Clozapine is an atypical antipsychotic, which has been shown to have superior efficacy in the remission of positive and negative symptoms in patients with treatment-resistant schizophrenia, compared to other antipsychotics. However, its benefits have been limited by the lethal adverse effects that this drug can cause, the most common, agranulocytosis. Other less serious and more common adverse effects are sedation, hypersalivation, hypo and hypertension, weight gain and urinary incontinence. It is estimated that approximately 1% of patients treated with Clozapine suffer from urinary incontinence. Data that varies from 0.3% to 42% in the articles reviewed, being undervalued in some of these for many reasons; it is stigmatizing and the patient is ashamed to express it.

The objective of this study is to assess the percentage of urinary incontinence in patients in treatment with clozapine, taking into account the presence or absence of this side effect as the main variable, and the diagnosis, gender and dose of clozapine as secondary variables.

A retrospective observational study was carried out in which 40 patients belonging to the Adult Mental Health area of the Nuestra Señora del Prado Hospital, were collected, all of them diagnosed with some type of psychotic disorder and undergoing treatment with Clozapine.

Of the total of patients studied, 25% presented urinary incontinence as an adverse effect, and of these, 60% were with doses equal to or greater than 400 mg of Clozapine.

We must be careful and bear this side effect in mind in all patients taking Clozapine.

No significant relationships.

Reviews suggest that family interventions including family therapy are effective for a range of disorders in youth. Family sculpting is used in different clinical settings to help young patients, their parents and siblings when words are not enough.

Participants will be able to understand the clinical relevance of family sculpting: shifting from discussions about family problems to physical representations of family dynamics and how to apply in their practice.

There will be a brief overview of the general principle of family sculpting followed by clinical vignettes of patients combined with videos of the intervention. These examples will guide the discussion on how relevant in our clinical work this therapeutic practice may be. This variation on sculpting incorporates theater warmup exercises and therapists joining the family experience.

Family sculpting captures an immediate picture of the family dynamics that is a therapeutic turning point for families and gives voice to the children. The clinical cases and videos will guide clinicians on how to integrate into their own practice.

This presentation will make possible integrating family sculpting into your own practice, providing an engaging alternative modality for complex cases.

No significant relationships.

Peripartum depression (PPD) impacts around 12% of women globally and is a leading cause of maternal mortality. However, there are currently no accurate methods in use to identify women at high risk for depressive symptoms on an individual level. An initial study was done to assess the value of deep learning models to predict perinatal depression from women at six weeks postpartum. Clinical, demographic, and psychometric questionnaire data was obtained from the “Biology, Affect, Stress, Imaging and Cognition during Pregnancy and the Puerperium” (BASIC) cohort, collected from 2009-2018 in Uppsala, Sweden. An ensemble of artificial neural networks and decision trees-based classifiers with majority voting gave the best and balanced results, with nearly 75% accuracy. Predictive variables identified in this study were used to inform the development of the ongoing Swedish Mom2B study.

The aim of the Mom2be study is to use digital phenotyping data collected via the Mom2B mobile app to evaluate predictive models of the risk of perinatal depression.

In the Mom2B app, clinical, sociodemographic and psychometric information is collected through questionnaires, including the Edinburgh Postnatal Depression Scale (EPDS). Audio recordings are recurrently obtained upon prompts, and passive data from smartphone sensors and activity logs, reflecting social-media activity and mobility patterns. Subsequently, we will implement and evaluate advanced machine learning and deep learning models to predict the risk of PPD in the third pregnancy trimester, as well as during the early and late postpartum period, and identify variables with the strongest predictive value.

Analyses are ongoing.

Pending results.

No significant relationships.

Experimental data from both clinical and preclinical studies have unequivocally shown positive correlations between stress and depression, stress, depression and epigenetic changes.

The aim of this research is to analyze clinical trials on coping mechanisms and their interaction with epigenetic mechanisms in patients with mood disorders. Generally, we studied the interaction between these two mechanisms and its effects on the onset, recurrence and progression of these disorders.

109 articles were analyzed, of which 37 were considered relevant. 72 studies were excluded based on titles and abstracts. Regarding the coping mechanisms, 10 longitudinal and cross-sectional studies were selected. Longitudinal studies are defined here by a follow-up period longer than 6 months.

There is a consistent association in the literature between the degree of methylation of the NR3C1 gene, stress and affectivity disorders. The analyzed studies showed that methylation of the NR3C1 gene is associated with both stress and mood disorders. FKBP5 influences glucocorticoid receptor sensitivity and stress response. SLC6A4 gene methylation has been systematically associated with stress and affectivity disorders. Higher BDNF methylation has also been found in people who report high levels of stress at work. The data collected suggest that SKA2 methylation may serve as a biomarker for certain features of depression, such as suicidal ideation, and is not directly involved in the etiology of mood disorders.

The results suggest that environmental stress and adversity in early childhood may change biological systems through epigenetic mechanisms and have long-term consequences, increasing the risk for unfavorable prognosis of mood disorders.

No significant relationships.

First psychosis programs have been developed during the past 30 years to influence the prognosis of a first psychotic episode by early integrative biopsychosocial interventions, with a focus on the processes that contribute to relapse. In the process of recovery, Navigate program emphasis on enabling a connection to what is important to the person (work, studies, relationships, intimacy), thus strengthening resiliency and quality of life and reducing self-stigma. Medication is part of any intervention program, however, there is a lot of ambivalence amongst the young person and family about its continuation and many will stop the medication altogether. Moreover, although evidence for the benefits of antipsychotic medication in short-term treatment is well established, there is an ongoing debate in the professional medical literature about the need and benefit of routine prophylactic long-term antipsychotics after first psychotic episode. There is also a significant uncertainty concerning the proportion of patients that will maintain remission without antipsychotics.

In this lecture, we will present some of the lessons that we have learned and are still learning from our clients, together with case examples.

In our Navigate Program, we have developed strategies based on literature and experience that enables the person/family to be part of the decision-making process, which at times presents dilemmas and risks but also promotes the potential for growth and transformation.

How do we talk about the medication issue? Who can continue without medication or with very low dosage? How can we taper antipsychotic treatment?

Are we willing to take the risk?

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.

Cyberbullying has become more prevalent with the increased use of social media among younger population. It is more harmful than traditional bullying as it can happen at any time, has a much wider audience, and can invade personal space. YouTube, Instagram and Snapchat are the most popular online platforms among teens. The victims of cyberbullying can present with social anxiety (41%), depression (37%), suicidal thoughts (26%) among many others (self-harm, substance use, etc). In the past year, these numbers have significantly risen due to switch to virtual learning due to the pandemic, hence the risk of exposure to cyberbullying has risen.

To study the impact of cyberbullying on Adolescent Mental health

A review of articles (2016-2021), was done using PubMed and Google scholar focusing on impact of cyberbullying in children and young adults.

John et al group showed that both victims [OR- 2.10 (95% CI 1.73-2.55)] and perpetrators [ OR 1.21 (95% CI 1.02-1.44)] have increased risk of exhibiting suicidal behaviors. Kwan I et al group showed a negative association between cyberbullying and mental health. One study suggested that during the pandemic there has been increased online perpetrators due to increased amount of fear and anger which has projected in the form online aggression.

There is an increase in prevalence of cyberbullying with young population spending more time on internet and social media. Psychoeducation of parents and mental health experts is needed to recognize early warning signs in order to take steps for early intervention.

No significant relationships.

The integration of Motivational Interviewing (MI) with behavioural and psychological interventions for the treatment of obesity has the potential to improve health-related outcomes of patients in the long-term.

Our objective is to examine the usability of a VR embodiment tool for treating obesity.

Fourteen participants (6 healthy and 8 with morbid obesity) with a desire to make lifestyle changes were randomly assigned to the experimental group (EG) and the control group (CG). Participants from the EG engaged in a virtual self-conversation aiming at understanding their own motivation to make lifestyle changes. Using the body swapping technique, participants were embodied alternately in their own virtual representation and in their counsellor’s body. To better guide this virtual self-conversation, participants were previously trained on MI skills. Participants from the CG were embodied in their own virtual bodies and participated in a “scripted dialogue” with a virtual counsellor who gave them practical recommendations about how to achieve lifestyle changes. A mixed-methods design was used, involving a semi-structured interview examining users´ satisfaction with the virtual experience, as well as self-report questionnaires, including readiness to change habits, body ownership, and system usability.

Participants showed high usability of the platform with higher scores among participants from the EG compared to the CG. Levels of body ownership were satisfactory, with no differences between groups.

Through the integration of MI in the VR context with the patient being properly trained to carry out his/her own motivational self-conversation, we will provide an important advance in the psychological treatments of obesity.

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 951930

Treatment options for ADHD in adults consist of psycho-education, cognitive behavioral therapy (CBT), pharmacotherapy or a combination thereof. Current studies do not yet provide insights into the additive effects of CBT and pharmacotherapy regarding the quality of life in adults with ADHD.

In this study, we investigated the effect of CBT combined with pharmacotherapy on the quality of life in adults with ADHD compared to pharmacotherapy alone.

In this multicenter prospective cohort study a total of 627 patients were included, 305 where included in the pharmacotherapy only group and 322 in de combination group (CBT and pharmacotherapy). The Adult ADHD Quality-of-Life scale (AAQoL) was conducted at baseline and at the end of treatment.

No significant differences were found in gender or age between groups at baseline. The average improvement in the AAQoL total score in the pharmacotherapy group was 26.81(17.12) and in the combination group 25.45(16.33) and showed no significant difference (t(543) = 0.96, p = 0.34). At baseline the average total score in the pharmacotherapy group was 45.5(12.37) and 42.22(12.73) in the combination group (t(543)=2.86, p = 0.004). The average total score at the end of treatment in the pharmacotherapy and combination group was 72.31(12.99) and 67.67(12.45), respectively (t(543)=426, p <0.001).

To our knowledge, this is the first study to describe the value of CBT in addition to pharmacotherapy on the quality of life in adults with ADHD. Contrary to our expectations, there was no significant effect of CBT in addition to pharmacotherapy on the quality of life.

No significant relationships.

Antisocial disorder is characterised by difficulty to adapt to social norms that normally rule different aspects of the person’s conduct in adolescence and adulthood. According to DSM-V, this disorder’s prevalence stands between 0.2% and 3%, and is more frequent in men.

Numerous studies have been made about the influence between the environment and genetics for the development of this disorder, finding in several patients a punctual mutation of the monoamine oxidase gen (MAOA); although impulsive behaviour has also been associated to the 5-HT tranporte gene (5-HTT), and the protein coding gene for Tryptophan Hydroxylase TPH1

The hospital admission for these patients must be made when there’s autoregressive or hetero aggressive behaviour, suicide attempts, psychotic symptoms, or symptoms that generate important repercussions in the person’s normal functions. Nevertheless, is important to identify during the hospitalization the improvement possibilities of these patients in order to make drug or psychotherapy adjustments; in the case that we don’t observe treatment benefits, the patient will be released from the hospitalization

The main treatment is psychotherapy.

There’s not much evidence of drug use in this disorder, however, mood stabilizers, antidepressants, atypical antipshychotics and benzodiazepines are used for rage control, impulsiveness, anxiety and aggressiveness.

No significant relationships.

Adolescents with major depressive disorder (MDD) often show reduced prefrontal functional connectivity with the subcortical regions than healthy controls (HC) (Tang et al., 2018). However, relatively little is known about longitudinal effects of antidepressant (AD) treatment on resting state functional connectivity (RSFC) in the prefrontal cortex (PFC).

This study aimed to investigate abnormal PFC RSFC in MDD adolescents compared to HC and longitudinal effects of AD on PFC RSFC.

This study included 59 adolescents with MDD and 43 HC. MDD adolescents were treated with escitalopram in an 8 week, open-label trial. The treatment outcome was assessed by Children’s Depression Rating Scale (CDRS-R) and patients showing at least a 40% improvement in CDRS-R scores from baseline to week 8 were defined as “responders”. Functional and T1 images collected before and after treatment were processed using AFNI and Freesurfer. Our seed was the lateral PFC (LPFC, BA46). T-tests and repeated measures ANCOVAs, controlling for age and IQ, were conducted to examine abnormal PFC RSFC and longitudinal effects of AD on LPFC RSFC.

Relative to HC, MDD showed increased LPFC RSFC with the posterior middle temporal gyrus (pMTG) and superior frontal cortex (SFG) involved in attentional networks. Responders showed greater changes in LPFC RSFC with the MTG and SFG after AD treatment compared to non-responders and HC (Figure 1).

Our finding suggests that reduced LPFC RSFC with the pMTG and SFG reflecting decreased attentional network connectivity may serve as a biomarker to predict AD treatment outcome in adolescents with MDD.

No significant relationships.

A 9-year-old girl under pediatric follow-up since the age of 4 years after diagnosis of neurofibromatosis type 1

To present a case of neurofibromatosis and ADHD comorbidity to raise awareness of the importance of screening for neurodevelopmental disorders.

Case report and literature review

The patient had an adequate control and follow-up of the disorder with periodic check-ups and magnetic resonance imaging during her follow-up. She was referred due to symptoms of inattention with failure to perform exams and impulsivity in interpersonal relationships, affecting her social functioning. In addition, the patient presented simple motor tics of eye contraction and shoulder elevation. The patient was diagnosed with attention deficit hyperactivity disorder together with tic disorder. She was treated with stimulant medication with worsening of tics and marked hyporexia. Therefore, medication with guanfacine was started up to 4 mg per day, adjusted by weight. With this dose there was a control of the tics, with improvement of the symptoms of inattention and impulsivity. In different spheres an improvement in their functionality was observed, with improvement in mood, self-esteem and academic performance.

Neurofibromatosis type 1 is a rare monogenic disorder with a varied presentation (ophthalmologic, dermatologic and predisposition to tumor development). Patientshave been shown to present with symptoms of inattention and executive function impairment, along with other neurodevelopmental disorders such as autism spectrum disorders, learning disabilities or intellectual disability. The literature shows that up to 60% of them has ADHD criteria.

No significant relationships.

Since Kraepelin and Bleuler, schizotypy was understood as a mild expression of psychosis, a latent form with the same trajectory but different severity. They pointed characteristics such as being eccentric, unreasonable, supersticious or hipersensitive, interpersonal aversiveness (often related to suspiciousness and expectation of rejection), ambivalence, anhedonia,… and psychosis-like features that don’t usually lead to help-seeking.

To do a case review

We report a case of a 17 years old boy with a childhood trauma history who started psychiatric consultations a year and a half ago because his “usual” (as his mother referred) strange behaviour got worse, which was perceived by his

ENT specialist. During the appointments, the patient showed suspiciousness, odd speech, inappropriate affect, tendency to social withdrawal, obsessive ruminations with sexual content and occasional perceptual experiences (such as depersonalization, derealization and auditory hallucinations).

Psychosis and schizotypy are linked historically and phenomenologically, which is evidenced by their placement in non-affective psychosis in the ICD-10 and DSM-5, and it is known that the direct observation (by clinicians or family members) during the childhood and adolescence are key for a correct diagnosis. In fact, this construct reflects a phenotypic expression of vulnerability to schizophrenia, and during childhood or adolescence it may be understood as an early mental risk state.

In contrast to models of psychosis that mainly rely on positive features and assume a progression of them, the positive traits of schizotypy seem to be beneficial and related to a “benign or happy schizotypy” according to the articles we reviewed.

No significant relationships.

Aripiprazole long-acting treatments can significantly control symptom, improve adherence and reduce the risk of relapse compared to oral drugs. An alternative start-up guideline has recently been approved in several countries that simplifies its administration.

To present a case report of a patient with schizophrenia treated with alternative starting regimen of aripiprazole long-acting treatment.

Presentation of a clinical case supported by a non-systematic review of literature.

We present the case of a 22-year-old patient diagnosed with schizophrenia, whose symptoms started after the birth of her son, 2 years ago. She has presented a poor clinical evolution, requiring several admissions to our inpatient service after discontinuation of her medication. The patient has taken different antipsychotics, including olanzapine and paliperidone long-acting treatment, which were suspended due to side effects (weight gain and increased prolactin levels). A switch to oral aripiprazole 20mg was made, which showed good response and tolerance. Given the persistence of irregular intake, it was decided to switch to aripiprazole long-acting treatment, applying an alternative initial regime consisting of two doses of aripiprazole long-acting treatments 400mg and one oral aripiprazole 20mg. The patient has since had no delusions or hallucinations and is living independently at home.

The administration of a simplified initial regime with aripiprazole long-acting treatments could improve therapeutic adherence while maintaining the same effectiveness and similar side effects.

No significant relationships.

The increasing global burden of mental disorders has led to rising demand for mental healthcare services. Effective resource management is essential to ensure safe and timely access to care. Electronic health records (EHRs) provide a real-time source of data on clinical presentation and prognostic factors that could be harnessed to provide clinicians with actionable insights to prioritise mental healthcare delivery. We describe the development and evaluation of MaST, an EHR data visualisation tool that provides information to clinicians on risk of mental health crisis defined as an admission to a psychiatric hospital or acceptance into a community crisis service.

(i) To develop an EHR-data driven risk prediction tool for risk of crisis. (ii) To evaluate predictive performance in a real-world clinical setting.

The risk of crisis algorithm was developed and evaluated with EHR data from six UK NHS mental health providers using Ordered Predictor List propensity scores grouped into 5 quintiles. The predictor variables were clinical and sociodemographic factors including previous mental health service contacts.

Data from 2,620 patients contributed to algorithm development which was subsequently tested on data from 107,879 patients. The risk of crisis algorithm performed well with an overall accuracy for predicting the greatest risk of crisis (top quintile) ranging from 64% to 80%.

The MaST algorithm accurately predicted risk of mental health crisis in UK community mental health services. EHR data visualisation tools can provide actionable insights to clinicians to prioritise mental healthcare delivery in real-world clinical practice.

This study was funded in full by Holmusk.

Neuropsychiatric disorders including Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), Major Depressive Disorder (MDD), Bipolar Disorder (BD), and Schizophrenia (SZ) have been considered distinct categories of diseases despite their overlapping characteristics and symptomatology.

We aimed to provide an in-depth review elucidating the role of glutamate/Glx and white matter (WM) abnormalities from a transdiagnostic perspective.

The PubMed online database was searched for studies published between 2010 and 2021. After careful screening, 399 studies were included.

The findings point to decreased levels of glutamate in the Anterior Cingulate Cortex in both SZ and BD, whereas Glx is elevated in the Hippocampus in SZ and MDD. With regard to WM abnormalities, the Corpus Callosum and superior Longitudinal Fascicle were the most consistently identified brain regions showing decreased fractional anisotropy (FA) across all the reviewed disorders, except GAD. Additionally, the Uncinate Fasciculus was found to be affected in all the reviewed disorders, except OCD. Decreased FA was also found in the inferior Longitudinal Fasciculus, inferior Fronto-Occipital Fasciculus, Thalamic Radiation, and Corona Radiata in SZ, BD, and MDD. Decreased FA in the Fornix and Corticospinal Tract were found in BD and SZ patients. The Cingulum and Anterior Limb of Internal Capsule exhibited decreased FA in MDD and SZ patients.

The results suggest a gradual increase in severity from GAD to SZ defined by the number of brain regions with WM abnormality which may be partially caused by abnormal glutamate levels. WM damage could thus be considered a potential marker of some of the main neuropsychiatric disorders.

No significant relationships.

According to the World Health Organization (2016), adolescence is one of the most important transitional steps in the life of a human being, recognized by an accelerated rate of growth and changes in behavior. Adolescents from Colombia have reached this step, immersed in a context with a history of social, interpersonal and economic violence. In this sense, study of constructs such as empathy and aggressive behaviors are crucial to appease a healthy school coexistence and thus, contribute to a peace cultur

Analyze the relationship between empathy and aggressive levels from adolescents.

This study was done through a cross-sectional study of correlational scope in 240 (N= 240) students. The Prosocial Behavior Questionnaire developed by Martorell and Gonzalez (1922) and the Aggressive questionnaire, developed by Buss and Perry (1992) were applied. The first one was used to measure empathy and the latter to appraise aggressiveness.

There was evidenced of adequate levels of empathy and a great percentage of medium levels of verbal and physical aggressiveness. (Graph 1). In addition, there was a significant statistical correlation of negative magnitude between these variables (Table 1).

It was concluded that the higher the optimal levels of empathy, the lower the aggressive behavior presented by teenagers.

No significant relationships.

Numerous studies have shown evidence that cannabis use increases the appearance of psychotic symptoms and disorders, and worsens the course of the disease in those with schizophrenia. However, a causal relationship between cannabis and schizophrenia has not been well established yet.

In this presentation we try to review the relationship between cannabis use and prevalence of schizophrenia.

We performed a search of Medline looking for systematic reviews and methodologically robust studies in the field published in English in the last 5 years.

A number of studies, both cross-sectional and prospective, find a prevalence of schizophrenia several times higher among cannabis users than in non-users. This association becomes stronger the lower the age of cannabis use onset, the higher the amount consumed and the higher the THC concentration are. Half of the patients with a cannabis-induced psychotic disorder turn into a diagnosis of schizophrenia within a few years. So far, it has not been possible to demonstrate a global increased prevalence of schizophrenia in relation to the increase of cannabis use in the population in recent decades.

Cannabis and schizophrenia have a complex relationship model; we still cannot clearly establish whether it is causal or the first works as a trigger for pathology in vulnerable subjects.

No significant relationships.

Maternal attachment style plays a major role in the intergenerational transmission of psychopathology. Previous studies indicated that a secure attachment style is associated with higher levels of mindfulness and a higher quality of the parent-child relationship.

The aim of this study was to explore the relationship between the mothers’ attachment style, mindful parenting, and perception of the child.

Data was collected from 144 non-clinical mothers, who have a child below the age of 3 years. Mothers completed self-report questionnaires including the following scales: a demographic questionnaire, Attachment Style Questionnaire (ASQ), Interpersonal Mindfulness in Parenting Scale (IMP), and the Mothers’ Object Relations Scale (MORS-SF). Mediation analyses with Mothers’ Object Relations Scale warmth and invasion subscales as dependent variables, mother’s attachment style as an independent variable and, mindful parenting as a mediator were conducted.

In mediation analysis, the direct effects of the mothers’ attachment style on the perception of the child were not significant. However, indirect effects through mindful parenting were significant; higher levels of mindful parenting were associated with higher levels of MORS-SF warmth and lower levels of MORS-SF invasion.

These findings suggest that attachment styles are related to the perception of the child through mindful parenting. Mindfulness-based parenting training might be useful in case of attachment-related problems to improve the parent-child relationship.

No significant relationships.

No significant relationships.