural social factors persistently present as barriers in clinical practice.

Race, language barriers and mental health diagnoses as well as other intersectional factors do have a great impact in the treatment patients receive. There is yet a lot to do when it comes to educating health professionals if we want to offer the best medical assistance.

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Psychiatric comorbidity has a significant impact on the patient’s overall health, with an increased risk of death for those patients with mental-physical comorbidity (Tan et al., 2021). This impacts, among other things, the average hospital stay of a patient with psychiatric comorbidity. For example, an American study shows that psychiatric comorbidity was associated with greater inpatient utilization, including the risk of additional hospitalizations, days of stay, and hospitalization charges (Sayers et al., 2007). Our study aims to confirm these results in patients admitted to a general hospital for any cause and presenting psychiatric comorbidity.

To compare the mean length of stay of patients admitted to a general hospital for any cause according to whether they have psychiatric comorbidity or not.

We made a descriptive retrospective study through the use of electronic medical records. The drug use history and average day of hospitalization were obtained for all patients admitted to the inpatient service of a general hospital during a 3-year period.

The mean length of stay was longer in patients with psychiatric comorbidity (mean = 9.87 days, SD = 15.45) than in patients without psychiatric comorbidity (mean = 5.23 days, SD = 7.16), the difference being statistically significant for the analysis of variance with a small effect size (F = 18.2; p < 0.001, η²=0.038). The assumption of the equality of variances of the two groups is not fulfilled (Levene F = 29.0; p < 0.01) so Welch’s nonparametric test was applied, whose results do not modify those obtained.

Our results are in line with other studies, showing a longer mean length of stay in those patients admitted for any cause and with associated psychiatric comorbidity. This highlights the importance of having an integrated psychiatry service in a general hospital, as Bronson points out, where they find a shorter mean length of stay in units that have integrated, proactive psychiatric care (Bronson et al., 2019).

Bronson, B. D., Alam, A., & Schwartz, J. E. (2019). The Impact of Integrated Psychiatric Care on Hospital Medicine Length of Stay: A Pre-Post Intervention Design With a Simultaneous Usual Care Comparison. Psychosomatics.

Sayers, S. L., Hanrahan, N., Kutney, A., Clarke, S. P., Reis, B. F., & Riegel, B. (2007). Psychiatric comorbidity and greater hospitalization risk, longer length of stay, and higher hospitalization costs in older adults with heart failure. Journal of the American Geriatrics Society.

Tan, X. W., Lee, E. S., Toh, M., Lum, A., Seah, D., Leong, K. P., Chan, C., Fung, D., & Tor, P. C. (2021). Comparison of mental-physical comorbidity, risk of death and mortality among patients with mental disorders - A retrospective cohort study. Journal of psychiatric research.

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Suicide is a global epidemic, with the World Health Organization (WHO) estimating that there are roughly 800,000 suicides annually, accounting for 1.4% of all deaths, and making suicide the 18th leading cause of death in 2016 (World Health Organization. There is a pressing need to better understand factors that contribute to suicide risk. One important domain for suicide prevention is inpatient psychiatric treatment, as many patients are admitted precisely in order to reduce their risk of suicide. Although inpatient psychiatric treatment is often used for suicide risk prevention the risk of suicide after inpatient treatment remains high. Patients who have been recently discharged have a greater risk of suicide than non-hospitalised mentally ill people.

Review suicidal risk after hospitalisations and the factors that may have an influence on it.

Presentation of a patient’s case and review of existing literature, in regards to the rate of suicide after a patient is released from psychiatric hospitalisation and the factors that surround it.

The patient in question is admitted into a psychiatric ward with a diagnosis of severe psychotic depression, after a suicide attempt trying to dissect his arms’ blood vessels. Health professionals at the hospital attend to his needs and the patient sees improvement. Not long after his release, there is a second hospital admission, which doesn’t have the same result and after his release he successfully ends his life. What comes to mind with these sorts of patients is: what kind of help would they have needed? Why hospital admission was not enough? And which factors and profile of patient is more prone to develop suicide behaviour?

Admissions at psychiatric wards always have to be thought of as a beneficial resource for patients. There are some cases in which patients do not get the help they need by being hospitalised, increasing the risk of comitting suicide. A lot more studies will have to be carried out to understand what variables play a part in this. Meanwhile an improvement in outpatient care to support patients after hospital release is crucial.

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The elderly represents the fastest growing group of the population. It is fair to assume that the portion of old age patients suffering from bipolar disorder will grow in a similar manner. Elderly patients represent approximately 25% of the bipolar population. Summarizing, 5–10% of patients were 50 years of age when they experienced their first manic episode, constituting the subgroup of late onset bipolar disorder (LOBD).

The purpose of this case report and literature review is to emphasise the importance of LOBD in old population and to highlight its still sparse-knowledge.

Descriptive case study and review of literature (Arnold,I. et al. Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment. Medicina 2021,57,587; Baldessarini et al. Onset-age of bipolar disorders at six international sites. J Affect Disord 2010;121(1-2):143-6).

A 60-year-old woman is brought to the emergency department for evaluation by her family. Over the past 7 days, the patient has become increasingly irritable and argumentative, is sleeping less, is talking faster than usual and has begun to express paranoid concerns about her students “stealing my exam”. The patient is a university professor.

In the assessment interview she is hyperverbal, expansive, and grandiose. The family has also just recently discovered that she has spent a large sum of money on the Internet.

She has no history of psychiatric contact or substance use disorders; however, she has a family history of severe depression.

In the absence of any plausible non-psychiatric condition that could mimic or induce mania, the working diagnosis is bipolar I disorder, most recent episode (MRE) manic with psychotic features.

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The share of older age bipolar disorder will grow constantly in the next decades and further research on this neglected patient group is urgently required.

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Intensive home treatment (IHT) for people experiencing a mental health crisis has been progressively established in many western countries as an alternative to in-ward admission. But is this a real alternative? We previously reported that patients treated in our IHT unit only differ from those voluntarily admitted to hospital in suicidal risk and severe behaviour disorders (not in other factors such as clinical severity) (Martín-Blanco et al., Rev Psiquiatr Salud Ment 2022;15:213-5). Now we are interested in disentangle if those patients who used to require inward management can be successfully treated at home.

To describe subsequent treatment trajectories of the first 1000 admissions to our IHT unit and to compare clinical characteristics among the different groups of trajectories.

Retrospective cohort study. Subsequent treatment trajectories were collected from December 2016 to October 2022 and classified: absence, hospital, IHT, and mixed (hospital and IHT). Statistical significance was tested by means of ANOVA or Kruskal-Wallis test for quantitative variables (corrected for multiple comparisons) and chi-square tests for qualitative variables.

Tables 1 shows the characteristics of the whole sample. Of the 1000 IHT admissions, 12.1% needed subsequent hospital admission(s), 12.7% IHT admission(s), and 9.3% mixed admission(s). There were no differences among these groups in median severity at IHT admission, but there were differences in the number of previous admissions (p=0.0001): the group with no subsequent admissions had less previous admissions than the other groups (pBonf<0.0001), and the group with subsequent IHT admissions had less than the group with mixed admissions (pBonf=0.0123). There were differences between groups regarding distribution of diagnoses (p<0.0001) (Fig. 1). When considering subsequent admissions by diagnosis, there were differences in severity at IHT admission (p=0.0068) and in number of previous hospitalizations (p<0.0001) (Fig. 2).Table 1.Clinical characteristics of the whole sample (N=1000)

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Patients that used to require inward management can now be treated at home when suffering an acute episode. Therefore, IHT has changed treatment trajectories for some patients with psychiatric disorders.

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Women with bipolar disorder often ask their treating clinician for information about family planning, as they are concerned about the impact of their illness on offspring. Pregnancy places additional stress on patients, and physiological changes are particularly acute during postpartum. On the other hand, the risk of abnormalities and teratogenicity from psychotropic drugs is significant. The decision wether resuming or discontinuating lithium is discussed.

We present a theoretical review on the topic.

A bibliographic review is presented.

The choice to continue medication during pregnancy balances the risks of an untreated illness with the risks of medication exposure. Abrupt discontinuation of psychotropic medications is associated with an increased risk for illness recurrence. Women with BD who discontinue their medications before or during pregnancy have a 71% risk of recurrence with new episodes occurring most frequently in the first trimester. Recurrent illness during pregnancy is associated with a 66% increase in the risk of postpartum episodes. Untreated or under-treated BD during pregnancy is associated with poor birth outcomes independent of pharmacotherapy exposure, including preterm birth, low birth-weight, intrauterine growth retardation, small for gestational age, fetal distress, and adverse neurodeve- lopmental outcomes. Women with untreated BD also have behavioral risk factors such as decreased compliance with prenatal care, poor nutrition, and high-risk behaviors. Impaired capacity to function may result in loss of employment, health care benefits, and social support. The biological and psychosocial risks of a BD episode are the justification for the risk of medication exposure.

Fetal exposure to lithium has been associated with an increased risk for cardiac abnormalities. The risk for Ebstein’s anomaly with first trimester exposure is 1 (0.1%) to 2 in 1000 (0.2%), but the absolute risk remains low. Folate supplementation with 5 mg reduces the risk and severity of congenital heart disease. Lithium toxicity causes lethargy, hypotonia, tachycardia, coma, cyanosis, and chronic twitching in the newborn.

Strategies to minimize fetal exposure and maintain efficacy include using the lowest effective dose, prescribing lithium twice daily to avoid high peak serum concentrations, and regular monitoring of lithium serum concentrations. The effective serum concentration must be established before pregnancy. If a therapeutic concentration has not been established, the lithium dose is titrated to a concentration within the therapeutic range. Breast feeding is discouraged in women taking lithium because of the high rate of transmission to the infant.

Treatment decisions for pregnant women with mood disorders must weigh the potential for increased risks of lithium during pregnancy, especially during the first trimester, against its effectiveness at reducing relapse.

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The occurrence of psychotic symptoms induced by dopaminergic drugs marks a new phase in the course of Parkinson’s disease (PD). The term drug induced psychosis may be used when other significant psychiatric diseases are excluded in patients with no history of psychosis. The prevalence of dopaminomimetic psychosis varies from 5% to 20%. Therefore, knowledge of the psychopharmacological management of this condition is essential.

The purpose of this case report and literature review is to to learn the psychopharmacological management of this not uncommon medical complication.

Descriptive case study and review of literature

We present the case of a 71-year-old man with a medical history of Parkinson’s disease with partial response to treatment with high doses of levodopa and carbidopa.

He was brought to the emergency department by his family due to the presence of behavioural alterations at home.

The patient reported seeing men in foam trying to harm his family. In a disjointed way in his speech, he links this idea with the delusional belief that he is being watched by electronic devices placed throughout the house. In a variegated manner he links this with a coelotypical type of discourse, however the delusional ideation remains unstructured throughout.

With no previous personal or family history of mental health and ruling out underlying organic conditions, a diagnosis of psychosis secondary to pharmacological treatment for Parkinson’s disease is presumed.

Considering the risks and benefits, it was decided to maintain the anti-Parkinson’s dose in order to avoid worsening the patient’s motor function. Therefore, after reviewing the literature, the best option was to introduce clozapine at low doses, up to 50 mg at night, with the respective analytical control. After a week’s admission, the patient began to improve psychopathologically, achieving an ad integrum resolution of the psychotic symptoms.

Despite the availability of other antipsychotic treatments such as quetiapine or the more recent pimavanserin, clozapine remains the treatment of choice for drug-induced psychosis in Parkinson’s disease.

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Home Treatment (HT) teams are among the better-studied options to reduce admission at the hospital, having been described as an alternative to hospitalization in patients with schizophrenia. There may be certain risk factors which has already been described such as living alone (Dean and Gadd, BMJ, 1990; 301, 1021–1023; Schnyder et al., Acta Psychiatr. Scand. 1999; 99, 179–187), lack of awareness of the illness, uncooperativeness (Cotton et al., BMC Psychiatry, 2007; 7, 52) and fewer visits carried out (Morgan et al., Aust. New Zeal. J. Psychiatry,2006; 40, 683–690) which together can negatively influence the possibility of conducting intensive home follow-up and, therefore, increase the likelihood of hospitalization.

To describe de relative contribution of several risk factors to patient hospitalization related to the possibility of conducting intensive home follow-up of patients diagnosed with Schizophrenia following home treatment. Second, to determine de risk of hospitalization related to the possibility of conducting intensive home follow-up according to the presence of one or more risk factors of patients diagnosed with Schizophrenia following home treatment.

All patients with schizophrenia who were visited by a home treatment team in Barcelona between January 2017 and December 2021 were included in the study. To assess whether there was an increased risk of hospitalization associated with factors such as living alone, uncooperativeness (PANSS G8 item >= 4) and ≤1 home visit, two bivariate logistic regression analyses were conducted. We studied these factors as independent variables to assess the relative contribution to the risk of hospitalization, and we studied if the presence of 1, 2, 3 or 4 of these risk factors as independent variables worsened the risk of hospitalization.

Uncooperativeness shows the highest contribution to the risk of hospitalization, followed by ≤ 1 home visit, lack of insight and living alone, all results reaching significance (p=0.000).

There is an increase in the risk of hospitalization depending of the presence of 1,2,3 or 4 of these risk factors (1 risk factor (Odds Ratio = 1.21), 2 risk factors (Odds Ratio = 5.28), 3 risk factors (Odds ratio = 13.53), 4 risk factors (Odds ratio = 29.18).

There are a number of factors directly related to the possibility of conducting intensive follow-up that appear relevant in the case of psychotic patients in acute crisis treated at home. This set of variables are the lack of awareness of the illness, lack of collaboration, living alone and the number of visits that have been made, all with statistically significant differences in our study. These factors together also greatly increase the risk of hospitalization, becoming almost 30 times more likely when these 4 factors are present.

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Nowadays, In the exercise of psychiatric clinical activity, the prescription of atypical antipsychotics is a widespread practice.

However, despite the approval in the treatment of psychoses and bipolar affective disorder, where its effectiveness is clearly demonstrated, these drugs are off-label prescribed in most of the clinical situations.

This work aims to clarify which atypical antipsychotics are most frequent prescribed and the clinical conditions where their off-label prescription is more common.

Bibliographic research in the Pubmed® database using the terms “atypical antipsychotics and off-label use”

According to the scientific literature consulted, the off-label prescription of atypical antipsychotics may represent about 70% of the total prescription of these psychotropic drugs.

Risperidone, olanzapine, quetiapine and aripiprazole are the most off-label prescribed among the atypical antipsychotics.

The psychiatric conditions where atypical antipsychotics are most often off-label prescribed are addictive disorders, anxiety disorders, post-traumatic stress disorder, personality disorders, eating disorders, insomnia and dementia, where therapeutic benefits are demonstrated when carefully selected.

The off-label prescription can be interpreted from two points of view. On the one hand, it can guide innovation in clinical practice and improve symptoms in patients who do not respond to standard treatments. On the other hand, it may be associated with negative consequences due to the lack of data on safety and efficacy in these situations.

Despite widespread prescribing of atypical antipsychotics, there is no evidence-based recommendation beyond psychoses and bipolar affective disorder.

Thus, when prescribed, we must proceed with careful monitoring and consider the risks and benefits in relation to off-label prescription.

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Dissociative identity disorder (DID) also referred as multiple personality disorder is a chronic post-traumatic condition. It is characterized according to DSM-5 by “disruption of identity characterized by two or more distinct personality states”, with “marked discontinuity in sense of self… accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning.”

Here, we present a case of a 33-year-old Caucasian female with no psychiatric history until 2 years ago, privately. The patient is admitted to the Psychiatry Service due to worsening. During admission, consultations are made to the Neurology Service and the Neurophysiology Service, who request an electroencephalogram, an MRI and a brain scan, resulting in normality.

After discharge, she returns home with her parents, and the crisis become more frequent and of longer duration. She acknowledges that during these periods she is dominated by her alternate personality, which she is unaware of until her family informs her. This personality is a demon, who verbally assaults and even physically threatens her surroundings, and can hardly be controlled by the prayers of her family.

Despite psychopharmacological treatment, as well as the cognitive-behavioral therapy carried out by the patient for more than two years, there was no improvement. Once she comes to the consultation, it is decided to carry out a therapy guided by the central Rogerian attitudes, originating a process of empathic resonance of the therapist, which influences the experience of the patient. Three main interventions are carried out, the awareness of the disease, the regulation of the intensity of this experience, to maintain the attention and the exploration of what guides the change. After carrying out this intervention, the patient is currently asymptomatic.

Currently, there are not evidence-based treatment guidelines. The most common approach is individual psychodynamic psychotherapy according to practice-based guidelines initiated by the International Society for the Study of Trauma and Dissociation.

To handle the present case, we used a model with two pillars, the patient’s commitment and the investigation of microprocesses within a process of experiential exploration, in which the therapist is a facilitator of reflective attention and experimental awareness.

The torpid evolution suffered by the patient, with little clinical improvement to the interventions carried out, and the absence of evidence on the treatment, led to a therapeutic approach focused on the empathic resonance process of the therapist, with good results.

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The semiological spectrum that encompasses musical imagery is a very confusing field, as it is often difficult to understand the nature of the underlying psychopathological phenomenon from the patient’s description.

The purpose of the authors is to explore reviewing, distinguishing and organizing the concepts such as Intrusive musical imagery, musical obsessions, musical hallucinations, pseudohallucinations and musical palinacousis.

A brief non-systematized review is presented, using the literature available on PubMed and Google Scholar.

Intrusive musical imagery (earworms, ohrwurms, or involuntary musical imagery) occur in more than 85% of general population, without pathology or ear disease. It involves the involuntary repetition of 15-30 seconds of a fragment of music/tune, persisting like a looping soundtrack, not being aversive.

Musical obsessions are a rare form of intrusive imagery, occurring either with other symptoms of Obsessive Compulsive Disorder or isolated (“The stuck song syndrome”). It is recurrent, persistent, intrusive, unintentional, time consuming and causes distress or functional impairment (although not as ego-dystonic and aversive as usually intrusive visual imagery are); preserved insight.

Musical hallucinations occur only in 0,16% in a general hospital; they can be linked to psychiatric diseases, but they are more common in neurological diseases (cerebral lesions, Parkinson’s disease, delirium, drug induced…). They are reported to with less controllability, less lyrical content, and lower familiarity, than other forms of inner music; are perceived to arise from an external source and are interpreted as veridical.

Musical Pseudohallucinations can arise after severe hearing loss, in hallucinogen intoxication and in psychotic or non-psychotic disorders (as dissociative states or in borderline personality disorder). They occur in inner/subjective space, but insight can fluctuate.

Musical palinacousis is associated with electroencephalogram and neuroimaging abnormalities, linked to structural brain pathology. There is perseveration (echoing) of an external auditory stimulus occurs after cessation of the stimulus.

A rash classification can lead to misdiagnosis (for e.g. interpreting obsessive symptoms as hallucinatory phenomena or rendering an organic pathology undiagnosed) and the institution of inappropriate therapy. It is important to carefully explore these musical imagery phenomena when patients present these complaints, taking some time to characterize them.

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Four cases are presented who debut with depressive episodes and after close follow-up, are diagnosed and treated for Alzheimer’s disease

The aim of this case series is to give a brief review of the depressive prodrome of dementia.

Four women, aged 67-77 years, treated on an outpatient basis, consulted for depressive symptoms. In addition to affective symptoms such as apathy, lack of interest, sadness, increased emotional lability and anhedonia, all three reported cognitive impairment. In their follow-up after two years, they became progressively more dependent on their partners, with more memory lapses, forgetfulness and progressive loss of higher cognitive functions. With the progression of cognitive impairment, anxious symptoms have become increasingly present.

The mean age of the patients is 70 years. Two of them had an insidious onset of depressive symptoms, while the other two had a psychotic onset of depression. None of the patients had no previous history of depression. All four were started on antidepressant treatment with little response. Following the diagnosis of cognitive impairment, treatment was started with rivastigmine, with an adequate response.

Dementia and depression are very common in the elderly. It appears that up to 40% of patients with dementia have depressive symptoms. It appears that depression in old age may actually be a prodromal symptom of dementia.

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Chronic back pain is one of the leading causes of disability and treatment is often ineffective. Approximately 85% of cases are primary, for which the peripheral etiology cannot be identified, and maintenance factors include fear, avoidance, and beliefs that pain indicates injury.Studies suggest that an excessively negative orientation towards pain (pain catastrophism) and fear of movement/(re)injury (kinesiophobia) are important in the aetiology of chronic low back pain and associated disability.

The aim is to identify the psychopatological profile (including levels of movement phobia and catastrophic thinking) in patients with chronic low back pain who participate in a multidisciplinary group Comprehensive Care Program for Patients with Chronic Pain (PAINDOC) in the Pain Unit of the Hospital Clínic i Provincial de Barcelona.

A cross-sectional descriptive study of 75 patients aged between 28 and 68 years who participate in the treatment is carried out. A clinical interview was carried out, anxiety and depression symptoms were assessed with thHospital Anxiety and Depression Scale (HADS), Kinesiophobia was evaluated with the Tampa Scale Kinesiophobia (TSK-11SV) and catastrophism with the Pain Catastrophizing Scale (PCS).

The results show that the patients presented a high level of catastrophic thinking, especially in the subgroup of women with a longer duration of pain.Movement phobia was observed in 27% of patients, and correlated with feelings of depression and anxiety.

Catastrophism is a multidimensional psychological construct that encompasses elements such as rumination, magnification, and incapacity.Catastrophic thinking in relation to pain is a risk factor for chronic pain. Kinesiophobia is based on the fear avoidance model and perpetuates a cycle of heightened fear of pain, disability, and depression. These constructs can be very useful to evaluate in patients to reduce the intensity of pain, the associated emotional suffering and reduce the probability that the pain will become chronic.

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