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Introduction: Self-perceived health (SPH) is an epidemiologically used variable, recognized as a subjective yet predictive indicator of mortality (Bopp et al. Plos One 2012; 7:e30795) SPH, among other subjective indicators, such as quality of life, contributes to understanding an individual's overall experience and well-being. While health information, including medical diagnoses given by physicians, forms a substantial part of an individual's subjective health (Falconer & Quesnel-Vallée, 2017; 190 227-236) the World Health Organization (WHO, 2014) defines health not only by the absence of somatic diseases but also encompasses components of social and mental well-being. Objectives: This study aims to explore factors associated with a poorer level of self-perceived health in inpatients due to non-psychiatric conditions with a focus on mental health and substance use-related factors. Methods: We recruited 800 patients during their hospital stay for various pathologies in cardiology, pneumology, internal medicine, and gastroenterology units. Self-reported sociodemographic variables and well-being-related variables, such as SPH, were collected during admission. The MINI Neuropsychiatric Interview was administered to screen for psychiatric conditions, the ASSIST scale assessed the risk related to the use of various substances. Data on the frequency and quantity of substance use, in the three months prior to admission, were also recorded by timeline follow-back. Information on the severity of somatic comorbidity was gathered using the Charlson Comorbidity Index. Non-parametric tests compared SPH in different groups, and variables showing significant differences were included in a multivariate linear regression analysis. This study obtained approval from the ethics committee. Results: Significant and clinically relevant differences were found in the SPH of patients with anxiety disorders, depressive disorders, and bipolar disorders. These patients reported lower SPH than those without these comorbidities. Patients scoring medium or high risk on the ASSIST scale for tobacco, alcohol, and cannabis also demonstrated lower SPH compared to those with low-risk scores. In the multivariate analysis, accounting for confounding factors, including comorbidity severity, patients with depressive disorders maintained statistically significant lower levels of SPH (ß = -13.391, p < 0.001), as did those with bipolar disorders (ß = -6.096, p = 0.019). Conclusions: Patients with anxiety, depressive, or bipolar disorders, as well as those with higher-risk use of tobacco, alcohol, and cannabis, exhibited lower SPH. After adjusting for other relevant factors, such as diagnosed somatic pathology, patients with affective disorders continued to score lower in SPH levels. Proper attention and management of psychiatric comorbidities and substance use are crucial in medical hospital settings. Disclosure of Interest: M. Pons-Cabrera Employee of: This work has been funded by Contractes Clínic de Recerca "Emili Letang - Josep Font" 2021 granted by Hospital Clínic of Barcelona, E. Caballería-Lamora: None Declared, L. Navarro-Cortés: None Declared, M. Balcells-Oliveró: None Declared, L. Pintor-Pérez: None Declared, H. López-Pelayo: None Declared [ABSTRACT FROM AUTHOR] more...

Background: Medically serious suicide attempts (MSSA) represent a subgroup of clinically heterogeneous suicidal behaviours very close to deaths by suicide. A simple definition of an MSSA is a suicide attempt with life-threatening consequences, regardless of the severity of the attempter's mental disorder. Few studies have specifically analysed the heterogeneity of MSSA. Therefore, the aim of this study is to describe the profile of individuals who made a highly severe MSSA and to compare those admitted to Intensive Care Units (ICU) - including Burn Units- with other MSSA admitted to other medical and surgical units., Methods: The study sample consisted of 168 patients consecutively admitted to non-psychiatric wards from two public hospitals in Barcelona after an MSSA during a 3-year period. In order to select more severe MSSA, the minimum hospital stay was expanded from Beautrais' definition of ≥ 24 h to ≥ 48 h. Mean hospital stay was 23.68 (SD = 41.14) days. Patients needing ICU treatment (n = 99) were compared to other MSSArs (n = 69) that were admitted to other medical and surgical units, not requiring intensive care treatment, with an initial bivariant analysis followed by a logistic regression analysis using conditional entrance., Results: Medically serious suicide attempters (MSSArs) spent more time hospitalized, more frequently reported recent stressful life events, were more likely to have at least one prior suicide attempt (SA) and their current attempt was more frequently non-planned, compared to the profile of MSSArs reported in previous studies. The most frequent method was medication overdose (67.3%) and jumping from heights (23.2%). Among those who chose more than one method (37.6%), the most frequent combination was medication overdose and drug use. Affective disorders and personality disorders were the most frequent diagnoses. Higher educational level, history of previous mental disorders and prior lifetime suicide attempts were significantly more frequent among those admitted to ICU compared to other MSSArs. Patients needing admission to ICU less frequently used self-poisoning and cuts., Conclusions: MSSA needing ICU admission can be regarded clinically as similar to attempts resulting in suicide. More research on this type of highly severe suicide behaviour is needed due to its serious implications both from a clinical and public health perspective., (© 2022. The Author(s).) more...

Introduction: The SARS-CoV-2 outbreak is posing unprecedented care scenarios, increasing the psychological distress among healthcare workers while reducing the efficiency of health systems. This work evaluated the psychological impact of the Covid-19 pandemic on Spanish frontline healthcare workers of two tertiary hospitals., Material and Methods: Healthcare workers were recruited from the medical units designated for the care of Covid-19 patients. The psychological assessment consisted of an individual, face-to-face session where gold-standard psychometric tests were administered to assess stress (VASS & PSS-10), anxiety (STAI), depression (PHQ-2) and posttraumatic stress disorder (PCL-5). Regression models were also fitted to identify predictors of psychological distress., Results: Overall, almost 13% of healthcare workers showed severe anxiety, while more than 26% had high levels of perceived stress. More than 23% presented severe posttraumatic stress symptoms, and another 13% had PHQ-2 scores equal to or above 3, compatible with Major Depressive Disorder (MDD) diagnosis, respectively. Women, stress-related medication, overworking, performing in Covid-19 wards, and substance abuse were risk factors for increased psychological distress. Instead, practising exercise reduced the burden., Conclusion: This study outlines the severe psychological impact of the Covid-19 pandemic on Spanish frontline healthcare workers. The stress, depression and anxiety levels found were similar to those reported in similar works but much higher than in Wuhan healthcare workers. Knowledge of risk factors for increased psychological distress may help to develop comprehensive intervention strategies to prevent, control and reduce the mental health exacerbation of healthcare workers, thereby maintaining the effectiveness of health systems in critical scenarios., (Copyright © 2021. Published by Elsevier Inc.) more...

Medically serious suicide attempts (MSSA) represent a subgroup of clinically heterogeneous suicidal behaviors very close to suicides. Personality disorders (PD) are highly prevalent among them, together with affective and substance use disorders. However, few studies have specifically analyzed the role of PD in MSSA. These suicide attempts (SA) are usually followed by longer hospitalization periods and may result in severe physical and psychological consequences. The aim of this study is to compare the profile of MSSA patients with and without PD. MSSA were defined according to Beautrais 'criteria, but had to remain hospitalized ≥48 h. Overall, 168 patients from two public hospitals in Barcelona were evaluated during a three-year period. Mean hospital stay was 23.68 (standard deviation (SD) = 41.14) days. Patients with PD ( n = 69) were more likely to be younger, female, make the first and the most serious SA at a younger age, reported recent stressful life-events and more frequently had previous suicide attempts compared to those without PD. However, no differences were found with regards to comorbid diagnoses, current clinical status, features of the attempt, or their impulsivity and hopelessness scores. Therefore, focusing on the subjective, qualitative experiences related to MSSA among PD patients may increase understanding of the reasons contributing to these attempts in order to improve prevention strategies in the future. more...

Introduction: The clinical management of patients with psychotic disorders (PDs) can be particularly complex if it takes place in the context of consultation-liaison psychiatry (CLP) services within a general hospital. However, there are few studies specifically investigating the acute treatment procedures for these patients in CLP settings., Objectives: To examine the characteristics of a sample of inpatients with a primary PD referred to a CLP service over a 10-year period and to compare the clinical features of this subgroup with patients with other diagnoses (ODs)., Materials and Methods: Observational and descriptive study over a 10-year period (2005-2014) assessing prospectively adult inpatients admitted to non-psychiatric units of the University Clinical Hospital of Barcelona who were consecutively referred to our CLP service. We performed a posthoc analysis to compare the clinical features between the subgroup of patients with PDs and the rest of patients who meet the criteria for ODs., Results: We requested 393 consultations for patients who either already had the diagnosis of a primary PD and 9,415 for patients with ODs. Our results showed that patients with PDs were younger than the patients with ODs, had a higher prevalence of somatic illnesses related with an unhealthy lifestyle (such as infectious, endocrine, or metabolic diseases), less frequency of cancer, and a need to receive a more intensive psychiatric care., Conclusions: Inpatients with PDs referred to CLP have different clinical features compared with those who met the criteria for ODs. They are a highly complex group with specific psychiatric care needs. more...

Objective: Previous research has described the characteristics of Consultation-liaison psychiatry (CLP) services over one or more years. The aim of this paper was to examine the patterns of a large sample of patients receiving CLP service over a 10-year-period (2005&#8211;2014) and to determine the possible changes over time of the clinical practice. The sample size of our study, the duration of the observation period and the application of standardized operating procedures for acquiring and coding data, will provide more robust evidence than has been reported by most similar studies published in the last years., Methods: Longitudinal observational and descriptive study. Data were collected prospectively with standardized operating procedures on consecutive inpatient consultation requests to the University Clinical Hospital of Barcelona CLP service., Results: 9,808 psychiatric consultation were requested (referral rate=2.2%). The referrals to our CLP service were requested mainly by medical units. The most frequent psychiatric diagnoses were alcohol-related disorders, delirium and adjustment disorders. The mean percentage of patients treated with psychopharmacologic drugs was 81.6%. The mean length of the hospital stays of patients with psychiatric comorbidity referred to our CLP service was significantly longer than that of all the admissions to the hospital during that period. Most of the studied variables remained constant over the 10-year-period. However, some somatic diagnoses at admission, reasons for referral and recommendations of psychotropic drugs presented significant changes., Conclusions: Despite the continuous evolution and changes of several factors in the last two decades, like the health care systems, the clinical practice of CLP services has been quite stable over time. However, our results support the idea of a non-static specialty. more...

Objective: Functional neurological disorder (FND) is a core neuropsychiatric condition that includes both physical and mental symptoms. Recently, a validated clinical phenotype termed neuroconnective endophenotype (NEP), which includes several physical and psychological characteristics together with joint hypermobility (hypermobility spectrum disorders), was found at a significantly higher frequency among patients with anxiety. The purpose of the present study was to examine the presence of the NEP among patients with FND., Methods: The authors conducted a multicenter case-control study comprising 27 FND patients and 27 healthy control participants (matched by sex and age) ages 13 to 58 years. Eight questionnaires were administered. Proportional differences were examined with Student's t tests, one-way analyses of variance, and chi-square tests., Results: Differences between FND patients and control participants were observed. FND patients had higher sensory sensitivity, increased prevalence of hypermobility features (including relevant physical signs and symptoms), greater frequency of polarized behaviors, a greater number of both psychiatric and physical comorbidities, and an increase in the characteristics and sensations typical of anxiety. Particularly striking was the presence of the hypermobility spectrum in more than 75% of FND patients compared with 15% among control participants., Conclusions: FND patients presented higher scores in all five dimensions included in the NEP. Thus, this phenotype, solidifying the original association between anxiety and the hypermobility spectrum, could help to identify an FND subtype when evaluating and managing FND patients, because it provides a new global view of patients' physical and mental symptoms., Competing Interests: Dr. Pérez-Sola has served as a consultant to or received honoraria or grants from AB-Biotics, AstraZeneca, Bristol-Myers Squibb, Centro de Investigación Biomédica en Red de Salud Mental, FIS-ISCiii, Janssen Cilag, Lundbeck, Otsuka, Servier, and Medtronic. The other authors report no financial relationships with commercial interests. more...

Introduction: Stroke is one of the main causes of death and disability and has a high economic cost. Anger after stroke is common and worsens functionality and quality of life. The study of this comorbidity has been hampered by the lack of standardization in anger's evaluation., Aim: To show the current evidence of anger's prevalence and anger's associated factors after stroke., Materials and Methods: Medline systematic review of original papers studying prevalence and associated factors of anger after stroke., Results: Post-stroke anger has a high prevalence (15-57.2%). Most studies have found a lack of association between irritability and sex, age, type, size, laterality and severity of the stroke and functionality. Occasionally anger has been associated with frontal infarcts and aphasia. Data regarding the association between anger and motor deficits and cognitive impairment has been inconclusive while the association between anger and psychiatric history, post stroke emotional incontinence and post stroke depression has been widely replicated. Environmental factors have been difficult to study but may be relevant., Conclusion: There is a high prevalence of anger post stroke. Psychiatric factors have been associated to it, while other associations are less conclusive. To improve anger knowledge and management, it would be necessary to improve its definition and assessment. more...

Psychogenic Non-Epileptic Seizures (PNES) are paroxysmal episodes of altered behavior that superficially resemble epileptic seizures but lack both the expected electroencephalographical epileptic changes and the association to dysfunction of central nervous system. They account for 17 to 30% of the population admitted to epilepsy units of tertiary hospitals for evaluation of seizures refractory to the pharmacological treatment. These episodes include most of the paroxysmal non-epileptic events and diverse studies have found a high prevalence of multiple psychiatric disorders during the lifetime. The simultaneous presence of 2 or more psychiatric disorders has even been observed in 70% of the patients. When there is evidence on the absence of real epileptic seizures, the first step is to slowly suppress the antiepileptic treatment. After, adequate psychopharmacological treatment should be initiated in relationship with the psychopathological state of the patient. The different emotional and psychological variables that may be affecting the appearance and perpetuation of PNES must be identified and then resolved with psychological treatment. The aim of the present case report is to present the difficulties of differential diagnosis between epilepsy and PNES, emphasizing the great importance of both neurological and psychiatric management in the treatment of these clinical symptoms. more...

Aim: To study the clinical characteristics in patients with conversion non-epileptic seizures, and the influence that traumatic childhood experiences could have in their psychopathologic status and personality., Methods: Seventeen patients with non-epileptic seizures confirmed through video-EEG were included. A structured clinical interview (SCID-DSM-III-R), a measure of personality variables (MMPI), and an interview designed for collecting data on personal history of childhood traumas were administered. Descriptive and comparative statistical methods were used., Results: More than 70% of the sample fulfilled the criteria for two or more simultaneous diagnoses in Axis I, and for at least one personality disorder. The subgroup experiencing childhood traumatic experiences showed more clinically significant MMPI scales, a younger age at correct diagnosis, and higher scores on the MMPI psychastenia and psychopathic deviation scales than the non experiencing childhood traumatics events., Conclusions: Our sample of patients with conversion non-epileptic seizures shows a significant level of psychopathology, and the absence of a unique character substrate. Under the generic term of pseudoseizures, a number of subgroups according to childhood traumatic experiences, with different levels of severity and different clinical and personality properties, may be defined. more...