Obesity is highly prevalent and disabling, especially in individuals with severe mental illness including bipolar disorders (BD). The brain is a target organ for both obesity and BD. Yet, we do not understand how cortical brain alterations in BD and obesity interact.

We obtained body mass index (BMI) and MRI-derived regional cortical thickness, surface area from 1231 BD and 1601 control individuals from 13 countries within the ENIGMA-BD Working Group. We jointly modeled the statistical effects of BD and BMI on brain structure using mixed effects and tested for interaction and mediation. We also investigated the impact of medications on the BMI-related associations.

BMI and BD additively impacted the structure of many of the same brain regions. Both BMI and BD were negatively associated with cortical thickness, but not surface area. In most regions the number of jointly used psychiatric medication classes remained associated with lower cortical thickness when controlling for BMI. In a single region, fusiform gyrus, about a third of the negative association between number of jointly used psychiatric medications and cortical thickness was mediated by association between the number of medications and higher BMI.

We confirmed consistent associations between higher BMI and lower cortical thickness, but not surface area, across the cerebral mantle, in regions which were also associated with BD. Higher BMI in people with BD indicated more pronounced brain alterations. BMI is important for understanding the neuroanatomical changes in BD and the effects of psychiatric medications on the brain.

Adding short-term psychodynamic psychotherapy (STPP) to antidepressants increases treatment efficacy, but it is unclear which patients benefit specifically. This study examined efficacy moderators of combined treatment (STPP + antidepressants) v. antidepressants for adults with depression.

For this systematic review and meta-analysis (PROSPERO registration number: CRD42017056029), we searched PubMed, PsycINFO, Embase.com, and the Cochrane Library from inception to 1 January 2022. We included randomized clinical trials comparing combined treatment (antidepressants + individual outpatient STPP) v. antidepressants in the acute-phase treatment of depression in adults. Individual participant data were requested and analyzed combinedly using mixed-effects models (adding Cochrane risk of bias items as covariates) and an exploratory machine learning technique. The primary outcome was post-treatment depression symptom level.

Data were obtained for all seven trials identified (100%, n = 482, combined: n = 238, antidepressants: n = 244). Adding STPP to antidepressants was more efficacious for patients with high rather than low baseline depression levels [B = −0.49, 95% confidence interval (CI) −0.61 to −0.37, p < 0.0001] and for patients with a depressive episode duration of >2 years rather than <1 year (B = −0.68, 95% CI −1.31 to −0.05, p = 0.03) and than 1–2 years (B = −0.86, 95% CI −1.66 to −0.06, p = 0.04). Heterogeneity was low. Effects were replicated in analyses controlling for risk of bias.

To our knowledge, this is the first study that examines moderators across trials assessing the addition of STPP to antidepressants. These findings need validation but suggest that depression severity and episode duration are factors to consider when adding STPP to antidepressants and might contribute to personalizing treatment selection for depression.

The consequences for the COVID-19 pandemic in the newborns of affected mothers remains unknown. Previous clinical experiences with other infections during pregnancy lead to considered pregnant women and their offspring especially vulnerable for SARS-COV-2. That is, the underlying physiopathological changes caused by the infection (e.g. storm of cytokines, micro-coagulation in placenta or vertical transmission) could clearly compromise fetal neurodevelopment.

To analyze the impact of maternal SARS-COV-2 infection during pregnancy in early neurodevelopment of infants gestated during the COVID-19 pandemic period compared to those gestated immediately prior (2017-2021).

212 pregnant women (14% infected) were followed throughout their pregnancy and postpartum, including newborn development. SARS-COV-2 infection was serologically confirmed during pregnancy. The Brazelton Neonatal Assessment Scale (NBAS) was administered at 6 weeks old by a trained neonatologist to evaluate neurological, social and behavioral aspects of newborn’s functioning. Differences in NBAS scores between cases and controls were tested by ANOVAs. All the analysis were adjusted for maternal age, sociodemographic status, anxious-depressive symptomatology, infant’s sex and gestational age at birth and NBAS, and for the period of gestation (previous or during COVID-19 pandemic).

NBAS social interactive dimension was significantly decreased in those infants exposed to prenatal SARS-COV-2 (F=4.248, p=.043), particularly when the infection occurred before the week 20 of gestation. Gestation during COVID-19 pandemic did not alter NBAS subscales.

SARS-COV-2 infection during pregnancy seems to be associated with lower NBAS scores on social dimension in 6 weeks old exposed newborns.

No significant relationships.

The prevalence of allergies in children has grown in last few decades. Allergies are very often associated with physical, mental, and emotional problems that could be detected through child’s behaviour and feelings.

to describe and compare children’s behaviour (internalizing and externalizing) across a sample of children aged 6–11 years with and without allergic diseases.

This was a cross-sectional observational case-control study. A survey to 366 families (194 allergic cases and 172 controls), including a child behaviour checklist (CBCL) and a socio-demographic questionnaire with questions related to family, school education, health conditions and allergy symptoms, was administered.

Children with a diagnosis of allergy showed higher scores in the overall CBCL score (standardised mean differences [SMD]= 0.47; confidence intervals [CI]: 0.26–0.68) and in the internalizing and externalizing factors (SMD=0.52 and SMD=0.36, respectively) than non-allergic children. Odds ratio (OR) analyses showed a higher risk (OR=2.76; 95% CI [1.61 to 4.72]) of developing a behavioural difficulty in children diagnosed with allergies. Age and level of asthma appear as modulatory variables.

Children aged 6–11 years diagnosed with allergies showed larger behavioural problems than non-allergic children. This relationship is stronger in internalizing behaviours. These findings suggest the importance of attending to them and treating them in the early stages of diagnosis to avoid future psychological disorders.

No significant relationships.

Available meta-analytic evidence suggests an increased risk of suicide among cancer patients, although most of the reports focused on the sole suicide death (SD) outcome and they are usually hampered by significant between-study heterogeneity.

The present meta-analysis aimed at assessing the prevalence and risk rates of SD, suicide attempt (SA), and suicidal ideation (SI) among cancer patients.

Systematic search up to April 2021 of observational studies documenting cancer and suicide outcomes associations. Pooled prevalence estimates, odd ratios (ORs), risk ratios (RRs), and hazard ratios (HRs) of SD, SA, and SI were computed according to the random-effects model. SD prevalence underwent cumulative and sub-group analyses for different variables. Risk estimates underwent sensitivity analysis for study design.

Overall, thirty-nine studies were included. A higher risk of SD based on HR, SA based on OR and HR, and SI based on each measure was recorded among cancer patients versus controls. OR and RR of SD were not significant. Pooled prevalence rates of SD, SA and SI among cancer patients were 1.9% (1.1-3.1%), 1.4% (0.3-7.1%), and 9.1% (5.8-14.0%), respectively. Although high between-study heterogeneity held upon sensitivity and sub-group analyses, the overall message brought by risk analyses likewise held true. Age, country, study design, cancer type, sample size, cases type and comparison affected SD prevalence estimates in cancer patients. SD prevalence decreased over time.

Cancer patients face higher risk for SA and SI versus controls. SD’ results were controversial. Cancer patients have higher prevalence rates of suicide outcomes compared to the general population.

No significant relationships.

Inflammation and neural plasticity play a significant role in major depressive disorder (MDD) pathogenesis and cognitive dysfunction. The olfactory neuroepithelium (ON), closely related to the central nervous system (CNS), allows a non-invasive, low-cost study of neuropsychiatric disorders. However, few studies have used ON cells to ascertain them as biomarkers for MDD.

Determine the relationship between inflammatory/neural plasticity markers and cognitive functioning in MDD patients and healthy controls.

Sample: 9 MDD patients and 7 healthy controls. Exclusion criteria: other Axis I mental disorders (patients) or any mental disorder (controls) and any inflammatory, autoimmune, or CNS diseases. Assessment: sociodemographic, clinical, and cognitive variables (CANTAB) were recorded. mRNA was isolated from ON cells and MAPK14, IL6, TNF-α, Mecp2, BDNF, GSK3, GRIA2, and FosB gene expression levels were quantified using quantitative polymerase chain reaction.

MDD patients showed decreased levels of BDNF (p=0.022), GSK3 (p=0.027), and working memory (p=0.024) compared with healthy controls. In healthy controls, planning was positively correlated with NRF2, BDNF, and MAPK14 gene expression. In MDD patients no correlation between cognitive parameters and inflammation/neural plasticity biomarkers was found.

These results reveal that: (1) Plasticity biomarkers such as BDNF and GSK3 could be useful diagnostic tools for MDD (2) MDD is associated with working memory deficits; (3) no association could be determined between planning and NRF2, BDNF, and MAPK14 gene expression in MDD and (4) the ON is a promising model in the study of neuropsychiatric disorders.

No significant relationships.

Dual pathology during pregnancy, described as the co-occurrence of substance use and mental health problems, is one of the leading preventable causes of maternal and perinatal mortality and morbidity; however, effective and accessible treatments are lacking.

As part of the WOMAP(Woman Mental Health and Addictions on Pregnancy) initiative, our study aimed to evaluate the effectiveness of an e-health-based psychotherapeutic program compared to enhanced usual care.

This effectiveness clinical trial was conducted between 2016-2020 in 5 hospitals in the Madrid (Spain) metropolitan area. 2014 pregnant women under 26 weeks of pregnancy were screened. Eligible participants(n=120) were those who screened positive for co-occurring symptoms (AC-OK screener) and were not receiving specialized behavioral treatment. Participants were assessed in depth at baseline, 2,4,8 and 12 months(PHQ-9;GAD-7;PCL-5;AUDIT;DAST;Fagerström) and randomized to the usual care control group(n=38) or to two groups of a 10-session pregnancy-adapted psychotherapeutic program, one delivered by App/internet(n=41) and one by telephone(n=41). Intent-to-treat analyses assessed effectiveness.

Statistically significant effects of the intervention were found for mental health symptoms in the telephone group as compared to the control and App/internet groups, with an improvement effect starting earlier (2 months) and lasting longer (figures 1-3). Regarding substance use, due to the lack of other substances consumption, only smoking and alcohol cessation rates were analyzed. Patients in the App/internet and telephone groups discontinued significantly more, earlier and for a longer period compared to the control group(figures 4-5).

E-health psychotherapeutic programs could benefit pregnant women with dual disorders. An App/internet implementation could only be useful if focused solely on substances.

No significant relationships.

Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors.

8996 healthcare workers evaluated on 5 May–7 September 2020 (baseline) were invited to a second web-based survey (October–December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview.

4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar.

Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565

Currently available psychotherapies and psychotropic drugs for post-traumatic stress disorder (PTSD) are poorly effective in a substantial proportion of patients. Dopaminergic dysfunction plays a prominent role in the pathophysiology of PTSD: intrusions, avoidance symptoms, anhedonia and emotional numbing. Dopamine reuptake inhibitors can be studied as novel drugs in PTSD treatment.

Explore methylphenidate as a promising drug in PTSD treatment.

Case report presentation based on the review of clinical notes and non-systematic review of the PTSD therapeutics state-of-the-art.

A 72-year-old Portuguese male, a veteran of the Angolan War, sought medical attention four years ago after the death of his brother, which had happened three years before the consultation. The clinical picture consisted of re-experiencing the war and the loss of his brother, flash-backs, nightmares, irritability, a fear of losing control, inner dialogues with occasional intra-psychic voices, emotional numbing with the impossibility of developing loving relationships with his relatives, feelings of unreality, an episode of dissociative fugue and complaints of episodic forgetfulness and time warp. He was diagnosed with PTSD with dissociative symptoms, based on DSM 5 clinical criteria. He was initially treated with SNRIs and risperidone, with little improvement. A year ago, he suffered a flare-up, with suicidal ideation. He was prescribed methylphenidate 36 mg, with progressive improvement, persisting mild PTSD residual symptoms.

There is enough evidence of the dopamine involvement in PTSD, although research on dopaminergic drugs is scarce. Methylphenidate may be promising in the treatment of at least some individuals that haven’t responded to current psychological and medical interventions.

Patients with substance use disorders (SUD) have higher alexithymia levels and present frequently suicidal ideation (SI) and suicide (SA) [1,2]. Beside, alexithymia has been related to suicidal behaviors in several psychiatric disorders[3]. Although, there are some studies on alexithymia and suicidality in SUD patients, to our knowledge there are no studies on this issue in Spanish population.

To compare the alexithymia levels in SUD patients with and without SI and SA in an outpatient addiction treatment center in Spain.

This is a cross-sectional study performed on 110 patients (74.3%males; mean age 43.6±14.5years old) for whom we had information from the Toronto Alexithymia Scale(TAS-20) and the presence or not of lifetime SI and SA.

Lifetime SI and SA were present in 55.5% and 35.5% of the sample respectively. The mean score of TAS-20, difficulties identifying feelings (DIF), difficulties describing feelings (DDT), and externally-oriented thinking(EOT) were 57.2±13.3, 20.0±7.0, 14.7±4.5, and 22.5±4.5 respectively.

SI and SA may be related to alexithymia levels. Hence, alexithymia should be further analyzed in SUD patients in longitudinal studies in order to analyze the bilateral association with suicidal spectrum behaviors. REFERENCES Rodríguez-Cintas L, et al. Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res. 2018;262:440-5. Morie KP, et al. Alexithymia and Addiction: A Review and Preliminary Data Suggesting Neurobiological Links to Reward/Loss Processing. Curr Addict Rep. 2016;3(2):239-48. Hemming L, et al. A systematic review and meta-analysis of the association between alexithymia and suicide ideation and behaviour. J Affect Disord. 2019;254:34-48.

Schizoaffective disorder is a psychotic disorder of controversial nosological entity. Affective symptomatology and psychotic features of varying intensity coexist simultaneously in him throughout evolution. The lack of consensus on the existence of this entity determines its diagnostic delay and the absence of specific treatment guidelines.

To review the diagnostic criteria for schizoaffective disorder and the published scientific evidence on the efficacy and safety of the different therapeutic options available. To analyze the efficacy of a multidisciplinary treatment plan implemented in an intensive follow-up program, presenting the evolution of a clinical case.

To review the psychiatric history and psychopathological evolution of a patient diagnosed with schizoaffective disorder from the beginning of an intensive follow-up program in a day center to the present. Review the existing scientific evidence on the usefulness of the treatments used in this nosological entity.

This is a longitudinal and retrospective study of a clinical case in which the areas for improvement are analyzed before implementing a multidisciplinary therapeutic program and the favorable results obtained today. Currently, the patient is euthymic and attenuated and chronic positive and negative symptoms persist that do not interfere with his functionality.

From the implementation of an individualized, personalized and multidisciplinary maintenance treatment plan, an overall improvement in psychopathological stability and functional recovery is observed. Among the psychopharmacological options in this patient, Paliperidone Long Acting Injection (PLAI) stands out for its long-term efficacy and safety.

People with borderline personality disorder are at higher risk of repeating suicidal behavior. At the same time, numerous publications have demonstrated the relationship between cocaine dependence and suicide attempts of repetition.

Review the relationship between cocaine addiction, borderline personality disorder and repeated suicide attempts. Present through a clinical case the effectiveness of a comprehensive and multidisciplinary therapeutic plan with different mental health devices.

To review the psychopathological evolution of a patient with a diagnosis of borderline personality disorder; dependence to the cocaine; Harmful alcohol consumption and suicidal behavior from the beginning of follow-up in mental health services to the present. Review the existing scientific evidence on the relationship between cocaine addiction and repeated suicide attempts. Analyze the eficacy of the different treatments available.

This is a longitudinal and retrospective study of the psychiatric history and evolution of a clinical case since the implementation of an individualized therapeutic program and the favorable results obtained. Intensive outpatient follow-up was carried out for high suicide risk and hospitalization in a psychiatric hospitalization unit, day care centre and therapeutic community.

At present, the patient remains in abstinence with remission of suicidal ideation. The literature has shown the usefulness of intensive mental health follow-up programs to achieve remission of suicidal ideation and maintain abstinence from illegal substances.

No significant relationships.

Insomnia has been related to a more severe substance use disorder presentation (1). There are few longitudinal studies in outpatients center for SUD treatment that evaluate how insomnia impacts on relapses.

To analyze how insomnia impacts on the time of the first substance relapse in SUD outpatients after the onset of addiction treatment.

This is a one-year follow-up study performed on 116 patients (73.3% males; mean age 43.4±14.3) for whom we had information from baseline insomnia and the time for the first relapse. A Kaplan-Meier survival analysis was performed. This is part of a greater research on Alexithymia in SUD in a longitudinal study.

The initial sample consisted of 116 patients, information on relapses was available for 113 patients. The main substances used at baseline were alcohol (62.1%), cocaine (56.0%), cannabis (42.2%), and opiates (30.2%).

It is important to evaluate insomnia at the onset of addiction treatment because insomnia may be related to earlier relapses. Furthermore, it should be analyzed further on how insomnia treatment impact on substance relapses. REFERENCES 1. Miller MB, Donahue ML, Carey KB, Scott-Sheldon LAJ. Insomnia treatment in the context of alcohol use disorder: A systematic review and meta-analysis. Drug Alcohol Depend. 2017;181:200-207. doi:10.1016/j.drugalcdep.2017.09.029

Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear.

The aim of the study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years.

The sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis.

At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (−10.215 to −0.337) and (−4.731 to −0.605) respectively).

Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.

This work was supported by the Carlos III Institute of Health and European Fund for Regional Development (PI08/1213, PI11/ 01977, PI14/01900, PI08/01026, PI11/02831, PI14/01621, PI08/1161, PI16/ 00359, PI16/01164, PI18/00805), the Basque Foundation for He