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Background: Suicide is a leading cause of preventable death worldwide, with its peak of maximum incidence in later life. Depression often puts an individual at higher risk for suicidal behaviour. In turn, depression deserves particular interest in old age due to its high prevalence and dramatic impact on health and wellbeing. Aim: To gather integrated evidence on the potential risk factors for suicide behaviour development in depressive older adults, and to examine the effects of depression treatment to tackle suicide behaviour in this population. Methods: A systematic review of empirical studies, published from 2000 onwards, was conducted. Suicidal behaviour was addressed considering its varying forms (i.e., wish to die, ideation, attempt, and completed suicide). Results: Thirty-five papers were selected for review, comprising both clinical and epidemiological studies. Most of studies focused on suicidal ideation (60%). The studies consistently pointed out that the risk was related to depressive episode severity, psychiatric comorbidity (anxiety or substance use disorders), poorer health status, and loss of functionality. Reduced social support and loneliness were also associated with suicide behaviour in depressive older adults. Finally, the intervention studies showed that suicidal behaviour was a robust predictor of depression treatment response. Reductions in suicidal ideation were moderated by reductions in risk factors for suicide symptoms. Conclusion: To sum up, common and age-specific risk factors seem to be involved in suicide development in depressive older adults. A major effort should be made to tackle this serious public health concern so as to promote older people to age healthily and well., Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub

Introduction: Borderline personality disorder (BPD) is characterized by intense affective reactions with underlying social and interpersonal cognitive deficits. Oxytocin has largely been associated with both stress regulation and social cognition in psychiatric patients and in non-clinical populations in previous studies. Finally, abnormal oxytocin levels have been preliminary reported in BPD patients. Methods: 53 patients with moderate-severe BPD and 31 healthy control subjects were investigated for plasma levels of oxytocin and protein expression of oxytocin receptor in blood mononuclear cells. Clinical assessments were made for severity, functionality, and comorbidity with axis I and II conditions. Results: Oxytocin plasma levels were significantly lower in BPD patients compared with controls. In addition, protein expression of oxytocin receptor was significantly reduced in the BPD group. A positive correlation was found between plasma oxytocin levels and the activity index score of the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). Oxytocin receptor protein expression, on the contrary, had a negative correlation with the ZKPQ sociability index score. Conclusions: Results support the evidence of a dysfunction of the oxytocin system in borderline personality disorder, which could be involved in emotional dysregulation and interpersonal disturbances in these patients., Instituto de Salud Carlos III, FEDER, Depto. de Farmacología y Toxicología, Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub

In recent years we have witnessed a great deal of media interest in climate change, echoing the growing public concern about a complex phenomenon with daunting consequences. This pa­per examines the impact of concepts such as “eco-anxiety” and “solastal­gia” in the Spanish and Latin American written and digital press. These neolo­gisms attempt to explain the emotion­al effects of climate change on men­tal health. Between 2015 and 2019 the words “solastalgia” and “Nature Deficit Disorder (NDD)” slowly made their way into the media, until 2019, when the term “eco-anxiety” became relatively successful in the newspapers. In addition to analysing the factors in­volved in the birth and evolution of this concept, the study describes the most frequently cited emotions, such as fear, anguish, stress, sadness and guilt. The results obtained indicate, on the one hand, that eco-anxiety is still a vague idea and not very present in the media, too often linked to negative emotions, in contradiction of clinical psycholo­gy advice. Meanwhile, emotions such as anger or indignation, which would enable a collective response to climate change, are often neglected., Depto. de Ciencias de la Comunicación Aplicada, Fac. de Ciencias de la Información, TRUE, pub

The relationship between psychotic symptoms and global measures of functioning has been widely studied. No previous study has assessed so far the interplay between specific clinical symptoms and particular areas of functioning in first-episode psychosis (FEP) using network analysis methods. A total of 191 patients with FEP (age 24.45 ± 6.28 years, 64.9% male) participating in an observational and longitudinal study (AGES-CM) comprised the study sample. Functioning problems were assessed with the WHO Disability Assessment Schedule (WHODAS), whereas the Positive and Negative Syndrome Scale (PANSS) was used to assess symptom severity. Network analysis were conducted with the aim of analysing the patterns of relationships between the different dimensions of functioning and PANSS symptoms and factors at baseline. According to our results, the most important nodes were “conceptual disorganization”, “emotional withdrawal”, “lack of spontaneity and flow of conversation”, “delusions”, “unusual thought content”, “dealing with strangers” and “poor rapport”. Our findings suggest that these symptoms and functioning dimensions should be prioritized in the clinical assessment and management of patients with FEP. These areas may also become targets of future early intervention strategies, so as to improve quality of life in this population., Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

Background: The contents of traditional communication media and new internet social media reflect the interests of society. However, certain barriers and a lack of attention towards mental disorders have been previously observed. Objective: The objective of this study is to measure the relevance of influential American mainstream media outlets for the distribution of psychiatric information and the interest generated in these topics among their Twitter followers. Methods: We investigated tweets generated about mental health conditions and diseases among 15 mainstream general communication media outlets in the United States of America between January 2007 and December 2016. Our study strategy focused on identifying several psychiatric terms of primary interest. The number of retweets generated from the selected tweets was also investigated. As a control, we examined tweets generated about the main causes of death in the United States of America, the main chronic neurological degenerative diseases, and HIV. Results: In total, 13,119 tweets about mental health disorders sent by the American mainstream media outlets were analyzed. The results showed a heterogeneous distribution but preferential accumulation for a select number of conditions. Suicide and gender dysphoria accounted for half of the number of tweets sent. Variability in the number of tweets related to each control disease was also found (5998). The number of tweets sent regarding each different psychiatric or organic disease analyzed was significantly correlated with the number of retweets generated by followers (1,030,974 and 424,813 responses to mental health disorders and organic diseases, respectively). However, the probability of a tweet being retweeted differed significantly among the conditions and diseases analyzed. Furthermore, the retweeted to tweet ratio was significantly higher for psychiatric diseases than for the control diseases (odds ratio 1.11, CI 1.07-1.14; P<.001). Conclusions: American m, Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub

Mental health stigma is a relevant phenomenon with implications for the people who suffer from it. Despite its importance, no studies have been carried out in Spain at national level with a representative sample of the population. Aims: The aim of this research is to analyze the stigma associated with MHPs in a representative sample of the Spanish population for the first time. Method: A cross-sectional quantitative descriptive study was carried out with a representative sample of the population (N = 2746). Descriptive analyses and regressions are carried out on the different dimensions of stigma such as attitude, attribution and intention of social distance. Results: Medium levels of stigma are obtained in stigmatizing attitudes and attributions, and medium-low levels in the intention of social distance. The best predictors of stigma in its different dimensions are attitudes, attributions and intention of social distance themselves. Progressive political ideology is related to less stigma in all dimensions. Knowing someone with mental health problems and talking openly about it together with higher education are also relevant protectors. Mixed results are obtained regarding age, gender and help-seeking. Conclusion: National programs and campaigns focused on attitudes, attributions and behavioral intentions are necessary to reduce the stigma still present in Spanish society., Depto. de Personalidad, Evaluación y Psicología Clínica, Fac. de Psicología, TRUE, pub

Although alterations in the gut microbiota have been linked to the pathophysiology of major depressive disorder (MDD), including through effects on the immune response, our understanding is deficient about the straight connection patterns among microbiota and MDD in patients. Male and female MDD patients were recruited: 46 patients with a current active MDD (a-MDD) and 22 in remission or with only mild symptoms (r-MDD). Forty-five healthy controls (HC) were also recruited. Psychopathological states were assessed, and fecal and blood samples were collected. Results indicated that the inducible nitric oxide synthase expression was higher in MDD patients compared with HC and the oxidative stress levels were greater in the a-MDD group. Furthermore, the lipopolysaccharide (an indirect marker of bacterial translocation) was higher in a-MDD patients compared with the other groups. Fecal samples did not cluster according to the presence or the absence of MDD. There were bacterial genera whose relative abundance was altered in MDD:Bilophila(2-fold) andAlistipes(1.5-fold) were higher, whileAnaerostipes(1.5-fold) andDialister(15-fold) were lower in MDD patients compared with HC. Patients with a-MDD presented higher relative abundance ofAlistipesandAnaerostipes(1.5-fold) and a complete depletion ofDialistercompared with HC. Patients with r-MDD presented higher abundance ofBilophila(2.5-fold) compared with HC. Thus, the abundance of bacterial genera and some immune pathways, both with potential implications in the pathophysiology of depression, appear to be altered in MDD, with the most noticeable changes occurring in patients with the worse clinical condition, the a-MDD group., Spanish Ministry of Science and Innovation, CIBERSAM, Catalan Intensification Programme, Instituto de Salud Carlos III, Depto. de Farmacología y Toxicología, Depto. de Microbiología y Parasitología, Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub

Regulatory agencies encourage computer modeling and simulation to reduce the time and cost of clinical trials. Although still not classified in formal guidelines, system biology-based models represent a powerful tool for generating hypotheses with great molecular detail. Herein, we have applied a mechanistic head-to-head in silico clinical trial (ISCT) between two treatments for attention-deficit/hyperactivity disorder, to wit lisdexamfetamine (LDX) and methylphenidate (MPH). The ISCT was generated through three phases comprising (i) the molecular characterization of drugs and pathologies, (ii) the generation of adult and children virtual populations (vPOPs) totaling 2,600 individuals and the creation of physiologically based pharmacokinetic (PBPK) and quantitative systems pharmacology (QSP) models, and (iii) data analysis with artificial intelligence methods. The characteristics of our vPOPs were in close agreement with real reference populations extracted from clinical trials, as did our PBPK models with in vivo parameters. The mechanisms of action of LDX and MPH were obtained from QSP models combining PBPK modeling of dosing schemes and systems biology-based modeling technology, i.e., therapeutic performance mapping system. The step-by-step process described here to undertake a head-to-head ISCT would allow obtaining mechanistic conclusions that could be extrapolated or used for predictions to a certain extent at the clinical level. Altogether, these computational techniques are proven an excellent tool for hypothesis-generation and would help reach a personalized medicine., Takeda, Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub

Background: This study aimed at depicting the course of depression symptoms over the old age, with a special interest in a) uncovering its relationships with sociodemographic and health-related factors; b) analysing its predictive role on healthy-ageing outcomes later in life. Methods: The sample comprised 8317 older adults (46.02% men) from the English Longitudinal Study of Ageing. Robust structural equation modelling was used to identify symptom trajectories and their relationships with time-varying factors. Trajectory class and covariates were used to predict outcomes (quality of life, satisfaction with life, and daily living functioning) in a 2-year follow-up. Results: Three trajectory classes (so-called, normative, subclinical, chronic symptom trajectories) were identified for both sexes. Rising hearing difficulties and history of psychiatric problems were consistently associated with the chronic symptom trajectory. Lower education level, history of psychiatric problems, and increasing visual difficulties were connected with the subclinical trajectories. Finally, participants with either a subclinical or a chronic symptom trajectory showed worse outcomes than the remaining participants in the follow-up. Conclusion: This study highlighted the presence of varying courses of depression symptoms (each showing some distinctive features from other another) over the old age, pointing to some relevant implications for clinical assessment and treatment prescription., Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub

Background This study aimed at depicting the course of depression symptoms over the old age, with a special interest in a) uncovering its relationships with sociodemographic and health-related factors; b) analysing its predictive role on healthy-ageing outcomes later in life. Methods The sample comprised 8317 older adults (46.02% men) from the English Longitudinal Study of Ageing. Robust structural equation modelling was used to identify symptom trajectories and their relationships with time-varying factors. Trajectory class and covariates were used to predict outcomes (quality of life, satisfaction with life, and daily living functioning) in a 2-year follow-up. Results Three trajectory classes (so-called, normative, subclinical, chronic symptom trajectories) were identified for both sexes. Rising hearing difficulties and history of psychiatric problems were consistently associated with the chronic symptom trajectory. Lower education level, history of psychiatric problems, and increasing visual difficulties were connected with the subclinical trajectories. Finally, participants with either a subclinical or a chronic symptom trajectory showed worse outcomes than the remaining participants in the follow-up. Conclusion This study highlighted the presence of varying courses of depression symptoms (each showing some distinctive features from other another) over the old age, pointing to some relevant implications for clinical assessment and treatment prescription., Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub

Se trata de un estudio de posibles relaciones familiares entre individuos datados en el periodo conocido como Cogotas I (>2900YBP), enterrados colectivamente empleando marcadores genéticos y software de uso forense convencional. La metodología empleada constituye una manera de objetivar los resultados., Background: This study relies on the discovery of two pit burials (LTA and LTB) of the Bronze Age Cogotas I archaeological culture (circa 3600–2950BP) in Spain. LTA was a single burial and LTB con- tained three skeletal remains of two adults and a newborn or foetus at term. Aim: The central question posed by this find was whether the LTB tomb constituted a traditional nuclear family (father, mother and son or daughter). Methods: Ancient and forensic DNA protocols were employed to obtain reliable results. Autosomal, X-STR markers and mitochondrial DNA were amplified. Subsequently, different kinship probabilities were estimated by means of LR values calculated using the Familias 3 software. Furthermore, an allelic dropout sensitivity test was developed in order to evaluate the influence of allelic dropout phenomena on the results. Results: It was possible to determine the molecular sex of all individuals and to establish a maternal relationship between the perinatal individual and one of the adults. Conclusion: The remains in the LTB tomb were not a traditional nuclear family (father, mother and son/daughter) and it was probably a tomb where two women, one of them pregnant, were buried., Antecedentes: Este estudio se basa en el descubrimiento de dos entierros en fosas (LTA y LTB) de la cultura arqueológica Cogotas I de la Edad del Bronce (alrededor de 3600-2950 a. C.) en España. LTA fue un entierro único y LTB contenía tres restos esqueléticos de dos adultos y un recién nacido o un feto a término. Objetivo: La pregunta central planteada por este hallazgo fue si la tumba de LTB constituía una familia nuclear tradicional (padre, madre e hijo o hija). Métodos: Se emplearon protocolos de ADN antiguos y forenses para obtener resultados confiables. Se amplificaron marcadores autosómicos, X-STR y ADN mitocondrial. Posteriormente se estimaron diferentes probabilidades de parentesco mediante valores de LR calculados mediante el software Familias 3. Además, se desarrolló una prueba de sensibilidad al abandono alélico para evaluar la influencia de los fenómenos de abandono alélico en los resultados. Resultados: Se logró determinar el sexo molecular de todos los individuos y establecer una relación materna entre el individuo perinatal y uno de los adultos. Conclusión: Los restos en la tumba de LTB no eran un núcleo familiar tradicional (padre, madre e hijo/hija) y probablemente se trataba de una tumba donde fueron enterradas dos mujeres, una de ellas embarazada., Ministerio de Economía y Competitividad, Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub

Background: Substance use disorders (SUD) represent one of the most important public health problems which has an onset in adolescence. Although substantial data exist on adolescent substance use, studies examining the role of parental psychopathological profiles on adolescent offspring SUD are lacking. Thus, this study aimed to identify parental psychopathological profiles, and to examine the extent to which these profiles predict the presence of SUD in their offspring. Method: Data comes from the National Comorbidity Survey – Adolescent Supplement, a nationally representative survey of adolescents. This study examined data of 5887 adolescents (48.60% boys; M = 15.07 years, SD = 1.46) whose biological parents responded to the Parent Self-Administered Questionnaire. Parental psychopathological profiles were identified by means of latent class analysis. Profile class membership was used to predict offspring SUD in adolescence. Results: Different psychopathological profiles were identified in fathers and mothers. Among fathers, two psychopathological profiles were found: “normative class” (i.e., low psychopathological symptoms) and “high psychopathology class” (i.e., high psychopathological symptoms). Among mothers, three psychopathological profiles were found: “normative class” (i.e., low psychopathological symptoms), and “high psychopathology class” (i.e., high psychopathological symptoms), and “suicide class” (i.e., low psychopathological symptoms and drug use, but high on suicidal ideation or attempting to commit suicide). Father’s high psychopathological profile significantly predicted adolescent’s drug abuse. Mother’s high psychopathological profile significantly predicted adolescent’s nicotine dependence, alcohol or illicit drug abuse. Conclusions: Family-based interventions should include skills training in reducing parental SUD and other mental health problems., Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub

Several hypotheses involving alterations of the immune system have been proposed among etiological explanations for psychotic disorders. The endocannabinoid system (ECS) has a homeostatic role as an endogenous neuroprotective and anti-inflammatory system. Alterations of this system have been associated with psychosis. Cannabis use is a robust risk factor for these disorders that could alter the ECS signalling. In this study, 95 patients with a first episode of psychosis (FEP) and 90 healthy controls were recruited. Protein expression of cannabinoid receptor 2 (CB2), the protein levels of the main endocannabinoid synthesizing enzymes N-acyl phosphatidylethanolamine phospholipase (NAPE) and diacylglycerol lipase (DAGL), and of degradation enzymes fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL) were determined by western blot analysis in peripheral blood mononuclear cells (PBMCs). Patients with a FEP showed a decreased expression of CB2 and of both endocannabinoids synthesizing enzymes (NAPE and DAGL) in comparison to healthy controls. After controlling for age, gender, body mass index, and cannabis use, NAPE and DAGL expression remained significantly decreased, whereas FAAH and MAGL expression were increased. On the other hand, FEP subjects with history of severe cannabis use showed a larger ECS dysregulation compared with healthy controls. These results indicate an ECS dysregulation in PBMC of FEP patients. The alteration of the ECS presented at the initial phases of psychosis could be contributing to the pathophysiology of the disease and constitutes a possible biomarker of psychotic disorders and an interesting pharmacological target to take into account for therapeutic purposes., Spanish Ministry of Economy and Competiveness, CIBERSAM, Instituto de Salud Carlos III, Comunidad de Madrid, Government of Catalonia, Esther Koplowitz Center, Depto. de Farmacología y Toxicología, Depto. de Medicina Legal, Psiquiatría y Patología, TRUE, pub

Background: In Spain, there has been great effort by lawmakers to put Advance Directives (ADs) into practice since 2002. At the same time, the field of bioethics has been on the rise, a discipline that has spurred debate on the right of patients to exercise their autonomy. Despite all this, the implementation of ADs can be said to have failed in Spain, because its prevalence is very low, there is a great lack of knowledge about them and they have very little impact on clinical decisions. The purpose of this article is to analyze and discuss the main reasons for the failure of ADs in Spain. Main body: The main reasons why ADs have no impact on clinical practice in Spain have been fundamentally four: (1) the training of health professionals about the end of life and AD is lacking; (2) there has been no public process to increase awareness about AD, and therefore people (with the exception of specific highly sensitized groups) know little about them; (3) the bureaucratic procedure to document and implement ADs is excessively complex and cumbersome, creating a significant barrier to their application; (4) in Spain, the remnants of a paternalistic medical culture continue to exist, which causes shared decision-making to be difficult. Conclusion: Due to the four reasons mentioned above, AD have not been a useful tool to help honor patients' autonomous decisions about their future care and, therefore, they have not achieved their objective. However, despite the difficulties and problems identified, it has also been observed that health care professionals and the Spanish public have a very positive view of AD. Having identified the problems which have kept AD from being successful, strategies must be developed to help improve their implementation into the future., Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub

Loneliness is considered a prognostic factor for poorer health status in the elderly. It is proposed to analyze the role of loneliness in health status in terms of various factors. A total of 1747 individuals from the pilot survey of the Aging in Spain Longitudinal Study (ELES-PS) were reviewed. ELES is a cross-sectional study for collecting health variables, food habits, socioeconomic data, and cognitive and functional capacities, which was carried out on a Spanish representative sample of noninstitutionalized persons of 50 years of age or older. Moreover, since telomere shortening is associated with cellular senescence, 35 telomere-related SNPs and cognitive impairments were analyzed. The results characterize the “solos” as males of 50–60 years, who were overweight and had lower levels of hemoglobin and neutrophils. There is also an association between five SNPs related to telomere length and BDNF. A group of people with loneliness and depression was identified with poorer health and cognitive status, poorer perception of their quality of life, poorer quality of sleep, and lower physical activity. Therefore, it follows that telomeres and BDNF play a role as intermediaries between loneliness and depression and their relationship with a worse state of health., UCM-SANTANDER, Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub

Background: Down syndrome (DS) is considered the most frequent cause of early-onset Alzheimer’s disease (AD), and the typical pathophysiological signs are present in almost all individuals with DS by the age of 40. Despite of this evidence, the investigation on the pre-dementia stages in DS is scarce. In the present study we analyzed the complexity of brain oscillatory patterns and neuropsychological performance for the characterization of mild cognitive impairment (MCI) in DS. Materials and methods: Lempel-Ziv complexity (LZC) values from restingstatemagnetoencephalography recordings and the neuropsychological performance in 28 patients with DS [control DS group (CN-DS) (n = 14), MCI group (MCI-DS) (n = 14)] and 14 individuals with typical neurodevelopment (CN-no-DS) were analyzed. Results: Lempel-Ziv complexity was lowest in the frontal region within the MCI-DS group, while the CN-DS group showed reduced values in parietal areas when compared with the CN-no-DS group. Also, the CN-no-DS group exhibited the expected pattern of significant increase of LZC as a function of age, while MCI-DS cases showed a decrease. The combination of reduced LZC values and a divergent trajectory of complexity evolution with age, allowed the discrimination of CN-DS vs. MCI-DS patients with a 92.9% of sensitivity and 85.7% of specificity. Finally, a pattern of mnestic and praxic impairment was significantly associated in MCI-DS cases with the significant reduction of LZC values in frontal and parietal regions (p = 0.01). Conclusion: Brain signal complexity measured with LZC is reduced in DS and its development with age is also disrupted. The combination of both features might assist in the detection of MCI within this population., Ministerio de Economía y Competitividad (Instituto de Salud Carlos III), Jérôme Lejeune Foundation, Ministerio de Ciencia, Innovación y Universidades, Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub

Se trata del estudio genético de relaciones familiares más antiguo hasta la fecha en la Península Ibérica, mediante la utilización de marcadores genéticos y software forenses de uso convencional. Igualmente, se aporta información relevante sobre el aspecto físico de los neolíticos del Pirineo, cosa no realizada hasta el momento (2020). Es el resultado de una intensa colaboración nacional e internacional con el Grupo de Genética Forense y Genética de Poblaciones de la Facultad de Medicina de la Universidad Complutense, dirigido por los Drs. Eduardo Arroyo-Pardo y la Dra. Ana M. López-Parra., One of the most important Neolithic necropolises in the north-east of the Iberian Peninsula is La Feixa del Moro (3975-3790 cal. BC), located at 1335 mamsl in the Pyrenees (Juberri, Sant Julia de Lòria, Andorra). Within the scarcity of multiple simultaneous Neolithic burials, the main importance of La Feixa del Moro lies in the fact that it is one of the very few cases to suggest a biological family burial, comprising two adults and a newborn baby. Accordingly, the purpose of the present work was the multidisciplinary interpretation of the necropolis in the Neolithic context of the Pyrenees, on a potential route between the Iberian Peninsula and Europe. Therefore, kinship and biogeographic analyses were performed, as well as external visible characteristics phenotyping. Our results suggest the possibility of a traditional nuclear family, pointing to a very probable relation between the newborn and both adults. First, two mitochondrial haplotypes and two lineages were determined: H1, for the presumable mother and newborn, and U5, for the presumed father. Second, regarding their physical appearance, they all had brown eyes, the adult female and the neonate had dark brown hair, while the adult male's hair was dark red-brown. Finally, it was possible to confirm the sex of two of the individuals, as the newborn baby gender was also confirmed by the High Troughoutput Sequencing analysis. The multidisciplinary analysis of the La Feixa del Moro burial place envisions a very probable familial burial. Not only does the genetic evidence point to biological kinship, but also the archaeological record indicates a habitational area surrounding the burial site. The similar artefacts and the care shown during the funerary ritual suggest a probable biological Neolithic family., Una de las necrópolis neolíticas más importantes del noreste de la Península Ibérica es La Feixa del Moro (3975-3790 cal. a. C.), situada a 1335 m sobre el nivel del mar en los Pirineos (Juberri, Sant Julià de Lòria, Andorra). Dentro de la escasez de múltiples enterramientos neolíticos simultáneos, la principal importancia de La Feixa del Moro reside en que es uno de los pocos casos que sugiere un entierro familiar biológico, compuesto por dos adultos y un recién nacido. En este sentido, el objetivo del presente trabajo fue la interpretación multidisciplinar de la necrópolis en el contexto neolítico del Pirineo, en una potencial ruta entre la Península Ibérica y Europa. Para ello, se realizaron análisis de parentesco y biogeográficos, así como fenotipado de características externas visibles. Nuestros resultados sugieren la posibilidad de una familia nuclear tradicional, apuntando a una relación muy probable entre el recién nacido y ambos adultos. En primer lugar se determinaron dos haplotipos mitocondriales y dos linajes: H1, para la presunta madre y el recién nacido, y U5, para el presunto padre. En segundo lugar, en cuanto a su apariencia física, todos tenían ojos marrones, la hembra adulta y el neonato tenían cabello castaño oscuro, mientras que el cabello del macho adulto era marrón rojizo oscuro. Finalmente, fue posible confirmar el sexo de dos de los individuos, ya que el sexo del recién nacido también fue confirmado mediante el análisis de secuenciación de alto rendimiento. El análisis multidisciplinar del lugar de enterramiento de La Feixa del Moro vislumbra un enterramiento familiar muy probable. No sólo la evidencia genética apunta a un parentesco biológico, sino que también el registro arqueológico indica un área habitacional que rodea el sitio de enterramiento. Los artefactos similares y el cuidado mostrado durante el ritual funerario sugieren una probable familia biológica neolítica., Santander-Universidad Complutense de Madrid, Ministerio de Ciencia, Innovación y Universidades, Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub

Background: The concept of European psychologisation of depression versus somatisation in non-European populations has been the basis of several studies of cultural psychopathology in the general population. Little is currently known about cross-cultural differences and similarities in late-life depression symptom reporting. We cross-culturally compared symptom reporting in the context of Major Depressive Disorder (MDD) among community-dwelling older adults from Spain and Nigeria. Methods: We relied on data from two household multistage probability samples comprising 3,715 persons aged 65 years or older in the Spanish and Nigerian populations. All participants underwent assessments for MDD using the World Mental Health Survey version of the Composite International Diagnostic Interview. Cross-cultural comparison of broad somatic and psychological categories as well as relationship and influence of individual symptoms were analysed using the Symptom Network Analysis approach. Results: Current MDD was diagnosed in 232 and 195 older persons from Spain and Nigeria, respectively. The symptom network of the two samples were invariant in terms of global strength, S(GSPAIN , GNIGERIA ) = 7.56, P = .06, with psychological and somatic symptoms demonstrating centrality in both countries. However, country-specific relationships and influence of individual symptoms were found in the network structure of both samples, M(GSPAIN , GNIGERIA ) = 2.95, P < .01. Conclusion: Broad somatic and psychological symptoms categories contributed to the structural network of older Africans and their peers from the Spanish population. Variations in the relationship and influence of individual symptoms suggests that the functional and "communicative" role of individual symptoms may be differentiated by context specific imperatives. J Am Geriatr Soc 68:-, 2020., Wellcome Trust, Unión Europea, Ministerio de Economía y Competitividad, Instituto de Salud Carlos III, Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub

Psychopathology networks consist of aspects (e.g., symptoms) of mental disorders (nodes) and the connections between those aspects (edges). This article aims to analyze the research literature on network analysis in psychopathology and mental health for the last ten years. Statistical descriptive analysis was complemented with two bibliometric techniques: performance analysis and co-word analysis. There is an increase in publications that has passed from 1 article published in 2010 to 172 papers published in 2020. The 398 articles in the sample have 1,910 authors in total, being most of them occasional contributors. The Journal of Affective Disorders is the one with the highest number of publications on network analysis in psychopathology and mental health, followed by the Journal of Abnormal Psychology and Psychological Medicine stand out. The present study shows that this perspective in psychopathology and mental health is a recent field of study, but with solid advances in recent years from a wide variety of researchers, mainly from USA and Europe, who have extensively studied symptom networks in depression, anxiety, and post-traumatic stress disorders. However, gaps are identified in other psychological behaviors such as suicide, populations such as the elderly, and gender studies., Depto. de Personalidad, Evaluación y Psicología Clínica, Fac. de Psicología, TRUE, pub

Background: The cortico-cerebellar-thalamic-cortical circuit has been implicated in the emergence of psychotic symptoms in schizophrenia (SZ). The kynurenine pathway (KP) has been linked to alterations in glutamatergic and monoaminergic neurotransmission and to SZ symptomatology through the production of the metabolites quinolinic acid (QA) and kynurenic acid (KYNA). Methods: This work describes alterations in KP in the post-mortem prefrontal cortex (PFC) and cerebellum (CB) of 15 chronic SZ patients and 14 control subjects in PFC and 13 control subjects in CB using immunoblot for protein levels and ELISA for interleukins and QA and KYNA determinations. Monoamine metabolites were analysed by high-performance liquid chromatography and SZ symptomatology was assessed by Positive and Negative Syndrome Scale (PANSS). The association of KP with inflammatory mediators, monoamine metabolism and SZ symptomatology was explored. Results: In the PFC, the presence of the anti-inflammatory cytokine IL-10 together with IDO2 and KATII enzymes decreased in SZ, while TDO and KMO enzyme expression increased. A network interaction analysis showed that in the PFC IL-10 was coupled to the QA branch of the kynurenine pathway (TDO-KMO-QA), whereas IL-10 associated with KMO in CB. KYNA in the CB inversely correlated with negative and general PANSS psychopathology. Although there were no changes in monoamine metabolite content in the PFC in SZ, a network interaction analysis showed associations between dopamine and methoxyhydroxyphenylglycol degradation metabolite. Direct correlations were found between general PANSS psychopathology and the serotonin degradation metabolite, 5-hydroxyindoleacetic acid. Interestingly, KYNA in the CB inversely correlated with 5-hydroxyindoleacetic acid in the PFC. Conclusions: Thus, this work found alterations in KP in two brain areas belonging to the cortico-cerebellar-thalamic-cortical circuit associated with SZ symptomatology, with a possible impact across a, MINECO-FEDER, Instituto de Salud Carlos III, ERDF, CIBERSAM, Depto. de Farmacología y Toxicología, Fac. de Medicina, TRUE, pub

Up to 30% of patients with attention-deficit hyperactivity disorder (ADHD) treated with psychostimulants discontinue the treatment because of intolerance or lack of therapeutic response. Therapeutic alternatives are needed for such patients. In the present case series, we study the effectiveness of reboxetine over a period of 6 months in a sample of 14 children diagnosed with ADHD according to DSM-IV-TR criteria, who had responded only partially or had presented poor tolerance to conventional treatment with methylphenidate. Clinical efficacy was evaluated through the application of the 18-item Attention-Deficit Hyperactivity Disorder Rating Scale (ADHD-RS-IV) and the Clinical Global Impressions-Global Improvement Scale (CGI-I). Percentages of responders (ADHD-RS ≥ 25%) and improvers (CGI-I absolute value < 4) were 90.9 and 72.7%, respectively. No serious side-effects were observed during treatment, the most frequent effects being headaches and insomnia. The initial findings of our study show that reboxetine may constitute an effective tool for long-term treatment of children with ADHD who present poor response or poor tolerance to initial treatment with methylphenidate., Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub

Auditory hallucinations (AHs) are one of the most distressing symptoms of schizophrenia (SZ) and are often resistant to medication. Imaging studies of individuals with SZ show hyperactivation of the default mode network (DMN) and the superior temporal gyrus (STG). Studies in SZ show DMN hyperconnectivity and reduced anticorrelation between DMN and the central executive network (CEN). DMN hyperconnectivity has been associated with positive symptoms such as AHs while reduced DMN anticorrelations with cognitive impairment. Using real-time fMRI neurofeedback (rt-fMRI-NFB) we trained SZ patients to modulate DMN and CEN networks. Meditation is effective in reducing AHs in SZ and to modulate brain network integration and increase DMN anticorrelations. Consequently, patients were provided with meditation strategies to enhance their abilities to modulate DMN/CEN. Results show a reduction of DMN hyperconnectivity and increase in DMNsingle bondCEN anticorrelation. Furthermore, the change in individual DMN connectivity significantly correlated with reductions in AHs. This is the first time that meditation enhanced through rt-fMRI-NFB is used to reduce AHs in SZ. Moreover, it provides the first empirical evidence for a direct causal relation between meditation enhanced rt-fMRI-NFB modulation of DMNsingle bondCEN activity and post-intervention modulation of resting state networks ensuing in reductions in frequency and severity of AHs., Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

Introduction: Women have been shown to be a vulnerable group in relation to mental health problems over time. Despite this, gender-focused studies are uncommon. The aim of this research is to study mental health in a sample of people with mental health problems and to analyze the differences and predictors focusing on gender. Methods: A cross-sectional study is conducted in a heterogeneous clinical sample in terms of mental health problems (N = 160). Interviews with hetero-reported standardized questionnaires to collect the data are conducted. Descriptive analyses, mean difference and a regression analysis on mental health are carried out taking into account different sociodemographic, clinical and psychosocial variables. Results: Women in the study present worse levels of mental health and subjective severity of the disorder. The main predictors of mental health are being female, followed by severity, shorter time with the diagnosis and internalized stigma. Conclusion: Being female is the most robust predictor of worse mental health and symptomatology. Recommendations according to the results found proposing a gender perspective are suggested., Real Colegio Complutense, Banco Santander, Depto. de Personalidad, Evaluación y Psicología Clínica, Fac. de Psicología, TRUE, pub

Plasma acylethanolamides (NAEs), including the endocannabinoid anandamide (AEA), have been proposed as circulating biomarkers of substance use disorders. However, the concentration of these lipid transmitters might be influenced by the use of drugs prescribed for either the treatment of addiction or the associated psychiatric co-morbidities such as psychosis. As an example, neuroleptics, used for attenuation of psychotic symptoms and sedation, might theoretically interfere with the monoamine-mediated production of NAEs, obstructing the interpretation of plasma NAEsasclinical biomarkers. To solve the lack of information on the impact of neuroleptics on the concentration of NAEs, we evaluated the concentrations of NAEs in a control group and compared them to those present in (a) substance use disorders (SUD) patients that are not prescribed with neuroleptics, and (b) SUD patients (both alcohol use disorder and cocaine use disorder patients) using neuroleptics. The results demonstrate that SUD patients exhibited greater concentrations of NAEsthan the control population, affecting all species with the exception of stearoylethanolamide (SEA) and palmitoleoylethanolamide (POEA). Neuroleptic treatment enhanced the concentrations of NAEs, especially those of AEA, linoleoylethanolamide (LEA), and oleoylethanolamide (OEA). This effect of neuroleptic treatment was observed independently of the drug addiction that motivated the demand for treatment (either alcohol or cocaine). This study remarks the need to control the current use of psychotropic medication as a potential confounding variable when considering the use of NAEsasbiomarkers in SUD., Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación (España), European Commission, Ministerio de Sanidad, Junta de Andalucía, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub, Descuento UCM

Department of Nursing, University of Jaen, 23071 Jaen, Spain Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain European University of Valencia, 46010 Valencia, Spain Department of Obstetrics and Gynecology, Delivery Ward, Hospital Antequera, 29200 Malaga, Spain Mental Health Unit, Virgen del Rocio University Hospital, 41013 Seville, Spain English Language Department, University of Seville, 41004 Seville, Spain Department of Nursing, The University of Granada, 18071 Granada, Spain Department of Legal Medicine, Psychiatry and Pathology, Complutense University of Madrid, CIBERSAM ISCIII, 28040 Madrid, Spain, The coronavirus SARS-CoV-2 generated an alert that became a state of emergency in health issues worldwide, a situation that affected the entire population, including pregnant women. The present study aims to understand the effect of the psychopathological profile of a sample of pregnant women at the time of the COVID-19 pandemic on themselves during childbirth (Phase 1) and after childbirth and the anthropometric measures of the neonate at birth (Phase 2). The total sample comprises 81 pregnant women aged 32.07 years (SD = 5.45) and their neonates. Sociodemographic and obstetric data of the sample were collected. During pregnancy, psychopathology was measured by means of the SCL-90, as well as other psychological measures on stress and social support. Cluster k-means techniques were used to uncover the heterogeneous profiles of psychopathology in Phase 1. Two main psychopathological profiles were found (Cluster 1: High psychopathological symptoms; Cluster 2: Low psychopathological symptoms). The clusters generated show significant differences in all the SCL-90-R subscales used and in the general index at Phase 1. After childbirth, high psychopathology profile membership was associated with a greater probability of having a non-eutocic delivery. On the other hand, the low psychopathological symptoms cluster shows higher levels of depressive symptoms, hostility, paranoid ideation, and psychotic symptoms in Phase 2. In conclusion, there seemed to exist two heterogeneous profiles of psychopathology in pregnant women during the pandemic; the stress related to the pandemic seemed uninfluential on the development of a profile of high psychopathological symptoms and the psychopathology profile may influence delivery and postpartum outcomes., Department of Nursing, University of Jaen, Instituto de Investigación Biosanitaria (ibs.GRANADA), European University of Valencia, Department of Obstetrics and Gynecology, DeliveryWard, Hospital Antequera, Mental Health Unit, Virgen del Rocio University Hospital, English Language Department, University of Seville, Department of Nursing, The University of Granada, Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub

Suicide is a serious global public health problem, with a worrying recent increase in suicide rates in both adolescent and adult populations. However, it is essential to recognize that suicide is preventable. A myriad of factors contributes to an individual’s vulnerability to suicide. These factors include various potential causes, from psychiatric disorders to genetic and epigenetic alterations. These changes can induce dysfunctions in crucial systems such as the serotonergic, cannabinoid, and hypothalamic–pituitary–adrenal axes. In addition, early life experiences of abuse can profoundly impact an individual’s ability to cope with stress, ultimately leading to changes in the inflammatory system, which is a significant risk factor for suicidal behavior. Thus, it is clear that suicidal behavior may result from a confluence of multiple factors. This review examines the primary risk factors associated with suicidal behavior, including psychiatric disorders, early life adversities, and epigenetic modifications. Our goal is to elucidate the molecular changes at the genetic, epigenetic, and molecular levels in the brains of individuals who have taken their own lives and in the plasma and peripheral mononuclear cells of suicide attempters and how these changes may serve as predisposing factors for suicidal tendencies., Red de investigación en atención primaria de adicciones, Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub, Descuento UCM

El amplío uso en la ínvestigación psicopatológica de paradigmas experimentales derivados del procesamiento de información exige el desarrollo de estímulos experimentales con adecuadas propiedades psicométricas. En el presente artículo se presentan dos conjuntos de estímulos verbales en español desarrollados para la investigación de constructos cognitivos relacionados con los trastornos de ansiedad social y depresión (p. ej., los autoesquemas depresivos y ansiosos, los nodos cognitivos de depresión y ansiedad, etc.), mediante tareas experimentales como la tarea Stroop, de anticipación semántica, de codificación autorreferente, o de decisión léxica. Estos dos conjuntos están formados por grupos de adjetivos de personalidad de valencia positiva y negativa cuyo contenido está específicamente relacionado con la depresión, la ansiedad social, con ambos trastornos (adjetivos mixtos) y con ninguno de ellos (adjetivos control). Además, los grupos de adjetivos que componen tales conjuntos no difieren entre sí en dimensiones tales como frecuencia objetiva de uso, frecuencia subjetiva de uso, imaginabilidad, emocionalidad y longitud en número de letras, lo que asegura en futuras investigaciones el control de los posibles efectos como variables extrañas de dichas dimensiones., The proliferatíon of experimental paradigms imported from information processing in psychopathological research calls for the development of experimental stimuli with appropríate psychometric properties. This paper presents two sets of Spanish verbal stimuli developed for the research of cognítive constructs related to social anxiety and depression (e.g., depressíve and anxious self-schemata, depression and anxíety cognitive nodes, etc.) with experimental tasks such as the Stroop, priming, self-referent encoding, or lexical decísion tasks. These two sets are composed of groups of personality trait adjectives with positive and negative valence, and with content specifically related to depressive, anxious, both depressíve and anxious (mixed adjectives), and normal themes (control adjectives). In addition, the groups of adjectíves do not díffer among them on dimensions such as objective frequency of use, subjectíve frequency of use, imagery, emotionality, and word length. Thís absence of differences warrants the control of possible effects as strange variables of those dimensíons in future studies., Depto. de Personalidad, Evaluación y Psicología Clínica, Fac. de Psicología, TRUE, pub

Growing evidence supports the hypothesis that temperamental traits are not static throughout adolescence. The known links between both reactive and regulatory temperament and anxiety symptoms should be investigated bearing this hypothesis in mind. This study collected self-reported data on behavioral inhibition system (BIS) sensitivity, attentional control (AC), and anxiety symptomatology, from 296 adolescents (64.2% girls; M = 12.96 years at the first assessment, SD = 0.47) every six months, four times over eighteen months. The relationships between temperament factors (AC and BIS sensitivity), considered longitudinally (by means of their trajectories) and anxiety symptoms were investigated using Multigroup Latent Growth Modeling (MLGM), as well as the mediating effect of sex on trajectories and anxiety. BIS sensitivity decreased over time and showed differential patterns across sexes. AC remained relatively stable and we found no sex influence on its trajectory. On the other hand, we observed that the BIS sensitivity trajectory was a significant predictor of anxiety symptomatology at age 15. In conclusion, temperamental changes between the ages of 13 and 15 seem to play a relevant role in explaining subsequent anxiety symptomatology, under the mediating influence of sex., Unión Europea, Ministerio de Economía y Competitividad (España), Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub

Background: The purpose of this study was to assess and compare the prevalence of self-reported mental disorders, psychological distress, and psychotropic drug consumption among people with diabetes mellitus (DM) and matched non-DM controls. Methods: A case–controlled study using data from the Spanish National Health Interview Survey was conducted in 2017. We identified 2116 DM adults (aged ≥35 years). Non-DM controls were matched 1:1 by age, sex, and province of residence. Results: Prevalence of mental disorders (25.0% vs. 19.2%; p < 0.001), psychological distress (29% vs. 19.5%; p < 0.001), and consumption of psychiatric medications (29.7% vs. 23.5%; p < 0.001) among DM cases were higher than those among matched non-DM controls. The DM patient variables associated with experiencing a mental disorder, psychological distress, and consumption of psychiatric medications were: being a woman, worse self-rated health, and a visit to a psychologist within the last year. Older age (≥80 years) was associated with a lower probability of reporting mental disorders and psychological distress among DM cases. Not practicing physical exercise was significantly associated with experiencing psychological distress. Conclusions: Adults with DM included in our investigation have a significantly higher prevalence of mental disorders, psychological distress, and consumption of psychiatric medications than non-DM controls. It is necessary to implement screening strategies and psychological interventions to improve the mental health of DM patients in Spain, focusing especially on women and those aged 35 to 59 years., Fondo de Investigaciones Sanitarias—Health Research Fund, Instituto de Salud Carlos III, Fondo Europeo de Desarrollo Regional, Depto. de Enfermería, Fac. de Enfermería, Fisioterapia y Podología, TRUE, pub

This study was funded by the Spanish Ministry of Science and Innovation (Ministerio de Ciencia e Innovación, Spain/Project PID2019-108657RB-I00: Modification of attentional bias, with virtual reality, for improving anorexia nervosa treatment and Project PSI2015-70389-R: Development of virtual reality-based exposure techniques for improving anorexia nervosa treatment) and by AGAUR, Generalitat de Catalunya, 2017SGR1693., In vivo body exposure therapy is considered an effective and suitable intervention to help patients with anorexia nervosa (AN) reduce their body image disturbances (BIDs). However, these interventions have notable limitations and cannot effectively reproduce certain fears usually found in AN, such as the fear of gaining weight (FGW). The latest developments in virtual reality (VR) technology and embodiment-based procedures could overcome these limitations and allow AN patients to confront their FGW and BIDs. This study aimed to provide further evidence of the efficacy of an enhanced (by means of embodiment) VR-based body exposure therapy for the treatment of AN. Thirty-five AN patients (16 in the experimental group, 19 in the control group) participated in the study. FGW, BIDs, and other body-related and ED measures were assessed before and after the intervention and three months later. The experimental group received treatment as usual (TAU) and five additional sessions of VR-based body exposure therapy, while the control group received only TAU. After the intervention, ED symptoms were clearly reduced in both groups, with most of the changes being more noticeable in the experimental group. Specifically, after the intervention and at follow-up, significant group differences were found in the FGW and BIDs, with the experimental group showing significantly lower values than the control group. The current study provides new insights and encouraging findings in the field of exposure-based therapies in AN. VR technology might improve research and clinical practice in AN by providing new tools to help patients confront their core fears (i.e., food- or weight-related cues) and improve their emotional, cognitive, and behavioral responses to their body image., Ministerio de Ciencia e Innovación (España), AGAUR, Generalitat de Catalunya, Fac. de Medicina, TRUE, pub

Introducció: El present treball exposa les característiques generals del fenomen de la immigració a Espanya i els diferents problemes que enfronten els joves en el seu procés d'adaptació i com aquests incideixen sobre la seva salut mental. Objectius: Determinar si l'exposició a factors psicosocials com la resiliència, el compromís escolar i la violència familiar incideix en la presència de problemes de salut mental i abús de substàncies addictives en adolescents immigrants i no immigrants d'Espanya. Materials i mètodes: Es va estudiar a 262 joves d'entre 12 i 17 anys de les ciutats d'Alacant i Barcelona., 139 espanyols i 123 immigrants. A tots ells se'ls va aplicar l'escala Youth Self Report (YSR) per a obtenir informació sistematitzada sobre diverses competències i problemes de conducta i el Student Engagement Instrument (SEI) per a conèixer el grau de compromís cognitiu i compromís psicològic. A més del Child and Youth Resilience Measure (CYRM-28) que mesura el nivell de resiliència individual, resiliència familiar i resiliència contextual. Posteriorment es van aplicar diferents proves estadístiques als resultats obtinguts. Resultats i conclusions: Es va trobar que existeix una incidència positiva entre factors protectors com els diferents tipus de resiliència i l'acompliment escolar i la salut mental dels joves, especialment dels nadius. D'igual forma es va trobar una incidència negativa entre la violència familiar i la salut mental dels joves, sobretot en el cas dels immigrants., Introducción: El presente trabajo expone las características generales del fenómeno de la inmigración en España y los diferentes problemas que enfrentan los jóvenes en su proceso de adaptación y cómo estos inciden sobre su salud mental. Objetivos: Determinar si la exposición a factores psicosociales como la resiliencia, el compromiso escolar y la violencia familiar incide en la presencia de problemas de salud mental y abuso de sustancias adictivas en adolescentes inmigrantes y no inmigrantes de España. Materiales y métodos: Se estudió a 262 jóvenes de entre 12 y 17 años de las ciudades de Alicante y Barcelona., 139 españoles y 123 inmigrantes. A todos ellos se les aplicó la escala Youth Self Report (YSR) para obtener información sistematizada sobre diversas competencias y problemas de conducta y el Student Engagement Instrument (SEI) para conocer el grado de compromiso cognitivo y compromiso psicológico. Además del Child and Youth Resilience Measure (CYRM-28) que mide el nivel de resiliencia individual, resiliencia familiar y resiliencia contextual. Posteriormente se aplicaron diferentes pruebas estadísticas a los resultados obtenidos. Resultados y conclusiones: Se encontró que existe una incidencia positiva entre factores protectores como los distintos tipos de resiliencia y el desempeño escolar y la salud mental de los jóvenes, en especial de los nativos. De igual forma se encontró una incidencia negativa entre la violencia familiar y la salud mental de los jóvenes, sobre todo en el caso de los inmigrantes., Introduction: This paper presents the general characteristics of the immigration phenomenon in Spain and the different problems faced by young people in their adaptation processes and how these affect their mental health. Objectives: To determine if exposure to psychosocial factors such as resilience, school commitment and family violence affects the presence of mental health problems and substance abuse of in immigrant and non-immigrant adolescents from Spain. Materials and methods: 262 young people between 12 and 17 years old from the cities of Alicante and Barcelona, ​​139 Spaniards and 123 immigrants were studied. The Youth Self Report (YSR) scale was applied to all of them to obtain systematized information on various skills and behavior problems and the Student Engagement Instrument (SEI) to know the degree of cognitive and psychological commitment. In addition to the Child and Youth Resilience Measure (CYRM-28) which measures the level of individual resilience, family resilience and contextual resilience. Subsequently, different statistical tests were applied to the results obtained. Results and conclusions: It was found that there is a positive incidence between protective factors such as different types of resilience and school performance and mental health of young people, especially of natives. Similarly, a negative incidence was found between family violence and the mental health of young people, especially in the case of immigrants., Universitat Autònoma de Barcelona. Programa de Doctorat en Psiquiatria

Les mossegades canines són un important problema de salut pública a nivell mundial. Producte d'aquest tipus d'incidents, es desprenen importants conseqüències, dins de les quals es troben les lesions físiques, traumes psicològics, transmissió de zoonosi, infeccions posteriors a les mossegades i costos econòmics, tant per l'estat de país en qüestió, com per a les pròpies víctimes d'aquests episodis. En els casos més extrems, es pot arribar fins i tot a la mort de la víctima. És així que, resulta fonamental poder abordar de manera integral aquesta problemàtica, considerant característiques epidemiològiques relacionats amb la víctima, animal agressor i context de l'atac; conseqüències d'aquest tipus d'incidents, percepció de la població sobre aquests temes i informació que nodreix a la comunitat a l'respecte per a la presa de decisions associades a la prevenció i control d'aquests accidents, així com, l'anàlisi de programes de prevenció i maneig d'aquesta problemàtica i polítiques públiques relacionades amb aquest. Aquest estudi va tenir per objectiu caracteritzar els incidents per mossegades canines en pacients atesos en els principals serveis públics de salut, d'atenció primària i urgència de Xile entre setembre de 2017 i setembre de l'any 2018; i analitzar la literatura de premsa, indexada i gris de mossegades canines publicades durant el període 2013-2017 a Xile i Espanya. En el primer estudi es van utilitzar dades provinents del "Sistema de Registre d'Animals Mossegadors" (SIRAM), pertanyent a el Ministeri de Salut de Xile. Es van analitzar 17.299 mossegades d'animals, de les quals 6.533 van ser de gossos. En relació als resultats sobre la víctima es va trobar que els més mossegats van ser les persones de gènere masculí de l'estrat etari> 40 a 64 anys (0,82 mossegades / 10,000 habitants). Els principals animals mossegadors van ser mestissos (59,99%), de grandària mitjana (41,05%) i la majoria estaven castrats (89,22%). L'estació de l'any amb major nombre d'inciden, Las mordeduras caninas son un importante problema de salud pública a nivel mundial. Producto de este tipo de incidentes, se desprenden importantes consecuencias, dentro de las cuales se encuentran las lesiones físicas, traumas psicológicos, transmisión de zoonosis, infecciones posteriores a las mordeduras y costos económicos, tanto para el estado del país en cuestión, como para las propias víctimas de dichos episodios. En los casos más extremos, se puede llegar incluso a la muerte de la víctima. Es así que, resulta fundamental poder abordar de manera integral dicha problemática, considerando características epidemiológicas relacionados con la víctima, animal agresor y contexto del ataque; consecuencias de este tipo de incidentes, percepción de la población acerca de estos temas e información que nutre a la comunidad al respecto para la toma de decisiones asociadas a la prevención y control de dichos accidentes, así como, el análisis de programas de prevención y manejo de esta problemática y políticas públicas relacionadas con este. Este estudio tuvo por objetivo caracterizar los incidentes por mordeduras caninas en pacientes atendidos en los principales servicios públicos de salud, de atención primaria y urgencia de Chile entre Septiembre del 2017 y Septiembre del 2018; y analizar la literatura de prensa, indexada y gris de mordeduras caninas publicadas durante el período 2013-2017 en Chile y España. En el primer estudio se utilizaron datos provenientes del "Sistema de Registro de Animales Mordedores"(SIRAM), perteneciente al Ministerio de Salud de Chile. Se analizaron 17.299 mordeduras de animales, de las cuales 6.533 fueron de perros. En relación a los resultados acerca de la víctima se encontró que los más mordidos fueron las personas de género masculino del estrato etario >40 a 64 años (0,82 mordeduras/10,000 habitantes) . Los principales animales mordedores fueron mestizos (59,99%), de tamaño mediano (41,05%) y la mayoría estaban castrados (89,22%). La estación, Dog bites are a major global public health problem. As a result of such incidents, there are significant consequences, including physical injury, psychological trauma, transmission of zoonoses, post-bite infections and economic costs, both to the state of the country concerned and to the victims of such episodes themselves. In the most extreme cases, the victim may even die. Therefore, it is essential to be able to address this problem in a comprehensive manner, considering epidemiological characteristics related to the victim, the animal aggressor and the context of the attack; consequences of this type of incident, the population's perception of these issues and information that feeds the community in this regard for decision making associated with the prevention and control of such accidents, as well as the analysis of prevention and management programmes and public policies related to this problem. The objective of this study was to characterize dog bite incidents in patients attended at the main public health, primary care and emergency services in Chile between September 2017 and September 2018; and to analyze the press, indexed and grey literature on dog bites published during the period 2013-2017. The first study used data from the "Sistema de Registro de Animales Mordedores" (SIRAM), which belongs to the Chilean Ministry of Health. A total of 17,299 animal bites were analyzed, of which 6,533 were from dogs. In relation to the results regarding the victim, it was found that the most bitten were male people from the age group >40 to 64 years (0.82 bites/10,000 inhabitants). The main biting animals were mestizos (59.99%), of medium size (41.05%) and most were castrated (89.22%). The season of the year with the highest number of incidents was winter (31.85%), with the dog's home being the main location of attacks (57.48%). The second study corresponded to a systematic review of scientific literature, grey literature and written press articles from Chile and Spa, Universitat Autònoma de Barcelona. Programa de Doctorat en Psiquiatria

Mentre les alteracions cerebrals funcionals en el trastorn bipolar han estat àmpliament estudiades, els canvis que tenen lloc en les diferents fases de la malaltia i la recuperació estan menys documentats. El trastorn bipolar s'ha associat amb canvis cerebrals durant la realització de neuroimatge funcional, sobretot una reducció en l'activitat o hipoactivació en el còrtex prefrontal i d'altres regions corticals, i un augment d'activitat en estructures subcorticals com l'amígdala, hipocamp i ganglis de la base. Més recentment s'ha descobert que, a més d'aquesta sèrie de fallades a l'hora d'activar determinades regions, hi ha també un fracàs a desactivar l'àrea prefrontal medial, específicament en el node anterior de l'anomenada xarxa neuronal per defecte ( "default mode network" , DMN). En un primer estudi es van examinar les alteracions funcionals durant la realització d'una tasca de memòria de treball, en pacients amb episodi maníac versus controls sans. Per a això es van reclutar 29 pacients que complien criteris DSM-IV de trastorn bipolar tipus I, amb una puntuació de la Young Mania Rating Scale ≥18, aparellats amb 46 controls sans per edat, sexe i coeficient intel·lectual. A tots ells se'ls va realitzar RMN funcional amb el paradigma N-Back. Els pacients maníacs van presentar un fracàs en activar o hipoactivació comparats amb els controls sans en l'àrees responsables de la realització de la tasca de memòria de treball (còrtex prefrontal dorsolateral (DLPFC) i parietal entre d'altres) i un fracàs a desactivar al còrtex frontomedial i cingulado.Es disposa d'un primer article: Failure of de-activation in the medial frontal còrtex in mania: evidence for default mode network Dysfunction in the disorder. Pomarol-Clotet I, Moro N, Sarró S, Goikolea JM, Vieta E, Amann B, Fernandez-Corcuera P, Sans-Sansa B, Vaig muntar GC, Capdevila A, McKenna PJ, Salvador R. World J Biol Psychiatry. 2012 Dec; 13 (8): 616-26. doi: 10.3109 / 15622975.2011.573808. Epub 2011 May 23. PMID: 2, Mientras las alteraciones cerebrales funcionales en el trastorno bipolar han sido ampliamente estudiadas, los cambios que tienen lugar en las diferentes fases de la enfermedad y la recuperación están menos documentados. El trastorno bipolar se ha asociado con cambios cerebrales durante la realización de neuroimagen funcional, sobre todo una reducción en la actividad o hipoactivación en el córtex prefrontal y de otras regiones corticales, y un aumento de actividad en estructuras subcorticales como la amígdala, hipocampo y ganglios de la base. Más recientemente se ha descubierto que, además de esta serie de fallos a la hora de activar determinadas regiones, existe también un fracaso en desactivar el área prefrontal medial, específicamente en el nodo anterior de la llamada red neuronal por defecto ("default mode network", DMN). En un primer estudio se examinaron las alteraciones funcionales durante la realización de una tarea de memoria de trabajo, en pacientes con episodio maníaco versus controles sanos. Para ello se reclutaron 29 pacientes que cumplían criterios DSM-IV de trastorno bipolar tipo I, con una puntuación de la Young Mania Rating Scale ≥18, apareados con 46 controles sanos por edad, sexo y coeficiente intelectual. A todos ellos se les realizó RMN funcional con el paradigma N-Back. Los pacientes maníacos presentaron un fracaso en activar o hipoactivación comparados con los controles sanos en la áreas responsables de la realización de la tarea de memoria de trabajo (córtex prefrontal dorsolateral (DLPFC) y parietal entre otras) y un fracaso en desactivar en el córtex frontomedial y cingulado.Se dispone de un primer artículo: Failure of de-activation in the medial frontal cortex in mania: evidence for default mode network dysfunction in the disorder. Pomarol-Clotet E, Moro N, Sarró S, Goikolea JM, Vieta E, Amann B, Fernandez-Corcuera P, Sans-Sansa B, Monté GC, Capdevila A, McKenna PJ, Salvador R. World J Biol Psychiatry. 2012 Dec;13(8):616-26. doi: 10.3109/15, While the functional brain alterations in bipolar disorder have been widely studied, the changes that take place in the different phases of the disease and recovery are less documented. Bipolar disorder has been associated with brain changes during the performance of functional neuroimaging, especially a reduction in activity or hypoactivation in prefrontal cortex and other cortical regions, and an increase in activity in subcortical structures such as amygdala, hippocampus and ganglia from the base. More recently it has been discovered that, in addition to this series of failures when activating certain regions, there is also a failure to deactivate the medial prefrontal area, specifically in the previous node of the so-called "Default Mode Network" (DMN). In a first study, functional alterations were examined during carrying out a working memory task, in patients with maniac episode versus healthy controls. For this, 29 patients who met DSM-IV criteria of type I bipolar disorder were recruited, with a score of the Young Mania Rating Scale ≥18, matched with 46 healthy controls by age, sex and intellectual coefficient. All of them were performed functional RMN with the N-Back paradigm. Maniac patients presented a failure to activate or hypoactivation compared with healthy controls in the areas responsible for carrying out the work memory task (dorso lateral prefrontal cortex (DLPFC) and parietal among others) and a failure to deactivate in the fronto medial cortex and cingulate. It has a first article: Failure of De-Activation in the Medial Front Cortex in Mania: Evidence for Default Mode Network Dysfunction in the Disorder. Pomarol-Clotet E, Moro N, Sarró S, Goikolea JM, Vieta E, Amann B, Fernandez-Corcuera P, Sans-Sansa B, Monté GC, Capdevila A, McKenna PJ, Salvador R. World J Biol Psychiatry. 2012 Dec; 13 (8): 616-26. Doi: 10.3109 / 15622975.2011.573808. EPUB 2011 May 23. PMID: 21604958 In a second study, functional alterations were examined during carrying out a, Universitat Autònoma de Barcelona. Programa de Doctorat en Psiquiatria

La Síndrome X Fràgil (SXF) és la segona causa més comuna de discapacitat intel·lectual de base genètica, per darrere de la trisomia 21, i la primera causa de discapacitat intel·lectual hereditària. En el cas dels homes, al comptar tan sols amb un cromosoma X, el fet de ser portadors de la mutació completa de el gen FMR1 provoca una absència total de la proteïna FMRP mentre que, en el cas de les dones, comporta una disminució parcial ja que el cromosoma amb el gen FMR1 sa serà capaç de sintetitzar certa quantitat de FMRP. Tot això implica que la clínica en homes sol expressar-se de forma més greu que en les dones. Aquest fet ha influït en què la gran majoria d'investigació científica s'hagi centrat en descriure el fenotip neurocognitiu dels homes afectes i que el nombre d'investigacions realitzades en dones sigui significativament inferior. La present tesi s'estructura en base a 4 articles. Aquests representen el nucli de la investigació que té com a objectius principals estudiar la relació entre diferents àrees del perfil neurocognitiu i la conducta adaptativa en noies amb el diagnòstic de SXF; així com el risc de patir assetjament escolar en el paper de víctima i la seva relació amb el seu nivell d'adaptació funcional. Tots ells compten amb una mostra de 26 noies amb SXF i 14 noies de grup control aparellades per edat i capacitat intel·lectual total, amb edats entre els 7 i els 16 anys., El Síndrome X Frágil (SXF) es la segunda causa más común de discapacidad intelectual de base genética, por detrás de la trisomía 21, y la primera causa de discapacidad intelectual hereditaria. En el caso de los varones, al contar tan solo con un cromosoma X, el hecho de ser portadores de la mutación completa del gen FMR1 provoca una ausencia total de la proteína FMRP mientras que, en el caso de las mujeres, conlleva una disminución parcial ya que el cromosoma con el gen FMR1 sano será capaz de sintetizar cierta cantidad de FMRP. Todo esto implica que la clínica en varones suele expresarse de forma más grave que en las mujeres. Este hecho ha influido en que la gran mayoría de investigación científica se haya centrado en describir el fenotipo neurocognitivo de los varones afectos y que el número de investigaciones realizadas en mujeres sea significativamente inferior. La presente tesis se estructura en base a 4 artículos. Éstos representan el núcleo de la investigación que tiene como objetivos principales estudiar la relación entre diferentes áreas del perfil neurocognitivo y la conducta adaptativa en chicas con el diagnóstico de SXF; así como el riesgo de sufrir acoso escolar en el papel de víctima y su relación con su nivel de adaptación funcional. Todos ellos cuentan con una muestra de 26 chicas con SXF y 14 chicas de grupo control emparejadas por edad y capacidad intelectual total, con edades comprendidas entre los 7 y los 16 años., Fragile X Syndrome (FXS) is the second most common cause of genetic-based intellectual disability, after trisomy 21, and the leading cause of inherited intellectual disability. In males, since they have only one X chromosome, the fact of being carriers of the complete mutation of the FMR1 gene causes a total absence of the FMRP protein while in females, it leads to a partial decrease, since the chromosome with the unaffected FMR1 gene will be able to synthesize a certain amount of FMRP. All this implies that the clinical manifestations in males tend to be more severe than in females. This has influenced the fact that the majority of scientific research has focused on describing the neurocognitive phenotype of affected males and that the number of investigations carried out in females is significantly lower. The present thesis is structured on the basis of 4 articles. These represent the core of the research whose main objectives are to study the relationship between different areas of the neurocognitive profile and adaptive behavior in girls diagnosed with FXS; as well as the risk of suffering bullying in the role of victim and its relationship with their level of functional adaptation. All of them have a sample of 26 girls with FXS and 14 girls of control group matched by age and total intellectual capacity, with ages between 7 and 16 years old., Universitat Autònoma de Barcelona. Programa de Doctorat en Psiquiatria

La manca de consciència de malaltia mental és una característica prevalent en l'esquizofrènia, i la seva relació amb altres variables clíniques, cognitives i / o neuroanatòmiques ha estat un tema freqüent de recerca, tot i que els resultats són inconsistents. Segons la concepció multidimensional que preval actualment, el insight està compost per tres facetes que poden aparèixer dissociades. En aquest context, ha augmentat l'interès per valorar una altra faceta potencial, el grau de consciència que els pacients amb esquizofrènia tenen dels seus dèficits cognitius. La consciència de dèficit cognitiu en l'esquizofrènia és un aspecte relativament poc investigat, i la seva relació amb la consciència de malaltia mental i amb els seus possibles variables etiològiques encara no s'ha aclarit. L'objectiu general d'aquesta tesi va ser estudiar la consciència de dèficit en l'esquizofrènia i la seva relació amb l'insight clínic. Es va examinar també la relació de les dues dimensions amb variables clíniques, cognitives i d'estructura cerebral amb la intenció d'identificar possibles patrons diferencials de relació amb les dues classes de falta de consciència. En el primer estudi es va examinar la consciència de dèficit cognitiu en una mostra de 42 pacients amb esquizofrènia crònica hospitalitzats i la seva relació amb la simptomatologia, la funció executiva, la memòria, l'insight clínic i l'estructura cerebral. La valoració de la consciència de dèficit es va dur a terme comparant l'autoinforme del pacient i l'avaluació cognitiva objectiva, i amb el càlcul de la puntuació de discrepància entre l'autoinforme del pacient i el de l'informant sobre el funcionament cognitiu de el primer. El insight clínic va ser valorat mitjançant l'escala SUMD (Scale to Assess Unawareness of Mental Disorder). Els resultats indicaven que la majoria dels pacients eren poc conscients dels dèficits cognitius presents, sense que aquesta manca de consciència estigués relacionada amb variables clíniques ni co, La falta de conciencia de enfermedad mental es una característica prevalente en la esquizofrenia, y su relación con otras variables clínicas, cognitivas y/o neuroanatómicas ha sido un tema frecuente de investigación, aunque los resultados son inconsistentes. Según la concepción multidimensional que prevalece actualmente, el insight está compuesto por tres facetas que pueden aparecer disociadas. En este contexto, ha aumentado el interés por valorar otra faceta potencial, el grado de conciencia que los pacientes con esquizofrenia tienen de sus déficits cognitivos. La conciencia de déficit cognitivo en la esquizofrenia es un aspecto relativamente poco investigado, y su relación con la conciencia de enfermedad mental y con sus posibles variables etiológicas aún no se ha clarificado. El objetivo general de esta tesis fue estudiar la conciencia de déficit en la esquizofrenia y su relación con el insight clínico. Se examinó también la relación de ambas dimensiones con variables clínicas, cognitivas y de estructura cerebral con la intención de identificar posibles patrones diferenciales de relación con las dos clases de falta de conciencia. En el primer estudio se examinó la conciencia de déficit cognitivo en una muestra de 42 pacientes con esquizofrenia crónica hospitalizados y su relación con la sintomatología, la función ejecutiva, la memoria, el insight clínico y la estructura cerebral. La valoración de la conciencia de déficit se llevó a cabo comparando el autoinforme del paciente y la evaluación cognitiva objetiva, y con el cálculo de la puntuación de discrepancia entre el autoinforme del paciente y el del informante sobre el funcionamiento cognitivo del primero. El insight clínico fue valorado mediante la escala SUMD (Scale to Assess Unawareness of Mental Disorder). Los resultados indicaban que la mayoría de los pacientes eran poco conscientes de los déficits cognitivos presentes, sin que dicha falta de conciencia estuviera relacionada con variables clínicas ni cogni, Lack of awareness of mental illness or poor insight is prevalent in schizophrenia, and its relationship with other clinical, cognitive and/or neuroanatomical variables has been the subject of significant investigation, although the results are inconsistent. According to a widely held current vies, insight is a multidimensional construct whose different aspects may be dissociated from one another, ie awareness of illness, awareness of the need for treatment and ability to label symptoms as pathological. In this context, there has recently been increased interest in another potential aspect of lack of insight in schizophrenia, the lack of awareness that patients have concerning their cognitive deficits. Nevertheless, awareness of cognitive deficit in schizophrenia remains relatively under-researched, and its relationship with awareness of mental illness and its possible etiological variables remains unclear. The general objective of this thesis was to examine lack of awareness of cognitive deficit in schizophrenia and its relationship with clinical insight. The relationship of both aspects of insight with clinical, cognitive, and neuroanatomical variables was also examined with the intention of identifying possible differential patterns between the two types of symptom. The first study examined cognitive deficit awareness in a sample of 42 hospitalized chronic schizophrenia patients, in relation to symptoms, memory and executive function, clinical insight and brain structure. Symptoms were evaluated using the Positive and Negative Symptom Scale (PANSS), obtaining scores for positive, negative, disorganized syndromes and depressive symptoms. Executive function and memory were assessed using two test batteries, the Behavioral Assessment of the Dysexecutive Syndrome (BADS) and the Rivermead Behavioral Memory Test (RBMT), respectively. Assessment of awareness of cognitive deficit was carried out by means of comparison between the patient's self-report and objective cognit, Universitat Autònoma de Barcelona. Programa de Doctorat en Psiquiatria

La teràpia electroconvulsiva (TEC) és una tècnica útil, a la fase aguda i de manteniment, en el tractament dels trastorns mentals greus. Malgrat això, la TEC s'utilitza de forma heterogènia a nivell mundial. Existeixen estudis que conclouen que presentar una millora precoç o early improvement (EI) amb el tractament, en el Trastorn Depressiu Major (TDM), prediu el resultat final del tractament, però existeixen poques dades respecte a la TEC. En aquests estudis, per a la definició d'EI, s'han utilitzat diverses reduccions de la Hamilton Depression Rating Scale (HDRS), en diversos punts temporals, però no existeix un consens respecte la definició d'EI en la TEC. L'eficàcia de la TEC com a tractament a llarg termini (TEC de continuació i/o manteniment; TEC-c/m) ha estat contrastada, a través d'estudis de diversa metodologia i revisions, però existeixen pocs estudis aleatoritzats. Així mateix, existeixen escasses dades sobre l'evolució dels pacients al retirar la TEC-c/m i quins son els possibles factors de risc per presentar recidives. Finalment, el darrer any 2020, amb la pandèmia COVID-19, els sistemes sanitaris han estat duts al límit i molts aspectes de la pràctica clínica habitual s'han hagut de replantejar. En aquest context, l'aplicació de la TEC a tot al mon s'ha vist fortament afectada. El treball de tesi posa el focus en aprofundir en el coneixement de la TEC, per tal de garantir el bon ús, permetent, si és possible, uns millors resultats. Els objectius son: 1) Conèixer el patró d'ús i les condicions d'aplicació de la TEC a Catalunya, així com la opinió dels professionals; 2) Estudiar aspectes clínics rellevants de: a) la TEC aguda, quant a la identifació d'una possible definició d'EI a la TEC en el TDM i el possible valor predictiu d'aquesta en el resultat final o remissió, i b) la TEC-c/m, respecte el seu paper en la prevenció de recaigudes i recurrències en el TDM, així com conèixer l'evolució dels pacients al discontinuar la TEC-c/m; 3) Avaluar l'impacte d, La terapia electroconvulsiva (TEC) es una técnica útil, en la fase aguda y de mantenimiento, en el tratamiento de los trastornos mentales graves. Aun así, la TEC se utiliza de forma heterogénea a nivel mundial. Existen estudios que concluyen que presentar una mejoría precoz o early improvement (EI), en el Trastorno Depresivo Mayor (TDM), predice el resultado final del tratamiento, pero existen pocos datos respecto a la TEC. Para la definición de EI, se han utilizado varias reducciones de la Hamilton Depression Rating Scale (HDRS), en varios puntos temporales, pero no existe un consenso respecto a la definición de EI en la TEC. La eficacia de la TEC como tratamiento a largo plazo (TEC de continuación y/o mantenimiento; TEC-c/m) ha sido contrastada, a través de estudios de diversa metodología y revisiones, pero existen pocos estudios aleatorizados. Además, existen escasos datos sobre la evolución de los pacientes al retirar la TEC-c/m y cuáles son los posibles factores de riesgo para recidivas. Finalmente, en 2020, con la pandemia COVID-19, los sistemas sanitarios han sido llevados al límite y muchos aspectos de la práctica clínica habitual se han tenido que replantear. En esto contexto, la aplicación de la TEC en todo el mundo se ha visto fuertemente afectada. El trabajo de tesis pone el foco en profundizar en el conocimiento de la TEC, para garantizar el buen uso, permitiendo unos mejores resultados. Los objetivos fueron: 1) Conocer el patrón de uso y las condiciones de aplicación de la TEC en Cataluña, así como la opinión de los profesionales; 2) Estudiar aspectos clínicos relevantes de: a) la TEC aguda, respecto a la identifación de una posible definición de EI con la TEC en el TDM y el posible valor predictivo de ésta en el resultado final o remisión, i b) la TEC-c/m, respecto a su papel en la prevención de recaídas y recurrencias en el TDM, así como conocer la evolución de los pacientes al retirar la TEC-c/m; 3) Evaluar el impacto de la COVID-19 en la TEC-c/m. L, Electroconvulsive therapy (ECT) is a useful technique in the acute and maintenance treatment of severe mental disorders. Even so, ECT is used heterogeneously worldwide. There are studies that conclude that early improvement (EI) in Major Depressive Disorder (MDD) predicts the final outcome of treatment, but there are few data regarding ECT. For the definition of EI, several reductions of the Hamilton Depression Rating Scale (HDRS) have been used at various time points, but there is no consensus regarding the definition of EI in ECT. The efficacy of ECT as a long-term treatment (continuation and/or maintenance ECT; c/m-ECT) has been contrasted, through studies of diverse methodology and reviews, but there are few randomized studies. In addition, there is little data on the evolution of patients after discontinuation of c/m-ECT and what are the possible risk factors for relapse. Finally, in 2020, with the COVID-19 pandemic, healthcare systems have been pushed to the limit and many aspects of routine clinical practice have had to be rethought. In this context, the application of ECT worldwide has been strongly affected. The thesis work focuses on deepening the knowledge of ECT, to ensure its proper use, allowing better results. The objectives were: 1) To know the pattern of use and the conditions of application of ECT in Catalonia, as well as the opinion of professionals; 2) To study relevant clinical aspects of: (a) acute ECT, regarding the identification of a possible definition of IE with ECT in MDD and the possible predictive value of this in the final outcome or remission, i (b) c/m-ECT, regarding its role in the prevention of relapses and recurrences in MDD, as well as to know the evolution of patients upon discontinuation of c/m ECT; 3) To evaluate the impact of COVID-19 on c/m ECT. The results suggest that the practice of ECT in Catalonia has changed since the 1990s, being administered more frequently, in a more standardized manner and in a greater number of un, Universitat Autònoma de Barcelona. Programa de Doctorat en Psiquiatria

Les demències constitueixen un grup de malalties d'origen multicausal, principalment associades a l'envelliment com a principal factor de risc. Les demències presenten en algun moment de la seva evolució trastorns psicològics i de comportament, com les al·lucinacions, deliris, l'agitació o la conducta agressiva que és motiu freqüent de consulta mèdica. Aquests símptomes poden obeir a múltiples causes i sol rebre tractaments diversos. La implementació de mesures no farmacològiques en aquests pacients ha estat irregularment valorada en la seva efectivitat real fins època molt recent. En el seu conjunt, les teràpies no farmacològiques per al tractament dels símptomes psicològics i conductuals (SPCD) tenen com a principals avantatges el fet que centren el seu objectiu en les causes ambientals o psicològiques de la conducta i eviten les limitacions dels psicofàrmacs. Existeixen nombroses teràpies no farmacològiques que han demostrat nivells variables d'eficàcia en les demències. Les teràpies no farmacològiques solen incidir sobre l'estat emocional del pacient, la reducció de la seva percepció de confusió i en les seves respostes conductuals. L'aplicació dels diferents tipus de teràpia sol produir millores en el rendiment cognitiu, el control de la conducta, la socialització, l'estat emocional i la capacitat funcional. L'estimulació multisensorial o Snoezelen, consisteix en l'aplicació d'estimulació visual, tàctil, auditiva i olfactòria (en càmera o en aplicació de 24 h). S'ha mostrat efectiva en SPCD especialment en depressió, apatia, agitació, conducta motora sense finalitat i en millora del contacte social. Atès que aprofita la via de comunicació sensorial en pacients amb una capacitat comunicativa severament afectada, resulta una teràpia útil especialment en demències en fase avançada. En institucions, millora també el benestar dels cuidadors en la seva aplicació en mode de 24 h. En el present treball es van avaluar inicialment 14 pacients ancians afectes de demència, Las demencias constituyen un grupo de enfermedades de origen multicausal, principalmente asociadas al envejecimiento como principal factor de riesgo. Las demencias presentan en algún momento de su evolución trastornos psicológicos y del comportamiento, como las alucinaciones, delirios, la agitación o la conducta agresiva que es motivo frecuente de consulta médica. Estos síntomas pueden obedecer a múltiples causas y suele recibir tratamientos diversos. La implementación de medidas no farmacológicas en estos pacientes ha estado irregularmente valorada en su efectividad real hasta época muy reciente. En su conjunto, las terapias no farmacológicas para el tratamiento de los síntomas psicológicos y conductuales (SPCD) tienen como principales ventajas el hecho de que centran su objetivo en las causas ambientales o psicológicas de la conducta y evitan las limitaciones de los psicofármacos. Existen numerosas terapias no farmacológicas que han demostrado niveles variables de eficacia en las demencias. Las terapias no farmacológicas suelen incidir sobre el estado emocional del paciente, la reducción de su percepción de confusión y en sus respuestas conductuales. La aplicación de los distintos tipos de terapia suele producir mejoras en el rendimiento cognitivo, el control de la conducta, la socialización, el estado emocional y la capacidad funcional. La estimulación multisensorial o Snoezelen, consiste en la aplicación de estimulación visual, táctil, auditiva y olfatoria (en cámara o en aplicación de 24 h). Se ha mostrado efectiva en SPCD especialmente en depresión, apatía, agitación, conducta motora sin finalidad y en mejora del contacto social. Dado que aprovecha la vía de comunicación sensorial en pacientes con una capacidad comunicativa severamente afectada, resulta una terapia útil especialmente en demencias en fase avanzada. En instituciones, mejora también el bienestar de los cuidadores en su aplicación en modo de 24 h. En el presente trabajo se evaluaron inicialmente 1, Dementias constitute a group of diseases of multicausal origin, mainly associated with aging as the main risk factor. At some point in their evolution, dementias present psychological and behavioral disorders, such as hallucinations, delusions, agitation or aggressive behavior, which is a frequent reason for medical consultation. These symptoms can have multiple causes and usually receive various treatments. The implementation of non-pharmacological measures in these patients has been unevenly valued in its real effectiveness until very recently. As a whole, non-pharmacological therapies for the treatment of psychological and behavioral symptoms (BPSD) have as main advantages the fact that they focus their objective on the environmental or psychological causes of behavior and avoid the limitations of psychotropic drugs. There are numerous non-pharmacological therapies that have shown varying levels of efficacy in dementias. Non-pharmacological therapies usually affect the emotional state of the patient, reducing their perception of confusion and their behavioral responses. The application of the different types of therapy usually produces improvements in cognitive performance, behavior control, socialization, emotional state and functional capacity. Multisensory stimulation or Snoezelen, consists of the application of visual, tactile, auditory and olfactory stimulation (in camera or in 24-hour application). It has been shown to be effective in SPCD especially in depression, apathy, agitation, purposeless motor behavior, or wandering, and in improving social contact. Since it takes advantage of the sensory communication pathway in patients with severely impaired communication skills, it is a useful therapy especially in advanced stage dementias. In institutions, it also improves the well-being of caregivers in its application in 24-hour mode. In the present work, 14 elderly patients with dementia institutionalized in the Hospital Sagrat Cor de Martorell (Barcelona, S, Universitat Autònoma de Barcelona. Programa de Doctorat en Psiquiatria

En l'estudi de la conducta suïcida, hi ha hagut col·lectius que han rebut menys atenció que d'altres, l'adolescència és un d'aquests col·lectius. En molts casos, les conclusions que s'apliquen a aquesta etapa vital, ve derivada d'estudis d'adults, però no sempre encaixen en una etapa tan complexa i canviant com l'adolescència. Això és especialment important, quan, entre els aspectes a valorar, contemplem la personalitat, fent més complex l'abordatge, per les controvèrsies de l'estudi de la personalitat en un període en què s'està conformant. Una altra característica de l'estudi de la conducta suïcida, especialment aquells que estudien la conducta suïcida sense resultat mortal, és la major representació de l'gènere femení, sent la conducta suïcida sense resultat mortal, més freqüent en dones que en homes, i les morts per suïcidi més freqüents en homes que en dones. Mitjançant la realització de dos estudis s'ofereix evidència empírica que pretén aportar llum a les dues preguntes que s'afronten en aquesta tesi doctoral: Hi ha diferències en la conducta suïcida que realitzen els homes i la que realitzen les dones adolescents? I ¿són explicables aquestes diferències per diferents perfils de personalitat, problemes referits, i intensitat de la clínica que presenten? Per respondre a la primera pregunta, s'ha realitzat una anàlisi retrospectiva de la població de pacients menors d'edat que van ser atesos per conducta suïcida al servei d'urgències hospitalàries de psiquiatria de l'Hospital Sant Joan de Déu des de Novembre de 2013 fins novembre de 2019. derivat dels resultats, es pot concloure que: 1) els trastorns de la conducta alimentària i la presència de trets desadaptatius de la personalitat són més prevalents en dones, mentre els trastorns de conducta, els trastorns de l'espectre autista i els trastorns per dèficit d' atenció i hiperactivitat, són més prevalents en homes; (2) els antecedents de conducta autolesiva no suïcida i els abusos sexuals en la infància són més p, En el estudio de la conducta suicida, ha habido colectivos que han recibido menos atención que otros, la adolescencia es uno de estos colectivos. En muchos casos, las conclusiones que se aplican a esta etapa vital, viene derivada de estudios de adultos, pero no siempre encajan en una etapa tan compleja y cambiante como la adolescencia. Esto es especialmente importante, cuando, entre los aspectos a valorar, contemplamos la personalidad, haciendo más complejo el abordaje, por las controversias del estudio de la personalidad en un periodo en el que se está conformando. Otra característica del estudio de la conducta suicida, especialmente aquellos que estudian la conducta suicida sin resultado mortal, es la mayor representación del género femenino, siendo la conducta suicida sin resultado mortal, más frecuente en mujeres que en hombres, y las muertes por suicidio más frecuentes en hombres que en mujeres. Mediante la realización de dos estudios se ofrece evidencia empírica que pretende aportar luz a las dos preguntas que se afrontan en esta tesis doctoral: ¿Hay diferencias en la conducta suicida que realizan los hombres y la que realizan las mujeres adolescentes? Y ¿son explicables estas diferencias por diferentes perfiles de personalidad, problemas referidos, e intensidad de la clínica que presentan? Para responder a la primera pregunta, se ha realizado un análisis retrospectivo de la población de pacientes menores de edad que fueron atendidos por conducta suicida en el servicio de urgencias hospitalarias de psiquiatría del Hospital Sant Joan de Déu desde Noviembre de 2013 hasta Noviembre de 2019. Derivado de los resultados, se puede concluir que: 1) los trastornos de la conducta alimentaria y la presencia de rasgos desadaptativos de la personalidad son más prevalentes en mujeres, mientras los trastornos de conducta, los trastornos del espectro autista y los trastornos por déficit de atención e hiperactividad, son más prevalentes en hombres; (2) los antecedentes de cond, In the study of suicidal behavior, there have been groups that have received less attention than others, adolescence is one of these groups. In many cases, the conclusions that apply to this life stage are derived from adult studies, but they do not always fit into a stage as complex and changing as adolescence. This is especially important when, among the aspects to be evaluated, we contemplate the personality, making the approach more complex, due to the controversies of the study of personality in a period in which it is taking shape. Another characteristic of the study of suicidal behavior, especially those that study suicidal behavior without fatal outcome, is the greater representation of the female gender, being suicidal behavior without fatal outcome, more frequent in women than in men, and deaths by suicide more frequent in men than in women. By conducting two studies, empirical evidence is offered that aims to shed light on the two questions faced in this doctoral thesis: Are there differences in the suicidal behavior of men and that of adolescent women? And are these differences explicable by different personality profiles, referred problems, and intensity of the symptoms they present? To answer the first question, a retrospective analysis has been carried out of the population of underage patients who were treated for suicidal behavior in the psychiatric hospital emergency service of the Sant Joan de Déu Hospital from November 2013 to November 2019. Derived from the results, it can be concluded that: 1) eating disorders and the presence of maladaptive personality traits are more prevalent in women, while conduct disorders, autism spectrum disorders and deficit disorders attention and hyperactivity, are more prevalent in men; (2) history of non-suicidal self-injurious behavior and childhood sexual abuse are more prevalent among women; (3) women seen in the emergency room for suicidal behavior have a more history of previous attempts, and repeat an attempt, Universitat Autònoma de Barcelona. Programa de Doctorat en Psiquiatria