Introduction Home hospitalization is an alternative to conventional hospitalization in several areas of medicine. In Portugal, we are now starting to think about its implementation in Psychiatry, given the positive experience of its use in other countries. Objectives Understand the advantages and disadvantages of a home hospitalization model and its logistical and clinical framework in an integrated community-focused care model. Methods We performed a literature review using Pubmed databases and UpToDate on home hospitalization, inpatient care and community-focused care model Results We have found reports of centers with experience in home hospitalization in Psychiatry, but there is still a notable lack of studies in this area. There is a discrepancy between the care needs of patients and the existence of community services for the treatment of mental illness. Home hospitalization is considered when there is partial remission of the symptomatology that motivated the hospitalization. Albeit demanding inclusion criteria limit eligible patients, there are several advantages with this hospitalization model: 1) it favors agility in the transition from hospital to home, with direct observation of contextual factors that may influence psychiatric decompensation, 2) integrates the patient in his natural environment, promoting his autonomy,; 3) allows psychoeducation of the family; 3) guarantees the continuity of the therapeutic process initiated in the hospital, 4) optimizes resources and cost-effectiveness, 5) prevents relapses and the “revolving-door “phenomenon. Conclusions We have found that a model of home hospitalization is a valuable element that should be included in an integrated system of psychiatric care. Disclosure No significant relationships.

Lithium toxicity. A case report E. Rodríguez Vázquez*, C. Capella Meseguer, I. Santos Carrasco, J. Gonçalves Cerejeira, A. Gonzaga Ramírez, M. Queipo De Llano De La Viuda, G. Guerra Valera, C. De Andrés Lobo, T. Jiménez Aparicio and C. Vallecillo Adame Psiquiatría, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Psiquiatría, HCUV, Valladolid, Spain; Psiquiatría, Hospital Clínico Universitario Valladolid, Valladolid, Spain and Psiquiatría, Hospital Clínico Universitario Valldolid, Valladolid, Spain *Corresponding author. doi: 10.1192/j.eurpsy.2021.1728

IntroductionHealth-related behavior correlates in critical ways with the current epidemic of chronic diseases. Modifiable behaviors increase the risk of chronic disease. Despite there are well-identified behaviors, efforts at behavior change are clinically-challenging and frequently ineffective.ObjectivesWe aim to establish how the current evidence and latest neuroscientific knowledge about behavioral change allow the most reliable assessment of patients with refractory health-related behaviors that negatively impact health outcomes.MethodsWe performed a literature review using Pubmed databases and UpToDate. The search included “behavioral change” and “health-related behavioral change”[MeSH Terms].ResultsHabitual behavior consists of behavioral patterns operating below conscious awareness and acquired through context-dependent repetition. Behavioral change is a complex multi-level field of intervention. The Health Belief Model allows a careful description of the patient’s perceived vulnerability, perceived disease severity, self-efficacy, and change motivation. The identification of social variables is critical since they correlated with poor health outcomes, particularly in chronic diseases. Temperament and character traits can have a strong influence on the difficulty of changing habitual behavior. Psychopathology, if present, must be addressed because it can be a notable factor of behavior instability and correlates negatively to health outcomes. Assertive and efficient communication skills in the clinical context are imperative. Motivational interviewing skills can allow effective behavioral change.ConclusionsInterventions addressing behavior change require careful, thoughtful work that leads to a deep understanding of the nature of what motivates people. Intervention based strategies focused on behavioral change must undergo further investigation in the future.DisclosureNo significant relationships.

ObjectiveMaintenance treatment may improve quality of life (QoL) in heroin-dependent patients.The study compares the QoL of heroin-dependent patients between those receiving methadone and those receiving buprenorphine maintenance treatment.Additionally, the study assessed QoLassociated factors. MethodsWe performed a cross-sectional study on patients with heroin dependence receiving maintenance treatment (either methadone or buprenorphine) for at least 3 months.The Chinese Health Questionnaire (CHQ-12), Obsessive Compulsive Drug Use (OCDUS) questionnaire, and World Health Organization Quality of life-BREF (WHOQOL-BREF) questionnaire were administered. ResultsA total of 149 patients on methadone and 31 on buprenorphine (mean age 49.9 ± 9.8 years) were surveyed.There were no differences in CHQ-12, but the buprenorphine group had a lower score on the OCDUS (P = .035)and a higher total score on the WHOQOL-BREF (P = .004)compared with the methadone group.After adjusting other variables, the buprenorphine group scored higher in the psychological domain of the WHOQOL-BREF (P = .032)than the methadone group.More participants in the buprenorphine group were employed than those in the methadone group (P = .024).Employment was associated with better QoL in the physical, psychological, and environmental domains of the WHOQOL-BREF. ConclusionsHeroin-dependent patients on buprenorphine maintenance treatment had a better QoL and higher likelihood of maintaining a job than those on methadone maintenance treatment.We recommend buprenorphine maintenance treatment for heroin-dependent patients. Acknowlegement

Osteoarthritis is a degenerative disease of the joint, affecting over 30 million people in the US1. A key characteristic of OA is chondrocyte hypertrophy, characterized by chondrocyte changes to a more rounded and osteoblastic phenotype, characterized by increased IL-6 and IL-8 secretion2. While there are no cures for OA, treatments focus on mitigating pain and inflammation, the two main symptoms of OA. However, the analgesics, NSAIDS and corticosteroids commonly used, do not target regeneration and have negative side effects. Local anesthetics (LA) can be used as a pain management alternative but are usually short lasting and therefore, not suited for chronic conditions such as OA. Our engineered sustained release local anesthetic construct successfully delivers bupivacaine for an extended period of time3-5. This study is designed to evaluate the effect of the LA system on chondrocytes in an inflammatory OA-like environment.Chondrocytes were cultured with bolus, liposomal, or construct LA and either untreated or treated with TNF-α and IL-1α for 24 hrs, 48 hrs, or 96 hrs. Chondrocyte viability, interleukin-8 (IL-8), interleukin-6 (IL-6), collagenase activity and proteoglycan deposition were assessed.In the presence of the engineered construct, the chondrocytes retained viability and regenerative function. Moreover, the construct allowed for higher initial doses to be used, which promoted more regeneration and decreased inflammation without compromising cellular viability.The construct promotes a less hypertrophic chondrocyte environment while promoting a more anti-inflammatory environment. These two factors are consistent with a less OA progressive environment when using the engineered construct, compared to bolus LA.