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Introduction Individuals with schizotypal personality disorder are characterized by tendencies to magical thinking, unusual perceptions, discomfort in social situations, and restricted affect. It is frecuent that they have social anxiety and have difficulty in understanding the motivations and thoughts of others. Objectives Presentation of a case of a patient who was first diagnosed with adjustment disorder, but on a closer study, was discovered to have a schizotypal personality disorder. Methods We conducted a bibliographic review by searching for articles about schizotypal personality disorder and theory of mind in Pubmed. Results We present the case of a 39-year-old woman, diagnosed with adjustment disorder after a conflict at work with a colleague that caused her anxiety-depressive symptoms. In consultations, the patient shows verbiage without expansiveness or euphoria, with rambling speech. She expresses feelings of indignation and injustice, she is irritable, with contained anger. She refers that she prefers to be distrustful of others because she does not understand their intentions. Her thoughts are very rigid, which leads her to have avoidant and phobic attitudes, having no relationships of friendship throughout her life. A neuropsychological evaluation is carried out, resulting in a surprising WAIS with a TIC of 128. However, the Mayer‐Salovey‐Caruso Emotional Intelligence Test (MSCEIT) shows difficulties in Perception, Comprehension and Emotional Management Considering the patient’s symptomatology as a whole, it is noteworthy: – Sustained social isolation throughout their life history – Superficiality of interpersonal relationships – Distrust and slight self-referentiality. Deficit in inferring the feelings and thoughts of others – Peculiar speech with ideas of magical content, superstitions and rituals… Which together supported a diagnosis of schizotypal personality disorder and generalized anxiety disorder. From this point we started to work on her self-esteem, modification of irrational beliefs and cognitive distortions, interpersonal communication and metacognitive therapy, with good results. Conclusions The type of schizotypal patients who come to consultations most frequently are the actively isolated/timorous profile due to their intense social anxiety and difficulties in understanding and adapting to the social world around them. Initial therapy should be empathic support. The theory of mind is the ability to infer the other’s mental states and therefore predict their behavior, this ability being diminished in the schizotypal patient. Mentalization tasks, metacognitive therapy, cognitive flexibility training, social skills training, and promoting self-worth are useful. On some occasions it may be necessary to start psychopharmacological treatment to control anxiety and unusual perceptions when they cause discomfort. Disclosure of Interest None Declared

Introduction It is widely described in the scientific literature that patients who suffer from some type of congenital syndrome such as Di George Syndrome are more likely to present some type of psychopathological alteration during their development that may require intervention and treatment by infant and juvenile mental health teams in coordination with neuropediatrics (1). On this occasion, we will present the clinical case of a patient who regularly attends psychiatry consultations for management of anxious symptoms with impulse control deficits associated with intellectual disability, diagnosed since childhood with tetralogy of Fallot and later with Di George syndrome. In this type of case, treatment is usually considered taking into account possible comorbidities at the organic level (since there may be cardiological involvement, which can be an added difficulty when taking into account the adverse effects of some psychotropic drugs) (2). Objectives This is followed by the presentation of the clinical case, which can serve to exemplify this type of case and clarify any doubts that may arise regarding treatment. Methods Presentation of the clinical case and review of updated scientific literature on the subject. Results Patient who first came to the infantile-junior consultations at the age of 8 years due to delay in the acquisition of verbal language and impulsivity. The patient had a history of pediatric follow-up since birth for different physical symptoms that finally led to the diagnosis of Di George syndrome. Given the difficulties he presented both at home and at school, different psychometric tests were performed and it was determined that it could be beneficial to initiate treatment with extended-release methylphenidate. Prior to treatment, psychomotor restlessness (without aggressiveness) and difficulty in concentration prevailed, which improved significantly after upward adjustment of the dose to a guideline corresponding to his age and weight. It was not necessary in this case to administer other treatments (the possibility of starting Aripiprazole in case of episodes of agitation was considered, but it was not necessary). The patient has continued to be monitored by cardiology to assess the possible side effects of the treatment (since it can increase heart rate and blood pressure (3), but so far no complications have been detected). Thanks to psychotherapeutic and educational intervention, language acquisition was achieved, although to date he still requires support due to the difficulties he still presents. Conclusions It is important to take into account the possible side effects of psychopharmacological treatment in patients with an associated congenital syndrome. Intensive and comprehensive follow-up by psychiatry and pediatrics (and later by their primary care physician) should be performed. Disclosure of Interest None Declared

Introduction Lithium was the first mood stabilizer and today continues to be a first-line treatment in the treatment of bipolar disorder despite its adverse effects, which make it important to monitor blood levels and control kidney function. Objectives Presentation of a case of litium withdrawal and relapse in bipolar disorder. Literature review relating to the risk of relapse when lithium treatment is interrupted. Methods We present a clinical case of a patient who suffers a deterioration in renal function that requires the withdrawal of lithium and who consequently suffers a relapse. We conducted a bibliographic research of articles in Pubmed on this topic. Results A 49-year-old male, with a history of multiple admissions to UHB since the age of 18 with a diagnosis of bipolar disorder and treatment with lithium. Decompensations towards the manic pole have always been related to interruptions in lithium treatment. On several occasions when the patient was feeling well emotionally, he believed himself to be “cured” and abandoned the treatment, triggering a manic episode, showing verbal aggression, increased self-esteem and delusional ideation of harm. Remission was usually achieved with the reintroduction of lithium and the addition of high-dose quetiapine. Between episodes, constant overvalued ideas of economic scarcity seemed to persist, which were accentuated in the form of delusional ideas of ruin in depressive decompensations. After 7 years of stability, control analysis showed blood litemia of 2.2 mEq/L with deterioration of kidney function and generalized tremor was observed, without improvement after serum therapy. He was admitted for dialysis and lithium was suspended. Treatment with valproate was started and a consultation scheduled in a week to adjust the dose. The patient did not attend that consultation and was admitted three days later to Psychiatry Hospitalization showing a challenging attitude, evident dysphoric mood, accelerated speech, with derailments and echolalia. Delusional ideation of harm with auditory hallucinations. Insomnia and hyporexia. Chronic renal failure persisted. Conclusions Lithium is a very effective drug but with a narrow therapeutic range that requires adequate monitoring due to the possible consequences of its use at different organs and systems of the body. when lithium is found in the blood at toxic levels with deterioration of kidney function and glomerular filtration fails to recover, lithium treatment should be suspended. Sudden withdrawal of lithium significantly increases the risk of relapse due to rebound effect. More than 50% of patients experience a recurrence within 10 weeks of withdrawal. Disclosure of Interest None Declared

Introduction Conversive disorder is characterised by the presence of one or more involuntary neurological symptoms that are not due to a clear medical pathology. On the other hand, consciously simulated illnesses fall into two diagnostic categories: factitious disorders and malingering, which are differentiated by both the motivation for the behaviour and the awareness of that motivation. Factitious disorder behaviours are motivated by an unconscious need to assume the sick role, whereas malingering behaviours are consciously driven to achieve external secondary gains. Objectives Study of the differences between conversion disorder and factitious disorder and their repercussions from a case of difficult diagnosis. Methods Bibliographic review of scientific literature based on a relevant clinical case. Results We present the case of a 14-year-old male patient. Adoptive parents. Studying in high school. Social difficulties since childhood. He comes to the emergency department on several occasions referring stereotyped movements and motor tics in the four extremities with left cervical lateralization. Increase of these symptoms in the last month, so it was decided to admit him to the pediatric hospital. After observation and study of the patient’s movements with normal complementary tests he should return home. The following day he returned to the emergency department after an episode of dizziness, mutism and emotional block. It was decided to admit him to Psychiatry for behavioral observation and differential diagnosis. Conclusions In the assessment of patients it is essential to make an appropriate diagnosis taking into account the patient’s symptomatology and the patient’s background and life context. Conversion disorder is the unintentional production of neurological symptom, whereas malingering and factitious disorder represent the voluntary production of symptoms with internal or external incentives. They have a close history and this has been frequently confounded. Practitioners are often confronted to medically unexplained symptoms; they represent almost 30% of neurologist’s consultation. The first challenge is to detect them, and recent studies have confirmed the importance of “positive” clinical bedside signs based on incoherence and discordance. Multidisciplinary therapy is recommended with behavioral cognitive therapy, antidepressant to treat frequent comorbid anxiety or depression, and physiotherapy. Factitious disorder and malingering should be clearly delineated from conversion disorder. Factitious disorder should be considered as a mental illness and more research on its physiopathology and treatment is needed, when malingering is a non-medical condition encountered in medico-legal cases. Disclosure of Interest None Declared

Introduction Schizotypal personality is a condition suffered by 4% of the population. It is defined by presenting interpersonal, behavioral and perceptual features similar to the clinical features of psychotic disorders, such as schizophrenia, in less intensity and dysfunctionality, but at risk of reaching psychosis. Objectives Presentation of a clinical case about a patient with premorbid schizotypal personality traits presenting with an acute psychotic episode. Methods Literature review on association between schizotypal personality and psychosis. Results A 57-year-old woman with a history of adaptive disorder due to work problems 13 years ago, currently without psychopharmacological treatment, goes to the emergency room brought by the emergency services due to behavioral alteration. She reports that “her husband and son wanted to sexually abuse her”, so she had to run away from home and has been running through the streets of the town without clothes and barefoot. Her husband relates attitude alterations and extravagant behaviors of years of evolution, such as going on diets of eating only bread for 40 days or talking about exoteric and religious subjects, as believing that the devil got inside her husband through a dental implant. He reports that these behaviors have been accentuated during the last month. She has also created a tarot website, and has even had discussions with several users. She is increasingly suspicious of him, has stopped talking to him and stays in his room all day long, with unmotivated laughter and soliloquies. It was decided to admit him to Psychiatry and risperidone 4 mg was started. At the beginning, she was suspicious and reticent in the interview. As the days went by, communication improved, she showed a relaxed gesture and distanced herself from the delirious ideation, criticizing the episode. Conclusions In recent years, there has been increasing interest in understanding the association between schizotypy and serious mental disorder. Several theories understand schizotypy as a natural continuum of personality that reveals genetic vulnerability and that can lead to psychotic disorder when added to precipitating factors. Other theories define schizotypy as a “latent schizophrenia” where symptoms are contained and expressed in less intensity. Around 20% evolves to paranoid schizophrenia or other serious mental disorders. It is complex to distinguish between those individuals in whom schizotypy is a prodrome and those in whom it is a stable personality trait. To date, studies applying early psychotherapeutic or pharmacological interventions have had insufficient and contradictory results, and the follow-up and treatment of these individuals could be a stress factor and a stigma. Some studies are looking for reliable markers of evolution to schizophrenia in order to establish adequate protocols for detention, follow-up and treatment. Disclosure of Interest None Declared

Introduction The harmful consumption of alcohol is known for how tortuous its management can be in mental health, encouraging introspection of it as a serious problem is perhaps the main key to starting to battle against its damaging influence on the development of a functional and full life. Objectives To describe a clinical case showing an unpredictible complication in an alcohol detoxification process. Methods 54-year-old man, native of Cádiz, widowed for half a decade, without children. He resides with his parents in the family home. Currently unemployed for approximately a year. He has previously worked in the IT sector. As a notable somatic history, we found long-established arterial hypertension and a total hip replacement. He has been under irregular follow-up with a mental health team for anxiety-depressive symptoms in the context of grief. He goes to the emergency service brought by his family to begin the detoxification process in the hospital setting. He acknowledges ethanol consumption since he was widowed, which began when he awakes; quantities that ranged between one or up to three bottles of distilled liquor per day, generally consumption is in the home environment. A little less than a year ago, he began to isolate himself in his room and abandon his self-care, eating increasingly insufficient food intake, refusing to receive professional care to quit the habit, mainly because he did not recognize it as disruptive. The patient was admitted to hospital with symptoms suggestive of withdrawal, making it extremely difficult to control blood pressure levels. On the third day of admission to the acute care unit, fever peaks, blood pressure levels well below normal parameters, and compromised level of consciousness began to be evident. Results Blood tests were performed that, together with the clinical picture, suggested imminent septic shock, so critical care was contacted for transfer and stabilization. A germ of probable urinary etiology sensitive to a broad spectrum of antibiotics was isolated in blood cultures, and the medication of the detoxification process was progressively optimized. Once clinical stability was achieved at all levels, an inpatient cessation resource was managed, which the patient accepted and considered suitable for his complete recovery. Conclusions A holistic approach to the alcoholic patient is important, since serious problems of an organic nature often arise. This is why a multidisciplinary intervention is necessary, as well as a holistic approach to care, involving both classic pharmacology and assiduous long-term psychotherapeutic intervention. Disclosure of Interest None Declared

Introduction In recent years, there has been an increase in the prevalence of illicit use of fentanyl and other opioids in the United States population. This has led to an increase in medical, psychopathological and abuse-associated comorbidity, an increase in deaths and a decrease in the age of consumption, and has become a serious emerging problem in young people. We present the case of an 18-year-old woman from the United States who recently settled in Spain and started a follow-up in Mental Health due to opioid and other substance abuse problems. Objectives To address the growing problem surrounding the illicit use of fentanyl and opioids as drugs of abuse based on the presentation of the clinical case mentioned above. Methods Bibliographic search and description of a clinical case of a patient under follow-up by Mental Health at the “Hospital Clínico Universitario de Valladolid”. Results An 18-year-old woman from the United States who has been living with her father in Spain since the summer of 2023, having moved to Spain due to problems related to substance abuse. With no previous medical or surgical history and with a history of follow-up in Mental Health in her country of origin for depressive symptomatology, dysfunctional personality traits and abuse of different toxic substances since adolescence. After a brief and erratic follow-up in Psychiatry for anxious-depressive symptoms reactive to a complex and conflictive relationship with his mother and marked academic difficulties during the first years of adolescence, at the age of 15 he started using cannabis and alcohol, thus beginning a period marked by relationships with marginalized sectors of the population, substance abuse and school failure. As his cannabis consumption intensified, he began to consume fentanyl prescribed to his mother, as well as other opioids to which he had access illegally, for which reason he had to be admitted twice to detoxification centers without results, which is why his family finally decided to move him to Spain. Conclusions In recent years, fentanyl abuse has become a serious public health problem that is mainly centered in the young population. High levels of impulsivity and lack of frustration tolerance predispose to the use of illicit substances for elusive purposes. Substance abuse carries with it not only an important organic comorbidity, but also a marked socio-familial and economic repercussion. Disclosure of Interest None Declared

Introduction In the early stages of schizophrenia the person experiences feelings of strangeness about themselves, difficulty in making sense of things and difficulty in interacting with their environment. Based on this, self-disorder assessment instruments have been developed and empirical studies have been conducted to assess people at risk of developing a schizophrenia spectrum disorder. These studies show that self-disorders are found in pre-psychotic stages and that their manifestation can predict the transition to schizophrenia spectrum disorders. Objectives We present the case of a patient with multiple diagnoses and mainly dissociative symptoms who, after years of evolution, was diagnosed with schizophrenia. Methods Bibliographic review including the latest articles in Pubmed about self-disorders and schizophrenia. Results We present the clinical case of a 51-year-old woman with a long history of follow-up in mental health consultations and with multiple hospital admissions to the psychiatric unit, with several diagnoses including: dissociative disorder, histrionic personality disorder, adaptive disorder unspecified psychotic disorder and, finally, schizophrenia. The patient during the first hospital admissions showed a clinical picture of intense anxiety, disorientation and claiming to be a different person. The patient related these episodes to stressors she had experienced, and they improved markedly after a short period of hospital admission. Later, psychotic symptoms appeared in the form of auditory and visual hallucinations and delusional ideation, mainly of harm, so that after several years of follow-up and study in mental health consultations and in the psychiatric day hospital, she was diagnosed with schizophrenia and treatment with antipsychotics was introduced, with a marked clinical improvement being observed. Conclusions It is important to take into account this type of symptoms (self-disorders), as they allow the identification of individuals in the early stages of the disorder and create the opportunity for early therapeutic interventions. Disclosure of Interest None Declared

Introduction Bipolar disorder comorbidity rates are the highest among the major mental disorders. In addition to other intoxicants, alcohol is the most abused substance because it is socially accepted and can be legally bought and consumed. Estimates are between 40-70% with male predominance, which further influences the severity with a more complicated course of both disorders. Objectives The objective of this article is to highlight the impact of substance use on the course and prognosis of bipolar disorder, as well as to make a differential diagnosis of a manic episode in this context. Methods Bibliographic review of scientific literature based on a relevant clinical case. Results We present the case of a 45-year-old male patient. Single with no children. Unemployed. History of drug use since he was young: alcohol, cannabis and amphetamines. Diagnosed with bipolar disorder in 2012 after a manic episode that required hospital admission. During his evolution he presented two depressive episodes that required psychopharmacological treatment and follow-up by his psychiatrist of reference. Since then, he has been consuming alcohol and amphetamines occasionally, with a gradual increase until it became daily in the last month. He went to the emergency department for psychomotor agitation after being found in the street. He reported feeling threatened by a racial group presenting accelerated speech, insomnia and increased activity. Conclusions The presence of substance abuse complicates the clinical presentation, treatment and development of bipolar disorder. It is associated with a worse prognosis with multiple negative consequences including worsening symptom severity, increased risk of suicide and hospitalization, increased medical morbidity and complication of social problems. In addition, this comorbidity delays both the diagnosis and treatment, by masking the symptoms, and making more difficult an adequate differential diagnosis. Disclosure of Interest None Declared

Introduction Adult ADHD diagnosis sometimes represents a challenge for the clinician, due to the comorbid psychiatric diseases that are often associated and which complicate de recognition of the primary symptoms of ADHD. The prevalence of ADHD in adult populations is 2’5% and it is a relevant cause of functional impairment. Objectives Presentation of a clinical case of a male cocaine user diagnosed with adult ADHD. Methods Literature review on adult ADHD and comorbid substance abuse. Results A 43-year-old male who consulted in the Emergency Department due to auditory hallucinosis in the context of an increase in his daily cocaine use. There were not delusional symptoms associated and judgment of reality was preserved. Treatment with olanzapine was started and the patient was referred for consultation. In psychiatry consultations, he did not refer sensory-perceptual alterations anymore, nor appeared any signals to suspect so, and he was willing to abandon cocaine use after a few appointments. He expressed some work concerns, highlighting that in recent months, in the context of a greater workload, he had been given several traffic tickets for “distractions.” His wife explained that he had always been a inattentive person (he forgets important dates or appointments) and impulsive, sometimes interrupting conversations. In the Barkley Adult ADHD Rating Scale he scored 32 points. He was diagnosed with adult ADHD and treatment with extended-release methylphenidate was started with good tolerance and evolution, with improvement in adaptation to his job and social environment. Since then, the patient has moderately reduced the consumption of drugs, although he continues to use cocaine very sporadically. Conclusions Early detection of ADHD and its comorbidities has the potential to change the course of the disorder and the morbidity that will occur later in adults. Comorbidity in adult ADHD is rather the norm than the exception, and it renders diagnosis more difficult. The most frequent comorbidities are usually mood disorders, substance use disorders, and personality disorders. Treatment of adult ADHD consists mainly of pharmacotherapy supported by behavioral interventions. When ADHD coexists with another disorder, the one that most compromises functionality will be treated first and they can be treated simultaneously. The individual characteristics of each patient must be taken into account to choose the optimal treatment. Disclosure of Interest None Declared

Introduction Both in consultations with the general practitioner and with the psychiatrist, antidepressants are one of the most used drugs (1). These have multiple indications, and there are different groups according to their mechanism of action. In relation to this case, we are going to talk about Venlafaxine, a dual-type antidepressant, that is, it inhibits the reuptake of serotonin and norepinephrine. One of the most common side effects is digestive discomfort, which usually resolves after a few weeks (2). However, we should not ignore these symptoms, since they can hide something more serious. Objectives Presentation of a clinical case on a patient who presented an increase in pancreatic amylase after starting treatment with Venlafaxine. Methods Bibliographic review including the latest articles in Pubmed on side effects of antidepressant treatment, and more specifically at the gastrointestinal level (in this case we will talk about pancreatitis). Results We present the case of a 49-year-old woman, who was hospitalized 2 years ago, due to a first depressive episode. During this admission, psychopharmacological treatment was started for the first time, on that occasion with a selective serotonin reuptake inhibitor (SSRI), treatment of first choice (3). The patient had no side effects at that time, but the response was very modest, so it was decided to replace that antidepressant with Venlafaxine (with dual action), up to 150mg. The depressive symptoms improved markedly, however the patient began to feel digestive discomfort (which at first did not seem to be of great importance). A general analysis was performed, in which an increase in lipase (978 U/L) and amylase (528 U/L) was detected. An echoendoscopy, an abdominal scan, and a magnetic resonance cholangiography were performed; Pancreatitis secondary to drugs was suspected (a severe condition). Luckily, no significant lesions were found in the tests, and the levels of amylase and lipase decreased when Venlafaxine treatment was withdrawn (without reaching the normal range). The patient was discharged and continued to attend consultations. In the last control, amylase had dropped to 225 U/L. His abdominal pain disappeared. Treatment with Vortioxetine (a multimodal antidepressant) was started, however the amylase levels continue to be monitored, and the patient continues to see the gastroenterologist. Conclusions Gastrointestinal side effects are very common when taking antidepressant treatment, and in most cases they do not usually represent a serious problem. However, it is described in the scientific literature that in some cases, acute pancreatitis secondary to some drugs, including Venlafaxine, can occur (4). In order to detect it, it is necessary to perform a blood test and sometimes also other complementary tests. For its treatment, the fundamental thing is to withdraw the causing drug, trying to find other alternatives, and carry out a control to monitor possible complications Disclosure of Interest None Declared

Introduction There is a fine line separating psychiatry and neurology. Most movement disorders can have psychiatric symptoms, not only those caused by the disease itself, but also those induced by the drugs used to treat them. Objectives Presentation of a clinical case about a patient diagnosed with Parkinson’s disease presenting a several-month-long delirious episode due to dopaminergic drugs. Methods Literature review on drug-induced psychosis episodes in Parkinson’s disease. Results A 57-year-old patient with diagnosis of Parkinson’s disease for six years, who went to the emergency room accompanied by his wife due to delirious ideation. He was being treated with levodopa, carbidopa and rasagiline for years, and rotigotine patches whose dosage was being increased over the last few months. His wife reported celotypical clinical manifestations and multiple interpretations of different circumstances occurring around her. He chased her on the street, had downloaded an app to look for a second cell phone because he believed she was cheating on him, and was obsessed with sex. He had no psychiatric background. It was decided to prescribe quetiapine. The following day, he returned because he refused to take the medication since he thought he was going to be put to sleep or poisoned. It was decided to admit him to Psychiatry. During the stay, rasagiline and rotigotine were suspended. Olanzapine and clozapine were introduced, with behavioral improvement and distancing from the psychotic symptoms which motivated the admission. The patient was also motorically stable. Although levodopa is best known for causing psychotic episodes, the symptons were attributed to rotigotine patches for temporally overlapping the dose increase. Conclusions Psychiatric symptoms are the third most frequent group of complications in Parkinson’s disease after gastrointestinal complications and abnormal movements. All medication used to control motor disorders can lead to psychosis, not only dopaminergics, but also selegiline, amantadine and anticholinergics. Excessive stimulation of mesocortical and mesolimbic dopaminergic pathways can lead to psychosis, which is the most common psychiatric problem related to dopaminergic treatment. In the face of a psychotic episode, antiparkinsonian drugs which are not strictly necessary for motor control should be withdrawn. If this is not sufficient, levodopa dose should be reduced, considering the side effects that may occur. When the adjustment of antiparkinsonian treatment is not effective, neuroleptics, especially quetiapine or clozapine, should be administered. In a recent study, pimavanserin, a serotonin 5-HT2 antagonist, was associated with approximately 35% lower mortality than atypical antipsychotic use during the first 180 days of treatment in community-dwelling patients. Medication should always be tailor-made to suit each patient and we usually have to resort to lowering or withdrawing the dopaminergic medication. Disclosure of Interest None Declared

Introduction Interconsultation with the psychiatry service is frequently requested from other specialties for the assessment and treatment of patients who present neuropsychiatric symptoms secondary to organic alterations. On the other hand (and in relation to this case), within the possible causes for the elevation of calcaemia figures, the most frequent are hyperparathyroidism and neoplasms, representing between these two entities 90% of cases (1). Among the organic mental disorders, Delirium stands out, with an approximate prevalence between 1 and 2% (general population), which increases in hospitalized and elderly patients (2). Objectives Presentation of a clinical case about a patient with delirium secondary to hypercalcemia, with hallucinations and behavioral disturbance. Methods Bibliographic review including the latest articles in Pubmed about delirium (causes and treatment) and hypercalcaemia secondary to neoplasms. Results We present a 52-year-old male patient, who went to the emergency room accompanied by his wife, due to behavioral alteration. Two days before, he had been evaluated by Neurology, after a first epileptic crisis (with no previous history) that resolved spontaneously. At that time, it was decided not to start antiepileptic treatment. The patient reported that he had left his house at midnight, looking for a cat. As he explained, this cat had appeared in his house and had left his entire bed full of insects. His wife denied that this had really happened, and when she told the patient to go to the emergency room, he had become very upset. As background, the patient used to consume alcohol regularly, so the first hypothesis was that this was a withdrawal syndrome. However, although the consumption was daily, in recent months it was not very high, and at that time no other symptoms compatible with alcohol withdrawal were observed (tremor, tachycardia, sweating, hypertension…). We requested a general blood test and a brain scan. The only relevant finding was hypercalcaemia 12.9mg/dL (which could also be the origin of the previous seizure). It was decided to start treatment with Diazepam and Tiapride in the emergency room, with serum perfusion, and keep under observation. After several hours, the patient felt better, the hallucinations disappeared, and calcium had dropped to 10.2mg/dL. A preferential consultation was scheduled, due to suspicion that the hypercalcaemia could be secondary to a tumor process. Image: Conclusions It is important to rule out an organic alteration in those patients who present acute psychiatric symptoms. Hypercalcaemia is frequently associated with tumor processes (1) due to secretion of PTH-like peptide (4), so a complete study should be carried out in these cases. Delirium has a prevalence between 1 and 2% in the general population (2). Psychopharmacological treatment is used symptomatically, with antipsychotics (3). For the episode to fully resolve, the underlying cause must be treated. Disclosure of Interest None Declared

Introduction Schizotypal disorder is conceptualized as a stable personality pathology (Cluster A) and as a latent manifestation of schizophrenia. It can be understood as an attenuated form of psychosis or high-risk mental state, which may precede the onset of schizophrenia or represent a more stable form of psychopathology that doesn’t necessarily progress to psychosis. Objectives To exemplify the continuum of psychosis Methods Review of scientific literature based on a relevant clinical case. Results 39-year-old male living with his parents. He started studying philosophy. He is a regular cannabis user and has an aunt with schizophrenia. He’s admitted to psychiatry for behavioral disturbance in public. He refers to having been hearing a beeping noise in his street for months, what he interprets as a possible way of being watched due to his past ideology. Without specifying who and why, he sometimes shouts “until it bursts” to stop the noise and he thinks that his neighbours alerted the police about his behavior. During the interview he alludes to Milgram’s experiment, saying that throughout history there have been crimes against humanity and those who pointed them out were labeled “crazy”. His father refers that he has always been “strange” and with certain extravagant revolutionary ideas and thoughts. He doesn’t maintain social relationships and dedicates himself to reading and writing. Conclusions It’s important to understand psychosis as a continuum to advance the understanding of etiology, pathophysiology and resilience of psychotic disorders and to develop strategies for prevention and early intervention Disclosure of Interest None Declared

Introduction Maintenance electroconvulsive therapy (mECT) is an option in the treatment of affective disorders which progress is not satisfactory. It is certainly neglected and underused during the clinical practice. Objectives To evaluate the efficacy of mECT in reducing recurrence and relapse in recurrent depression within a sample of three patients. Methods We followed up these patients among two years since they received the first set of electroconvulsive sessions. We applied the Beck Depression Inventory (BDI) in the succesives consultations for evaluating the progress. Results The three patients were diagnosed with Recurrent Depressive Disorder (RDD). One of them is a 60 year old man that received initially a cycle of 12 sessions; since then he received 10 maintenance sessions. Other one is a 70 year old woman that received initially a cycle of 10 sessions; since then she received 6 maintenance sessions. The last one is a 55 year old woman that received initially a cycle of 14 sessions; since then she received 20 maintenance sessions. All of them showed a significant reduction in depressive symptoms evaluated through BDI and clinical examination. In the first case, we found a reduction in the BDI from the first consultation to the last that goes from 60 to 12 points; in the second case, from 58 to 8 points; and in the last case, from 55 to 10 points. The main sections that improved were emotional, physical and delusional. As side-effects of the treatment, we found anterograde amnesia, lack of concentration and loss of focus at all of them. Conclusions We find mECT as a very useful treatment for resistant cases of affective disorders like RDD. It should be considered as a real therapeutic option when the first option drugs have been proved without success. Disclosure of Interest None Declared

Purpose: To analyze the leadership network structure among nursing leaders in Spain identified through the Grupo40Enfermeras y Universidad event. Methods: A descriptive cross-sectional study using social network analysis was used. Study sample consisted of 210 individuals, of whom 119 received nominations as referents. Structural analysis of the network was conducted using centrality and cohesion. Results: A network structure was generated in which different leadership strategies were identified through InDegree, Eigenvector, and Betweenness Centrality. Five leaders were identified as bridges to other individuals using Betweenness. The whole network presented little cohesion although two highly cohesive cores were detected by K-core measurements. Conclusion: A strategy is needed to support nursing leaders with high degree of Betweenness to serve as bridges to connect other nursing leaders.

La Competencia Digital Docente se está convirtiendo en una línea de investigación consolidada, siendo el eje central de numerosas investigaciones. La Comisión Europea publicó en 2017 el Marco de Competencia Digital del profesorado: DigCompEdu, en el que se encuadra el presente trabajo, cuyo objetivo principal versa en averiguar qué percepción tiene el profesorado de la Universidad Pablo de Olavide sobre su nivel de competencia digital. Con diseño no experimental, y bajo un enfoque descriptivo, planteamos este estudio, centrado en la participación de 214 docentes a los que se les ha aplicado el cuestionario (DigComEdu Check-in). Los análisis realizados se centran en una primera aproximación descriptiva con puntuaciones medias y desviaciones típicas, por ítems y áreas. Los principales resultados arrojan una muestra joven, pero con más de 10 años de experiencia que reconoce estar familiarizada con el uso de las tecnologías de la información y comunicación (TIC) como herramienta educativa desde hace tiempo y que se autorreconoce con un nivel de Competencia Digital “Aceptable”.

La Enfermedad de Parkinson es un trastorno que afecta al Sistema Nervioso Central de forma crónica y progresiva, pertenece al grupo de los llamados Trastornos del Movimiento. Se habla de Enfermedad de Parkinson de Inicio Temprano o Parkinson precoz, cuando la enfermedad aparece en personas menores de 50 años. Objetivo: determinar el efecto de una intervención educativa combinada enfermera sobre la calidad de vida de personas con Enfermedad de Parkinson de Inicio Temprano. Metodología: estudio cuasi-experimental pre-post con un solo grupo, focalizándose en pacientes diagnosticados con Enfermedad de Parkinson de Inicio Temprano con edades comprendidas entre 21-50 años. La intervención, consistirá en la realización de dieciséis sesiones en las que se incorporan diferentes actividades: educación sanitaria, musicoterapia, actividad física y Taichí. Se llevará a cabo en la consulta de la Unidad de Trastornos de Movimiento del Hospital Universitario de La Princesa. Las variables a estudio serán: calidad de vida, actividad física, ansiedad y depresión, apoyo social y percepción de la función familiar. Serán recogidas a través de cuestionarios específicos al inicio y finalización de la intervención. Abstract Parkinson's disease is a disorder that affects the central nervous system in a chronic and progressive manner and belongs to the group of so-called movement disorders. We speak of Early Onset Parkinson's Disease or Early Parkinson's Disease, when the disease appears in people younger than 50 years old. Objective: to determine the effect of a combined nurse educational intervention on the quality of life of people with Early Onset Parkinson's Disease. Methodology: a quasi-experimental pre-post study is designed with a single group, focusing on patients diagnosed with Early Onset Parkinson's Disease aged 21-50 years. The intervention will consist of sixteen sessions in which different activities will be incorporated: health education, music therapy, physical activity and tai chi. It will be carried out at the Movement Disorders Unit of the Hospital Universitario de La Princesa. The variables to be studied will be: quality of life, physical activity, anxiety and depression, social support and perception of family function. They will be collected through specific questionnaires at the beginning and end of the intervention.

El objetivo del artículo es describir el papel que las agencias internacionales tienen en la educación para el desarrollo desde un enfoque de derechos de la infancia. Considerando, como uno de los principales hitos, la aprobación en 1989 de la Convención de las Naciones Unidas sobre los Derechos del Niño y estableciendo el bienestar infantil como base para la consecución de la Agenda 2030, se detalla una experiencia exitosa, el Programa Ciudades Amigas de la Infancia de UNICEF-Comité Español, y la evaluación del impacto del Programa de Formación de Postgrado en Derechos y Políticas Municipales de Infancia. Los resultados ponen de manifiesto que la formación mejora la estabilidad laboral, las competencias profesionales y el desarrollo de iniciativas integrales de infancia, pero también que no tiene un efecto tan positivo en el reconocimiento que las organizaciones otorgan a los profesionales. Se concluye acerca de la importancia de la formación como una potente herramienta en la transformación de los contextos socioeducativos.

Irrigation is essential for maintaining food production in water-scarce regions. The irrigation need depends on the water content of the soil, which we measured with the novel technique of cosmic-ray neutron sensing (CRNS). The potential of the CRNS technique for drip irrigation scheduling was explored in this study for the Picassent site near Valencia, Spain. To support the experimental evidence, the neutron transport simulation URANOS was used to simulate the effect of drip irrigation on the neutron counts. The overall soil water content (SWC) in the CRNS footprint was characterized with a root mean square error

In this study, hybrid pepper rootstock NIBER® is tested for its ability to overcome water stress situations under soil conditions. The impact of deficit irrigation (DI) on yield and fruit quality, irrigation water use efficiency is evaluated, and consequently, the agronomic impact of employing water-stress tolerant rootstock is compared to ungrafted pepper plants. For this purpose, plants of the California-type sweet pepper ‘Maestral F1’ grafted onto NIBER® underwent a sustained DI regime during seasons 2018 and 2019 and were compared to their respective controls. Plants were drip-fertirrigated, and volumetric soil water content was continuously monitored by capacitance sensors. Gas exchange and leaf water potential measurements were taken early in the morning and midday 58, 79, and 114 days after transplanting. Plant and fruit dry biomass, marketable quality, blossom-end rot incidence and harvest index were also determined. For consecutive years, our results confirmed that grafting a pepper cultivar onto an appropriate rootstock (NIBER® in this case) as part of a DI strategy can overcome the negative effects of sustained water stress conditions. The plant biomass production and fruit yields of grafted plants were less affected by DI due to less sensitivity to water stress. This can be attributed to a less marked reduction in shoot dry weight in the grafted plants, which allowed greater whole photosynthesis by maintaining sink activity compared to ungrafted plants.

Si algo caracteriza el contexto social actual, es el profundo desarrollo de las tecnologías de la información y la comunicación. Nunca antes se ha contado con tal variedad de recursos cuyo uso didáctico nos ayuda no sólo a enseñar, sino también y primordialmente, a aprender en cualquier momento de la vida. Frente a la necesidad de atender la demanda de un alumnado que cada vez tiene a su alcance un mayor número de recursos y fuentes de información, hemos encontrado en los PLE (Personal Learning Environment) un aporte elemental para la construcción de aprendizajes significativos. Pero tal y como exponemos a lo largo de este artículo, el profesorado tiene la responsabilidad de ajustar, a nuevas formas de aprender, nuevas formas de enseñar. Ya no es suficiente con incorporar elementos al aula, debemos adaptar la metodología a contextos de aprendizaje que no se encuentran bajo la supervisión del docente. Con esta visión se plantea la siguiente reflexión, cuyo objeto es aportar ideas que faciliten la integración de aspectos tecnológicos y pedagógicos en un entorno flexible de colaboración e intercambio, desde una acción regulada ya no por el profesorado, sino por el propio estudiante.

Normalmente se trata Internet desde el lado de sus posibilidades de aprendizaje. Con esta comunicación, queremos poner de manifiesto que, gracias al proyecto Averroes, muchos centros andaluces han podido contribuir a la gran telaraña mundial, poniendo a disposición de miles de personas información sobre sus planes de estudio y ofertas de actividades, así como intercambiar información con otros centros, etc. Como consecuencia de este proyecto, encontramos hoy más de 1500 centros Andaluces conectados en la red, cuyos alumnos y profesores han pasado de utilizar la red internet exclusivamente como medio de adquisición de información, a participar directamente en ella para compartir sus centros con todos aquellos que lo requieran.

Este trabajo presenta el resultado de una experiencia docente universitaria con recursos de la Web 2.0. Bajo la modalidad de formación presencial, apoyada en el uso de una plataforma de formación virtual (Blackboard), se evalúan competencias generales y específicas con la confección de un portafolio electrónico por parte del alumnado, para el que se ha optado por el empleo de un blog reforzado por herramientas como GoogleDocs, SlideShare o YouTube. En el documento se recogen los elementos clave de esta experiencia y sus ventajas e inconvenientes.

Objetivo. Identificar los factores individuales y contextuales que se relacionan con la utilización de la investigación por parte de los profesionales de enfermería que trabajan en los centros de hospitalarios del Servicio Madrileño de Salud durante el periodo de estudio 2013-2015. Métodos. Estudio descriptivo, transversal, multicéntrico y de validación psicométrica. Población. Profesionales de enfermería que presten cuidados directos al paciente en unidades médicas, quirúrgicas y de cuidados críticos. El tamaño muestral es de 842 sujetos, asumiendo que la población es de 44188 sujetos. Se ha estimado una tasa de reposición del 30%. Instrumentos. “Practice environmet Scale”, validado en el contexto hospitalario español; “Actitudes y concienciación de los profesionales de enfermería hacia la investigación y desarrollo en cuidados de salud”, validado en el contexto español; “Research Utilization Survey”, para el que se realizará una validación analizando la fiabilidad test-retest, la validez de contenido (mediante el Índice de Validez de Contenido), la validez de constructo (análisis de componentes principales). Además se medirán variables sociodemográficas y de formación de la enfermeras y características de las instituciones. Análisis de datos. Se analizarán los datos mediante estadística descriptiva y se evaluará un modelo conceptual de la relación entre el contexto y la utilización de la investigación (nivel de confianza del 95%). Implicaciones. Disponer de una herramienta validada para medir la utilización de la investigación y un modelo teórico validado para establecer cuáles son las características de los centros que apoyan la utilización de la investigación.

El papel que juega la cultura en el proceso salud-enfermedad y más concretamente en el contexto de los cuidados es fundamental. Estamos inmersos en un prisma de sociedades multiculturales en el que se hace imprescindible replantear las situaciones de cuidados e incorporar nuevos enfoques, tanto propios como de otras disciplinas. Los conocimientos antropológicos y su método, pueden ayudar a la disciplina de la enfermería a abordar e ilustrar las situaciones de cuidados y encontrar su dimensión simbólica. Con este artículo se pretende describir la situación académica de la enfermería en España, en relación a su base de conocimientos en Antropología de los Cuidados y analizar la importancia que adquiere, dentro del planteamiento académico del enfermero, su base de conocimientos y su proyección en el futuro.

Atopic Eczema (AE) is a chronic inflammatory skin disease that affects children and adults, and alters quality of life with a high morbidity rate and severe economic burden. The objective of the present work was to analyse specific atmospheric pollutants (O3, NO, PM10 and SO2) affecting the prevalence of diagnosed AE and its symptoms among 6-7-year-old schoolchildren. The participants included 21311 schoolchildren aged 6-7 years from 8 Spanish regions, whose parents completed the ISAAC Phase III questionnaire to ascertain AE diagnosis and symptoms. The mean levels (µg/m3) of O3, NO, PM10 (particles 10 micrometers or less in diameter) and SO2 were determined in each geographical area participating in this study. According to these mean levels, three levels of exposure to each pollutant were considered: level 1 (percentiles 0-25); level 2 (percentiles 26-74); level 3 (percentiles 75-100). Exposure to O3 was associated with increased prevalence of rashes (exposure level 2, Odds Ratio (OR): 1.22, 95% Confidence Interval (95%CI): 1.02-1.45; level 3 OR: 1.33, 95%CI:1.10-1.61) and diagnosed AE (level 2, OR: 1.27, 95%CI: 1.17-1.39; level 3 OR: 1.27, 95%CI:1.15-1.41). An association was found between the level of NO and a drop in the prevalence of diagnosed AE (exposure level 2, OR: 0.88, 95%CI: 0.81-0.95; level 3 OR: 0.85, 95%CI:0.74-0.97). There was also an association between the highest exposure level to PM10 and a reduced prevalence of rashes (level 3 OR: 0.42, 95%CI: 0.22-0.81) and diagnosed AE (level 3OR: 0.53, 95%CI: 0.38-0.75). Future studies into exposure to O3 and its relationship with allergic diseases may be conducted in order to prevent this association.

Introduction A 28 year old patient will be presented. This paramilitary man was brought to the Emergency Room due to an autolytic attempt with Benzodiazepines, along with a mouth suture, in the context of a soon to be resolved problematic ankle osteosynthesis procedure. The patient claimed to be suffering pain, furthermore struggling due to the fact he could not be working due to his ankle issue. Language barrier was a problem during the interview. Objectives The objetives of this case is to try to explain the issues that may arise in patients with personality disorders in the context of an autolytic attempt Methods This patient will be presented, along with systematic bibliography review of the topic. Results The following results were extracted upon the attention given to this patient which was admitted to the Psychiatric Unit. First of all, the mouth stitches were removed, along with a petition for toxicological analysis. The results gave positive for cannabis and benzodiazepines. The patient was also brought previously this year with another autolytic attempt, this time on cocaine consumption too. Furthermore, a thorough review was made of the other autolytic attempts, including those which happened in his country of origin. The patient has hundreds of small cuts among his arms, from previews cuts made in the past. Furthermore, subcutaneous wounds were auto inflicted in the ER, with a small blade. Among the whole interview, it was clear he had a personality disorder, with high impulsivity levels and lack of control once the situation overflows. We also tried to understand the outcome of suturing his mouth. The patient referred his acts of impulsiveness due to his overwhelming situation of both having no job at this moment and the pain he was suffering due to his ankle procedure. The patient was admitted to our Unit due to the high risk he could repeat this act. Upon arrival, the same day he was admitted, the patient asked if he had to stay at the unit. When explaining the following already told event, furthermore insisting in the possibility of been evaluated by the Traumatology team, he proceeded to try and hang himself with his medical-hospital clothing. The patient was treated with antipsychotics. Along with Lormetazepam at night. At the end of the hospitalization, and after been evaluated by the Psychiatrist of this Unit, the patient was also treated with Lithium due to its effectiveness in the treatment of autolytic attempts. Conclusions Personality disorders are one of the psychiatric pathologies that prevail with greater frequency in autolytic attempts 1. Additionally, it should be taken into account the possible ongoing consumption of psychoactive drugs that could also derive in psychopathological decompensation. On top of the following, the use of antipsychotic treatment is indicated for the managing of conduction altercations 2, besides Lithium being a great option in managing suicidal temptations 3. Disclosure of Interest None Declared

Introduction Delusional parasitosis, also known as delusional infestation or Ekbom’s syndrome, is a rare psychotic disorder characterized by the false belief that a parasitic skin infestation exists, despite the absence of any medical evidence to support this claim. These patients often see many physicians, so a multidisciplinary approach among clinicians is important. Many patients refuse any treatment due to their firm belief that they suffer from an infestation, not a psychiatric condition, so it is crucial to gain the trust of these patients. Objectives The comprehensive review of this clinical case aims to investigate Ekbom syndrome, from a historical, clinical and therapeutic perspective. Methods Literature review based on delusional parasitosis. Results A 65-year-old woman comes to the psychiatry consultation referred by her primary care physician concerned about being infested by insects that she perceives through scales on her skin for the last three months. She recognizes important impact on her functionality. She is also convinced that her family is being infected too. As psychiatric history she recognizes alcohol abuse in the past (no current consumption) and an episode of persecutory characteristics with a neighbor, more than ten years ago. On psychopathological examination, she shows delusional ideation of parasitosis, with high behavioral repercussions, cenesthetic and cotariform hallucinations, as well as feelings of helplessness and anger. Treatment with Pimozide was started and the patient was referred to dermatology for evaluation, a plan she accepted. Her primary care physician and dermatology specialist were informed about the case and the treatment plan. In the recent reviews, the patient is calmer, however, despite the corroboration of dermatology and in the absence of organic lesions in cranial CT, she is still unsatisfied with the results, remaining firm in her conviction of infestation. It was decided to start treatment with atypical neuroleptics (Aripiprazole), with progressive recovery of her previous functionality. Conclusions Despite the increase in the number of studies in recent years, there are still few studies on this type of delirium. The female:male ratio varies in the bibiliography (between 2:1 and 3:1). The onset is usually insidious, generally appearing as a patient who comes to his primary care physician convinced of having parasites in different skin locations. It is usual to observe scratching lesions or even wounds in search of the parasite. In the past, the most used and studied treatment was Pimozide. Currently the treatment of choice is atypical neuroleptics due to their lower side effects. The latest reviews on the prognosis of this disorder show data with percentages of complete recovery between 51% and 70%, and partial responses between 16.5% and 20%. Finally, for a good diagnosis and therapeutic management, it is important to achieve a multidisciplinary approach. Disclosure of Interest None Declared

Abstract Background Atopic dermatitis (AD) prevalence has considerably increased worldwide in recent years. Studying indoor environments is particularly relevant, especially in industrialised countries where many people spend 80% of their time at home, particularly children. This study is aimed to identify the potential association between AD and the energy source (biomass, gas and electricity) used for cooking and domestic heating in a Spanish schoolchildren population. Methods As part of the ISAAC (International Study of Asthma and Allergies in Childhood) phase III study, a cross-sectional population-based survey was conducted with 21,355 6-to-7-year-old children from 8 Spanish ISAAC centres. AD prevalence, environmental risk factors and the use of domestic heating/cooking devices were assessed using the validated ISAAC questionnaire. Crude and adjusted odds ratios (cOR, aOR) and 95% confidence intervals (CIs) were obtained. A logistic regression analysis was performed (Chi-square test, p-value Results It was found that the use of biomass systems gave the highest cORs, but only electric cookers showed a significant cOR of 1.14 (95% CI: 1.01-1.27). When the geographical area and the mother’s educational level were included in the logistic model, the obtained aOR values differed moderately from the initial cORs. Electric heating was the only type which obtained a significant aOR (1.13; 95% CI: 1.00-1.27). Finally, the model with all selected confounding variables (sex, BMI, number of siblings, mother’s educational level, smoking habits of parents, truck traffic and geographical area), showed aOR values which were very similar to those obtained in the previous adjusted logistic analysis. None of the results was statistically significant, but the use of electric heating showed an aOR close to significance (1.14; 95% CI: 0.99-1.31). Conclusion In our study population, no statistically significant associations were found between the type of indoor energy sources used and the presence of AD.

Abstract Background Retinitis pigmentosa (RP), a clinically and genetically heterogeneous group of retinal degeneration disorders affecting the photoreceptor cells, is one of the leading causes of genetic blindness. Mutations in the photoreceptor-specific gene RP1 account for 3–10% of cases of autosomal dominant RP (adRP). Most of these mutations are clustered in a 500 bp region of exon 4 of RP1. Methods Denaturing gradient gel electrophoresis (DGGE) analysis and direct genomic sequencing were used to evaluate the 5' coding region of exon 4 of the RP1 gene for mutations in 150 unrelated index adRP patients. Ophthalmic and electrophysiological examination of RP patients and relatives according to pre-existing protocols were carried out. Results Three novel disease-causing mutations in RP1 were detected: Q686X, K705fsX712 and K722fsX737, predicting truncated proteins. One novel missense mutation, Thr752Met, was detected in one family but the mutation does not co-segregate in the family, thereby excluding this amino acid variation in the protein as a cause of the disease. We found the Arg677Ter mutation, previously reported in other populations, in two independent families, confirming that this mutation is also present in a Spanish population. Conclusion Most of the mutations reported in the RP1 gene associated with adRP are expected to encode mutant truncated proteins that are approximately one third or half of the size of wild type protein. Patients with mutations in RP1 showed mild RP with variability in phenotype severity. We also observed several cases of non-penetrant mutations.

The aim of the present study is to assess the outcomes of monoportal arthroscopic disc repositioning (discopexy) for disc displacement of the temporomandibular joint. A retrospective, single-institutional clinical study included patients with temporomandibular joint internal derangements diagnosed and treated by monoportal discopexy. Each patient was diagnosed as having anterior disk displacement with or without reduction. The arthroscopy treatment consists of one portal approach fixing the disc with a 3/0 nylon to the tragus cartilage without anterior liberation. Arthroscopy surgery was carried out with a 1.9-mm 0° arthroscope and only one simple cannula. We use a needle to pierce of the disc through the skin and retrieve the suture inside the joint using a blind method through the arthroscopic cannula. The evaluated variables included the maximum interincisal opening, the presence of clicking and pain score. A total of 19 patients, 21 joints, were included in the present study. Of the 21 joints, 16 were classified as disc displacement with reduction and 5 without. Visual analogue scale (VAS) values (0–10) decreased from 5.5 to 1.26 (p < 0.0001) 1 year after surgery. At the first review, all patients had a VAS of at least 4 points less than before the surgery, four patients showed a VAS of 0, and nine patients near to 1. Mouth opening increased from 36.6 (±8.09) mm to 39.37 (±4.35) mm, and no significant limitations in the mouth opening range were seen (p < 0.12) 1 year after surgery. Clicking disappeared in all patients and remained stable after 12 months of follow-up. Postoperative magnetic resonance imaging demonstrated a correct or improved position of the disc in all but one patient. A minimally invasive single portal arthroscopic discopexy is an effective technique to improve function and pain reduction in patients with anterior disk displacement with or without reduction. [ABSTRACT FROM AUTHOR]

Introduction Subjective memory complaints remain a relevant aspect to be considered in patients with mild cognitive impairment. Likewise, their association with depressive symptoms, quality of life and cognitive performance is also an objective to be studied in such patients. Objectives Our clinical case represents just one opportunity to study how memory complaints are related to depressive states and how they affect the quality of life of patients with mild cognitive impairment. Methods We conducted a bibliographical review by searching for articles in Pubmed. Results PERSONAL HISTORY: Male, 73 years old, separated, residing alone in Valladolid. He has home help, a person comes to help him with the household chores. Little social and family circle. History in Mental Health He has a history of an admission in 2013 to this Short Hospitalization Unit for ethanol detoxification. Since then, he has been followed up in the Mental Health Unit. According to the reports, he has been diagnosed with depressive disorder and cluster B personality disorder. Current psychopharmacological treatment: diazepam, olanzapine, duloxetine 60 mg, quetiapine. Toxic habits: history of chronic ethanol consumption. Smoker. He denies other toxic habits. Current Episode The patient presents a worsening of his mood of 15 days of evolution, coinciding with a voluntary decrease of his psychopharmacological treatment that the patient has carried out on his own. He walks with the aid of a crutch. Hypomimic facies. Slowed language, circumstantial, with speech focused on current discomfort. On assessment, he reports initial improvement after reducing his medication, but in recent days he has experienced a decrease in initiative accompanied by feelings of emptiness, sadness and loneliness. He refers to memory complaints for which he is awaiting evaluation by Neurology. The patient explains that at other times in his life he has presented self-harming ideas that he has been controlling. At this time he expresses desire for improvement and adequate future plans, and accepts plans to attend a memory workshop. He also reports visual hallucinations with no affective repercussions and preserved judgment of reality. Therapeutic Plan Treatment adjustment: Duloxetine 60 mg, 2cp/day. The patient is recommended to lead an active lifestyle and attend a day center or memory workshop. Conclusions In numerous patients with mild cognitive impairment, we have observed that memory complaints are closely related to depressive symptoms and to the patient’s functioning in daily life. In one study memory complaints were a negative predictor of quality of life in these patients. Therefore, in addition to considering the importance of treating depressive symptoms, it is also important to address quality of life in patients with mild cognitive impairment. Disclosure of Interest None Declared

Introduction Bipolar Disorder (BD) is considered a serious mental disorder characterized by a changing mood that fluctuates between two completely opposite poles. It causes pathological and recurrent mood swings, alternating periods of exaltation and grandiosity with periods of depression. We talk about rapid cyclers when four or more manic, hypomanic or depressive episodes have occurred within a twelve-month period. Mood swings can appear rapidly. Approximately half of the people with bipolar disorder may develop rapid cycling at some point. Objectives Presentation of a clinical case about a patient with Bipolar Disorder with rapid cycling and poor response to treatment. Methods Review of the scientific literature based on a clinical case. Results 33-year-old male, single, living with his mother, under follow-up by mental health team since 2012. First debut of manic episode in 2010. The patient has filed multiple decompensations related to consumption of toxics (alcohol and cannabis). Currently unemployed. He attended to the emergency service in June 2022 accompanied by his mother, who reported that he was restless. The patient refers that he has interrupted the treatment during the vacations, having sleep rhythm disorder with abuse of caffeine drinks. Currently the patient does not recognize any consumption.The patient reports that during the village festivals he felt very energetic, occasionally consuming drinks rich in taurine and sugars, even having conflicts with people of the village. Finally, the patient was stabilized with Lithium 400 mg and Olanzapine. In September, the patient returned to the emergency service on the recommendation of his referral psychiatrist due to therapeutic failure. The only relevant finding we observed in the analytical determinations were low lithium levels (0.4 mEq/L). The transgression of sleep rhythms and the abuse of psychoactive substances required the admission of the patient to optimize the treatment (Clozapine, Lithium, Valproic Acid). At discharge, he is euthymic, has not presented behavioral alterations and is resting well. Finally, it was decided that the patient should go to the Convalescent Center to continue treatment and achieve psychopathological stability. Conclusions Bipolar disorder is an important mental illness, having an incidence of 1.2%, being responsible for 20% of all mood disorders. Therefore, it is important to perform an adequate and individualized follow-up of each patient. Treatment with mood stabilizers tries to improve and prevent manic and depressive episodes, improving chronicity and trying to make the long-term evolution as good as possible, being important psychoeducation and psychotherapy. Disclosure of Interest None Declared

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