Comparison of severity scales for acute bronchiolitis in real clinical practice.

Several clinical scales have been developed to assess the severity of bronchiolitis as well as the probability of needing in-hospital care. A recent systematic review of 32 validated clinical scores for bronchiolitis concluded that 6 of them (Wood-Downes, M-WCAS, Respiratory Severity Score, Respiratory Clinical Score, Respiratory Score and Bronchiolitis risk of admission score) were the best ones regarding reliability, sensitivity, validity, and usability. However, to the best of our knowledge, no study has compared all of them in a clinical scenario. Also, after this review, three more scales were published: BROSJOD, Tal modified, and one score developed by PERN. Our main aim was to compare the ability of different clinical scales for bronchiolitis to predict any relevant outcome. A prospective observational study was conducted that included patients of up to 12 months old attended to, due to bronchiolitis, in the paediatric Emergency Department of a secondary university hospital from October 2019 to January 2022. For each patient, the attending clinician filled in a form with the items of the scales, decomposed, in order to prevent the clinician from knowing the score of each scale. Then, the patient was managed according to the protocol of our Emergency Department. A phone call was made to each patient in order to check whether the patient ended up being admitted in the next 48 h. In the case of those that were impossible to contact by phone, the clinical history was reviewed. For the purpose of the study, any of the following were considered to be a relevant outcome: admission to ward and need for supplementary oxygen, non-invasive ventilation (NIV) or intravenous fluids, and admission to the paediatric intensive care unit (PICU) within the next 48 h or death. For the aim of the study, the area under the curve (AUC) and the odds ratio (OR) for a relevant outcome were calculated in each scale. Also, the best cut-off point was estimated according to the Youden index, and its sensitivity (Sn) and specificity (Sp) for a relevant outcome were calculated. We included 265 patients (52.1% male) with a median age of 5.3 months (P25-P75 2.6-7.4). Among them, 46 (17.4%) had some kind of relevant outcome. AUC for prediction of a relevant outcome ranged from 0.705 (Respiratory Score) to 0.786 (BRAS), although no scale performed significantly better than others. A score ≤ 2 in the PERN scale showed a sensitivity of 91.3% (CI95% 79.7-96.6) for a relevant outcome, with only 4 misdiagnosed patients (only 2 of them needed NIV).   Conclusions: There were no differences in the performance of the nine scales to predict relevant outcomes in patients with bronchiolitis. However, the PERN scale might be more useful to select patients at low risk of a severe outcome. What is Known: • Several clinical scales are used to assess the severity of bronchiolitis. Nevertheless, none of them seems to be better than others. What is New: • This is the first study comparing different bronchiolitis scales in a real clinical scenario. None of the nine scales compared performed better than the other. However, the PERN scale might be more useful to select patients at low risk of relevant outcomes.

Episodic Memory Impairment in Parkinson's Disease: Disentangling the Role of Encoding and Retrieval.

OBJECTIVE: The source of episodic memory (EM) impairment in Parkinson's disease (PD) is still unclear. In the present study, we sought to quantify specifically encoding, consolidation, and retrieval process deficits in a list-learning paradigm by a novel method, the item-specific deficit approach (ISDA). METHODS: We applied the ISDA method to the Free and Cued Selective Reminding Test (FCSRT) in a sample of 15 PD patients and 15 healthy participants. RESULTS: The results revealed differences in free recall performance between PD patients and controls. These patients, however, benefited from cues as much as controls did, and total recall did not differ between groups. When analyzing the ISDA indices for encoding, consolidation, and retrieval deficits, the results showed a general memory deficit, but with a clear focus on encoding and retrieval, as revealed by the sensitivity values. Moreover, controlling for initial learning did not eliminate group effects in retrieval. CONCLUSIONS: Our findings reveal a mixed pattern in PD patients, with deficits in both encoding and retrieval processes in memory. Also, despite the fact that an encoding dysfunction may explain some of the deficits observed at retrieval, it cannot fully account for the differences, highlighting that both encoding and retrieval factors are necessary to understand memory deficits in PD.

Postoperative neurological complications after brachial plexus block: a retrospective study conducted at a teaching hospital.

PURPOSE: Serious complications after ultrasound-guided regional anaesthesia can be devastating for the patient. The pathogenesis of postoperative neurological complications (PONC) is multifactorial and includes mechanical, vascular and chemical factors besides the nerve puncture itself. The primary aim of this study was to assess the incidence of PONC after brachial plexus block (BPB). METHODS: This is an observational retrospective single-centre study conducted at the regional anaesthesia unit of a teaching hospital. All BPBs performed from January 2011 to November 2019 were included. The outcomes analysed were the incidence, aetiology and diagnosis of PONCs and the incidence of other postoperative complications such as local anaesthetic systemic toxicity (LAST), pneumothorax, wrong-side block, etc. The performance of trainees and experienced anaesthesiologists was compared across all the outcomes. RESULTS: From a total of 5340 BPBs included, 15 cases developed PONC, yielding a rate of 2.81:1000 (95% CI 1.70-4.63). Thirteen patients underwent neurophysiological exams which confirmed nine neuropathies. The rate of PONCs for supervised trainees was 1.80:1000 (95% CI 0.701-4.62), not statistically different from that of experienced anaesthesiologists (p = 0.241). Three cases were considered to present with a PONC probably related to BPB [0.562:1,00 (95% CI 0.191-1.65)]. The incidence of long-term PONCs was 1.12:1000 (95% CI 0.515-2.45). Such complications proved irreversible in 2 cases. The incidences of LAST, pneumothorax and other complications observed were 0.749:1000 (95% CI 0.291-1.92), 0.187:1000 (95% CI 0.0331-1.06) and 4.31:1000 (95% CI 2.87-6.46), respectively. CONCLUSIONS: This survey suggests that complications after ultrasound-guided BPB, including blocks performed by trainees, are uncommon. TRIAL REGISTRATION: Clinicaltrials.gov ID: NCT04451642.

The role of chronic physical exercise and selective attention at encoding on implicit and explicit memory.

Despite the evidence revealing benefits of chronic cardiovascular exercise on executive functions, little research has been conducted on long-term memory. We aimed to investigate the effect of physical exercise on implicit and explicit memory when attention was modulated at encoding in two groups of active and sedentary participants. With this purpose, attention was manipulated in a similar way in the implicit and explicit memory tasks by presenting picture outlines of two familiar objects, one in blue and the other in green, and participants were asked to pay attention only to one of them. Implicit memory was assessed through conceptual priming and explicit memory through a free recall task followed by recognition. The results did not reveal significant differences between groups in conceptual priming or free recall. However, in recognition, while both groups had similar discrimination for attended stimuli, active participants showed lower discrimination between unattended and new stimuli. These results suggested that exercise may have effects on specific cognitive processes, that is, that active participants may suppress non-relevant information better than sedentary participants, making the discrimination between unattended and new items more difficult.

Synthesis of Nature-Inspired Medium-Sized Fused Heterocycles from Amino Acids.

Herein, we describe the synthesis of molecular scaffolds consisting of medium-sized fused heterocycles using amino acids, which are some of the most useful building blocks used by nature as well as chemists to create structural diversity. The acyclic precursors were assembled by using traditional Merrifield solid-phase peptide synthesis, and cyclization was carried out through acid-mediated tandem endocyclic N-acyliminium ion formation, followed by nucleophilic addition with internal nucleophiles. The synthesis of molecular scaffolds consisting of seven-, eight-, and nine-membered rings proceeded with full stereocontrol of the newly generated stereogenic center in most cases.

Aging increases distraction by auditory oddballs in visual, but not auditory tasks.

Aging is typically considered to bring a reduction of the ability to resist distraction by task-irrelevant stimuli. Yet recent work suggests that this conclusion must be qualified and that the effect of aging is mitigated by whether irrelevant and target stimuli emanate from the same modalities or from distinct ones. Some studies suggest that aging is especially sensitive to distraction within-modality while others suggest it is greater across modalities. Here we report the first study to measure the effect of aging on deviance distraction in cross-modal (auditory-visual) and uni-modal (auditory-auditory) oddball tasks. Young and older adults were asked to judge the parity of target digits (auditory or visual in distinct blocks of trials), each preceded by a task-irrelevant sound (the same tone on most trials-the standard sound-or, on rare and unpredictable trials, a burst of white noise-the deviant sound). Deviant sounds yielded distraction (longer response times relative to standard sounds) in both tasks and age groups. However, an age-related increase in distraction was observed in the cross-modal task and not in the uni-modal task. We argue that aging might affect processes involved in the switching of attention across modalities and speculate that this may due to the slowing of this type of attentional shift or a reduction in cognitive control required to re-orient attention toward the target's modality.

From amino acids to nature-inspired molecular scaffolds: incorporation of medium-sized bridged heterocycles into a peptide backbone.

Novel molecular scaffolds comprising two to four bridged and fused heterocycles were synthesized from amino acids using seven-membered endocyclic N-acyliminium ions as key intermediates in acid-mediated tandem reactions with internal nucleophiles. This complexity-generating synthesis proceeds with high efficiency and with full stereocontrol of the newly generated stereogenic center. These results have extended the scope of medium-sized cyclic iminium ion chemistry, making it applicable as a regio- and stereoselective synthetic strategy for the generation of complex polycyclic structures. Furthermore, its compatibility with the traditional Merrifield synthesis of peptides on solid supports allowed the incorporation of the previously unexplored conformationally restricted cyclic systems into peptides without a need to independently synthesize the scaffold.

Metamemory in temporal lobe epilepsy: a study of sensitivity to repetition at encoding.

The purpose of the current study was to determine whether the level of metacognitive sensitivity previously observed in global Judgments-of-Learning (JOLs) in temporal lobe epilepsy (TLE) patients could also be established when making item-by-item JOLs. Fourteen TLE patients and 14 control participants were compared on a memory task where 39 semantically unrelated word pairs were presented at three different levels of repetition. Thirteen word pairs were assigned to each level. A combined JOL and Feeling-of-Knowing (FOK) task was used to examine metamemory monitoring and control processes. The results showed that control participants outperformed TLE patients on recall and recognition. However, both groups were sensitive to repetition of the word pairs throughout the list, revealing intact online monitoring and control processes at encoding. These results are consistent with the findings of Howard et al. (2010) of intact metamemory in TLE patients and extend the findings of Andrés et al. (2010) of metamemory sensitivity from the global level to the item-by-item level. Finally, the current findings provide additional evidence of a dissociation between memory and metamemory in TLE patients.

Intermittent boluses versus pump continuous infusion for endoscopist-directed propofol administration in colonoscopy.

BACKGROUND: non-anesthesiologist administration of propofol (NAAP) using continuous infusion systems may achieve a more sustained sedative action. AIM: to compare intermittent boluses (IB) with pump continuous infusion (PCI) for NAAP, targeted to moderate sedation, for colonoscopy. METHODS: 192 consecutive outpatients were randomized to receive IB (20 mg propofol boluses on demand) or PCI (3 mg/kg/h plus 20 mg boluses on demand). Sedation could be stopped at cecal intubation at the discretion of the endoscopist. Satisfaction rates of the patient, nurses and endoscopist, propofol doses, depth of sedation (at the beginning, at cecal intubation and at the end), recovery times, complications and were collected. RESULTS: there were no differences between groups regarding patient, nurse or endoscopist satisfaction rates with procedural sedation. Propofol doses (mg) were significantly higher during the induction phase -86 (30-172) vs. 78 [30-160], p 0.03- and overall -185 (72-400) vs. 157 (60-460), p = 0.003- for PCI group. 81 % of assessments of the depth of sedation were moderate. The level of sedation (O/AAS scale) was borderline significantly deeper at cecal intubation (2.38 vs. 2.72; p = 0.056) and at the end of the procedure (4.13 vs. 4.45; p = 0.05) for PCI group, prolonging thus early recovery time (6.3 vs. 5.1 minutes, p = 0.008), but not discharge time. Complications, all of them in minors, were non-significantly more frequent in the PCI group (9 vs. 7 %, p = 0.07). CONCLUSIONS: NAAP for colonoscopy was safely administered with comparable satisfaction and complication rates with either IB or PCI.

Are social isolation and loneliness associated with cognitive decline in ageing?

Objective: Social isolation and loneliness are associated with poor health (immunity, inflammation, etc.) in ageing. The purpose of this scoping review was to investigate the link between social isolation, loneliness (as distinct constructs, in contrast to previous published work) and cognition in cognitively healthy older adults. Method: We followed PRISMA-ScR guidelines. Our search, conducted between January 2017 and April 2021, yielded 2,673 articles, of which, twelve longitudinal studies were finally identified as meeting the inclusion criteria. Multiple cognitive functions (short-term and episodic memory, attention, and global cognitive functioning) were measured. Results: The results showed that both social isolation and loneliness were associated with poor cognition in ageing, with depression as a possible mediator between loneliness and poor cognition. Some studies also suggested that the link between social isolation, loneliness and cognitive decline may be bidirectional. Conclusion: We conclude that both social isolation and loneliness may have a different impact on cognition. While depression may be an important mediator between loneliness and cognitive decline, the lack of cognitive stimulation may be a greater mediator between social isolation and cognitive health.

Extended FNAME performance is preserved in subjective cognitive decline but highly affected in amnestic mild cognitive impairment.

OBJECTIVE: The cognitive characterization of Alzheimer's disease risk states, such as amnestic mild cognitive impairment (aMCI) and subjective cognitive decline (SCD), is fundamental for timely diagnosis and interventions. The Face Name Associative Memory Exam (FNAME) is sensitive to early Alzheimer's disease brain changes, and an extended version captures a fuller range of associative memory abilities. We aimed to assess group effects in the extended FNAME in older adults with SCD, aMCI, and older adult controls (CON). METHOD: Two concurrently created versions of the extended FNAME were used to test three groups of older adults (CON = 35, SCD = 37, aMCI = 31) at two sites (Mexico = 59, Netherlands = 44). Extended FNAME memory abilities were analyzed in five analyses of variance. Group and site were considered as independent variables. For the recall ability, subtest levels were entered as a within-subject variable. The remaining abilities (Face Recognition, Name Recognition, Spontaneous Name Recall, and Face-Name Matching) were analyzed in independent models. RESULTS: In all models, the main effect for group was significant with large effect sizes, driven by a worse performance of aMCI participants. No significant differences were found between SCD and CON. The main effect for site was only significant in Face Recognition. CONCLUSIONS: The worse performance of aMCI in the extended FNAME implies an impairment in associative memory abilities beyond recall. The similar performance of CON and SCD might be explained by the recruitment of SCD participants that did not spontaneously seek help for memory decline. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Facial emotion recognition in Parkinson's disease: The role of executive and affective domains.

OBJECTIVE: The ability to recognize emotions from facial expression (FER) may be impaired in Parkinson's disease (PD). We aimed to explore FER in PD patients by using a dynamic presentation of emotions across different intensities and to examine the extent to which executive and affective alterations contributed to FER deficits. METHOD: Fifteen PD patients and 15 healthy controls were assessed on the emotion recognition task (ERT). We also explored how clinical and executive factors could have contributed to ERT accuracy. RESULTS: PD patients showed poorer performance on the ERT, specifically on angry expressions, but they benefited from increased intensity as much as controls did. Differences were also found for apathy, depression, and executive tests, especially in the inhibition domain. Importantly, differences between groups on the ERT disappeared when controlling for inhibition and the affective symptoms. A significant effect of inhibition dysfunction was also observed on the ERT performance. CONCLUSIONS: Our findings demonstrate the presence of emotion recognition deficits of morphed facial expressions in patients with PD. Moreover, they suggest that inhibition dysfunctions may act as an important factor negatively influencing FER. The present study highlights the complex nature of emotion processing and its relation with emotional-affective and cognitive aspects to provide a better understanding of FER deficits in PD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Face name matching and memory complaints in Parkinson's disease.

Objective: Memory impairment is a hallmark cognitive deficit in Parkinson's disease (PD). However, it remains unclear which processes underlie this deficit in PD. Also, little is known on these patients' subjective experiences of memory difficulties and their relationship with objective measures. We aim to portray memory deficits in PD by combining objective and subjective memory measures. Methods: Fifteen PD patients and 15 controls were assessed with an extended version of the Face-Name Associative Memory Exam (FNAME) and the Memory Failures of Everyday Questionnaire (MFE-28). We also explored the relationship among clinical and cognitive variables. Results: Participants with PD presented with more memory complaints. On the FNAME, these patients exhibited lower performance in free recall, as well as in name recognition and matching. Importantly, when controlling for initial learning, group effects disappeared, except for matching. Associative memory therefore was significantly compromised in PD and correlated with subjective memory complaints (SMC). Conclusion: Our findings suggest that associative memory may constitute a sensitive measure to detect subtle memory deficits in PD. Moreover, the current study further clarifies the source of memory impairment in PD. Thus, our study highlights the clinical value of including associative memory tests such as the FNAME in PD neuropsychological assessment.

Distraction by violation of sensory predictions: Functional distinction between deviant sounds and unexpected silences.

It has been established that participants performing a continuous categorization task respond significantly slower following the presentation of unexpected, task-irrelevant, auditory stimuli, compared to a repetitive (standard) sound. Evidence indicates that such distraction emerges because of the violation of sensory predictions. This has typically been studied by measuring the impact of replacing the repeated sound by a different sound on rare and unpredictable trials. Here, we examine the impact of a different type of violation: the mere omission of the standard sound. Capitalizing upon the recent finding that deviant sounds exert distinct effects on response times as a function of whether participants produced or withheld a response on the previous trial, we present the results of an experiment seeking to disentangle two potential effects of sound omission: deviance distraction and the removal of an unspecific warning signal. The results indicate that deviant sound and the unexpected omission of the standard sound impact response times through, at least partially, distinct mechanisms. Deviant sounds affect performance by triggering the orienting of attention towards a new sensory input. Sound omissions, in contrast, appear to affect performance in part because responses no longer benefit from an unspecific warning signal to prepare for action.

Distraction by deviant sounds is modulated by the environmental context.

Evidence shows that participants performing a continuous visual categorization task respond slower following the presentation of a task-irrelevant sound deviating from an otherwise repetitive or predictable auditory context (deviant sound among standard sounds). Here, for the first time, we explored the role of the environmental context (instrumentalized as a task-irrelevant background picture) in this effect. In two experiments, participants categorized left/right arrows while ignoring irrelevant sounds and background pictures of forest and city scenes. While equiprobable across the task, sounds A and B were presented with probabilities of .882 and .118 in the forest context, respectively, and with the reversed probabilities in the city context. Hence, neither sound constituted a deviant sound at task-level, but each did within a specific context. In Experiment 1, where each environmental context (forest and city scene) consisted of a single picture each, participants were significantly slower in the visual task following the presentation of the sound that was unexpected within the current context (context-dependent distraction). Further analysis showed that the cognitive system reset its sensory predictions even for the first trial of a change in environmental context. In Experiment 2, the two contexts (forest and city) were implemented using sets of 32 pictures each, with the background picture changing on every trial. Here too, context-dependent deviance distraction was observed. However, participants took a trial to fully reset their sensory predictions upon a change in context. We conclude that irrelevant sounds are incidentally processed in association with the environmental context (even though these stimuli belong to different sensory modalities) and that sensory predictions are context-dependent.

Aging Increases Cross-Modal Distraction by Unexpected Sounds: Controlling for Response Speed.

It is well-established that task-irrelevant sounds deviating from an otherwise predictable auditory sequence capture attention and disrupt ongoing performance by delaying responses in the ongoing task. In visual tasks, larger distraction by unexpected sounds (deviance distraction) has been reported in older than in young adults. However, past studies based this conclusion on the comparisons of absolute response times (RT) and did not control for the general slowing typically observed in older adults. Hence, it remains unclear whether this difference in deviance distraction between the two age groups reflects a genuine effect of aging or a proportional effect of similar size in both groups. We addressed this issue by using a proportional measure of distraction (PMD) to reanalyze the data from four past studies and used Bayesian estimation to generate credible estimates of the age-related difference in deviance distraction and its effect size. The results were unambiguous: older adults exhibited greater deviance distraction than young adults when controlling for baseline response speed (in each individual study and in the combined data set). Bayesian estimation revealed a proportional lengthening of RT by unexpected sounds that was about twice as large in older than in young adults (corresponding to a large statistical effect size). A similar analysis was carried out on the proportion of correct responses (PC) and produced converging results. Finally, an additional Bayesian analysis comparing data from cross-modal and uni-modal studies confirmed the selective effect of aging on distraction in the first and not the second. Overall, our study shows that older adults performing a visual categorization task do exhibit greater distraction by unexpected sounds than young adults and that this effect is not explicable by age-related general slowing.

COVID pandemic as an opportunity for improving mental health treatments of the homeless people.

BACKGROUND: Homeless population has been severely affected by the COVID-19 pandemic. Their living conditions, comorbidity with different pathologies and a greater frequency of mental disorders, make this population vulnerable. METHOD: We implemented a program of serial visits in a hostel for confined homeless of the city council social services, for the monitoring and treatment of mental disorders and substance abuse problems. Accompanied by serial phone and email contacts. RESULTS: A highly significant percentage (63%) had mental disorders or substance abuse, requiring pharmacological intervention, and 37% began follow-up in resources of the Mental Health and Addiction network of the Psychiatric Service at the end of the program. Hospital emergency service visits were drastically reduced. None of them were infected with COVID-19. An individualized Social plan was drawn up in order to reintegrate them with support in the community. CONCLUSIONS: The Results have been really positive, meeting all the objectives and opening up developing new programs in the future, in the pandemic outbreak and out of it.

Worse associative memory recall in healthy older adults compared to young ones, a face-name study in Spain and Mexico.

INTRODUCTION: The Face Name Associative Memory Exam (FNAME) is sensitive to associative memory changes early in the Alzheimer's disease spectrum, but little is known about how healthy aging affects FNAME performance. We aimed to assess aging effects on an extended version of the test, which captures further associative memory abilities beyond the recall and recognition domains measured in the original version. METHOD: We adapted FNAME versions in Spain and Mexico, adding new subtests (Spontaneous Name Recall, Face-Name Matching). We compared the performance of 21 young adults (YA) and 27 older adults (OA) in Spain, and 34 YA and 36 OA in Mexico. Recall was analyzed using a mixed-model ANOVA including subtest scores as dependent variables, age group as a fixed-factor independent variable, and recall subtest as a three-level repeated-measure independent variable. The rest of the associative memory domains were analyzed through t-tests comparing the performance of YA and OA. RESULTS: In Spain, we found significant effects for age group and recall subtest, with large effect sizes. The recognition subtests (Face Recognition, Name Recognition) displayed ceiling effects in both groups. The new subtests displayed medium-to-large effect sizes when comparing age groups. In Mexico, these results were replicated, additionally controlling for education. In both studies, recall performance improved after repeated exposures and it was sustained after 30 minutes in YA and OA. CONCLUSIONS: We document, in two different countries, a clear aging pattern on the extended FNAME: regardless of education, OA remember fewer stimuli than YA through recall subtests. The new subtests provide evidence on associative memory changes in aging beyond recall.

Cognitive and Behavioral Inhibition Deficits in Parkinson's Disease: The Hayling Test as a Reliable Marker.

OBJECTIVE: The present study seeks to provide an overview of executive (inhibition and flexibility) deficits in Parkinson's disease (PD) by combining a cognitive and behavioral approach. METHODS: Fifteen PD patients and 15 healthy controls underwent a neuropsychological and behavioral assessment including the Hayling and Trails Tests, the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP-RS), the Behavior Rating Inventory of Executive Function (BRIEF-A), and the Short Form-36 Health Survey (SF-36). The level of awareness of executive functioning was also analyzed. We finally explored how these neuropsychological and clinical outcomes could relate to each other. RESULTS: PD patients performed significantly worse in both neuropsychological tasks designed to evaluate inhibition abilities. They also reported more inhibition difficulties in everyday life and poorer quality of life. Associations between neuropsychological measures and self-reports were found. Moreover, as indicated by the discrepancy score, PD patients were as accurate as their relatives in self-reporting their executive daily difficulties. CONCLUSION: Inhibition and cognitive flexibility impairments assessed by the neuropsychological tests (Hayling and Trails tests) seem to capture daily life executive problems in PD. Furthermore, our study provides a deeper understanding of PD patients' and their relatives' experience of these executive dysfunctions.

The response of the mental health network of the Salamanca area to the COVID-19 pandemic: The role of the telemedicine.

The COVID-19 pandemic reached world-wide causing a great impact on healthcare services. The aim of this work is to describe the response of the Mental Health Network of the Salamanca´ Area (Spain) to this crisis and the reorganization of its resources within the first 8 weeks after the state of alarm was declared. The Psychiatry Service applied a contingency plan which included the reorganization of the human resources, the closure of some of the units and the implementation of telemedicine programs along with two specific programs, namely a mental health assistance program in the context of the infection by coronavirus, and another program for homeless people. 9.038 phone interviews were carried out in the outpatients and community mental health programs. The activity in subacute and acute wards, as well as that of the day hospital programs was decreased to 50%. Based on that this real-world response provided we concluded that the usage of telemedicine is promising in patients with any kind of disorder. Its implementation in daily practice will be considered in the future. Research must continue on COVID-19's impact on patients with mental disorders and Psychiatry's necessary adaptations and new approaches to them.