We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
Would you like to know what your stay at Vall d'Hebron will be like? Here you will find all the information.
The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
Amyotrophic lateral sclerosis (ALS) causes muscular degeneration that can affect motor autonomy, oral communication, swallowing and breathing, but the senses, intellect and eyes muscles remain intact. It can therefore affect the respiratory muscles, which is why respiratory care is essential for patients’ quality of life.
In order to improve the respiratory difficulties in patients, ventilation therapy can be used through non-invasive ventilation.
Ventilation therapy refers to breathing support using a ventilator, usually at night during sleep, to achieve:
Ventilation is carried out non-invasively, by means of a patient-adjusted mask (nasal or full face) connected by a tube to the ventilator or respirator.
When patients need this therapy, the place and time it is started, whether outpatient or hospital admission, is planned in a personalised way with the consent of the patient and the person caring for them.
Education for the patient and their main carer should begin as soon as possible, both from the point of view of managing secretions and the resulting care, as well as the emotional support they need to receive. This means that during the patient’s admission or outpatient visit, the patient and their carer will be trained in:
The patient and the carer must take care to keep the airway in good condition to allow secretions to be managed. It is important to preserve the ability to cough where possible, but if coughing is no longer effective, the patient and carer will need to start learning how to use mechanical aids (cough assist or mechanically assisted cough). In certain cases secretion suction may also be used.
To improve the quality of life of patients it is important to follow the advice below:
Patients with Asperger’s syndrome need a stable and predictable environment that can be easily adapted. It is key to their well-being to establish routines according to their interests, organise their time, avoid inactivity or over intense activity as well as sudden changes. Although the syndrome has no cure, appropriate treatment and involving family members can improve the quality of life of patients.
People with Asperger’s syndrome may have different requirements depending on their age, surroundings and the awareness that they have of their difficulties. For this reason, they need a tailor-made programme that responds to their specific case.
The aim of these customised programmes is to:
It is important to manage their development through different disciplines. These may include cognitive treatments, social skills programmes and occupational therapy for the patient. You also have to consider guidelines on how to resolve conflicts and how to manage pyschoeducational groups for families or caregivers.
In infants, from an emotional and attitudinal point of view, it is important to learn to identify the warning signs in their mood. In this way, we can prevent difficulties in anger management and low tolerance to frustration, since they are patients with a high degree of sensitivity to criticism. Avoid punishment as much as possible and establish more positive reinforcement strategies.
All these guidelines must be established in a space where the differences the child or adolescent presents are valued positively, including their limitations, but also their possibilities and positive aspects.
In adults, many of these characteristics continue, as Asperger’s cannot be cured. In any case, personalised treatment, involving family members and good communication with professionals can allow a better quality of life.
Foetal alcohol syndrome disorder (FASD) is characterised by cognitive, behavioural and physical problems caused by exposure to alcohol during pregnancy.
FASD may result in physical symptoms (such as facial abnormalities), growth retardation, damage to the nervous system and cognitive and/or behavioural problems. 90% of people with FASD suffer from psychological disorders, attention deficit hyperactivity disorder (ADHD) being the most common.
The main symptoms of FASD are poor memory and attention span, learning difficulties, problems with recognising cause and effect and lack of social skills and emotional self-regulation. These issues may lead to secondary complications such as poor academic performance, legal issues, inappropriate sexual behaviour, substance abuse and problems finding employment as an adult.
Babies exposed to alcohol in the womb.
FASD diagnosis requires not just physical examination but also neurocognitive and behavioural assessment.
Treatment for FASD is multidisciplinary and often requires a combination of psychology and pharmacology. The psychological approaches shown to be most effective are based on training in social skills, emotional self-regulation and guidelines for parents on how to manage the conflicts involved in having a child with FASD. Appropriate interventions for FASD also involve relevant adjustments to the child’s education.
Psychological monitoring should include both the patient and their parents or guardians. The psychological treatments available include: group treatment (for teenagers and parents), one-to-one psychological treatment and assisted therapy with dogs.
Interventions are based on the age of the child/teenager and their cognitive difficulties. Before any psychological intervention, a neuropsychological assessment must be performed to indicate which cognitive functions the patient has most difficulty with. Treatment can then be adapted to their abilities and carers can manage their expectations and adapt the child/teenager’s environment according to their behaviour.
Clinical history. Psychological interview. Neuropsychological examination. Physical examination and in some cases MRI and EEG tests.
The best way to prevent FASD is to avoid drinking alcohol during pregnancy. Patients with this syndrome have the best prognosis when diagnosed early (before 6 years old) and within a stable family environment.
Somatic symptom disorder is a disorder characterised by the presence of persistent somatic symptoms accompanied by thoughts, feelings and behaviours related to health that are excessive and disproportionate. The symptoms may have a known medical cause or not, and cause the patient to frequently attend primary care departments, A&E and/or specialists.
Somatic symptom disorder, according to the diagnostic and statistical manual of mental disorders (DSM-5) from the American Psychiatric Association, is a disorder involving one or more persistent somatic symptoms, with or without a medical explanation, accompanied by excessive and exaggerated thoughts, feelings or behaviours. At the same time, there is a severe decrease in the quality of life of the people who suffer from the condition.
The origin of the disorder is unknown, but we do know that it is exploited by multiple biological, psychological and environmental conditions, which interact in a non-linear way and predispose the patient to present with the condition. There is often a tendency for patients to attend multiple specialists, with several requests for complementary testing, which can often become iatrogenic, with the patient often feeling misunderstood and ill-treated by the healthcare system. The most common symptom is pain and the systems most commonly affected are the digestive system, the musculoskeletal system and the skin.
A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
B. Excessive thoughts, feelings or behaviours related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health concerns.
The prevalence of the disorder in the general population is around 5-7% and in primary care populations it broadly ranges from 5-35%. It is proportionately more common in women, with a ratio of 2:1 compared to men and often starts towards the beginning of adulthood. 30% of people suffering this disorder tend towards chronicity.
Diagnosis is CLINICAL. An appropriate clinical history needs to be conducted with the patient and/or relatives by a specialised healthcare professional. There are several scales to evaluate the severity of symptoms or associated comorbid disorders.
It needs to be tackled in various ways: Psychoeducation, cognitive behaviour therapy and pharmacological treatment in the case of comorbid psychiatric conditions. The cornerstone of treatment is a good doctor/patient relationship, avoiding unnecessary and iatrogenic complementary testing.
Clinical history. Psychological evaluation. Blood test, vital signs, weight and height.
Work with healthcare professionals through regular and scheduled appointments and adequate management of requests for complementary tests in order to avoid iatrogenic illness. Do regular physical exercise, try to rest well at night, stay active and take part in employment and/or leisure activities, learn and practise relaxation therapies such as mindfulness and avoid consuming toxic substances.
Chronic pelvic pain is defined as "chronic or persistent pain in the structures related to the pelvis in both men and women". It commonly impacts on cognitive, sexual and emotional behaviour. It often manifests as gynaecological, sexual, intestinal or pelvic floor dysfunction. A multidisciplinary approach must therefore be taken to treatment.
Chronic pelvic pain lasts for six months or more and affects the pelvic area, the abdominal wall of the bellybutton and below, the lumbosacral area of the back and/or buttocks and is of sufficient intensity to cause disability in the patient and/or require medical attention.
This has a clear effect on the quality of life of people suffering from the condition.
Its origin is unknown, but we do know that it is exploited by multiple biological/organic, psychological and environmental conditions, which interact in a non-linear way and predispose the patient to present with the condition. There is a clear trend for patients to attend multiple specialists, with requests for complementary testing, which can become iatrogenic, with the patient often feeling misunderstood and ill-treated by the healthcare system.
As it is more of a clinical condition rather than a diagnosis as such, the symptoms can vary a lot, but they always centre around persistent pain. It has a major impact on women of reproductive age and its impact on quality of life varies depending on the causes. It is worth remembering that it gravely impacts on patients’ sex lives and this can cause very significant psychological issues.
According to research, the prevalence of pelvic pain in epidemiology is vary variable. This almost certainly has to do with sociocultural aspects. According to the latest studies, it could be as much as 6.4-25.4% in women and lower in men, at around 2-17%. It is very likely that in the case of men there is an underestimation of this prevalence as there is less willingness to look at problems that also affect the sexual sphere.
Diagnosis is clinical. An appropriate clinical history needs to be conducted with the patient and/or relatives by a specialised healthcare professional. There are different scales to assess the severity of symptoms or associated comorbid disorders, and neuropsychological tests that evaluate cognitive difficulties in terms of attention and concentration. There are also some useful complementary tests to rule out organic causes and make a good diagnosis.
A multi-modal approach is required: psychoeducation, psychological treatment and pharmacological treatment. If the condition is also affecting the patient’s sexuality, we must consider tackling the issue with the patient’s partner as a priority. Several drugs have been shown to help control the symptoms. It very important for treatment to create a good doctor/patient relationship, avoiding unnecessary and iatrogenic complementary testing.
Clinical history. Psychological interview. Neuropsychological examination. Blood test, vital signs, weight and height. Neuroimaging. Scans.
Work with healthcare professionals from the different specialisms that treat chronic pelvic pain. Schedule regular appointments and manage requests for complementary tests and medical interventions to prevent iatrogenic illness. Do regular physical exercise, try to rest well at night, stay active and take part in employment and/or leisure activities, practise relaxation therapies such as mindfulness and avoid consuming toxic substances. Rehabilitation physiotherapy.
Borderline personality disorder (BPD) is a severe psychopathological disorder characterised by emotional instability, impulsive behaviour, difficulty in interpersonal relationships and identity problems. Appearing during adolescence, if left untreated it can have very negative effects on psychosocial development. To improve prognosis, early diagnosis and treatment are required.
Borderline personality disorder (BPD) is a disorder associated with neurodevelopment. It is thought to be the result of the interaction between biologically determined vulnerability and a series of stressful environmental circumstances that compromise an individual’s emotional maturation process. During adolescence, the person demonstrates a lower capacity to manage negative emotions than might be expected for their age and develops a pattern of interpersonal relationships characterised by instability and dependence. In this context, behaviours begin to manifest themselves that show little ability to adapt in order to control discomfort, such as self-harm or drug use, which have a negative effect on the way the person functions at different levels: family relationships, academic performance, affective life and social life. In addition, early manifestations of BPD tend to be associated with greater impulsiveness, meaning that the risk of suicidal behaviour is very high. Left untreated, the evolution of the disorder throughout life is associated with significant deficiencies at all levels and will require more complex therapeutic approaches compared to those that may be applied in adolescents or young adults.
The psychopathology of BPD can be placed into three clinical groups according to the diagnostic criteria of the disorder:
1. Emotional dysregulation, which includes affective instability, inappropriate anger and fear of abandonment.
2. Altered relationships, which include unstable relationships, change of identity, chronic feelings of emptiness and cognitive alterations related to stress.
3. Behavioural dysregulation, which includes self-harming and impulsive behaviour in at least two adaptive areas.
The prevalence of BPD in the general adult population is between 1.4% and 5.9%, making it the most diagnosed Personality Disorder (PD) at the different healthcare levels. Among adolescents, BPD has a prevalence of between 0.7 and 2.7%. Females are more frequently diagnosed with BPD. Males with BPD are often diagnosed with other disorders in error and thus there is not thought to be any real difference between the sexes.
Diagnosis is based on clinical criteria identified during a strict medical history conducted by specialists. It is important to identify the presence of dysfunctional personal traits from adolescence or early adulthood. It is advisable to supplement the medical history with structured interviews to explore the psychopathology of the BPD as well as the other PDs and psychopathological disorders of a similar clinical nature, to make a differential diagnosis and to be able to treat it properly.
The treatment of choice is psychotherapeutic. Psychopharmaceuticals, especially atypical antipsychotics, increase the efficacy of psychotherapy by facilitating patient control. There are psychotherapies specifically designed to treat BPD, such as dialectical behaviour therapy (DBT), mentalisation based treatment and transference focused psychotherapy. The aim of these therapies is to improve the capacity to manage negative emotions and interpersonal relationships.
Clinical history. Structured psychopathology interview. Neuropsychological examination. Blood test and urinalysis. Vital signs and anthropometric measurements.
Early identification and treatment of behaviours or disorders associated with a greater risk of developing BPD are important, such as self-harming or Attention Deficit Hyperactivity Disorder (ADHD). Strategies aimed at avoiding drug and alcohol consumption should be explored, as these are the main factors contributing to a poor prognosis in BPD. Adults with a long history of BPD should work towards preventing deterioration of psychosocial functioning.
Post-traumatic stress disorder is a clinical condition that can develop after an extremely traumatic experience (e.g. natural disasters, accidents or violence). It is marked by characteristic symptoms of reliving the experience, hypervigilance, avoiding stimuli related to the event and altered mood and cognition.
Although the majority of people exposed to a traumatic event recover in a reasonably short space of time and with few negative effects, some people may develop a variety of responses that make their recovery more difficult. Some of these responses are specific to traumatic stress, such as Acute Stress Reaction (ASR) and Post-Traumatic Stress Disorder (PTSD), in its various forms. In line with the Statistical Manual of Mental Disorders (DSM-5), there are currently four groups of symptoms defined for diagnosis, following a traumatic experience, requiring a duration of symptoms greater than one month and giving rise to clinically significant discomfort or a significant deterioration in the patient's functioning. It may be accompanied by dissociative symptoms (depersonalisation and/or derealisation) and presented with a delayed expression (if all criteria are not met until at least 6 months after the event). Although exposure to the traumatic event is the precipitating cause of its development, it is increasingly evident that biological and psychosocial risk factors can be predictors of the onset of symptoms, their severity and chronicity.
1. INTRUSIVE symptoms (1 or more): memories, nightmares, dissociative reactions, intense psychological and/or physiological discomfort when faced with things that evoke the trauma.
2. AVOIDANCE symptoms (of 1 or more stimuli related to the trauma): memories, people, places, etc.
3. HYPERAROUSAL and reactivity associated with the trauma (irritability, hypervigilance, concentration problems, exaggerated overwhelming response).
4. Negative cognitive and mood alterations.
PTSD has been identified in people all over the world who have suffered traumatic experiences. Its prevalence varies depending on the intensity and type of traumatic experience as well as several vulnerability factors (social, financial, cultural and biological).
Diagnosis is CLINICAL and an adequate assessment must be made by an expert healthcare professional. There are different scales to assess the severity of the symptoms and/or associated comorbid disorders (particularly disorders relating to anxiety, mood and substance abuse).
Based on the evidence, treatment should be multi-modal: Psychoeducation, specific psychological treatments (e.g. Trauma-Focused Cognitive Behavioural Therapy (TF-CBT), exposure therapy and Eye Movement Desensitisation and Reprocessing (EMDR) and pharmacological treatments (e.g. SSRIs, mainly sertraline and paroxetine)
Clinical history. Psychiatric and psychological interview, with the help of validated scales and questionnaires.
Screening in risk groups for early diagnosis and treatment.
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder, neurobiological in origin, that begins in infancy but can continue into adolescence and adulthood.
Patients with this disorder may have difficulty paying attention, can be hyperactive and restless and/or may act impulsively.
The symptoms of ADHD manifest themselves in different activities and areas, such as school, work or any other social environment.
1) Inattention: difficulty paying attention, misunderstandings, lack of organisation and planning, losing or forgetting things, easily distracted.
2) Hyperactivity: excess movement, difficulty relaxing or sitting down, feeling of being driven by an internal engine, very chatty.
3) Impulsiveness: quick responses, difficulty waiting, constant interruptions. People with ADHD also present emotional instability, low self-esteem, academic failure, employment and family instability.
In general terms, the prevalence of ADHD is around 3-7%. 50% of children will continue having clinical symptoms throughout adolescence and into adulthood.
ADHD is more frequent in males than females among the general population, with a ratio of 2:1 in children and 1.6:1 in adults. Females have a greater tendency to mainly show inattention.
Diagnosis is CLINICAL. An appropriate clinical history needs to be conducted with the patient and/or relatives by a specialised healthcare professional. There are different scales to assess the severity of symptoms or associated comorbid disorders, and neuropsychological tests that evaluate attention difficulties and executive dysfunction.
ADHD needs to be tackled in various ways: Psychological education, psychological treatment and pharmacological treatment. In children, treatment includes educating parents and school intervention. There are several stimulant and non-stimulant drugs that have been proven to be effective and safe to control symptoms.
Clinical history. Psychological interview. Neuropsychological examination. Blood test, vital signs, weight and height.
Electroconvulsive therapy (ECT) consists of producing mild convulsive activity by administering a brief and controlled electric stimulus with variable frequency through electrodes that are placed on the surface of the brain. This convulsive activity produces biochemical changes in the brain that help to improve symptoms or cause them to go into remission.
ECT is a safe and effective medical treatment that is indicated above all in depressive disorders: Severe depression with psychotic symptoms or at high risk of suicide and serious physical deterioration. It is also indicated in certain psychotic disorders, acute mania and severe treatment-resistant mental health issues. ECT is also indicated in non-psychiatric pathologies within neurology, such as; refractory epilepsy, Parkinson's disease, neuroleptic malignant syndrome and late-onset dyskinesia.
Its application has evolved significantly. It is a pain-free technique that is performed under brief anaesthesia with muscle relaxation and artificial ventilation. Electric stimulation is induced with computer-assisted equipment that monitors the effect of a mild convulsion induced using brief-pulse waves on the brain’s electrical activity. This allows the minimum intensity of electrical stimulation to be administered, decreasing cognitive side effects and drastically reducing the complications associated with treatment. Nowadays, the technique is considered to have no contraindications whatsoever.
Some patients with psychiatric disorders that do not respond to conventional treatment have not, however, been treated with ECT despite its high level of safety and therapeutic predictability. This therapeutic inhibition could be due to the stigma based on outdated beliefs about the treatment.
The Psychiatry Department offers high quality clinical care to patients with mental health problems and addictions. We are also responsible for a significant amount of teaching linked to the Autonomous University of Barcelona, in addition to highly competitive research programmes at the Vall d'Hebron Research Institute.
At the Psychiatry Department, our mission is to serve as the reference health care resource in the Barcelona Nord healthcare district for people with mental health problems and addictions. We offer a comprehensive service that is both effective and efficient, based on the professional quality of our staff, our modern facilities and coordination with all the mental health resources in the sector.
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