bluuebunny/crossref_metadata_2025 huggingface dataset:
Valproate induced encephalopathy: Paradigm of normal ammonia levels
Authors: Barbosa P. , Nombora O. , Monteiro J. , Ribeiro L.
Published: February 2022

Introduction

Valproic Acid (VPA) is one of the most commonly used mood stabilizer drugs. Although uncommon, serious adverse effects have been reported. One particularly relevant side effect is the induced encephalopathy, usually secondary to Hyperammonemia. However, some descriptions have shown an altered mental state with normal serum levels of ammonia.

Objectives

We aim to present a case of VPA induced-encephalopathy without hyperammonemia and emphasize its suspicion when patients taking VPA present altered mental states.

Methods

We present a clinical case of VPA induced-encephalopathy without Hyperammonemia and a qualitative review of this topic using the Pubmed database.

Results

A 66-year-old woman, with an history of Major Depressive Disorder, previously medicated with Venlafaxine 75mg/day and Mirtazapine 30mg/day, was admitted in our acute psychiatric inpatient unit due to a first manic episode. During the stay, her antidepressants were interrupted, and she was started on VPA, then optimized to 750mg/day. After that, she presented an altered mental state with confusion and prostration. Analytical results were normal including normal ammonia levels and no imagiological abnormalities. Despite these results, we decided to stop VPA empirically. The patient clinical status resolved the day after.

Conclusions

Studies have shown that only a few patients have developed encephalopathy with normal serum levels of ammonia. Although the pathogenesis behind this remains unknown, a few mechanisms have been proposed. Therefore, it is important to remind that even without abnormal analytical status, VPA is a possible cause of encephalopathy. We also emphasize the need for further studies on the mechanisms behind this phenomenon.

Disclosure

No significant relationships.
Pontine hemorrhage as beginning of bipolar disorder or organic mania. A case report
Authors: Limeres P. Coucheiro , Soler A. Franco , Del Campo A. Cerame , Lega L. Amaya
Published: February 2022

Introduction

Published evidence describes the appearance of manic episodes in patients who suffer localized brain lesions with no prior psychiatric history.

Objectives

A case report is presented alongside a review of the relevant literature regarding the relationship between Bipolar disorder and strokes.

Methods

We present the case of a 54-year-old man who, after suffering a pontine hemorrhage, developed a depressive mood for which he was treated with Sertraline 50 mg. The following month the patient developed hypomanic mood, disinhibition, insomnia and megalomaniac ideation. He was treated with Risperidone 2 mg and the antidepressant was withdrawn. The symptomology disappeared shortly after but a few months later he developed a major depressive disorder (inhibition, ideas of ruin and guilt, low mood, decreased intake and daily activities…). He was treated again with antidepressants (Citalopram 30mg) and lithium was introduced in the absence of a total response.

Results

Mania secondary to brain lesions has been observed in multiple studies, where an association is made mainly with lesions at the frontal, temporal, subcortical limbic brain areas and in lesions causing hypofunctionality on the right side. Most of the cases described occurred in male patients with no prior psychiatric record and with associated vascular risk.

Conclusions

It is important to carry out an exhaustive medical history to be able to identify the cases of secondary mania so as not to ignore the underlying neurological condition in the approach.

Disclosure

No significant relationships.
A first manic episode in an elderly patient
Authors: Vázquez E. Rodríguez , Meseguer C. Capella , Valera G. Guerra , Ramírez A. Gonzaga , De Llano De La Viuda M. Queipo , Carrasco I. Santos , Cerejeira J. Gonçalves
Published: February 2022

Introduction

The bipolar disorder is characterized by instability mood. It normally happens in the middle-aged. In elderly patients with a first manic episode, you have to dismiss organic pathology.

Objectives

To present an elderly patient with a first manic episode

Methods

A descriptive study of a clinical case and literature review

Results

A 67-year-old man, married. Consulted Mental Health 5 years ago, about low mood after his early retirement. With no psychiatric treatment. Somatic antecedents: Acute myocardial infarction, hypertension and dyslipidemia. Came to the hospital accompanied by his son-in-law presenting rapid speech and thinking, bright clothing, risky behaviour, irritability, grandiosity deliration ideas and less sleep; being necessary a hospital admission. Blood and urine analysis: with no abnormalities. No toxics in the urine. Asenapine 20mg and Lorazepam 3mg were prescribed with clinical improvement. Brain CT: with no abnormalities. After that, Lithium 400mg per day was prescribed to avoid the induction of depression. Clinical judgement: manic episode. Bipolar disorder Type I

Conclusions

After dismissing somatic causes, the symptomatic treatment of a manic episode in older patients is on the same lines as the treatment for mania in young adults. 8-10% of psychiatric inpatients over age 55-60 years are diagnosed with bipolar disorder. Since there is an increase in the number of individuals living longer, an expected increase in the number of older adults who will be diagnosed with bipolar disorder. Older adults with bipolar disorder will increase in absolute numbers as well as the proportion of the general populations.

Disclosure

No significant relationships.
To what extent do sexual hormones influence bipolar disorder?
Authors: Viegas F. Gonçalves , Ferreira F. , Figueiredo I. , Lourenço A.
Published: February 2022

Introduction

It is known that female reproductive events and hormonal treatments can impact the course of bipolar disorder (BD) in women, some of whom are more vulnerable to the development of mood instability under periods of hormonal fluctuation. The mechanisms involved are, however, largely unknown. The aim of this work is to review the impact of sexual hormones on the course of BD, regarding a clinical case.

Objectives

To explore the role of sexual hormones in BD.

Methods

Literature review using Medline database.

Results

This is a case of a 36-year-old woman with type 1 BD who develops a manic episode after starting oral contraception (OC). This episode remitted with suspension of the pill. Estrogen and progesterone are involved in various aspects of brain function, such as brain development, synaptic plasticity, and modulation of neurotransmitter systems. Studies indicate that there is a relationship between ovarian hormones and intracellular signaling systems involved in the pathophysiology of BD. However, research on OC use in patients with mood disorders is limited. Recent studies state that OC aren’t associated with a worse clinical course and don’t negatively influence BD, while other studies show there is a subgroup of bipolar women that improve with hormonal stability, while others get worse.

Conclusions

Further studies are needed to determine possible relationships between sexual hormones and BD, and it is essential to identify patients vulnerable to these risks by measuring baseline hormone levels, assessing hormone sensitivity through a history of mood changes during menstrual cycle and a history of previous mental health problems.

Disclosure

No significant relationships.
Completed suicide in bipolar i patients after their first hospitalisation
Authors: Nieto E. , Palau A. , Alvarez P. , Russo C.
Published: February 2022

Introduction

Bipolar disorder is a mental disorder that has one of the greatest risk of completed suicide (CS)

Objectives

Determine the rate and the risk factors of CS in a cohort of Bipolar I patients followed after their first hospitalization

Methods

We choose all Bipolar I patients (DSM-IV) who were first time hospitalized in our Psychiatric unit between 1996 and 2016. We reviewed the charts of first hospitalization and recorded multiple baseline variables. In the follow-up we updated the database recording all patients who CS. We compared the different baseline variables between Bipolar patients who CS and the rest.

Results

Of a total of 254 bipolar I patients 9 (3,5%) CS in the mean of 13 years of follow up (rate 40 times higher than General Population). The average age at CS was 41.1 years (range between 26 and 71 years old) so there was a 9 years gap on average between the first psychiatric hospitalization and suicide. CS was characterized by a violent act (8 out of 9 cases, 89 %). When we compared BP patients who CS with the rest, only history of suicide in first-degree relatives was detected as a risk factor significantly associated (P<0.01) with CS. Conversely baseline treatment with anticonvulsants (mainly valproate) was detected as a significantly (P<0.004) protective factor of CS.

Conclusions

1-Bipolar I patients after first hospitalization completed suicide 40 times higher than general population almost always by violent method 2-History of CS in first-degree relatives is predictor of completed suicide

Disclosure

No significant relationships.
Completed suicide in bipolar ii patients after their first hospitalization
Authors: Nieto E. , Palau A. , Russo C. , Alvarez P.
Published: February 2022

Introduction

Bipolar disorder, especially Bipolar II subtype, is a mental disorder that has one of the greatest risk of completed suicide (CS).

Objectives

Determine the rate and the risk factors of CS in a cohort of Bipolar II patients followed after their first hospitalization

Methods

We choose all Bipolar II patients (DSM-IV) who were hospitalized for first time in our Psychiatric unit between 1996 and 2016. We reviewed the charts of first hospitalization and recorded multiple baseline variables. In the follow-up we updated the database recording all patients who CS. We compared the different baseline variables between Bipolar II patients who CS and the rest

Results

Of a total of 59 bipolar II patients 6 (10 %) CS in the mean of 13 years of follow up (rate 120 times higher than General Population). The average age at CS was 45.3 years (range between 33 and 57 years old) so there was a 2 years gap on average between the first psychiatric hospitalization and suicide. CS was characterized by a violent act (5 out of 6 cases, 83 %). When we compared BP II patients who CS with the rest, only history of previous violent suicide attempt was detected as a risk factor significantly associated (P<0.04) with CS.

Conclusions

Bipolar II patients CS early after their first hospitalization and at very high rate (120 times than GP) almost always by violent method. History of previous violent suicide attempt is predictor of completed suicide

Disclosure

No significant relationships.
Lithium intoxication and its implications, pertaining to a clinical case
Authors: Quintão A. , Simião H.
Published: February 2022

Introduction

Lithium is the most effective maintenance drug in Bipolar Disorder (BD), although it has a narrow therapeutic index, between 0.6 and 1.5 mEq/L; recommended doses for maintenance are 0.6-1.2 mEq/L.

Objectives

To describe a clinical case of lithium intoxication and discuss relevant literature.

Methods

Clinical examination of a patient and her medical records; non-systematic PubMed review on “lithium intoxication”.

Results

A 73-year-old woman, diagnosed with BD, stabilized on lithium monotherapy for twenty-five years, was admitted to the Emergency Room (ER) with nausea, lethargy, drowsiness, confusion, cough, and fever. A respiratory tract infection is diagnosed, based on clinical presentation, x-ray and blood analysis. Blood tests also revealed a serum lithium concentration of 2.4 mEq/L and impairment of renal function, indicating lithium intoxication; hemodialysis was initiated, with lithium discontinuation. Over weeks, renal function and general state improved, and BD treatment was reinitiated, this time with valproic acid 800mg/day. Two weeks after discharge, she was admitted again at the ER, for an episode starting in the week prior, compatible with a manic episode; olanzapine 10mg was added to the prescription. A week after, the patient is admitted again in the ER, still in a manic episode.

Conclusions

There are no clear indications in the literature about reinitiating lithium on someone who had an intoxication. Given that lithium brings an unparalelled quality of life to BD patients, careful consideration about reintroduction, with close monitoring, should be made, but there is a critical need of more studies and guidelines to orient clinical practice.

Disclosure

No significant relationships.
Model of medical and psychological support for adolescents with depressive behavior
Authors: Mykhailova I. , Mitelov D. , Matkovska T. , Mayorov O. , Mikhanovska N.
Published: February 2022

Introduction

Traditional methods of preventing the deviant behavior in adolescents are aimed at clinical variants of certain forms of deviant behavior.

Objectives

The study included 160 teenagers with depression.

Methods

Study design included: Depression Test, Projective Drawing Tests, Pathoharacterological Diagnostic; Package of AUDIT tests for the diagnosis of dependent behavior.

Results

Symptoms of depressive behavior disorder in adolescents depending on age and gender were identified: in girls aged 12-14 – autoaggression, food disorders and suicidal behavior; in boys aged 12-14 – gaming, internet addiction; in boys aged 15-18 – gambling, drug addiction and smoking. Anxiety of younger teenagers turns into a chronic anxiety-dreary depression, with frequent attacks behavioral disorders.

Conclusions

The use of technology makes it possible to identify informative imprinting of stereotypical behavior and the locus of the therapeutic window, provide medical and psychological support for adolescents with depressive disorders and the quality of social functioning, provide primary and secondary prevention of depression progression and the formation of dependent behavior.

Disclosure

No significant relationships.
Guanfacine as an effective drug for the treatment of tic disorder. Case report
Authors: Del Sol Calderon P. , Izquierdo A. , Moreno M. García
Published: February 2022

Introduction

A 15-year-old man who comes to the consultation referred from neurology for a poorly progressive tic disorder that is resistant to treatment. This is a patient with no relevant medical history. He has good academic performance, without symptoms of inattention, hyperactivity or impulsivity. He does not present buccophonatory tics

Objectives

To Show guanfacine as a efficient treatment fot tics disorder

Methods

Case report

Results

He has presented complex motor tics as cervical contractions that have had to receive physiotherapeutic treatment. He also presents simple ocular tics. The patient at our evaluation is on a 4 mg dose of pimozide without response. He was previously on risperidone. It was decided to start treatment with guanfacine up to 5 mg with reduction of pimozide, to 1 mg. The patient with this dose adjustment shows a notable improvement in the frequency and intensity of the tics, both cervical and ocular. The patient also refers to a feeling of being calmer and being able to face stressful situations such as being exposed to social relationships, intervening more in class without increasing their anxiety levels.

Conclusions

Guanfacine is a selective alpha-2a adrenergic receptor agonist that has an indication for attention deficit hyperactivity disorder. Like its precursor, clonidine, there is more and more literature that proposes this medication and others for ADHD as useful drugs in pathologies such as tic disorder. It has a safe use profile, which with progressive adjustment and hardly any side effects is placed as a treatment to take into account in this pathology.

Disclosure

No significant relationships.
Anxiety symptoms and their frequencies in albanian children: Differences by age, gender and other variables
Authors: Skendi V. , Alikaj V. , Dashi E.
Published: February 2022

Introduction

Anxiety symptoms in childhood represent an important risk factor for developing anxiety disorders in subsequent developmental stages. This study examines the frequency and characteristics of the symptoms of the principal anxiety disorders in children and adolescents using a self-report questionnaire based on the diagnostic categories of the American Psychiatric Association (APA) manual.

Objectives

Our main aim was to have a bigger view of anxiety symptoms spectrum in Albanian children, their frequencies and diferences related to age, gender or other variables.

Methods

A cross-sectional, non-interventional study was conducted on 50 children/adolescents aged 8 to 17 years (45% males), frequenting Child/Adolescent Psychiatric Service, who completed the Spence Children’s Anxiety Scale.

Results

More than one in four of the children and adolescents showed high scores in any anxiety disorder. The anxiety symptoms due to separation were the most frequent in the sample (5.5%), followed by physical fears. Girls scored significantly higher in all disorders (P < .001), except in obsessive-compulsive disorder. Differences were found as regards to age in all disorders, except physical fears, but the effect sizes were only in anxiety due to separation, which decreased with age, and generalized anxiety, which was higher in adolescents than in children.

Conclusions

This study puts emphasizes to the early detection of anxiety symptoms in children, in order to provide the early and effective intervention and prevent the development of anxiety disorders in later life.

Disclosure

No significant relationships.
Suicidal ideation during the first wave of COVID-19 pandemic in a child and adolescent psychiatry emergency care sample
Authors: Cordeiro F. , Santos V. , Cartaxo T.
Published: February 2022

Introduction

The COVID-19 pandemic forced many countries to apply restrictive measures. During the first wave Portugal went through a lockdown, and all the child and adolescents had to stay home and could only contact with the one’s they lived with for several months.

Objectives

This study aimed to evaluate the impact of those restrictions on suicidal ideation in the pediatric population evaluated in a child and adolescent psychiatry emergency care of a tertiary referral hospital.

Methods

We conducted an exploratory retrospective study. All the data from discharge notes were collected between March 15th and June 15th of 2020 (n=59), and in the homologous period of the previous year (n=178). The referral after evaluation (primary care, child and adolescent psychiatry consultation, inpatient unit) was considered a measure of severity.

Results

The demographic variables (sex, age) were homogeneous between the two groups (p ≥ 0,05). 17,4% (n=31) of the sample from 2019, and 16,9% (n=10) of the sample of 2020 had suicidal ideation, which was not statistically different between groups (p=1,000). The referral, after evaluation between groups were also not statistically different (p=0,186).

Conclusions

Even though the proportion of patients with suicidal ideation was homogenous during the two periods, the total number of patients evaluated in the emergency room were lower during the first wave of Covid-19 pandemic. We assume that the population had fear of seeking help in hospital facilities, but we also believe that the pause on school burdens and the reconnection between some families could have function as protective factors.

Disclosure

No significant relationships.
Community treatment for adolescents with mental health problems
Authors: Diaz-Caneja A. , Hernández A. , Toral M.I.
Published: February 2022

Introduction

This is the case of a 15-year-old boy who had been socially isolated in his house for over 1 year. He had become increasingly agitated, but refused any help offered.

Objectives

To establish the role of community treatment in adolescents with mental health problems.

Methods

Summary of the interventions taken place during the treatment

Results

Initially this young person refused any medical treatment, so we tried first supportive therapy and CBT. He dicho not obtain any benefits as he appeared experiencias paranoid ideation and thoughts of being persecuted in the streets. With support from the occupational therapist, the young person started to take care of his personal hygiene. Afterwards he started to take oral medication with partial response. We decided to switch to im treatment. In conjunction with CBT, the young person was gradually able to llaves the house. All the sessions during the first few months took place at his family home. These visits were weekly or twice weekly. Once he left the house, he attended the grupos at the day hospital. After 18 months, he was discharged without medication and he is currently studying for a degree.

Conclusions

Community treatment in adolescent with mental health problems is a better opción to establish good rapport and avoid stressful situations that could take place in an in-patient facilita.

Disclosure

No significant relationships.
Brainfood cluster
Authors: Adan R. , Dickson S.
Published: February 2022

Brainfood cluster The mission of EBRA brainfood is to increase awareness of the importance of research exploring the bidirectional links between brain health and nutrition, including the mediating systems, and to use this knowledge to identify novel nutritional, neuropsychological and neuropharmacological intervention strategies. The BRAINFOOD cluster builds new bridges across research disciplines and strengthens links to relevant stakeholders across Europe, including those involved in health and food policy. It gathers experts on brain health and nutrition that by combining and integrating strengths and complimentary expertise has the volume and capacity to develop novel intervention strategies that improve brain health of European citizens, working together with public health and the food industry. BRAINFOOD is built upon an existing network that includes: 1 Discovery, with expertise in human genetics, metabolomics, nutrition, the microbiome and brain health that utilizes existing data from a variety of population and disease cohorts across the lifespan and aims to propose testable hypotheses; 2 Mechanism, with expertise in animal models, metabolomics, the microbiome and neuroscience that tests hypothesis of how the microbiome and nutrients impact on performance in different behavioral domains; 3 Experimental medicine, with expertise in psychiatry, neurology and nutrition with capacity to run randomized controlled trials; 4 Implementation, with expertise in dissemination and policy making and behavior change, to ensure that EU citizens benefit from novel insights gained in the project.

Disclosure

No significant relationships.
Environmental stressors associated with suicidal behavior in adolescents with psychiatric pathology
Authors: Sánchez S. Pérez , Herrero I. Martín , Fernández M.A. Cutillas , Güimil D. Raya , Portero A. Crespo
Published: February 2022

Introduction

In the assessment of suicidal behavior, recent studies describe the great influence of an environmental component with adverse life events and stressors that can influence self-harm ideation and gesture.

Objectives

1. To analyze the reasons for consultation of adolescents between 11 and 17 years of age who consult for suicidal behavior. 2. To estimate the frequency of the different socio-family life events.

Methods

A retrospective review of the emergency room visits in the last 3 months was carried out. Sociodemographic data, vital events, reason for consultation and evolution are collected in the following 30 days after consultation in the emergency room.

Results

Data were collected from 16 adolescents who consulted in the emergency room for suicidal ideation / gesture in a period of 3 months, of which 43% (7) were women and 56% (9) were men between 11 and 18 years old. The reasons recorded as stressful life events were: 22% unstructured family environment, 10% death of a close relative, 43% little parental supervision, 26% end of a romantic relationship, 5% legal problems, 2% sexual or physical abuse, 70 % academic problems, 3% bullying. It was observed that in 63% of the cases they presented more than one adverse experience.

Conclusions

Suicidal ideation and behavior are frequently preceded by different adverse life events that can be minimized or go unnoticed and undervalued. A meticulous medical history can clarify some of the reasons that influence the hopelessness and clinical anguish that the suicidal patient presents. Its early detection provides the opportunity for an early and specialized approach.

Disclosure

No significant relationships.
Post-ictal psychosis: A case report
Authors: Turki M. , Ouali R. , Ellouze S. , Charfi R. , Abid W. , Babbah T. , Halouani N. , Alouou J.
Published: February 2022

Introduction

People suffering from chronic diseases, especially epilepsy, are more likely to suffer from neurobehavioral disorders, like psychotic states. Postictal psychosis (PIP) is one of these potentially serious complications, that classically follows exacerbations of seizures.

Objectives

The present paper aimed to study the clinical and therapeutic aspects of PIP.

Methods

We report a case of PIP, which involved a patient hospitalized in psychiatry department, and discuss it in light of the relevant literature.

Results

We report the case of a 27-year-old man, with medical history of generalized epilepsy which was well stabilized under treatment (carbamazepine 600 mg/day). The patient was hospitalized for dangerous behaviors after having experienced 2 episodes of seizure activity in context of poor therapeutic adherence. Psychiatric assessment revealed a psychomotor instability, a pressured speech and hallucinatory behavior. There were no delirium symptoms. Neurological examination showed no localization signs, and cerebral imaging was normal. The patient was treated with benzodiazepines (Diazepam), associated to antipsychotics (Haloperidol). His antiepileptic drug was quickly reintroduced. After 48 hours of treatment, psychiatric symptoms improved. The patient returned to its baseline condition after 7 days.

Conclusions

The short-term prognosis of PPI is often favorable, compared to other psychotic disorders. However, more severe psychiatric disorders can potentially develop in the long-term, raising diagnostic and therapeutic difficulties. Thus, a good collaboration between psychiatrists and neurologists is highly desirable in order to better adapt the treatment.

Disclosure

No significant relationships.
Slamming sex and psychotic symptoms. A case report
Authors: Gómez A. Sotillos , Mata A. Hernández , Coscujuela P. Marco
Published: February 2022

Introduction

Chemsex is the term used to describe the use of psichoactives drugs to practice sex, mostly among men who have sex with other men. When drugs are administered by intravenously it is know as slamming or slamsex. Mephedrone is drug more used to this practice, in combination with other as anfetamines. This practice has been associated with a lot of psychiatric and organic complications.

Objectives

Describe a case about one of chemsex complications such as drug- induce psychosis. Moreover, show the multiple medical complications associated with this practice.

Methods

Patient’s data is obtained from medical history, psychiatric interviews carried out during his hospitalizations and his psychological follow-up in CAID.

Results

45 year-old man patient was admitted into a psychiatric unit due to paranoid ideation, behavioral disturbances and heteroaggressive behavior after mephedrone, amphetamines and other drugs intoxication in the context of slamsex practice. He has a history of two previous autolytic attempts but no psychotic episodes. After one week of hospitalization and antipsychotic treatment psychotic symptons disappear. Concerning his medical history, he was infected for HIV, syphilis, hepatitis A, visceral Leishmania.

Conclusions

It is necessary to be aware of the increased in chemsex and slamsex rates and therefore of the comorbilities that have associated. Rapid detection is important in order to reduce and control the severe addiction they entail (especially intravenous consumption).

Disclosure

No significant relationships.
Psoriasis and psychiatric disorders
Authors: Ghabi H. , Aissa A. , Meddouri S. , Ouali U. , Nacef F.
Published: February 2022

Introduction

Psoriasis is a common psychophysiological chronic skin disease with an important impact on patient’s quality of life. The prevalence of psychiatric conditions in psoriasis may range from 24% to 90%. The mechanisms that may explain this relationship still remain debatable.

Objectives

The purpose of this work was to report two cases of psychiatric comorbidities associated with psoriasis and to discuss the possible etiopathogenic mechanisms behind this connection.

Methods

To report two cases of psychiatric comorbidities associated with psoriasis.

Results

Case1 Mr. A.K. is a 30-year-old male patient. He was admitted to our department in February 2020 for acute mania with psychotics features.the patient reported that since 2010, he was treated for psoriasis with local treatment (cortisone cream). The lesions did not grow or expand. Case2 Mr.A.B.is a 27-year-old male patient, with past history of psoriasis under local treatment. He is treated since 2019 in our department for schizophrenia.

Conclusions

High levels of pro-inflammatory cytokines observed in psoriasis may in part explain the associated psychiatric disorders. The psychodermatologic approach would be beneficial for the adequate management of patients suffering from psoriasis.

Disclosure

No significant relationships.
Lithium toxicity. A case report
Authors: Vázquez E. Rodríguez , Meseguer C. Capella , Carrasco I. Santos , Cerejeira J. Gonçalves , Ramírez A. Gonzaga , De Llano De La Viuda M. Queipo , Valera G. Guerra , Lobo C. De Andrés , Aparicio T. Jiménez , Adame C. Vallecillo
Published: February 2022

Introduction

Lithium is widely used in the treatment of the bipolar disorder. Once introduced, it is necessary to carry out an adequate control of the therapeutic range, since it is potentially toxic, and can affect various organs.

Objectives

To present the case of a patient suffering from lithium poisoning and to review the symptoms of lithium poisoning.

Methods

A descriptive study of a clinical case and review of the literature

Results

49-year-old woman, married. Diagnosed with bipolar disorder. She went to the emergency room due to a low level of consciousness, kidney failure, trembling of the limbs, hyperthermia and leukocytosis. In the last two weeks, the patient has reduced her intake of food, not water, finding herself more and more shaky and less reactive. Lithium in blood at admission 1.71, so conventional dialysis was performed with a progressive decrease into 0.65. On examination, he is practically mutist, bradypsychia with a significant response latency. Clinical judgment: Accidental lithium poisoning.

Conclusions

The primary site of toxicity is the central nervous system and clinical manifestations vary from asymptomatic supratherapeutic drug concentrations to clinical toxicity such as confusion, ataxia, or seizures. Severe lithium neurotoxicity occurs almost exclusively in the context of chronic therapeutic administration of lithium and rarely results from acute ingestion of lithium, even in patients currently taking lithium. As such it is an iatrogenic illness, occurring in patients who have identifiable clinical risk factors: nephrogenic diabetes insipidus, older age, abnormal thyroid function and impaired renal function.

Disclosure

No significant relationships.
The difficult differential diagnosis of BPD look-alikes
Authors: Gondek T.
Published: February 2022

The traits of Borderline Personality Disorder (BPD) and various other personality or mental disorders may overlap, causing diagnostic difficulties and pitfalls for psychiatrists early in their career. An online survey conducted among psychiatric trainees and young specialists in 2019 showed that only 63% of them think they are well prepared to diagnose BPD. Predispositions such as impulsivity or emotional instability, which commonly are present in BPD, may also be prevalent in such disorders as Antisocial Personality Disorder, Bipolar Disorder, in people misusing psychoactive substances, or in neurodevelopmental disorders such as ADHD. These symptoms can lead to considerable difficulties in global functioning and performing adequate social roles unless appropriate treatment is provided. Therefore, a proper differential diagnosis is crucial in good psychiatric management of people with BPD features. Dr. Gondek will present what BPD symptom domains may be shared with other mental and personality disorders and how to navigate the diagnostic process to set the correct diagnosis in often unobvious clinical presentations of BPD and its look-alikes.

Disclosure

No significant relationships.
Psychological profile of the bariatric surgery candidates in a spanish hospital in 2020: a descriptive study
Authors: Espada N.M. Casado , Ortiz-Fune C. , Bersabe-Pérez M. , Delgado-Perales S. , Díaz-Trejo S. , González-Parra D. , Roncero C.
Published: February 2022

Introduction

Previous research has found that candidates for bariatric surgery usually present anxiety, depression, personality disorders and/or a tendency to binge eating. The situation related with the pandemic and the lockdowns during the 2020 are possible aggravating factors for these characteristics.

Objectives

To study the more important psychological characteristics presented by candidates for bariatric surgery.

Methods

40 people between 29 and 65 years old (M=46.4, SD=9.1; 37.5% male, 62.5% female) were evaluated between July and December of 2020. The assessment consisted in an interview carried out by a clinical psychologist, and a pool of questionnaires to evaluate depression and anxiety symptoms (Beck Depression Inventory, BDI; and the Goldberg Anxiety and Depression Scale, GADS) the existence of a binge eating pattern (the Binge Eating Scale; BES) and personality traits (the Salamanca Screening Test).

Results

The 25% of the sample had previous mental health antecedents. Eight people disclosed to feel stress in relation with the COVID-19, and 18 presented an emotional regulation strategy using food during the lockdown. 62.5% scored above the cut-off point on the BDI (mild=27.5%, moderate=20%, severe=15%) and a 40% and a 47.5% did it for the anxiety and the depression (respectively) GADS subscales. 20% presented a binge eating pattern according with the BES. Most common personality traits were histrionic (50%), emotionally unstable impulsive type (45%), and anxious (42.5%).

Conclusions

These findings support the previous scientific literature. Psychological intervention programs may be considered to guarantee the surgery’s success, especially when adverse contextual circumstances are presented.

Disclosure

No significant relationships.
Mind the gap! the lack of concordance in diagnostic in liaison psychiatry in a portuguese hospital
Authors: Marques J. , Silva M. , Laureano C.
Published: February 2022

Introduction

Neurosciences evolved very rapidly in last few years and helped the establishment of Liaison Psychiatry as a fundamental part of the general hospitals functioning. However, the use of this department by the other specialties still needs to be refined, as it is common to find wrong assessments in the referral of the patients.

Objectives

We aim to study the concordance between the referral motives and the assessment by the psychiatry team.

Methods

Data was collected through the informatic registry. Contains patient data observed by a liaison psychiatrist in the period between 1st of July and 30th of September of 2020. In this period there were 80 requests, of which, 6 were refused for various reasons. We decided to study the concordance when one of these symptoms were in the request: anxious symptoms, depressive symptoms, psychotic symptoms and psychomotor agitation. 46 requests met this criteria.

Results

The mean age was 63,3yo and 46% were older than 65yo. Most were women (54%) and 68% had history of psychiatry disorder. About 50% were requests from the Medicine wards. The concordance between the medical request and the psychiatry assessment was higher for psychomotor agitation (n=11; 64%) and depressive symptoms (n=23; 57%), but it was lower in anxious symptoms (n=3; 33%) and in psychotic symptoms (n=9; 33%). Most common diagnosis was delirium.

Conclusions

Non-psychiatrist doctors appear to have more difficulty when assessing anxious and psychotic symptoms. Those concordance percentages are in line with recent research. Actions should be taken to improve this, like academic training and standardization of referral.

Disclosure

No significant relationships.
Barking dogs seldom bite? a case of diagnostic overshadowing in emergency department
Authors: Cerejeira J. Gonçalves , Burón C. , Carrasco I. Santos , Meseguer C. Capella , Vázquez E. Rodríguez , De Llano De La Viuda M. Queipo , Ramírez A. Gonzaga , Valera G. Guerra
Published: February 2022

Introduction

Diagnostic overshadowing is one of the main consequences of stigma involving patients diagnosed with a psychiatric disorder. Some studies show that in emergency departments, being diagnosed with a psychiatric illness can lead to a poor evaluation of organic symptoms, delaying the diagnosis and putting the patient’s life at risk.

Objectives

- To present the case of a patient diagnosed with factitious disorder who was misdiagnosed after attending the emergency department due to the stigma related to his psychiatric diagnosis. - To provide a reflection on stigma in mental health.

Methods

We will present a case report and a literature review.

Results

We report a case of a 57-year-old man diagnosed with a factitious disorder. He attended the emergency department of our tertiary care center with confused speech, desorientation and disruptive behavior at home. Although the clinical picture was compatible with a confusional state, he was ordered to be admitted to the psychiatric service. No blood test was previously requested. Three hours after being admitted, he suffered an episode of seizures. A blood test was requested and severe hypomagnesemia (0.2 mg / dl) was found. Because of this episode the patient was admitted to the Intensive Care Unit for three days.

Conclusions

Factitious disorder is a serious mental disorder with a significant stigmatizing burden. Giving a patient this diagnostic label should be the subject of careful thought in order to protect him from future diagnostic neglect.

Disclosure

No significant relationships.
The role of national trainees associations in pandemic times
Authors: Santos M.J. , Samouco A. , Azvee Z. , Seker A. , Mogren T. , Da Costa M. Pinto
Published: February 2022

Introduction

The challenges posed by the COVID-19 pandemic were many and daunting. Almost overnight, the lives of millions of people all over Europe was disrupted and people had to adapt to a completely new situation. Healthcare personal were amongst the ones most affected by it, whether by changes in their everyday work routine or by being the people directly in charge of responding to the demands of the pandemic. Trainees are an indispensable part of healthcare personal and, as a result, they were vastly affected by the pandemic.

Objectives

Discussing the role of National Trainees Associations (NTAs) in pandemic times, including how they dealt with the new challenges, their successes and hardships, and their steps going forward.

Methods

Gathering of institutional information about the work of the Portuguese, Irish and Turkish NTAs during the COVID-19 pandemic. Critical appraisal of each of their contributions and projects.

Results

There were impacts to trainees’ clinical work, formative activities and even personal lives. Amidst this turmoil, NTAs were precious institutions. Their objective is to represent the trainees of each country, looking for formative opportunities and linking trainees. During the pandemic, the work developed by the NTAs increase in importance, serving as a beacon of important information and as intermediaries in a number of discussions. They also aimed to minimize the impact on formative activities, whether by providing recommendations or by organizing some form of educational activity.

Conclusions

We provide some national examples – Portugal, Ireland and Turkey – and draw comparisons and lessons from each one.

Disclosure

No significant relationships.
Role of media surveillance function during COVID-19 breakout
Authors: Naveed A. , Masood S.
Published: February 2022

Introduction

It is a digital era and people always turn on television to gain knowledge of what’s happening around, same is the case with COVID-19 breakout. Whole world relied on media to understand the scenario, as media has always played substantial role in providing information regarding precaution and treatment of the disease.

Objectives

To assess influence of media surveillance function on society during COVID-19 breakout.

Methods

Participants included in the study are 11 and above who can utilize abstract thinking as per Piaget’s theory of cognitive development. Questionnaire used in the study was Media surveillance questionnaire, it was previously used in the study done during Ebola Virus Disease (EVD) spread in Nigeria. In current study the questionnaire was used by replacing disease name i.e. EVD to COVID-19. Questionnaire was distributed online on social media groups.

Results

According to data analysis majority agrees that major source of COVID-19 news is television and Radio, messages on media help in avoiding sick people, media provides helpful information regarding disease prevention and control and messages on media needs more clear directions.

Conclusions

Media played positive role during COVID-19 breakout and it also spread awareness about the myths, false home remedies and precautionary measures. Media also informed society about the health emergencies in case if anyone is infected with the virus. Still media messages need more clarity and direction as people rely more on media than social media. It is media’s responsibility to provide accurate information and more clear messages after inquiring matter properly especially when it’s about human life

Disclosure

No significant relationships.
Tunisians peoples dealing with death in COVID-19 pandemic: Lived experiences of grief
Authors: Ghabi H. , Aissa A. , Meddouri S. , Ouali U. , Nacef F.
Published: February 2022

Introduction

As Dame Cecily Saunders said, “How people die remains in the memory of those who live on.” For Muslim people, funerals and burial procedures are crucial moments that help them come to terms with the loss of a loved one. The COVID-19 pandemic has disrupted usual experiences of grief since funerals and burials are held without the presence of family. Approaches to support grief are needed to be adapted to these particular circumstances.

Objectives

Describe the lived experiences of grief of the Muslim Tunisian family for patients who died due to COVID -19.

Methods

This was a qualitative study with a phenomenological approach. Data of patients who died due to COVID -19 were collected. One family member or more of each deceased was contacted. Semi directive interview was conducted to help participants to describe the lived experience.

Results

30 persons participated in this study. The reactions of participants towards death were crying, being sad, and being choked. The reactions of grief were influenced by several factors. These included: the circumstances of the deceased, relationship with him, the hospitalization in an intensive care unit, doctors’ expectation, and the average length of stay in hospitals before the death. Islamic religious beliefs influenced the way family experienced grief, mainly toward the management of the dead body and the imposed funeral protocol.

Conclusions

This study describes the devastating impact of COVID-19 toward lived experiences of grief of Muslim Tunisian. In light of these results, grief therapies should be adapted and evaluated in this population.

Disclosure

No significant relationships.
Internet addiction in times of COVID-19: Review of the situation
Authors: Regaya M. , Abdelghaffar W. , Amamou B. , Rafrafi R. , Gaha L.
Published: February 2022

Introduction

Covid-19 pandemic represents a sanitary crisis with social, economic and political negative impacts. Studies had well established the link between stress and the display or maintenance of addictive behaviour. Measures like social distancing and confinement imposed by governments during this pandemic, could explain an outbreak of internet addiction cases.

Objectives

Assess the prevalence of internet addiction in times of the covid-19 pandemic and to study its relationship with personal and family factors but also with the psychiatric comorbidities.

Methods

We conducted a cross sectional analytical study during the period of the covid-19 pandemic, using an internet survey exploring socio-demographic and clinical data: through Hamilton depression and anxiety rating scale and the Rosenberg self esteem scale. The assessment of internet addiction was carried out using Young’s Internet Addiction test.

Results

Our study included 150 users, the average age was 36 years, mainly made up of women, married, having children, with a good socioeconomic level and of university education. The prevalence of depressive and anxious symptoms were respectively 7.3% and 18.7%. The prevalence of internet addiction in our study was 9.4% including 0.7% having severe repercussions. Being married (p<10-3) and having children (p=0.006) were considered as protective factors against internet addiction. People having an internet addiction were at bigger risk of having low self esteem (p=0.023), depressive (p=0.04) and anxious symptoms (p<10-3).

Conclusions

Internet addiction is a new concept, though it’s impact on the well being is well established and it’s likely to worsen in times of pandemic. Therefore, it’s necessary to take preventive measures to deal with it.

Disclosure

No significant relationships.
Depressive symptoms and suicidal ideation during the COVID-19 pandemic in Russia
Authors: Medvedeva T. , Enikolopov S. , Boyko O. , Vorontsova O.
Published: February 2022

Introduction

The COVID-19 pandemic may bear serious consequences for mental health, such as the increase in psychopathological symptoms.

Objectives

Analysis of changes in depressive suicidal ideation symptoms and during the COVID-19. Depressive symptoms and suicidality were considered separately.

Methods

Internet survey 22.03.20–22.06.20 (908 responses), included SCL-90R, COPE, question about suicidal ideation.

Results

The analysis showed a positive correlation between suicidal thoughts and depression (Spearman .45; p<.001), a growing trend in the depressive symptoms (Std.J-T=2.51, p=.012), and the increase in severity of suicidal thoughts (Fisher’s Exact Test, 5.92, p=.046). Severity of depression positively correlates with the emergence of the virus in the city, contraction of disease among friends (Spearman .165; p<.001), sick and die fears, an also is linked to more expressed seeking «emotional, social and instrumental help» (COPE). The intensity of suicidal ideation was not associated with these factors, but negatively correlated with «acceptance» and «planning».

Conclusions

The increase in depressive symptoms and suicidal thoughts is determined by different factors. Depressive symptoms is associated with various fears and mediated by non-constructive ways of coping, but there are also constructive coping-strategies as the search for help. The intensity of suicidal thoughts is associated with higher levels of stress, which cannot be explained by the «objective» threat of contagion and fears, but is experienced as an «indefinite» anxiety, supposedly linked to the measures to counter the pandemic, such as restrictions on social interactions, loneliness and uncertainty. The increase in depressive symptoms is linked with an orientation to another person, but the suicidal ideation is not.

Disclosure

No significant relationships.