Suicide attempts (SA) leading to highly lethal consequences have been associated with heightened suicide planning (Barker et al., 2022), along with deficits in social cognition (Levi-Belz et al., 2022). Hypomentalizing, characterized by excessive uncertainty regarding mental states, may contribute to heightened social withdrawal and an increased risk of SA (Nestor & Sutherland, 2022). Although certain studies have identified a connection between hypomentalizing profiles and self-harm (Badoud et al., 2015), research into the lethality of SA remains limited.

This study aimed to explore the association between hypomentalizing and SA lethality.

Our study encompassed a cohort of 1,371 patients who committed a SA. We conducted assessments of mentalizing using the RFQ-8 instrument, and evaluations of suicidal ideation and behavior employing the CSRSS questionnaire. Demographic and clinical characteristics were compared using the T-student and Chi-square tests. To investigate the relationship between hypomentalizing and the SA lethality, we employed logistic regression models.

Descriptive date are presented in Table 1. Our results show that hypomentalizing do not predict a higher SA lethality. Additionally, hypomentalizing increased the risk of SA planning (p≤0.001, B=-0.182), and SA planning predicted a higher SA lethality (see Table 2).Table 1.

Means Comparison for low and high lethality (N=1371)

While the association between hypomentalizing and high SA lethality was not significant, a discernible trend toward such relationship can be noted. Further studies examining the moderating effects of planning in the association between hypomentalizing and SA lethality are required.

None Declared

In clinical practice, significant delays in requesting help are observed in patients with depressive symptoms and suicidal ideation.

The objective of this study was to determine factors associated with the time of untreated illness in a population with depressive disorder attending mental health for the first time in the area of Hospital Clínico Universitario de Valladolid (HCUV).

Methods: This is an observational study including adult patients of both sexes, referred to their first mental health consultation from their Primary Care Physician, with a picture of depressive symptomatology associated with an identifiable stressor. Informed consent was obtained from the patients and authorized by the Ethics Committee of the HCUV. R Studio ® statistical analysis.

The degree of emotional confusion was quantified with item 1 (“I am often confused about the emotions I feel”) of the Toronto Alexithymia Scale (TAS). This item is scored ( 1-5 )from most severe (1) to least (5). On the other hand, the time in weeks between symptom onset to referral, age and symptom severity according to the Montgomery Scale (MADRS) were recorded.

Results: We present data collected in an initial sample of 278 treated patients, with a female predominance (68%), a MADRS severity score (18.05 ± 5.01) and a calculated time without treatment of 59.66 ± 62.26 weeks (Tables 1,2,3).

A subsample of 72 patients with death ideation was studied, with a female predominance (75%) compared to the overall sample (X2 =1.99, p = 0.1585) (Table 4).

It was also observed that death ideation was higher in younger patients (t = 3.18, p = 0.001907) and with a severe MADRS depression score (t = -7.92, p < 0.0001), however they took a similar length of time to receive mental health treatment (T student t = -1.6605, p = 0.099); (Table 5).

There is no previous published evidence that considers the timing of untreated symptoms. According to test statistics, there are differences in untreated symptom time considering gender and TAS score (Table 6).

Death ideation is a current health problem that deserves attention. In multivariate analysis models, an association with clinical and demographic factors has been found; however, there is up to 20% of the variation in prevalence that is not explained by the aforementioned factors. The factors that determine the time delay in seeking help (treatment delays) have not been studied so far.

In this study we observe how a single variable doesn’t explain the delay in the first visit. The interaction between age, gender, alexithymia and hypoprosexia explains the delay in seeking help, although symptom severity doesn’t seem to be related. These data suggest that unexplained causality in multivariate studies may be related to the interaction between clinical and neuropsychological factors.

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Suicide is a global public health issue. According to the latest available data from the National Institute of Statistics, 4,003 people died by suicide in 2021, reaching a new historical high. Approximately 90% of suicide victims suffer from one or more severe psychiatric disorders, and there is a documented 20-fold higher risk of suicide in individuals with affective disorders compared to healthy subjects (Abdelnaim et al., 2020). Repetitive transcranial magnetic stimulation (rTMS) has been established as an effective alternative or complementary treatment option for patients with depressive disorders, but little is known about its effects on suicide risk.

To assess the efficacy of rTMS in reducing depressive symptoms in patients with suicidal ideation and behaviors.

Population and Methods: A retrospective analysis was conducted on a sample of 28 psychiatric patients (23 females; mean age 49.36 ± 16.23) with suicidal ideation identified by item 3 (suicidality) of the Hamilton Depression Rating Scale (HDRS), who were treated with rTMS. All patients received a minimum of 30 sessions, consisting of the application of a high-frequency (>10Hz) or intermittent theta burst stimulation (TBS) over the left dorsolateral prefrontal cortex (DLPFC) at an intensity of 120% of the resting motor threshold (RMT), and repeated low-frequency pulses (1Hz) or continuous TBS over the right DLPFC with an intensity of 110% of the RMT.

Results: The results show a statistically significant improvement in depressive symptoms following rTMS intervention (p < 0.001). Furthermore, remission was observed in 46% of the sample (HDRS < 8).

Discussion: In line with recent studies (Abdelnaim et al., 2020; Hines et al., 2022) and systematic reviews (Cui et al., 2022; Bozzay et al., 2020) on suicidal ideation in the context of psychiatric disorders, the findings of this study demonstrated that rTMS achieved satisfactory results in reducing depressive symptoms and suicidal ideation.

Conclusions: This clinical study indicates preliminary promise for the prevention of suicidal acts and underscores the need for more detailed and specific research on rTMS in the field of suicide.

Keywords: rTMS, neuromodulation, depression, suicide.

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Gestational Loss represents a set of abrupt and unexpected losses throughout pregnancy or after childbirth. Every year, around two million babies die after 28 weeks of gestation, with between 14% and 20% of all pregnancies ending in loss. In most situations, pregnancy loss occurs in a pregnancy without signs of risk or irregularities, something that increases the shock and suffering felt by parents.

The present study aims to understand the relationship between pregnancy loss and parents’ grief experiences after spontaneous abortion, stillbirth or neonatal death with qualitative evidence.

This review followed the principles of PRISMA, and the search was carried out in the Web of Science and Scopus databases, aiming to find relevant articles about parental grief experiences resulting from pregnancy loss, published between 2012 and 2022. After research and analysis Of the studies, 15 qualitative studies were included.

The pain and sadness when experiencing the loss of a child was a common point in all the studies found. In this review, the majority of men revealed a duality in wanting to protect, physically and emotionally, their partner, while experiencing their own grief, something that led to the internalization of their emotions and the minimization of their pain. Grieving fathers and mothers report experiencing this process alone, describing the difficulty in expressing what they feel due to the lack of recognition of the loss. It was found that confrontation with other pregnant women leads bereaved parents to reveal jealousy and shame, as well as feelings of guilt. The farewell rituals, the process of writing and talking about their experience helped the women to not feel so alone and to find a purpose: to transform their pain and help other grieving mothers. Fathers and mothers who experienced pregnancy loss stated that the death of their child provided change and growth.

After Pregnancy Loss, adapting to the new reality is extremely painful, despite the work of mourning being necessary and crucial. This process is a search to integrate and accept the reality of the loss of the baby in a way that has meaning for the mother and father, it is the adaptation to a world without the lost child and to a relationship that had been built during the gestation period, which was violently broken. It is necessary for health professionals to be present and available to address these parents’ fears, provide advice and support.

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Cancer patients are among the most vulnerable populations during and after a disaster. We evaluated the impact of treatment interruption on the survival of women with gynecologic cancer in Puerto Rico following Hurricanes Irma and María.

A retrospective cohort study among a clinic-based sample of women with gynecological cancer diagnosed between January 2016 and September 2017 (n = 112) was done. Women were followed from their diagnosis until December 2019, to assess vital status. Kaplan-Meier survival curves and Cox proportional hazards models were performed.

Mean age was 56 (± 12.3) years; corpus uteri (58.9%) was the most common gynecologic cancer. Predominant treatments were surgery (91.1%) and chemotherapy (44.6%). Overall, 75.9% were receiving treatment before the hurricanes, 16.1% experienced treatment interruptions, and 8.9% died during the follow-up period. Factors associated with treatment interruption in bivariate analysis included younger age (≤55 years), having regional/distant disease, and receiving > 1 cancer treatment (P < 0.05). Crude analysis revealed an increased risk of death among women with treatment interruption (HR: 3.88, 95% CI: 1.09-13.77), persisting after adjusting for age and cancer stage (HR: 2.49, 95% CI: 0.69-9.01).

Findings underscore the detrimental impact of treatment interruption on cancer survival in the aftermath of hurricanes, emphasizing the need for emergency response plans for this vulnerable population.

Population-wide restrictions during the COVID-19 pandemic may create barriers to mental health diagnosis. This study aims to examine changes in the number of incident cases and the incidence rates of mental health diagnoses during the COVID-19 pandemic.

By using electronic health records from France, Germany, Italy, South Korea and the UK and claims data from the US, this study conducted interrupted time-series analyses to compare the monthly incident cases and the incidence of depressive disorders, anxiety disorders, alcohol misuse or dependence, substance misuse or dependence, bipolar disorders, personality disorders and psychoses diagnoses before (January 2017 to February 2020) and after (April 2020 to the latest available date of each database [up to November 2021]) the introduction of COVID-related restrictions.

A total of 629,712,954 individuals were enrolled across nine databases. Following the introduction of restrictions, an immediate decline was observed in the number of incident cases of all mental health diagnoses in the US (rate ratios (RRs) ranged from 0.005 to 0.677) and in the incidence of all conditions in France, Germany, Italy and the US (RRs ranged from 0.002 to 0.422). In the UK, significant reductions were only observed in common mental illnesses. The number of incident cases and the incidence began to return to or exceed pre-pandemic levels in most countries from mid-2020 through 2021.

Healthcare providers should be prepared to deliver service adaptations to mitigate burdens directly or indirectly caused by delays in the diagnosis and treatment of mental health conditions.

S100B is a calcium-binding astrocyte-specific cytokine, that is considered a biomarker of neurodegeneration; which may be involved in the imbalance of the inflammatory response observed in several brain disorders, including major depression and schizophrenia. Two meta-analyses have reported higher serum levels of S100B in patients with schizophrenia respect to healthy controls.

Different studies have described circadian and seasonal variations of biological variables, such as melatonin or cortisol. It has been reported that there is not circadian rhythm of S100B blood levels in healthy subjects. However, it is not known whether there are circadian oscillations in S100B blood concentrations in patients with schizophrenia.

The aim of this study is to describe S100B serum levels in patients with schizophrenia and to analyse whether they follow a circadian rhythm.

Our sample consists in 47 patients in acute phase and stabilized status. Blood samples were collected at 12:00 and 00:00 hours by venipuncture. Serum levels of Protein S100B were measured three times: at admission, discharge and three months after discharge. Protein S100B was measured by means of ELISA (Enzyme-linked immunosorbent assay) techniques.

There is a significance difference between 12:00 and 24:00 at admission for the Protein S100B.However, these difference did not occur at discharge and at three months after discharge.It can be interpreted as there is a circadian rhythm of Protein S100B when the patient has got a psychotic outbreak and disappears at discharge and when is psychopathologically stable.

With respect to our results we can hypothesize that schizophrenic patients in acute relapse present circadian S100B rhythm that is not present when the patients are clinically stable.Furthermore, the decrease of serum protein S100B levels at discharge is indicative of a reduction of the cerebral inflammation, thus it can be a biomarker of cerebral inflammation and this reduction can be the effect of the treatment. Finally, its circadianity could be a guide of this process and clinical improvement.

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Previous research has shown that neurocognitive deficits, especially deficits in executive functions, may persist during euthymia in in patients with bipolar disorder (BD) and that those are associated with an impairment of psychosocial functioning. The assessment of executive functions (EFs) is normally carried out using laboratory tests. Novel methodologies such as virtual reality (VR) allow the creation of immersive environments, to evaluate executive performance with greater potential for ecological validity than evaluations with standard tasks.

The objectives of this project are to evaluate executive performance in euthymic patients with BD with a novel virtual reality task compared to standard computerized tasks, and to find predictors of functioning associated with cognitive performance.

This is a cross sectional study in which 46 euthymic patients with BD treated at La Fe University and Polytechnic Hospital were assessed with a battery of standard computerized tasks (ST) (TMT/Stroop,/Go-No-Go/TOL/DOT) and with the Cooking Task virtual reality task. The Cooking Task presents 4 tasks of increasing difficulty in which you must cook food in a specific time. It records total time to complete the task, whether food is cooled or burned, the simultaneous use of two fires, the proper use of seasonings and the time to set the table.

Functioning was assessed with the Functioning Assessment Short Test (FAST) that evaluates the overall functioning of patients with a mental illness in 6 subscales.

Correlation analyses between cognitive performance variables and clinical variables were done. Multiple linear regression was performed with the FAST score as a dependent variable and cognitive performance variables and relevant clinical variables to executive functioning (months of euthymia, age, and number of total episodes) were included as independent variables.

A worse psychosocial functioning was significantly associated with a worse performance in standard tasks (TMTA, TMTB, STROOP, and TOL) and cooking task (total time spent on task 2, burning time and total time spent on task 3, and total time spent on task 4). In the regression analysis, the correct simultaneous use of the two fires was the best predictor of a better psychosocial functioning in BD patient. This implies the preserved ability of planning and performing dual tasks.

Our findings suggest that euthymic patients with BD present deficits in executive functions related with a worse psychosocial functioning. Among the tasks, the cooking task may have a greater sensitivity than standards task to predict real functioning. This in an opportunity to design virtual applications for diagnostic and therapeutic purposes.

None Declared

There are manic episodes to involve a challenge in treatment due to finding resistance or secondary effects with the drugs of choice, this situation oblige forcing us to seek alternatives in the data sheet.

To describe the complicated evolution of a case of acute mania difficult to threat with stabilizer drugs and antipsychotics of choice. We discuss the psychopharmacological approach.

Case summary. We have conduced a systematic review of the descriptions published to date, regarding this case.We presented a case, in a 48-year-old female, admitted to our hospital due to psychopathological descompensation of bipolar affective disorder, where we observed manic and psychotic symtoms.

In the first instance, we started treatment with Lithium and Olanzapine, in increasing doses, along with benzodiazepine support.

During more than four months of follow-up , multiple drugs have been tested sequentially: olanzapine, aripiprazole and quetiapine. We observed a good response but low tolerance issue to secondary effects consisting of severe akathisia, in progressive stiffness (spasticity) and hands tremor, it was very disabling problem for patient, even though the use of biperiden.

This situation forced us to search another option of treatment, different from non-pharmacological therapies (ECT). After checking the literature and publications about it, we decided to start treatment with Caripracine 3mg/24h, for which the therapeutic indication is the treatment of manic with mixed symtoms.

We propose, through a clinical case, the use of cariprazine as a first choice in the acute decompensation of bipolar affective disorder, without symptoms of mixed mania.

During the treatment, the patient presente multiple difficulties and finally, a good response is was obtained with the use of Cariprazine, althought this patient continued showing slight akathisia well tolerated, she was able to leave after four months of hospitalization in the acude mental health unit.

None Declared

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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Image 2:

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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Cognitive symptoms in psychosis represent a major unmet clinical need (Acuna-Vargas et al. Cog in Psych 2019; 21(3), 223–224). Deficit in memory has been largely described in first episode early onset psychosis (Mayoral et al. Eur Psych 2008; 23(5), 375-383) and has been associated to a worse functionality (Øie et al. Neuropsychology 2011; 25(1), 25–35). However, results from existing studies are quite mixed on memory deficits of early psychosis patients, particularly in terms of memory contents and storage resources.

The aims of this study were 1) to examine the nature and extent of cognitive impairment in early-onset psychosis and 2) to analyze which type of memory (verbal and visual) is more affected in the disorder.

The present systematic review and meta-analysis was conducted according to the PRISMA criteria (Moher et al. Systematic Reviews 2015; 4(1), 1 - 9). A systematic search of CINAHL, PsycInfo, PubMed, Redalyc, SCOPUS and Web of Science (published from 2000 to 2020) identified case-control studies of early onset psychotic disorder (under 18 years old). Those studies focused on both verbal and visual memory performance.

Twenty articles were included in the review. A deficit in memory in child and adolescent psychotic disorders was obtained displaying a large effect size in memory tasks (g = -0.83). Also, a medium effect size was found in visual memory tasks (g = - 0.61) and a large effect size was found in verbal memory tasks (g = -1.00).

It was observed a strong memory deficit on early psychotic disorders already present at the onset of the illness. This deficit was stronger when verbal memory tasks were used compared to the effect found with visual memory tasks. Based on previous literature (García-Nieto et al. Jou Cli Child & Ado Psych 2011; 40(2), 266-280; Lepage et al. Eur Psych 2008; 23(5):368- 74; Hui et al. Psych Med 2016; 46(11):2435-44), these results contribute to describe and characterize the cognitive symptoms in the first-episode psychosis in a youth population.

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It is well known that eating disorders are related to comorbidity. At least, half of these patients have other mental disorders and, in addition to it, the presence of physical comorbidity (cardiovascular, kidney, nervous system, digestive tract, metabolic or endocrine disorders) comes with a decline in life expectancy.

Description of a patient with a diagnosis of anorexia nervosa (AN) who developed a gastric bezoar during hospitalization.

Case treated in a specific Eating Disorder Unit in a Third-Level Hospital.

26 years old woman with a diagnosis of AN hospitalized in General Psychiatric Unit with BMI of 11,78 kg/m2. Nasogastric tube was necessary and, after 1 month with a progressive weight recovery (BMI 13,84 kg/m2), the patient was transferred to the Eating Disorder Unit in order to follow specific psychological therapy. No incidence related to physical exploration or clinical analyses happened during this month apart from pancytopenia due to malnutrition.

However, 8 days after, patient developed nausea and had 3 vomit episodes, constant abdominal pain at hipogastrium (moderate intensity), dizziness, instability and constipation. The patient refused possibility of pregnancy. The physical exam showed bowel sounds augmented but no mass or peritoneal irritation appeared. Blood test results were normal. Abdominal X-Ray showed gastric dilatation with small bowel faeces sign, which suggested diagnosis of gastric bezoar.

The treatment was the dissolution of the bezoar by Coca-Cola, solving the symptoms completely.

The patient refused having eaten hair or any other kind of object or indigestible material but admitted to be following a strict vegan diet. Finally, after an endoscopy was done, the patient was diagnosed of phytobezoar.

Based on literature, bezoars are rare in AN, being phytobezoars the most common between the types of bezoars. Nevertheless, there are some risk factors, such as delayed gastric emptying, dehydration or, in the case of phytobezoar, ingestion of food containing high amount of cellulose, hemi-cellulose, lignin, and tannins (celery, pumpkin, grape skins, prunes, raisins and, in particular, persimmons). Some of the symptoms caused by phytobezoar can be similar to those of the AN (abdominal pain, intestinal obstruction, poor appetite, vomiting, malnutrition, weight loss). Therefore, gastric bezoar could be an underdiagnosed or even undiagnosed disease in this group of patients. Taking this into account could reduce time until diagnosis and treatment, decreasing the risks associated.

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The prevalence of mental disorders in Higher Education Students (HES) is high and has shown a worrying growth. However, only a small percentage of HES in need of psychological support request it, due to the stigma related to mental illness, requesting informal help from friends and family. Training and increasing Mental Health Literacy (MHL) have been stated as appropriate strategies to reduce stigma and increase the demand for professional psychological support. However, with the increase in the demand for help, the difficulty of providing an adequate response from psychological support of HE services also increases. Therefore, procedures that develop socio-emotional skills in the HES and strategies that enhance the responsiveness of these services are necessary.

Taking in consideration the literature review in this field, we develop a project to improve the mental health of HES. The project objectives’: a) the reduction of stigma related to mental disorders through the promotion of MHL in the academic community; b) the promotion of mental health and socio-emotional skills of HES; c) increasing detection and active search for professional mental health support, and d) the implementation of psychological intervention based on a stepped care model that provides an adequate response to most of the students’ mental health needs, according to individual needs.

The project proposes to perform the following methods: a) training in mental health open to the academic community, which will aim to train volunteers to be Gatekeepers, in order to promote awareness, detection and referral of students in need of professional psychological support; b) implementation of a Student Observatory, with tracking of psychopathological symptoms, supported on the Web; c) implementation of a psychological intervention program based on a stepped care model, which will include the following progressive phases by severity: 1) digital self-help manual; 2) web-based self-help groups; 3) psychological intervention groups supported by the Web; 4) face-to-face intervention groups and 5) individual psychological intervention.

Students will be assessed before and after each step of care, with the following psychological instruments: Mental Health Inventory (MHI); Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7).

The implementation of the presented methods expect to achieve improvements on HES’ mental health, namely improvement of MHI, reduction of PHQ-9 and GAD-7 after each step of the psychological care.

The project presented encloses evidence-based interventions, with inspiration on psychoeducation and cognitive behavioral approaches, and it is expected to contribute to the improvement of mental health of HES. The results will be collected and disseminated. We encourage other researcher and clinicians to perform studies about the mental health of HES.

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Obsessive-compulsive disorder (OCD) is a mental disorder in which patients who suffer from it have repetitive and undesirable thoughts, feelings, ideas, sensations (obsessions) and behaviors that drive them to do something over and over again (compulsions).

Often the person tries to get rid of the obsessive thoughts through compulsions, but this only provides short-term relief. Not carrying out the obsessive rituals can cause enormous anxiety and suffering.

To describe a 23-year-old male patient, who suffers from anxiety and mood symptoms, reacts to ego-dystonic obsessive ideas and sexual content, of months of evolution, and who manages to calm down through compulsive masturbation or watching sexual videos on the internet. All this clinic negatively interferes with their quality of life, asking the patient for medical help to calm these ideas.

We carried out a review in Pubmed with the terms Antiandrogens and TOC, in order to make a better description of the clinical case.

After several treatment attempts (Sertraline, Paroxetine, Clomipramine, Clomipramine + SSRI), reaching maximum doses according to clinical guidelines, and with poor therapeutic response, it was decided to discuss the case with the endocrinology department of our hospital, deciding to start treatment with antiandrogens, in order to alleviate the persistent intrusive ideas of a sexual nature. The administration of antiandrogens in men can cause a decrease or increase in the development or involution of secondary sexual characteristics in men, reducing the activity or function of accessory sexual organs, and hyposexuality, with decreased sexual desire or libido.

After several weeks, there was improvement in the obsessive symptoms with a decrease in compulsive rituals. However, after the 3rd mo, some symptoms reappeared, but not with the same severity and intensity as before treatment. In addition, we cannot ignore the adverse effects that have occurred, such as involution of secondary sexual characteristics. However, and taking into account the negative repercussion that this clinic had on the patient’s quality of life, the benefit obtained exceeded the risk, having noted clear improvement with this therapy, and maintaining evolutionary controls by both psychiatry and endocrinology.

Patients suffering from obsessive-compulsive disorder can be effectively treated with anti-androgenic pharmacological agents with various modes of action. The most effective group of such agents is the long-acting analogues of the gonadotropin-releasing hormone. The objective of this review is to elucidate the possibility of using such powerful anti-androgenic agents in the treatment of obsessive-compulsive disorder.

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The comorbidity between Schizophrenia and Obsessive-Compulsive Symptoms represents almost 25% of schizophrenic patients and it is believed that almost 12% match the diagnostic criteria for Obsessive-Compulsive Disorder. Some second-generation antipsychotics may worsen or even induce those symptoms, which makes the treatment of this patients a difficult challenge.

To assess the link between Schizophrenia and Obsessive-Compulsive Symptoms, to discuss the diagnostic challenges and treatment options. To present a clinical case report of a schizophrenic patient with Obsessive-Compulsive Symptoms, which improved with proper treatment.

We performed a non-systematic review of the existent literature with the keywords “Schizophrenia” and “Obsessive-Compulsive Symptoms”. Description of a clinical case report.

We present the case report of a male, 21 years old, single, diagnosed with Schizophrenia. In the past year, he was admitted twice in a psychiatric ward for persecutory and mystic delusions, which lead him to erratic behaviour. Since his adolescence he manifested repeated washing and compulsive cleaning associated with the fear of being contaminated with multiple diseases. Those compulsions worsened when he started being treated with antipsychotics. However, with therapeutic adjustments and with the introduction of an antidepressant we were able to control those symptoms.

Some antipsychotics may induce or even aggravate Obsessive-Compulsive Symptoms in psychotic patients. It is of extreme relevance to differentiate those symptoms as comorbid in Schizophrenia or if they existed prior to the first positive symptoms, since they can be representative of an Obsessive-Compulsive Disorder. Understanding this diagnostic and treatment complexity enables us to be more familiar with the development of Obsessive-Compulsive Symptoms in schizophrenic patients.

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Catatonia is a clinical syndrome characterized by behavioral alterations, which may include motor immobility or excitation. As a symptom, catatonia may be present in several mental disorders, primarily schizophrenia and mood disorders. Symptoms can be severe and can lead to dangerous and lethal conditions if not diagnosed and treated properly.

To describe the complicated evolution of a case of major depression with psychotic symptoms, which developed catatonic status. We discuss the psychopharmacological approach and non-pharmacological therapies (ECT).

Case summary. We have conducted a systematic review of the descriptions published to date, regarding this case.

We present a case of extreme severity, in a 55-year-old male, with a broad differential diagnosis with organic pathology, which required multidisciplinary management in conjunction with other specialties and multiple complementary tests.

Eventually diagnosed with major depression with psychotic symptoms evolving into a catatonic state. During more than one year of follow-up, multiple drugs have been tested sequentially: SSRI antidepressants, dual action, low-dose antipsychotics (caripracin, lurasidone, aripiprazole, olanzapine).

Finally, a good response was obtained in the treatment with lorazepam 1mg /6h and 12 sessions of ECT administered concomitantly.

In this case, the patient presented a refusal to eat and weight loss with a BMI of malnutrition. We had to be coordinated with the endocrinology service for a nutritional restitution strategy through dietary supplements. Once nutritional restitution was achieved, we started treatment with clomipramine, with good results on affective symptoms.

Nowadays, the origin and treatment of catatonia are still unclear.

We present the case of a man with melancholic depression with psychotic symptoms, who evolved into a catatonic syndrome. A good response was achieved with the combination of ECT and benzodiazepines.

We want to highlight nutritional recovery as an important point to achieve good absorption of antidepressant drugs. Once achieved, we started treatment with clomipramine with good results.

During the treatment, he has presented multiple difficulties and finally, he was able to leave after five months of hospitalization in the acute mental health unit.

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More than 700,000 people die by suicide in 2019 globally (World Health Organitation 2021). Mental health problems constitute a risk factor for suicidal behavior and death by suicide (Hoertel et al. Mol Psychiatry 2015; 20 718–726). Different mental disorders have been related to different forms of suicidal ideation and behavior (Conejero et al. Curr Psychiatry Rep 2018; 20, 33) (Quevedo et al. Compr Psychiatry 2020; 102 152194). However, little is known on comorbidity profiles among suicide attempters.

The aim of our work was to identify the psychiatric comorbidity profiles of individuals who were admitted a hospital emergency department due to a suicide attempt. Moreover, it intended to know their clinical characteristics according to comorbidity profile.

A sample of 683 attempters (71.30% female; M age= 40.85, SD= 15.48) from the SURVIVE study was used. Patients were assessed within the 15 days after emergency department admission. Sociodemographic (i.e., sex, age, marital status and employment status) and clinical data were collected. The International Neuropsychiatric Interview (MINI) was used to assess DSM-V Axis 1 mental health diagnoses and the Columbia Suicide Rating Scale (C-SSRS) to assess suicidal ideation and behavior. The Acquired Capacity for Suicide-Fear of Death Scale (ACSS-FAD), the Patient Health Questionnaire (PHQ-9) to assess the frequency of depressive symptoms during the past 2 weeks, and the General Anxiety Disorder-7 (GAD-7) scale to assess symptoms of worry and anxiety were also conducted. For the identification of comorbidity profiles, latent class analysis framework was followed considering diagnosis to each individual disorder as clustering variables. On the other hand, binary logistic regression was used to study the relationship between comorbidity profile membership and clinical factors.

Two classes were found (Class I= mild symptomatology class, mainly featured by emotional disorder endorsement; and Class II= high comorbidity class, featured by a wide amount of endorsed diagnoses) (see figure 1). Individuals from the High comorbidity class were more likely to be female (OR= 0.98, p<.05), younger in age (OR= 0.52, p< .01), with more depressive symptoms (OR=1.09, p<.001) and have greater impulsivity (OR= 1.01, p<.05).

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We found two profiles of people with suicidal behavior based on the presence of mental disorders. Each of the suicidal subtypes had different associated risk factors. They also had a different profile of suicidal behavior.

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Ayahuasca is a traditional brew containing the psychedelic 5-DMT (a tryptamine that acts as a 5HT2A-R agonist) used to achieve non-ordinary states of consciousness, with a long tradition among various cultures in ritual and therapeutic contexts. Ayahuasca is being studied as potential treatment in Mental Health, which has led to non-controlled and recreational use. This has led to a rise in the description of side effects, such as substance-induced psychosis.

To describe a case of a possible psychotic episode related to the intake of ayahuasca brew in a ritual context.

Clinical assesment and bibliographic review of pertinent literature.

We will present the case of a 43 year old woman, who participated in three ayahuasca sessions in three consecutive months. Two days after the last session, she suffered and episode of loss of consciousness, convulsions, loss of streng and paraesthesia in right forearm and righr side of the face and head; and apparition of perceptual alterations and delusions that she did not experience during the trip. Such alterations included the perception of electromagnetic fields (EMF) robbing her of her vital energy and lifeforce. She required ICU treatment for four days, after which se was hospitalized in Internal Medicine Unit and was assessed by Mental Health team. Though the symptoms were coherent with the previous beliefs of the patient, they were clearly exacerbated and interfered with her normal and previous functioning. She was treated with risperidone 1,5 mg, with complete symptom remission.

The case presented is consistent with other reports of ayahuasca-induced psychotic symptoms, though with less intensity and duration. We discuss prevalence and repercussions of the rising use of this powerful substance; that must be taken into consideration by clinicians worldwide.

None Declared