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Background: despite numerous attempts to reduce the use of mechanical restraint (MR), this technique continues to be widely applied in many acute psychiatric care settings. In order to reduce MR, a better understanding of the variables associated with its use and duration in different clinical environments is essential. Aim: to determine the proportion of patients subjected to MR and the duration thereof in two acute care psychiatric units; and to identify the variables associated with the use and duration of MR. Methods: descriptive study of all patients admitted to the acute psychiatric units at the Parc de Salut Mar (Barcelona, Spain) in the year 2018. The number and percentage of patients subjected to MR, as well as the duration of each episode were assessed. The following data were also registered: sociodemographic characteristics, psychiatric diagnosis, and presence of cultural and/or language barriers. Multivariate analyses were performed to assess determinants of MR and its duration. Results: of the 464 patients, 119 (25.6%) required MR, with a median of 16.4 h per MR. Two factors - a diagnosis of psychotic disorder [Odds ratios (OR) = 0.22; 95%CI: 0.06-0.62; P = 0.005] and the presence of a language barrier (OR = 2.13; 95%CI: 1.2-3.7; P = 0.007) - were associated with a significantly higher risk of MR. Male sex was associated with a longer duration of MR (B = -19.03; 95%CI: -38.06-0.008; P = 0.05). Conclusion: the presence of a language barrier and a psychotic disorder diagnosis are associated with a significantly higher risk of MR. Furthermore, male sex is associated with a longer duration of MR. Individualized restraint protocols that include the required tools are necessary to ultimately limit the use of mechanical restraint.

Background: Cognitive impairment has been reported in patients with Major Depressive Disorder (MDD). This study aims to explore the association between lifestyle habits and health-related factors and the presence of cognitive symptoms in MDD patients. Methods: Demographic, clinical, health-related variables and cognitive scores measured with the Cambridge Neuropsychological Test Automated Battery (CANTAB) were compared between 74 patients with current MDD and 68 healthy controls (HC). To test the hypothesis of associated factors to cognitive symptoms, multivariate backward stepwise linear regression models were run. Results: Significant neuropsychological deficits were evident in MDD compared with HC in the global cognitive index (F=8.29; df=1, 140; p=0.005). In the regression analysis performed on MDD and HC, years of schooling (β=-0.11; p=

Introduction Suicide is one of the leading causes of avoidable death. Gathering national data on suicidal behaviour incidence is crucial to develop evidence-based public policies. The study has two primary objectives: (1) to determine the incidence of suicide attempts in Spain and related risk factors, and (2) to analyze the efficacy of secondary prevention programmes to prevent suicide re-attempting in comparison to treatment as usual (TAU). Materials and methods Multisite, coordinated, cohort study with three nested randomized controlled trials. A cohort of 2000 individuals (age >=12) with suicidal behaviour will be recruited at ten sites distributed across Spain. Assessments will be conducted within 10 days of the suicide attempt (V0-baseline visit) and after 12 months (V4-last visit) and will include clinician reported and participant reported outcomes (PROs). Between V0 and V4, PROs will be collected remotely every three months (V1, V2 and V3). Optatively, cohort participants will participate in three nested randomized-controlled-trials (RCTs) evaluating different secondary prevention interventions: Participants aged 18 years and older will be randomly allocated to: Telephone-based Management + TAU vs. TAU or iFightDepression-Survive + TAU vs. TAU. Participants aged between 12 and 18 years will be allocated to a specific intervention for youths: Self Awareness of Mental Health + TAU vs. TAU. Results This study will provide interesting data to estimate suicide attempt incidence in Spain. and will provide evidence on three. Conclusions Evidence on three potentially efficacious interventions for individuals at high risk of suicide will be obtained, and this could improve the treatment given to these individuals. Trial registration NCT04343703

Background: The study explores the association between pain and functional impairment in patients with partially remitted MDD, considering both clinician and patient reported outcomes. Methods: Multicenter, observational, and cross-sectional study, with 583 outpatients with partially remitted MDD. Measures of pain intensity (VAS), functional impairment (SOFAS), depressive symptomatology (HAM-D6), and remission from MDD and functional status from a patient-centered perspective (RDQ) were collected. VAS scores (cut-off: 30) were used to divide the sample in two groups: no pain (n = 274) and pain (n = 309). Descriptive data, correlation and regression analyses were obtained. Results: Functional impairment (SOFAS) and pain (VAS) were negatively and significantly correlated in the total sample, and in the group with pain. Lower pain predicted higher functioning. The pain sub-sample was older, less educated, with higher medical comorbidities, higher HAM-D6 scores, and lower functionality (SOFAS). In the RDQ, the pain group showed significantly higher scores in the symptom-related subscales, and lower scores in the subscales related to positive mental health, functioning and wellbeing. Limitations: Correlational and observational design. The criteria and instruments used to measure pain and to define a threshold might limit the generalizability of findings. Conclusions: Pain and functionality should be assessed and treated in patients with MDD in partial remission. Our results indicate that functionality should be assessed with a broader perspective, that also considers positive mental health features.

The objective of this study is to determine whether cannabis influences BDNF levels in patients with psychosis (FEP) and healthy volunteers (HV) to help understand the role of BDNF in psychosis. We assessed the association between BDNF and cannabis in a cohort of FEP antipsychotic-naïve patients and HV, whilst controlling for other potential confounding factors. 70 FEP drug-naive patients and 57 HV were recruited. A sociodemographic variable collection, structured clinical interview, weight and height measurement, substance use determination, and blood collection to determine BDNF levels by ELISA analysis were done. In FEP patients, cannabis use was associated with BDNF levels (high cannabis use was associated with lower BDNF levels). Moreover, cannabis use was statistically significantly associated with age (high use of cannabis was associated with younger age). In HV, no relationship between cannabis use and BDNF levels was observed. Otherwise, cannabis use was significantly associated with tobacco use, so that high cannabis users were also high tobacco users. This study showed a different association between cannabis use and BDNF levels in FEP patients compared with HV, particularly, with high doses of cannabis. These findings may help understand the deleterious effects of cannabis in some vulnerable individuals, as well as discrepancies in the literature.

Negative symptoms are core symptoms of schizophrenia associated with poorer clinical outcome (Strauss et al., 2010). They can be clinically subdivided into primary and secondary features, representing different phenomenology and pathophysiological mechanisms (Miller et al., 1994). Secondary negative symptoms phenotypically present as primary symptoms, but are attributed to external causes. Positive symptom severity, depression and antipsychotic side-effects are known sources of secondary negative symptoms (Carpenter et al., 1985). Discriminating whether a negative symptom is primary or secondary is clinically relevant as it might require specific, and often opposite interventions (Miller et al., 1994). Despite the development of new symptom severity rating scales, none have considered this distinction.

Background Cognitive and negative symptoms are key determinants in schizophrenia functionality. Cognitive remediation (CR) has shown to improve cognition in patients with schizophrenia but the impact on functionality is still unsatisfactory. On the other hand, an improvement in negative symptoms has also been described with CR and some studies have shown physical exercise (PE) may also improve negative symptoms. The present study sets out to investigate the effects of CR+PE in overall negative symptoms, and more specifically, in the avolition and expression factor, as well as in functionality, in a sample of patients diagnosed with multi-episode schizophrenia. Furthermore, it sets out to investigate determinants of functionality at follow-up. Methods Randomized controlled trial with two groups: CR+PE and CR plus lifestyle promotion (LP) (control group) (www.clinicaltrials.gov NCT 02864576). Participants: Subjects fulfilling DSM-IV-TR criteria for schizophrenia or schizo-affective disorder diagnosis, aged between 25–60 years, with an illness duration >o = 10 years, clinically stable and with low physical activity were included. Each randomly assigned intervention consists of 36 sessions carried out 3-times/week in groups of 4–6 participants of CR+PE or CR+LP. Analyses: Baseline sociodemographic and clinical characteristics were assessed at baseline in both groups. Repeated measures of multiple analysis of variance (MANOVA) was performed for negative symptoms (BNSS total scale and avolition and expression factors) and functionality (GAF score) with group (CR+PE vs CR+LP) as the between-subject factor and time (pre-treatment and post-treatment) as the within-group factor. The main effects of time, group, and time × group were examined. Multiple regression analysis (whole sample) with GAF at follow-up as the dependent variable and avolition, expression and PANSS-P subscale at follow-up, and gender and age as independent variables was also carried out. Results 43 patients were included and randomized. 38 patients completed the study, 19 in each group. There were not statistically significant differences between both groups at baseline. There was a time x grup effect on GAF at follow-up (F=4.25 p= 0.047) and on the avolition factor (F=2.99 p= 0.09), with improvements in favour of the CR+ PE group. Furthermore, GAF at follow-up was only related with the avolition factor in the multiple regression analysis (B= -0.63, t -2.84, p=0.009 (CI -1.09-0.17)). Discussion CR+PE is associated with an improvement in negative symptoms, and more specifically, in the avolition factor, as well as in functionality. This specific improvement in the avolition factor is important, as functionality at follow-up is specifically associated with the avolition factor in our study, in accordance with previous studies. This work is funded by the Instituto de Salud Carlos III-Subdirección General de Evaluación y Fomento de la Investigación, with the Research Project PI15/00453.

Background Cognitive remediation (CR) is an evidence-based behavioral intervention for cognitive impairment in schizophrenia. Although the effectiveness of CR is well stablished, its effects are modest, especially in terms of functional outcome. There is an emerging literature suggesting that adding aerobic exercise to CR may exert synergistic effects. Despite these promising reports, the extent to which aerobic exercise in combination with CRT can improve cognitive and daily functioning in multiepisode schizophrenia and schizoaffective disorder remains unclear. Methods This is a single-blinded, randomized clinical trial (NCT02864576) with two different groups: 1) patients with multiepisode schizophrenia or schizoaffective disorder receiving 3-month Aerobic exercise plus CR treatment (three weekly sessions, 40min of Aerobic exercise and 90min of CR), and 2) patients with multiepisode schizophrenia or schizoaffective disorder receiving Healthy lifestyle promotion plus CR treatment (three weekly sessions, 40min of Healthy lifestyle promotion and 90min of CR). Primary outcome measures were the MATRICS Consensus Cognitive Battery (MCCB) and the Global Assessment of Functioning (GAF), which were assessed (among others) at baseline and immediately after treatment. For the present work, the sample included in the analysis were 34 patients for whom cognitive data were available. Treatment effects on neurocognition and functional outcome were analyzed by applying the multivariate general linear model (GLM) repeated measures. Results After treatment, both groups exhibited a significant improvement in MCCB visual learning memory (F=14.298, p= 0.001), working memory (F=6.626, p= 0.015) and speed of processing (F=16.344, p= 0.001) domains. However, no significant benefits were evidenced for problem solving (F=2.143, p= 0.153), verbal learning memory (F= 0.321, p= 0.575) and attention/vigilance (F=0.740, p= 0.397) domains. Functional outcome, as measured by the GAF, was more improved in the Aerobic exercise plus CR group than in the Healthy lifestyle promotion plus CR group (F=4.248, p= 0.047). Discussion Our preliminary findings indicate that combining aerobic exercise with cognitive remediation may promote a large impact on functional outcome in patients with multiepisode schizophrenia or schizoaffective disorder.

AIM: To systematically review studies measuring peripheric brain-derived neurotrophic factor (BDNF) levels on first-episode psychosis patients and variables related to them. METHODS: A systematic search was made of articles published in the Medline database from 2002 up to June 2014. Included are original studies that report enzyme-linked immunosorbent assay measurement of BDNF levels in serum or plasma in patients with a diagnosis of first episode psychosis (FEP) and age- and gender- matched healthy controls. RESULTS: Of the initially identified 147 articles, only 18 satisfied the inclusion criteria. Of this, 15 found a significant reduction in patients with FEP compared with age- and gender - matched controls. CONCLUSION: Peripheral BDNF levels are generally reduced in FEP patients. There are some factors that may influence BDNF levels that need to be further studied. Furthermore, a future meta-analysis in this topic is needed.

This study investigates differences in terms of clinical and treatment management in psychiatric hospitalization associated to smoking ban. We collected data regarding medication, socio-demographic and admission characteristics from all patients admitted to an acute psychiatric hospital before and after a smoking ban was in force. We also assessed a limited sample of patients before and after the ban regarding nicotine dependence, motivation to quit smoking and attitudes towards the ban. More number of leaves of absence and movement restrictions during the ban period occurred in comparison to the pre-ban period. On the contrary a lack of significant differences in terms of hospital stay (duration, rate of voluntary admissions and voluntary discharges), use of sedatives and doses of antipsychotics was found. A period of adjustment regarding the deal with leave of access and facilitate nicotine replacement treatment may help future psychiatric facilities planning smoking free policies.

Introduction Some studies have shown that more than 40% of patients with first episode psychosis (FEP) are nonadherent and treatment with long – acting antipsychotics (LAIs) could increase their compliance. However, studies on efficacy of LAIs versus oral antipsychotics for preventing relapse among schizophrenia patients have produced conflicting results. Objectives With this study we want to asses if patients with FEP in treatment with LAIs have a decreased incidence of readmission compared with patients in treatment with oral antipsychotics over 6 month follow – up. Methods 188 FEP patients were consecutively admitted to Hospital del Mar since January 2008 to September 2014. The included evaluation was, among others: sociodemographic data, duration of untreated psychosis (DUP), diagnosis, substance use and clinical data at baseline. Later, antipsychotic treatment and number of admissions and of emergencies over 6 months were also recorded. We studied difference sin readmission, number of emergencies between patients on LAI and oral treatment. Results We found a significative decreased incidence of readmission (p=0,000) and a lower number of emergencies (p=0,017) in the group of FEP patients treated with LAIs versus the group treated with oral antipsychotics. Conclusions In our sample, treatment with LAIs is associated with a reduced readmission rate and a lower number of emergencies in patients with FEP. This finding are agree with the results of other studies that show a significantly reduced relapse and a lowest risk of rehospitalization in FEP patients treated with LAIs.