Aims:Examine tobacco and alcohol use patterns in a cohort of patients at their first (FE) or consecutive (CE) admission to a cardiology ward, and trajectories of use between groups over time. Methods:Tobacco and alcohol use was assessed at baseline and after one year on a prospective cohort of 249 patients admitted for CVD using the Timeline Followback method, and the Alcohol, Smoking and Substance Involvement Screening Test. Trajectories within and between groups were analysed using generalized multilevel mixed-effect models for repeated measures. Results and conclusions:Baseline prevalence of FE tobacco use was 29.5% and 15.4% in CE. The mean of weekly cigarettes was 35.8 for FE and 30.2 for CE (n.s.). The study found a significant effect of time on the cessation (p < 0.001) and the reduction (p = 0.018) of tobacco use. FE demonstrated a greater reduction in tobacco use prevalence (p = 0.003) and quantity (p < 0.001) -positive interaction between group and time. Baseline prevalence of alcohol use was 63.8% and 41.9% on FE and CE. Although there was a reduction in the prevalence and quantity of alcohol use in both groups, it remained relatively high. Although the occurrence of a cardiovascular event has a significant impact on the reduction of tobacco use, alcohol use appears more resistant to change post-event.

Levetiracetam (LEV) is a widely used antiepileptic but associated with psychiatric side effects. While mild reactions are common, manic and psychotic episodes are less frequent, though clinically significant. This review critically assesses published cases of (hypo)manic and psychotic episodes related to LEV. A systematic review was conducted using MEDLINE (PubMed), Cochrane Library, and Web of Science (up to 1 June 2025), restricted to studies with primary clinical data on (hypo)manic or psychotic episodes associated with LEV. The quality of each case was assessed using a critical appraisal checklist, and the Naranjo Adverse Drug Reaction Probability Scale was applied to evaluate causality. A total of 50 cases met the inclusion criteria: Eight (hypo)manic and 42 psychotic episodes. The most frequent psychiatric manifestations were delusions (48%), aggressiveness (44%), and manic symptoms (38%). Temporal lobe epilepsy was present in 26% of patients, and 66% had uncontrolled seizures. Although case reports describe an association between LEV and (hypo)manic and psychotic episodes, causality assessment based on the methodological approach applied indicated a low probability that LEV alone was responsible. Alternative explanations, including epilepsy-related factors and comorbid medical conditions, were frequently cited. In some cases, an alternative diagnosis might be manic episode with psychotic features.

BACKGROUND:Smoking and alcohol use worsen Chronic Respiratory Diseases (CRD). Smoking cessation is a cornerstone of treatment. We aim to describe the trajectories of alcohol and tobacco use in patients admitted due to first (FE) or consecutive episodes (CE) of CRD. METHODS:This prospective study assessed tobacco and alcohol use in 219 patients upon admission for CRD and one year later. Generalized multilevel mixed-effect models analyzed changes within and between groups. RESULTS:Significant differences between groups were observed in tobacco use prevalence (p = 0.001) and quantity (p = 0.009). Although overall tobacco use prevalence remained stable over time (p = 0.08) and no significant group-by-time interaction was found, weekly cigarette consumption decreased over time (from 32.1 to 19.7 in FE, 15.5 to 4.9 in CE) (p = 0.009). Alcohol use prevalence remained at approximately 50% in both groups and time points. The number of standard drink units per week (SDU)/week showed significant group effects (p = 0.03). CONCLUSIONS:Admission for a respiratory event alone is not sufficient to induce smoking cessation in many patients. Alcohol use prevalence remains high without significant changes. This gap could be reversed by implementing integrated brief interventions based on motivational interviewing for these patients.

Shortcomings of intensive care units (ICU) delirium screening tools include not measuring its core features, not excluding stupor/coma and not being continuous measurement instruments. We validated the Delirium Diagnostic Tool-Provisional (DDT-Pro) that assesses all 3 core symptom domains for delirium and subsyndromal delirium (SSD) in the ICU. This is a multicenter validation following STARD guideline. Delirium reference standards were DSM-5 criteria, cluster analysis (CA) of the DDT-Pro scores and clinical validators for preestablished DDT-Pro ≤ 6 and ≤ 7 cutoffs (0–9 range) for delirium and SSD. DDT-Pro dimensionality and internal consistency reliability are reported. Of 127 patients, 29 (22.8%) had DSM-5 delirium. The area under the receiver-operator DDT-Pro curve was 90% with the ≤ 7 and ≤ 6 DDT-Pro cutoffs which had 82.7% and 80.3% accuracy at the most balanced sensitivity-specificity. The ≤ 6 cutoff specificity (85.7%) was higher, while ≤ 7 cutoff sensitivity (89.7%) was higher with NPV = 96.2%. According to CA, ≤7 cutoff differentiated 100% of nondelirium patients from SSD and delirium, whereas DSM-5 misattributed SSD. Validation of an SSD group was supported by delirium severity gradients and various clinical validators. Cases in this CA also coincided exactly with nondelirium, SSD and delirium groups prespecified by DDT-Pro cutoffs from non-ICU samples. One factor explained 69.9% of the DDT-Pro variance, Cronbach α = 0.79 (cohesive delirium dimension). Our findings indicate that the DDT-Pro has very good construct validity and discriminates ICU delirium against DSM-5, performing even more cleanly using agnostic CA for SSD and delirium diagnosis. Its continuous score structure discernment of SSD was supported by clinical validators. ICU cutoffs were the same as in previous inpatient samples.

Introduction The Acute Organic Change of Character (AOCC) is an organic mental disorder subtype in which perception, thought, mood and personality impairment predominate. It consists in a change in the individual’s general behaviour or attitude, which is shown to be closely associated with or caused by an underlying organic process, and which is rapidly resolved when the organic noxious agent is eliminated (Pintor et al. Journal of Psychiatry and Psychiatric Disorders 4 (2020): 354-358). Objectives To describe the importance of taking AOCC diagnosis into consideration and the role of liaison psychiatrists in AOCC management by presenting two AOCC cases admitted to the Hospital Clinic of Barcelona. Methods We retrospectively reviewed two AOCC cases in patients followed by our hospital’s liaison psychiatry unit during the summer of 2023. We also searched for previous case reports of AOCC using a PubMed query. Results Case 1: A 50-year-old male who suffered a polytrauma with diffuse axonal injury (DAI). His relatives and the referring medical team observed a change in his behaviour consisting in irritability, suspicion, hostility and impatience. No cognitive impairment nor fluctuation in the described symptoms were observed. At the time of discharge character changes were still present due to DAI slow and unpredictable clinical course. Symptomatic treatment with risperidone 6mg/day and quetiapine 100mg/day was administered achieving a satisfactory clinical response. Case 2: A 47-year-old woman with type 2 diabetes who suffered an infectious cellulitis that spread causing sepsis. The patient began to appear disruptive with verbose and tangential speech during her admission. No cognitive impairment nor fluctuation in the described symptoms were observed. Symptomatic treatment with risperidone 10mg/day and olanzapine 5mg/day was administered achieving a satisfactory clinical response. At the time of discharge character changes described before were almost resolved. Conclusions The clinical presentation of both cases suggested organic mental disorders in which a change in general behaviour predominates. Liaison psychiatrists play a key role in AOCC management by recognizing the clinical pattern, helping if needed with psychopharmacological treatment and ensuring a good understanding of the disorder both by the referring medical team and the patient’s relatives. To our knowledge, it would be of great importance to achieve a better understanding of this clinical condition which to date we consider to be underdiagnosed. Disclosure of Interest None Declared

Psychotic disorders are more frequent in people with epilepsy than the general population. They constitute one of the most serious psychiatric comorbidities which require an immediate psychopharmacologic intervention. Yet, access to psychiatrists is often limited or not available and the neurologists taking care of these patients are called-upon to start treatment with antipsychotic medication. The purpose of this manuscript is to provide clinicians with pragmatic psychopharmacologic strategies to treat interictal psychotic disorders in patients with epilepsy. We review the case of a 45 years-old man with a 35-year history of treatment-resistant focal epilepsy of bitemporal origin who developed a de-novo psychotic episode that began with insomnia, mood lability and agitation and evolved into paranoid delusions, auditory hallucinations and a thought disorder. The patient was diagnosed with an interictal psychotic episode and was treated with aripiprazole which resulted in significant improvement after reaching a 20 mg /day dose and allowed for the patient to be discharged home. In summary, interictal psychotic episodes of epilepsy are relatively frequent in patients with epilepsy and require of an early psychopharmacologic treatment to facilitate their remission or stabilization until mental health professionals can take over their long-term care. Compared to primary psychotic disorders, interictal psychotic episodes respond better and at lower doses of antipsychotic drugs.

Objective: Psychogenic non-epileptic seizures (PNES) are complex clinical manifestations and misdiagnosis as status epilepticus remains high, entailing deleterious consequences for patients. Video-electroencephalography (vEEG) remains the gold-standard method for diagnosing PNES. However, time and economic constraints limit access to vEEG, and clinicians lack fast and reliable screening tools to assist in the differential diagnosis with epileptic seizures (ES). This study aimed to design and validate the PNES-DSC, a clinically based PNES diagnostic suspicion checklist with adequate sensitivity (Se) and specificity (Sp) to discriminate PNES from ES. Methods: A cross-sectional study with 125 patients (n = 104 drug-resistant epilepsy; n = 21 PNES) admitted for a vEEG protocolised study of seizures. A preliminary PNES-DSC (16-item) was designed and used by expert raters blinded to the definitive diagnosis to evaluate the seizure video recordings for each patient. Cohen's kappa coefficient, leave-one-out cross-validation (LOOCV) and balance accuracy (BAC) comprised the main validation analysis. Results: The final PNES-DSC is a 6-item checklist that requires only two to be present to confirm the suspicion of PNES. The LOOCV showed 71.4% BAC (Se = 45.2%; Sp = 97.6%) when the expert rater watched one seizure video recording and 83.4% BAC (Se = 69.6%; Sp = 97.2%) when the expert rater watched two seizure video recordings. Conclusion: The PNES-DSC is a straightforward checklist with adequate psychometric properties. With an integrative approach and appropriate patient history, the PNES-DSC can assist clinicians in expediting the final diagnosis of PNES when vEEG is limited. The PNES-DSC can also be used in the absence of patients, allowing clinicians to assess seizure recordings from smartphones.

RESUMEN Introducción y objetivos: El abordaje sistemático en pacientes con angina con arterias coronarias no obstruidas (ANOCA) o con isquemia con arterias coronarias no obstruidas (INOCA) no está bien protocolizado. Métodos: Todos los pacientes con diagnóstico de INOCA o ANOCA se trasladaron a una clínica ambulatoria específica para evaluar su elegibilidad para el programa NOCA. Si eran elegibles, se sometían a una angiografía coronaria programada con pruebas de función coronaria y provocación intracoronaria con acetilcolina. La terapia médica se optimizó en consecuencia. Todos los pacientes tuvieron un seguimiento a 1, 3, 6 y 12 meses. Al inicio y a los 3 meses se aplicaron los cuestionarios SAQ y EuroQol-5D. Resultados: De 77 pacientes se excluyeron 23 (29,9%) y se incluyeron 54 (70,1%) (29 [53,7%] con INOCA y 25 [46,3%] con ANOCA). Se diagnosticó angina microvascular a 19 (35,2 %) pacientes, angina vasoespástica a 12 (22,2 %), angina microvascular y angina vasoespástica a 18 (33,3 %), y dolor torácico no coronario a 5 (9,3 %). Hubo un aumento significativo en el uso de bloqueadores beta, bloqueadores del calcio y nitratos. Se presentaron complicaciones en 3 (5,5%) pacientes. No hubo diferencias en la puntuación media del EQ-5D a los 3 meses y se observó una...

Introduction and objectives: A systematic approach to patients with angina with no obstructed coronary arteries (ANOCA) or ischemia with no obstructed coronary arteries (INOCA) patients is not routinely implemented.Methods: All consecutive patients diagnosed with ANOCA/INOCA were referred to a designated outpatient clinic for a screening visit to assess their eligibility for a NOCA program. If eligible, patients underwent scheduled coronary angiograms with coronary function testing and intracoronary acetylcholine provocation testing. Medical therapy was optimized accordingly. All patients were then followed up at 1, 3, 6, and 12 months. Baseline and 3-month follow-up assessments included the Seattle Angina Questionnaire (SAQ) and EuroQol-5D questionnaire.Results: Of 77 patients screened, 23 (29.9%) were excluded and 54 (70.1%) were included (29 [53.7%] with INOCA and 25 [46.3%] with ANOCA). Microvascular angina was diagnosed in 19 (35.2%) patients, vasospastic angina in 12 (22.2%), both microvascular angina and vasospastic angina in 18 (33.3%), and noncoronary chest pain in 5 (9.3%). There was a notable increase in the use of beta-blockers, calcium channel blockers and nitrates. Complications occurred in 3 (5.5%) patients. Compared with baseline, there was no difference in the mean EQ-5D score at the 3-month follow-up, but there was a significant improvement in the SAQ score related to physical limitations, angina stability, and disease perception, with no differences in angina frequency or treatment satisfaction. No events were recorded at the 1-year follow-up.Conclusions: A specific diagnostic and therapeutic protocol can be easily and safely implemented in routine clinical practice, leading to improvement in patients' quality of life.

OBJECTIVE:Psychogenic non-epileptic seizures (PNES) mimic epileptic seizures without electroencephalographic correlation. Although classified as psychiatric disorders, their neurobiological or structural basis remains unclear. This study aimed to assess the prevalence and characteristics of MRI abnormalities in patients with PNES and those with comorbid epilepsy, compared to the general population, to enhance radiological evaluation and management. METHOD:We retrospectively identified patients with a definitive diagnosis of PNES, evaluated in the refractory epilepsy unit of our tertiary epilepsy center. Patients were classified into two groups according to their comorbidity with epilepsy (PNES and PNES+). The MRI findings were evaluated and classified by two radiologists, who reported the category of the findings, laterality, and location. The two groups were compared using the chi-square test, as well as the frequencies of findings in the general population extracted from the literature. RESULTS:Forty-six patients fulfilled the inclusion criteria. Thirty females and 16 males. MRI findings were present in 25/35 (71.4%) patients in the PNES group and 9/11 (81.8%) In the PNES + group, showing statistically significant differences in the frequency of findings with the general population (8.4-28.1%). SIGNIFICANCE:MRI anomalies are common in PNES patients and even more prevalent in complex cases referred to epilepsy units, underscoring the necessity of correlating MRI findings with clinical-electrical patterns. PLAIN LANGUAGE SUMMARY:In this article, we observed a higher frequency of cerebral magnetic resonance findings in patients with psychogenic non-epileptic seizures than in the general population. We also observed a higher frequency of this pathology among women, as well as right cerebral hemisphere affections. The exposed findings suggest a potential structural basis of this pathology. This hypothesis requires confirmation with larger studies.

AbstractObjectiveThe Epilepsy Self‐Stigma Scale (ESSS) has been developed in Japan for patients with epilepsy (PWE). We aimed to validate the scale in Spanish and examine its validity and reliability.MethodsThe transcultural adaptation of the ESSS was conducted using translation and back‐translation, along with pilot testing and an expert panel review. An online questionnaire was used to assess construct validity, criterion validity, and internal consistency.ResultsA total of 260 out of 628 participants completed the questionnaires. We found a two‐factor structure that explained 61.3% of the total variance: factor 1 “self‐perceived discrimination” with a Cronbach's alpha of 0.80, and factor 2 “social isolation” with a Cronbach's alpha of 0.75. The reliability of overall ESSS‐S 8‐item scores was high (Cronbach's alpha = 0.74). Convergent validity was tested and demonstrated a significant correlation. P.Self‐perceived discrimination scores were associated with higher anxiety and depression scores (r = 0.53/0.54; p < 0.001), lower self‐esteem (−0.53; p < 0.001), and lower quality of life (r = −0.66; p < 0.001). Social isolation scores were associated with higher anxiety and depression scores (r = 0.41/0.33; p < 0.001), lower self‐esteem (−0.34; p < 0.001), and lower quality of life (r = −0.35; p < 0.001). Temporal reliability was also tested, showing a test–retest ICC of 0.87. The mean self‐stigma score in the Spanish population was 17.68 ± 5.45 out of 32 points. Invariance across gender and age groups indicated that there are no systematic response biases by gender or age, so stratified scores could be related to other constructs.SignificanceThe Spanish version of ESSS (ESSS‐S) is a valid and reliable tool for the assessment of self‐stigma in PWE among Spanish speakers.Plain Language SummaryThis study aimed to validate the Epilepsy Self‐Stigma Scale (ESSS) for Spanish speakers (ESSS‐S). We conducted transcultural adaptation of the scale. ESSS‐S showed high reliability and strong validity, correlating with higher anxiety and depression, lower self‐esteem, and quality of life. ESSS‐S is a reliable and valid tool for assessing self‐stigma in Spanish‐speaking people with epilepsy.

This study examined the dynamic properties of brain regions involved in the genesis and spread of seizures in 10 individuals diagnosed with pharmacoresistant focal epilepsy. The patients and 30 healthy controls underwent resting-state functional magnetic resonance imaging scans and the brain's functional network dynamics were analyzed using the intrinsic ignition framework. Comparative statistical analyses examined the differences in the integration and metastability measures in both groups in the whole brain and specific local brain regions. Invasive electroencephalography evaluations validated the findings of significant global and regional changes in the patient's brain network dynamics. There was a marked increase in global integration and metastability across the brain, reflecting substantial alterations in the overall connectivity and flexibility of the functional networks. Specific brain regions exhibited paradoxical dynamics within the seizure onset zone, with decreased intrinsic ignition and increased metastability. Increased intrinsic ignition was observed in remote brain regions, suggesting a reorganization of the brain network hubs and potential pathways for seizure propagation. Using the intrinsic ignition framework provided insights into dynamic alterations in the brain networks of patients with epilepsy. These have increased our understanding of the mechanisms underlying epileptic seizures and may guide the development of diagnostic biomarkers and targeted therapeutic interventions.

Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by a wide variety of symptoms, including frequent neurological and psychiatric symptomatology. Psychiatric symptoms encountered in SLE are frequent, between 37 and 95% of SLE patients present them, can appear at any point in the course of the disease and may include almost any type of disorder. We present the case of a 32-year-old woman who presented an SLE debut with catatonic symptoms without previous psychiatric history, representing a diagnostic and therapeutic challenge given that the diagnosis was initially wrongly filtered out and required up to three hospital admissions in a row to reach a proper diagnosis and treatment.

BACKGROUND:Suicide has become a first-order public health concern, especially following the negative impact of COVID-19 on the mental health of the general population. Few studies have analysed the effects of early psychotherapeutic interventions on subjects who have attempted suicide, and even fewer have focused on those hospitalized in non-psychiatric units after a Medically Serious Suicide Attempt (MSSA). The main aim of this study is to describe the protocol designed to evaluate the effectiveness of individual psychological treatment for patients hospitalized after an MSSA. The secondary objectives of the study are: (1) to evaluate the impact on quality of life and other psychosocial variables of patients with a recent MSSA who receive early psychological intervention; (2) to analyse the biological, psychological, and clinical impact of early psychotherapeutic treatment on subjects hospitalized after an MSSA. METHODS:A longitudinal randomised controlled trial will be conducted with patients over 16 years of age admitted to two general hospitals. The case intervention group will enrol for 8-sessions of individual psychotherapy, Suicide Attempts Multi-component Intervention Treatment (SAMIT), combining Dialectical Behaviour Therapy (DBT), Mentalization-Based Therapy (MBT), and Narrative approaches, while the control group will receive a treatment-as-usual intervention (TAU). Longitudinal assessment will be conducted at baseline (before treatment), post-treatment, and 3, 6, and 12 months after. The main outcome variable will be re-attempting suicide during follow-up. DISCUSSION:Some psychotherapeutic interventions, usually implemented in outpatient, have proven to be effective in preventing suicidal behaviours. The combination of some of these may be a powerful treatment for preventing future SA in patients hospitalised after an MSSA, which is the most severely suicidal subgroup. Moreover, assessment of the biological, clinical and psychometric impact of this new intervention on patients during the first year after the attempt may help understand some of the multi-level factors associated with the effectiveness of psychotherapeutic interventions in MSSAs. The prevalence of high suicide rates requires the design of effective psychological interventions for their prevention, and also in order to design new pharmacological and psychological treatments. TRIAL REGISTRATION:ClinicalTrials.gov ID: NCT06238414. Date of registration: 1st February 2024, final update is protocol version 3.0, 19th March 2024.

BACKGROUND:Delirium is the most prevalent neuropsychiatric syndrome experienced by patients admitted to inpatient clinical units, occurring in at least 20% of medically hospitalized patients and up to 85% of those admitted to critical care units. Although current guidelines recommend the implementation of universal prevention strategies, the use of management strategies largely depends on constant surveillance and screening. This allows for the timely diagnosis and correction of its underlying causes and implementation of management strategies. OBJECTIVE:It was to adapt and analyze the Spanish adaptation of the Stanford Proxy Test for Delirium (S-PTDsv) instrument for its use among Spanish-speaking populations. The S-PTD is an instrument consisting of 13 observational items to be completed by a clinician observer, usually the patient's nurse. The completion of the questionnaire takes about 1 minute and does not require the active participation of the person evaluated, which has important clinical advantages compared to other available instruments (e.g., the Confusion Assessment Method). METHODS:The psychometric properties of the S-PTDsv were evaluated in a population of 123 patients using a quantitative, cross-sectional design. All subjects were over 18 years of age and hospitalized in various inpatient medico-surgical and intensive care unit services, either at the Barcelona Clinical Hospital (Barcelona, Spain) or the UC-Christus Health Network Clinical Hospital (Santiago, Chile, S.A.). The ultimate diagnosis of delirium was made by a member of the Psychiatry Consult Service by means of an independent neuropsychiatric evaluation based on the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, published in 2013, which is the latest version of the diagnostic manual. All study tests were performed by study personnel who were blinded to each other's test results within an hour of each other. RESULTS:In the receiver operator characteristic (ROC) curve analysis, the S-PTDsv demonstrated excellent classification qualities when compared with the DSM-5 as the classification reference standard. Using a cutoff point of ≥3, the S-PTDsv had a sensitivity of 94% and a specificity of 97%. The area under the curve indicator was equal to 0.95, suggesting the S-PTDsv has an excellent overall performance in accurately identifying cases of delirium. Accordingly, the S-PTDsv's positive predictive value = 0.93, and the negative predictive value = 0.97. The internal reliability measured with Cronbach's alpha was 0.96. Confirmatory factor analysis revealed a 1-dimensional structure with high loadings (>0.72), demonstrating that all items similarly contribute to the total diagnostic dimension, suggesting adequate construct validity. This provided evidence of convergent validity. CONCLUSIONS:The performance of the S-PTDsv, as compared to a blinded neuropsychiatric assessment based on DSM-5, indicates that it is an effective instrument for the detection of delirium, in the Spanish-speaking populations. These results are comparable and consistent with previously published studies in the English language version.

The dysregulation of excitatory and inhibitory neurotransmission is considered a pathological marker of Anorexia Nervosa (AN), however, no systematic evaluation of the proton Magnetic Resonance Spectroscopy (1H-MRS) literature has been conducted to date. Accordingly, we conducted a systematic review of neurometabolite differences between individuals with AN and healthy controls (HC). A comprehensive database search (until June 2023) identified seven studies meeting inclusion criteria. Samples included adolescents and adults with similar mean age (AN: 22.20 HC: 22.60), and female percentages (AN: 98%; HC: 94%). The review found a considerable need for improving study design and the reporting of MRS sequence parameters and analysis. Reduced glutamate concentrations in the ACC and OCC, and reduced Glx concentrations in the ACC were reported by one and two studies, respectively. Lastly, only one study to date has quantified GABA concentrations, with no significant differences found. In conclusion, there is currently insufficient evidence of excitatory and inhibitory neurometabolites changes in AN. As the 1H-MRS literature in AN increases, the key questions herein proposed must be revisited.