ResumenEl duelo es la reacción emocional que se da ante una pérdida. Estas reacciones son universales, afectan a las diferentes dimensiones de la persona y suelen expresarse de forma diversa según la cultura en donde se desenvuelven. La complicación del proceso del duelo, conlleva unas series de manifestaciones clínicas que vulneran y comprometen la salud física y emocional de las personas, y por ello, requieren ser atendidas por profesionales especialistas que puedan aliviar su sufrimiento consecuente. En las últimas décadas se ha invertido mucho trabajo en la descripción de cuáles son los criterios que nos ayuden a diferenciar los duelos normativos de las complicaciones del mismo. Se ha propuesto, tras las evidencias encontradas en las investigaciones realizadas, una entidad clínica propia de los cuadros más complicados, diferenciada de otros trastornos psicológicos. A partir de aquí se podría hablar en un lenguaje común a la hora de definirlo y evaluarlo, facilitando el desarrollo de estudios y resultados aplicables posteriormente al ámbito clínico. En referencia al tratamiento del duelo, en la literatura científica se despliegan un gran número de investigaciones que abordan esta problemática desde las diferentes orientaciones psicológicas, desde donde se sustentan sus procedimientos y ofrecen direcciones y líneas de intervención que ayuden a poder consolar la magnitud de esta vivencia. A pesar de ello, las diferentes revisiones que AbstractThe mourning is the emotional reaction because of a death. These reactions are universals; affect at the different dimensions of the individual and usually to be expressed in a diverse way depends on the culture where it is developed. The complication of the process of the mourning entails a series of clinic manifestations that damage and endanger the physic and emotional health of the people and thus, require to be attended for specialist professionals that can give relief his consequent suffering. In the last decades have been inverted a lot of energies on the description for which criterions help us to differentiate the normative mourning than the difficulties of itself. It has been proposed, after the evidences found in the investigations realized, a clinic entity typical from the symptoms more complex, diversified of other psychological disorders. From here it could be spoken in a communal language to define and evaluate it, facilitating the development of studies and outcomes applicable subsequent to the clinic field. According to the treatment of the mourning, in the scientific literature displays a big number of studies that address this problematic from the different psychological orientations, from where support his procedures and offer directions and lines of intervention helping to give comfort the magnitude of this experience. However, the different revisions realized to value the

IntroductionAnti-NMDA encephalitis normally appears as a characteristic syndrome with typical symptoms that undergoes with multiphase evolution. However, it sometimes develops atypical symptoms so we must perform a careful differential diagnosis.ObjectivesTo conduct a current review of detection and management of anti-NMDAr encephalitis, and psychiatric manifestations.MethodSystematic review of the literature in English (PubMed), with the following keywords: “Autoimmune encephalitis”, “psychosis”, and “NMDA receptor”.ResultsWe present the case of a 15-year-old boy referred to evaluation for a first psychotic episode. He had no past history of psychiatric illness or substance abuse. The only relevant antecedent is multiple sclerosis in a first degree relative. For the last months, he presented high levels of anxiety symptoms apparently related to college stressful events and fluctuating hypoesthesia of left cranial side. Days later, it appeared autolimited gastrointestinal symptoms, headache and fever. During the next days it appeared psychomotor retardation, choreic movements, suicide ideation and mood-congruent paranoid and nihilistic ideation, auditory and visual hallucinations, perplexity and catatonic symptoms so he was hospitalized. We observed cognitive functions impairment, unsteady gait, dysartria, dysphasia, clonus and left babinsky sign. EEG showed slow waves on right frontal area. CFS showed protein elevation and immunologic study revealed positive anti-NMDA antibodies. Treatment with methylprednisolone and gammaglobuline was started with partial response, needing addition of rituximab.ConclusionsIn this case, we highlight the importance of early detection and a detailed differential diagnosis, to determine whether the etiology of psychiatric symptoms in order to achieve an accurate and early treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ResumenObjetivo: En este estudio se va a valorar la prevalencia del diagnóstico de duelo prolongado y evaluar la gravedad de síntomas depresivos, ansiosos y la sintomatología de duelo complicado a los dos meses de darse la pérdi-da. Asimismo, pretendemos estudiar qué variables asociadas al riesgo de duelo, pudieran ser más determinante en su diagnóstico y síntomas y el malestar emocional consecuente.Método: Se han evaluado un total de 66 familiares de pacientes de la Unidad de Cuidados Paliativos (UCP) del Hospital San Cecilio de Granada. Se han realizado medidas a los dos meses después del fallecimiento. En esta investigación se ha explorado el malestar emocional existente, en los cuestionarios Inventario de Depresión de BECK (BDI-II), el Inventario de Ansiedad de Beck (BAI), el Inventario de Duelo Complicado (IDC) y el cuestionario de Duelo Prolongado (PG-12).Resultados: Los resultados muestran que el 30,3% y 21,21% de los dolientes presentaban puntuaciones de depresión y ansiedad clínica a los dos meses del fallecimiento. La prevalencia de diagnósticos de duelo prolongado, según el PG-12, es de 10,6%, y el 53,03% de los participantes, presentan sintomatología de duelo complicado según el IDC. Asimismo, se muestran diferencias estadísticamente significativas en los dolientes con y sin diagnós-tico de duelo prolongado y las puntuaciones Abstract Aim: This study is going to assess the prevalance of prolonged grief diagnoses and it will evaluate the severity of the symptoms of depression, anxiety and complicated grief two months after a loved one is lost. We also intend to study which variables associated with the risk of grief could be more decisive when diagnosing it, its symptoms and the consequent emotional distress.Method: A total of 66 families of patients in the Palliative Care Unit (PCU) at Hospital San Cecilio in Granada have been evaluated. Measurements were taken two months after the death. This investigation has explored the existing emotional distress using the following questionnaires: Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), Inventory of Complicated Grief (ICG) and Prolongued Grief Disorder (PG-12).Results: The results show that 33.3% and 21.21% of the sufferers had high levels of depression and clinical anxiety two months after the death. The prevalence of prolongued grief diagnoses, according to the PG-12, is 10.6% and 53.03% of the participants showed symptoms of complicated grief according to the ICG. Additionally, statistically significant differences are found in the sufferers with and without a prolongued grief diagnosis and scores in the ICG and BDI-II. The family's financial situation is linked to the presence

IntroductionConsultation-liaison (CL) psychiatry is a branch of psychiatry that study and treat mental health of patients with other medical or surgical conditions. The assistance between hospitals and health services is heterogeneous.Aims and objectivesFor this reason, the objective of our research is to define the clinical characteristics from our CL service and check out the quality relationship with the applicant service, for improving future assistance.MethodsWe made a descriptive analysis of clinical variables from the patients who received assistance during 2 months by the CL service from the hospital del Mar, Barcelona. We got the frequencies and we used the Chi2 test for the comparison between variables: Diagnosis, appearance in the report and treatment in the report.ResultsTotal of the sample: 42 patients, 61.9% women. Mean age: 55.1 years. Psychiatric diagnosis was present before the assistance on 57.1% of the patients. The most frequent diagnosis was Adjustment Disorder (47.6%) and more than one diagnosis was made in the 14.3%. Near the half of the patients required only primary care assistance after the discharge from the hospital. In the 68.3% of the reports appeared information about CL assistance and the indicated treatment didn’t appear in all the reports. Statistically significant differences weren’t found in the comparisons.ConclusionsAdjustment Disorder is supposed to be the most common psychiatric diagnosis in our CL psychiatry service, as we found in the reviewed literature. The results reveal that relationships between services can be improved. More studies must be done for completing information in this issue.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Introduction:More than 60% of psychiatric patients are smokers. Besides a culture of smoking allowance amongst these patients, in the last years all psychiatric services in developed countries are becoming smoking free. Several studies have found negative expectancies in staff and patients where smoking bans are planned. Nevertheless, not many studies have focused on objective measures as changes in medication and features of the admissions period.Objectives:We want to find differences in terms of clinical and treatment management in psychiatric hospitalization associated to smoking ban.Methods:We collected data (regarding medication, socio-demographic and admission characteristics) from all patients admitted to an acute psychiatric hospital in two different time periods, before and after the smoking ban was in force. We collected data (regarding medication, sociodemographic and admission characteristics) from all patients admitted to an acute psychiatric hospital in two different time periods, before and after the smoking ban was in force.Results:More number of leaves of absence (p=0,020) and movement restrictions (p=0,001) during the ban period occurred in comparison to the pre-ban period. On the contrary a lack of significant differences in terms of hospital stay (duration (p=0,479), rate of involuntary admissions (p=0,371) and voluntary discharges (p=0,377)), use of sedatives and doses of antipsychotics was found (p= 0,640 and p=0,194).More number of leaves of absence (p=0,020) and movement restrictions (p=0,001) during the ban period occurred in comparison to the pre-ban period. On the contrary a lack of significant differences in terms of hospital stay (duration (p=0,479), rate of involuntary admissions (p=0,371) and voluntary discharges (p=0,377)), use of sedatives and doses of antipsychotics was found (p= 0,640 and p=0,194).Conclusions:The smoking-ban may have driven to increased grants for leave of absence that secondarily may have underpin demands for leave of absence in patients not allowed to and thus, it may have contribute to an increase in movement restrictions. Further studies with longer periods after the ban may clarify this issue. The smoking-ban may have driven to increased grants for leave of absence that secondarily may have underpin demands for leave of absence in patients not allowed to and thus, it may have contribute to an increase in movement restrictions. Further studies with longer periods after the ban may clarify this issue.