COVID-19 Posttraumatic Stress Disorder and Mental Health among Spanish Adolescents: SESSAMO Project.

Background: Child and adolescent mental health problems have increased after the COVID-19 pandemic. The objective of this study was to establish the association of the presence and intensity of posttraumatic stress due to COVID-19 with the presence of (1) self-harm and suicide risk, (2) depressive and anxious symptoms, (3) eating disorders and (4) problematic Internet and video game use. Methods: A cross-sectional analysis was performed on a sample of second-fourth grade secondary school students (14 to 16 years old) from Navarra and the Canary Islands recruited at the SESSAMO project. Validated questionnaires were used to assess the intensity of posttraumatic stress due to COVID-19, risk of suicide and presence of self-harm, symptoms of mental disorder and problematic use of the Internet and video games. Results: Out of 1423 participants analyzed, those with the highest level of posttraumatic stress showed a significant increase in the risk of suicide (OR = 5.18; 95% CI = 2.96-9.05) and in the presence of eating disorder symptoms (OR = 3.93; 95% CI = 2.21-7.00), and higher anxiety and depression scores (b coefficient for anxiety = 11.1; CI = 9.7-12.5; for depression = 13.0; CI = 11.5-14.5) as compared to those with the lowest level. Participants with a high level of posttraumatic stress were almost 10 times more likely to present problematic video game use (OR = 9.49; 95% CI = 3.13-28.82). Conclusions: Years after the pandemic, posttraumatic stress derived from it continues to impact the mental health of adolescents. Further long-term research is needed, as well as close follow-up and intervention in this population.

SESSAMO, follow-up of secondary students to assess mental health and obesity: a cohort study.

During last decades, a departure from health-related lifestyles has been observed among adolescents. Evidence reports that healthy lifestyles could be predictors of better mental health status. The aims of the SESSAMO Project are: 1) to assess the association between lifestyles and physical and mental health; 2) to assess how self-concept and stressful life events can modulate these associations; and 3) to establish the role of social determinants in the lifestyle and in adolescents' health. The SESSAMO Project is a prospective cohort carried out in Spain. Students aged 14-16 years (2nd-4th ESO) and their parents are invited to participate. Baseline data are collected through on-line, validated, self-administered questionnaires through a digital platform. Information on lifestyles, stressful life events and self-concept are collected. Screening of depression, anxiety, eating disorders, suicide risk, psychotic experiences and COVID impact is assessed. Every three years, up to age of 25, participants will be contacted again to update relevant information.

[Intentos de suicidio en personas mayores en servicios de Urgencias psiquiátricas hospitalarias.] / Elderly people's suicide attempts in psychiatric emergency departments.

OBJECTIVE: Elderly people have a high prevalence of mental disorder, low demand for care and increased risk of suicidal behaviour. Psychiatric emergency care may be the gateway to health services. Therefore, the aims of this study were: 1) to compare the profile of people aged sixty-five years and older seen for suicide attempts (SA) and those seen for other mental health problems in hospital psychiatric emergency departments; and 2) to establish the specificity of the Columbia Screening Scale (C-SSRS) in the exploration of suicide risk. METHODS: We carried out a secondary analysis of a descriptive, multicentre, observational, descriptive study comparing all persons seen for SA (n=21) and a control group (n=27) seen for another reason, between January and October 2015. Non-parametric analyses were performed on sociodemographic and clinical variables, stressful life events experienced and C-SSRS. RESULTS: 1) Among those attending for SA, 52.4% were men while those attending for another reason accounted for 18.5%. 2) 38.1% of those attending for SA were in mental health follow-up compared to 66.7% of those attending for other reasons. 3) C-SSRS screening discriminated between those seen for SA and those seen for other reasons. CONCLUSIONS: SA in older men may be the opportunity to initiate care and continuity of care in mental health services. The use of the C-SSRS scale in hospital psychiatric emergency departments is recommended.

OBJETIVO: En las personas mayores hay una alta prevalencia de trastorno mental, baja demanda asistencial y mayor riesgo de conducta suicida. La atención en Urgencias psiquiátricas puede ser la puerta de acceso a los servicios de salud. Por lo tanto, este trabajo tuvo como objetivos: 1) comparar el perfil de las personas de sesenta y cinco o más años atendidas por intento de suicidio (IS) y las atendidas por otros problemas de salud mental en Urgencias psiquiátricas hospitalarias; y 2) establecer la especificidad de la Escala de Cribado Columbia (C-SSRS) en la exploración del riesgo de suicidio. METODOS: Se realizó un análisis secundario de un estudio observacional descriptivo, multicéntrico, en el que se compararon todas las personas atendidas por IS (n=21) y un grupo control (n=27) atendido por otro motivo, entre enero y octubre de 2015. Se realizan análisis no paramétricos en variables sociodemográficas, clínicas, acontecimientos vitales estresantes vividos y C-SSRS. RESULTADOS: 1) Entre quienes acuden por IS el 52,4% eran hombres mientras que los que acudían por otro motivo eran el 18,5%. 2) El 38,1% de quienes acudieron por IS se encontraban en seguimiento en salud mental frente al 66,7% de los atendidos por otros motivos. 3) El cribado mediante C-SSRS discriminó entre las atenciones por IS y otro motivo. CONCLUSIONES: El IS en los hombres mayores puede ser la oportunidad para iniciar la atención y continuidad de cuidados en los servicios de salud mental. Se recomienda el uso de la escala C-SSRS en Urgencias psiquiátricas hospitalarias.

Psychiatric Hospitalization for Attempted Suicide and Reattempt at the One-Year Follow-Up.

BACKGROUND: People hospitalized for suicide attempt (SA) have a high risk of repeating and committing suicide during the first months after discharge. The aim of this study is to compare the usual treatment (TAU) with a TAU supplemented with a telephone follow-up programme (TAU + T). METHOD: Multicentre, open-trial, ex post facto pre-post prospective study that compared two samples of 90 (TAU) and 101 (TAU + T) people admitted in 2018-2019 for attempted suicide in two psychiatry units after one-year follow-up. Repeated SAs were analysed. RESULTS: A total of 31.4% (n =60) of the sample attempted suicide at least once during follow-up, with no differences between the units. A total of 32.5% (n =62) were readmitted during the following year, 15.6% of those readmissions were due to new suicide attempts. In TAU, the highest proportion of reattempts was among those diagnosed with personality disorders (77.8%) vs. other diagnoses (28.4%). In TAU + T, the highest proportion was found among those with previous SAs (50%) vs. those admitted for the first SA (4.4%). CONCLUSIONS: People admitted to psychiatric units for a first SA seem to benefit from TAU + T as it was associated with a lower recurrence of SA after discharge.

SESSAMO, follow-up of secondary students to assess mental health and obesity: a cohort study / SESSAMO, seguimiento de estudiantes de secundaria para valorar salud mental y obesidad: estudio de cohortes

During last decades, a departure from health-related lifestyles has been observed among adolescents. Evidence reports that healthy lifestyles could be predictors of better mental health status. The aims of the SESSAMO Project are: 1) to assess the association between lifestyles and physical and mental health; 2) to assess how self-concept and stressful life events can modulate these associations; and 3) to establish the role of social determinants in the lifestyle and in adolescents’ health. The SESSAMO Project is a prospective cohort carried out in Spain. Students aged 14-16 years (2nd-4th ESO) and their parents are invited to participate. Baseline data are collected through on-line, validated, self-administered questionnaires through a digital platform. Information on lifestyles, stressful life events and self-concept are collected. Screening of depression, anxiety, eating disorders, suicide risk, psychotic experiences and COVID impact is assessed. Every three years, up to age of 25, participants will be contacted again to update relevant information. (AU)

En las últimas décadas se ha producido un alejamiento de los estilos de vida saludables en adolescentes. Los hábitos saludables pueden predecir una mejor salud mental. El proyecto SESSAMO tiene como objetivos: 1) determinar la asociación entre el estilo de vida y la salud física y mental; 2) determinar cómo el autoconcepto y los acontecimientos vitales estresantes pueden modular dichas asociaciones; y 3) establecer el papel de los determinantes sociales en el estilo de vida y en la salud de los adolescentes. Se trata de un estudio de cohortes prospectivo, dirigido a estudiantes de secundaria de 14-16 años y a sus padres. Los datos basales se recogen con cuestionarios validados y autoadministrados en una plataforma on-line. Se realiza un cribado de depresión, ansiedad, trastornos alimentarios, riesgo de suicidio, experiencias psicóticas e impacto de la COVID-19. Cada 3 años, hasta la edad de 25 años, se les volverá a contactar para actualizar la información relevante. (AU)

Intentos de suicidio en personas mayores en servicios de Urgencias psiquiátricas hospitalarias / Elderly people’s suicide attempts in psychiatric emergency departments

Fundamentos: En las personas mayores hay una alta prevalencia de trastorno mental, baja demanda asistencial y mayor riesgo de conducta suicida. La atención en Urgencias psiquiátricas puede ser la puerta de acceso a los servicios de salud. Por lo tanto, este trabajo tuvo como objetivos: 1) comparar el perfil de las personas de sesenta y cinco o más años atendidas por intento de suicidio (IS) y las atendidas por otros problemas de salud mental en Urgencias psiquiátricas hospitalarias; y 2) establecer la especificidad de la Escala de Cribado Columbia (C-SSRS) en la exploración del riesgo de suicidio. Métodos: Se realizó un análisis secundario de un estudio observacional descriptivo, multicéntrico, en el que se compararon todas las personas atendidas por IS (n=21) y un grupo control (n=27) atendido por otro motivo, entre enero y octubre de 2015. Se realizan análisis no paramétricos en variables sociodemográficas, clínicas, acontecimientos vitales estresantes vividos y C-SSRS. Resultados: 1) Entre quienes acuden por IS el 52,4% eran hombres mientras que los que acudían por otro motivo eran el 18,5%. 2) El 38,1% de quienes acudieron por IS se encontraban en seguimiento en salud mental frente al 66,7% de los atendidos por otros motivos. 3) El cribado mediante C-SSRS discriminó entre las atenciones por IS y otro motivo.Conclusiones: El IS en los hombres mayores puede ser la oportunidad para iniciar la atención y continuidad de cuidados en los servicios de salud mental. Se recomienda el uso de la escala C-SSRS en Urgencias psiquiátricas hospitalarias.(AU)

Background: Elderly people have a high prevalence of mental disorder, low demand for care and increased risk of suicidal behaviour. Psychiatric emergency care may be the gateway to health services. Therefore, the aims of this study were: 1) to compare the profile of people aged sixty-five years and older seen for suicide attempts (SA) and those seen for other mental health problems in hospital psychiatric emergency departments; and 2) to establish the specificity of theColumbia Screening Scale (C-SSRS) in the exploration of suicide risk. Methods: We carried out a secondary analysis of a descriptive, multicentre, observational, descriptive study comparing all persons seen for SA (n=21) and a control group (n=27) seen for another reason, between January and October 2015. Non-parametric analyses were performed on sociodemographic and clinical variables, stressful life events experienced and C-SSRS. Results: 1) Among those attending for SA, 52.4% were men while those attending for another reason accounted for 18.5%. 2) 38.1% of those attending for SA were in mental health follow-up compared to 66.7% of those attending for other reasons. 3) C-SSRS screening discriminated between those seen for SA and those seen for other reasons. Conclusions: SA in older men may be the opportunity to initiate care and continuity of care in mental health services. The use of the C-SSRS scale in hospital psychiatric emergency departments is recommended.(AU)

Manía transcultural en UCI / Cross-cultural mania in ICU

Objetivo: Presentar el caso clínico de una fase grave de manía que padece un posible síndrome neuroléptico maligno (SNM). Caso clínico joven de 16 años, natural de España, con familia de origen argelina. Diagnosticada de trastorno bipolar. En el episodio actual, inicia un cuadro de descompensación psicopatológica tras el abandono del tratamiento psicofarmacológico. Presenta agripnia, irritabilidad, fugas de domicilio, ánimo expansivo, así como alteraciones del comportamiento rechazando toda práctica de su cultura islámica. Debido a todo ello, precisa un ingreso involuntario en la unidad de hospitalización. Durante este, debido a conductas graves, se requiere contención mecánica y farmacológica. Súbitamente comienza con un cuadro de fiebre, temblor generalizado y aumento de CPK en la analítica, lo que motiva su traslado a UCI para observación y tratamiento intensivo ante la posibilidad de SNM.Resultadostras la estabilización se decide el alta con diagnóstico de posible SNM e infección respiratoria, apreciándose una mejoría clínica evidente.Conclusionesno existen criterios universales para el SNM, la paciente presenta varios síntomas típicos no pudiéndose confirmar que estemos antes un SNM en su totalidad. Los aspectos socio-culturales modulan la psicopatología de una forma característica. (AU)

Objective: To present the clinical case of a severe phase of mania suffering from a possible Neuroleptic Malignant Syndrome (NMS).Clinical case16-year-old girl, native of Spain, family of Algerian background. Diagnosed with bipolar disorder. In the current episode, she begins a psychopathological decompensation after abandoning psychopharmacological treatment. She presents agripnia, irritability, escapes from home, expansive mood, as well as behavioral alterations rejecting any practice of her Islamic culture. Due to all this, she needs an involuntary admission to the hospitalization unit. During this, due to serious behaviors, mechanical and pharmacological restraint is required. Suddenly she begins to develop fever, generalized tremor and increased CPK in blood tests, which led to her transfer to the ICU for observation and intensive treatment due to the possibility of NMS.ResultsAfter stabilization, discharged was decided with a diagnosis of possible NMS and respiratory infection, with evident clinical improvement.ConclusionsThere are no universal criteria for NMS, the patient presents several typical symptoms but it is not possible to confirm that we are before a NMS in its totality. Socio-cultural aspects modulate psychopathology in a characteristic way. (AU)

La complejidad neuroconductual del síndrome de diógenes: a propósito de un caso / The neurobehavioral complexity of diogenes syndrome: A case report

El síndrome de Diógenes constituye un reto para los clínicos. Descrito en adultos mayores, está caracterizado por el abandono extremo del autocuidado, acumulación de objetos inservibles, autonegligencia, aislamiento social y nula conciencia de la enfermedad. Entre un tercio y la mitad cursa con demencias frontotemporales o con algún trastorno mental. Se presenta el caso de un varón de 71 años que ingresa en psiquiatría por alteraciones conductuales. Presenta conducta de acumulación, abandono de higiene, desorganización y pérdida de hábitos. La conducta genera conflictos vecinales y alarma social, por lo que intervienen los servicios sociales. Las pruebas de imagen no aportan hallazgos patológicos significativos. La exploración neuropsicológica indica afectación leve de las áreas prefrontales dorsolaterales, dorsomediales y orbitofrontales. No se objetiva psicopatología aguda. Se interviene multidisciplinarmente, en formato de hospital de día, con supervisión conductual, plan de estructuración del tiempo, promoción de la autonomía y apoyo social. Este caso evidencia la complejidad del proceso diagnóstico y la movilización de recursos sociales, sanitarios y legales dadas las repercusiones en todas las áreas. (AU)

Diogenes syndrome is a challenge for clinicians. It is described in older adults. It is characterized by extreme neglect of self-care, accumulation of useless objects, self-neglect, social isolation and no awareness of illness. Between a third and a half of the patients have frontotemporal dementias or a mental disorder. We present the case of a 71-year-old male admitted to psychiatry due to behavioral disorders. He presents hoarding behavior, neglect of hygiene, disorganization and loss of habits. The behavior generates neighborhood conflicts and social alarm, for which social services intervene. Neuroimaging studies do not provide significant pathologic findings. Neuropsychological examination showed mild involvement of dorsolateral, dorsomedial, and orbitofrontal prefrontal areas. No acute psychopathology was observed. Multidisciplinary intervention is performed in a day hospital, with behavioral supervision, time structuring plan, promotion of autonomy and social support. This case shows the complexity of the diagnostic process and the mobilization of social, health and legal resources given the repercussions in all areas. (AU)

Psychiatric Hospitalization for Attempted Suicide and Reattempt at the One-Year Follow-Up / Hospitalización Psiquiátrica por Intento de Suicidio y Reintento al Año de Seguimiento

Background: People hospitalized for suicide attempt (SA) have a high risk of repeating and committing suicide during the first months after discharge. The aim of this study is to compare the usual treatment (TAU) with a TAU supplemented with a telephone follow-up programme (TAU + T). Method: multicentre, open-trial, ex post facto pre-post prospective study that compared two samples of 90 (TAU) and 101 (TAU + T) people admitted in 2018-2019 for attempted suicide in two psychiatry units after one-year follow-up. Repeated SAs were analysed. Results: A total of 31.4% (n=60) of the sample attempted suicide at least once during follow-up, with no differences between the units. A total of 32.5% (n=62) were readmitted during the following year, 15.6% of those readmissions were due to new suicide attempts. In TAU, the highest proportion of reattempts was among those diagnosed with personality disorders (77.8%) vs. other diagnoses (28.4%). In TAU + T, the highest proportion was found among those with previous SAs (50%) vs. those admitted for the first SA (4.4%). Conclusions: people admitted to psychiatric units for a first SA seem to benefit from TAU + T as it was associated with a lower recurrence of SA after discharge.(AU)

Antecedentes: las personas hospitalizadas por un intento de suicidio (IS) tienen un riesgo alto de repetir/consumar el suicidio en los meses siguientes al alta. El objetivo de este estudio es comparar un tratamiento habitual (TAU) con un TAU complementado con un programa de seguimiento telefónico (TAU + T). Método: estudio multicéntrico, abierto, ex post-facto pre-post prospectivo de dos grupos que comparó dos muestras de 90 (TAU) y 101 (TAU+T) personas ingresadas en 2018-2019 por IS tras un año de seguimiento. Se analizó las repeticiones de los IS. Resultados: el 31,4% (n=60) realizó al menos un intento de suicidio en el seguimiento, sin diferencias entre los dos centros. El 32,5% (n=62) reingresó en el año siguiente, de ellos el 15,6% debido a nuevos intentos. En TAU, la mayor proporción de reintentos se dio entre quienes estaban diagnosticados de trastornos de personalidad (77,8%) vs. resto de diagnósticos (28.4%). En TAU + T la mayor proporción se dio entre quienes presentaban IS anteriores (50%) vs. ingresados por primer IS (4.4%). Conclusiones: las personas ingresadas en unidad de hospitalización por un primer IS, parecieron beneficiarse del TAU + T ya que se asoció a una menor recurrencia de los IS posterior al alta.(AU)

Trastorno ciclotímico de inicio en la adolescencia: a propósito de un caso clínico / Adolescent onset of a Cyclothymic Disorder: About a clinical case

El trastorno bipolar (TB) es uno de los trastornos psiquiátricos con mayor tasa de heredabilidad, no solo de trastorno bipolar, sino también de otros trastornos afectivos, incluyendo el trastorno ciclotímico (TC). Es por ello que resulta de máxima importancia la detección temprana de trastornos afectivos en la descendencia. Presentamos el caso de una adolescente de 16 años con antecedentes de primer grado de TB Tipo I, que es remitida a nuestra unidad ante la presencia de sintomatología afectiva para estudio y tratamiento. (AU)

Bipolar Disorder (BP) is one of the psychiatric disorders with a higher heritability rate, not only of bipolar disorder, but other forms of affective and mood disorders as well, including cyclothymic disorder (CD). Given this information, early detection in young descendants seems of the utmost importance. We present de clinical case of a 16 years old female, with a first-degree relative affected by BD Type I, referred to our unit given the presence of affective symptoms, for its study and treatment. (AU)

Cocaína y síndrome de Ekbom: a propósito de un caso / Cocaine and Ekbom syndrome: A case report

El delirio de parasitosis es un trastorno psicocutáneo caracterizado por la presencia de una convicción delirante de parasitación en el paciente. Se presenta el caso clínico de una mujer diagnosticada de síndrome de Ekbom, secundario al consumo de cocaína, que presentó una buena respuesta clínica al tratamiento con olanzapina. Para el tratamiento del delirio de parasitosis es fundamental el trabajo multidisciplinar junto a psiquiatría, así como el establecimiento de un estrecho vínculo terapéutico con el paciente. (AU)

Delusional infestation is a psycho-cutaneous disorder in which sufferers have a fixed belief of parasitization.A case report of a woman diagnosed with delusional infestation secondary to cocaine use is presented, with a good clinical response to treatment with olanzapine. For the treatment of delusional infestation, multidisciplinary work with psychiatry is essential, as well as the establishment of a strong therapeutic rapport with the patient. (AU)