bluuebunny/crossref_metadata_2025 huggingface dataset:
Evolution of Delusional Disorder across the DSM editions
Authors: Conde Moreno M. , Ramalheira F. , Vila-Chã D. , Terêncio D.
Published: September 2022

Introduction

States compatible with “Delusional disorder” have been described since the XIX century. Esquirol mentioned “irrational ideas and actions that would develop via logical and plausible arguments”; Kraepelin referred to the condition as “paranoia” and considered that hallucinations could not be present– unlike Bleuler, who considered them to be a possible feature. The criteria for delusional disorder have suffered several changes in the last centuries.

Objectives

We aim to review the evolution of the criteria for delusional disorder across the editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Methods

Review of DSM editions.

Results

Criteria for the diagnosis of “paranoia” (DSM III) or “delusional disorder” (DSM III-IV.V) underwent several changes. In the first editions hallucinations could not be prominent (DSM-III-IIIR) and in the DSM IV, only tactile or olfactory hallucinations related to delusions could be present. In DSM-V hallucinations of other modalities related to the delusional theme can be present. Regarding delusional themes, the first edition of the DSM III regarded persecutory delusions only – which was changed in the DSM-III-R, with the inclusion of grandiose, jealous, erotomaniac, and somatic. Only in the DSM-V did the occurrence of bizarre delusions become possible in delusional disorder. Across the editions, there is a consensus about the absence of negative symptoms, absence of disorganized speech, and that the behavior is not odd aside from delusional content.

Conclusions

The most debatable symptoms across centuries in the classification of delusional disorders were: presence of hallucinations, the nature of the delusional content, and inclusion of bizarre delusions.

Disclosure

No significant relationships.
Trait-anger, hostility, and the risk of incident type 2 diabetes and diabetes-related complications: a systematic review of longitudinal studies
Authors: Mohseni M. , Lindekilde N. , Forget G. , Burns R. , Schmitz N. , Pouwer F. , Deschenes S.
Published: September 2022

Introduction

There is a well-established association between anger, hostility, and an increased risk of cardiovascular disease. Emerging evidence also suggests associations between anger/hostility and type 2 diabetes (T2D), though evidence from longitudinal studies has not yet been synthesized.

Objectives

To systematically review findings from existing prospective cohort studies on trait anger/hostility and the risk of T2D and diabetes-related complications.

Methods

Electronic searches of MEDLINE (PubMed), PsychINFO, Web of Science, and CINAHL were performed for articles/abstracts published up to December 15, 2020. Peer-reviewed longitudinal studies conducted with adult samples, with effect estimates reported for trait anger or hostility and incident T2D or diabetes-related complications, were eligible for inclusion. Risk of bias/study quality was assessed. The review protocol was published a priori in PROSPERO (CRD42020216356) and was in keeping with PRISMA guidelines. Screening for eligibility, data extraction, and quality assessment was conducted by two independent reviewers.

Results

Four studies with a total of 155,146 participants met the inclusion criteria. A narrative synthesis of extracted data was conducted according to the Synthesis Without Meta-Analysis guidelines. While results were mixed, our synthesis suggested a positive association between high trait-anger/hostility and increased risk of incident T2D. No longitudinal studies were identified relating to anger/hostility and incident diabetes-related complications. Geographical locations of the study samples were limited to the USA and Japan.

Conclusions

Further research is needed to investigate whether trait-anger/hostility predicts incident type 2 diabetes after adjustments for potential confounding factors. Longitudinal studies are needed to investigate trait-anger/hostility and the risk of diabetes-related vascular complications.

Disclosure

No significant relationships.
Symptomatic generalised joint hypermobility and autism spectrum disorder are associated in adults
Authors: Glans M. , Bejerot S. , Elwin M. , Humble M.
Published: September 2022

Introduction

Intriguingly, autism spectrum disorders (ASD) and symptomatic generalised joint hypermobility (S-GJH) (e.g. hypermobility spectrum disorders and Ehlers Danlos Syndrome) share several clinical manifestations including motor difficulties, sensory hypersensitivity and autonomic dysfunction. Moreover, many syndromic forms of ASD manifest a hypermobile phenotype. Despite the increased interest in the area, few systematic studies are available.

Objectives

This large cross-sectional comparative study aimed to examine the association between S-GJH and ASD in adults.

Methods

We assessed GJH by physical examination using the Beighton Scoring System (BSS) and collected data on musculoskeletal symptoms and skin abnormalities amongst 156 adult patients with ASD and 413 adult community controls. A proxy for S-GJH was created by combining a positive BSS with at least one additional musculoskeletal symptom or skin abnormality.

Results

The prevalence of S-GJH was significantly higher amongst patients with ASD than amongst controls (16.7% vs 4.8%, p< .001). A logistic regression model, adjusting for candidate covariates of GJH (age, sex, race), revealed a significant influence of ASD on S-GJH with adjusted odds ratio of 5.4 (95% CI 2.8-10.5, p< .001).

Conclusions

ASD and S-GJH are associated in adults. If recognised, musculoskeletal complications related to S-GJH can be relieved by physiotherapy. Clinicians should be familiar with that symptoms frequently occurring in GJH such as pain, fatigue and orthostatic intolerance may mimic or aggravate psychiatric symptoms (e.g. depression, anxiety). Knowledge about comorbidities may provide clues to underlying aethiopathological factors. Future research to clarify the mechanisms behind this association and to evaluate how comorbid S-GJH affects ASD outcome is warranted.

Disclosure

No significant relationships.
Post-ictal psychosis syndrome : A case report
Authors: Moalla M. , Staali N. , Bergaoui E. , Zrelli M. , Melki W.
Published: September 2022

Introduction

Psychiatric comorbidity is prevalent among patients with epilepsy. Post-ictal psychosis syndrome (PIP) is a recent entity important to know. It belongs to the group of epileptic psychoses. The clinical presentation is often atypical, and symptoms are usually related to seizures.

Objectives

This work aimed to study the particularities of PIP.

Methods

It is a case report of PIP, involving a patient hospitalized in psychiatry department.

Results

We report the case of a 45-year-old woman, with medical history of generalized epilepsy which was stabilized under antiepileptic treatment (phenobarbital 150 mg/day). The patient was hospitalized for psychomotor instability and inconsistent speech after having experienced a generalized tonic-clonic seizure in the context of discontinuation of treatment. Psychiatric assessment revealed a hostility, a reluctance , a persecution delirium and auditory and visual hallucinations. A series of examinations have been carried out ; Neurological examination revealed no anomaly , a computed Tomography Scan of the Brain was normal. A lombar puncture was normal. A covid-19 infection was eliminated. The usual antiepileptic medication was reintroduced to the patient (Phenobarbital 150 mg/day),in association to benzodiazepines (clonazepam 4 mg/day). After 72 hours of treatment, psychiatric symptoms improved. The patient returned to its baseline condition after 7 days. A similar episode was reported two months earlier in the same circumstances with a similar symptomatology and a spontaneous resolution within 7 days.

Conclusions

PPI syndrome, regardless of its good short-term prognosis, can potentially evolve into other psychiatric disorders of less good prognosis. Thus, this syndrome should be managed in collaboration with neurology and psychiatry.

Disclosure

No significant relationships.
Characterization of neuropsychiatric symptoms in a group of individuals with manifest or pre-motor Huntington’s disease in Medellín, Colombia
Authors: Vasquez D. , Agudelo M. , Gomez C. , Aguillon D. , Quintero J. , Rassi S. , Zuluaga M. , Pineda D. , Buritica O. , Lopera F.
Published: September 2022

Introduction

Huntington’s disease (HD) is a rare (1-9/100 000), inherited disease characterized by an elongated CAG repeat on chromosome 4p, leading to a degeneration of neurons. Also, psychiatric symptoms are very common in the early stage and may appear before motor symptoms.

Objectives

To characterize neuropsychiatric symptoms in a group of individuals with manifest or pre-motor Huntington’s disease in Medellín, Colombia.

Methods

Data obtained from clinical records of individuals with HD (motor-manifest or pre-motor with triplets count) evaluated for ENROLL-HD project in the Group of Neuroscience of Antioquia. We explored variables related to substances abuse, neuropsychiatric symptoms, the respective age of onset, sex, and triplet count when available.

Results

Twenty-six (53%) were women, 8% had a familiar history of psychotic illness in a first-degree relative and 88% presented motor symptoms. Also, 59% had a history of depression, 53% irritability, 57% aggressiveness, 34% apathy, 29% perseverative/obsessive behavior, 14% psychosis, and 30% mild cognitive impairment. Ten individuals (20%) had motor without neuropsychiatric symptoms. Also, thirty-seven individuals (76%) presented motor and neuropsychiatric symptoms; of these, 41% had neuropsychiatric symptoms before motor symptoms. No psychiatric symptoms were associated with the use of alcohol, cigarettes, or drugs of abuse.

Conclusions

Neuropsychiatric symptoms are highly prevalent among individuals with HD and studies oriented to create relevant knowledge for the development of advice oriented to people with this disease are necessary.

Disclosure

No significant relationships.
Network Analyses: Understanding the Pathways of Functional Improvement in Schizophrenia
Authors: Mucci A. , Galderisi S. , Rocca P. , Rossi A. , Bertolino A. , Rucci P. , Maj M.
Published: September 2022

Improving real-life functioning is the main goal of the most advanced integrated treatment programs in people with schizophrenia. The Italian Network for Research on Psychoses used network analysis in a four-year follow-up study to test whether the pattern of relationships among illness-related variables, personal resources and context-related factors differed between patients who were classified as recovered at follow-up versus those who did not recover. In a large sample (N=618) of clinically-stable, community-dwelling subjects with schizophrenia, the study demonstrated a considerable stability of the network structure. Functional capacity and everyday life skills had a high betweenness and closeness in the network at both baseline and follow-up, while psychopathological variables remained more peripheral. The network structure and connectivity of non-recovered patients were similar to those observed in the whole sample, but very different from those in recovered subjects, in which we found few connections only. These data strongly suggest that tightly coupled symptoms/dysfunctions tend to maintain each other’s activation, contributing to poor outcome in subjects with schizophrenia. The data suggest that early and integrated treatment plans, targeting variables with high centrality, might prevent the emergence of self-reinforcing networks of symptoms and dysfunctions in people with schizophrenia.

Disclosure

Honoraria, advisory board, or consulting fees from Angelini, Astra Zeneca, Bristol-Myers Squibb, Gedeon Richter Bulgaria, Innova-Pharma, Janssen Pharmaceuticals, Lundbeck, Otsuka, Pfizer, and Pierre Fabre, for services not related to this abstract
Theory and Practice of Treatment of Concurrent Major Depressive and Alcohol Use Disorders
Authors: Samokhvalov A.
Published: September 2022

Introduction

Both Major Depressive and Alcohol Use Disorders are highly prevalent. They also are the major contributors to disability and decreased quality of life and, as they are often comorbid with each other, the diagnosis and treatment of concurrent depression and alcohol use disorder represents a challenging task with multiple clinical questions requiring evidence-based recommendations.

Objectives

The goal of this presentation is to review the optimal strategies to treat concurrent alcohol use and major depressive disorders in the context of current research findings and clinical practice.

Methods

Narrative review, knowledge synthesis.

Results

The most up-to-date research findings in the areas of epidemiology of concurrent depression and alcohol use disorder, their differential diagnosis, and treatment approaches will be reviewed. This review will include the current evidence of effectiveness of various antidepressants in treatment of depression concurrent with alcohol use disorder and antidipsotropic agents use for alcohol use disorder in the context of depressive symptoms, as well as their combinations. We will discuss the timeline of initiation of both antidepressants and antidipsotropic agents, non-pharmacological treatment modalities as well as the clinical tools that can be used to properly monitor patients’ progress and optimize the treatment process, and the integrative teamwork necessary to achieve optimal results.

Conclusions

Ultimately, the optimal diagnostic and treatment algorithm and the set of evidence-based treatment recommendations will be presented.

Disclosure

No significant relationships.
Myasthenia and bipolar disorder: a case report and review of literature
Authors: Emna B. , Kammoun R. , Kroui M. , Ellouz F.
Published: September 2022

Introduction

The association between somatic diseases and bipolar disorder (BD) have been described especially for auto-immune diseases.

Objectives

Through a case study and a review of literature we are going to describe a comorbidity of BD and myasthenia.

Methods

Starting from a case report, we conducted a literature review on “PubMed”, using a key word “myasthenia and bipolar disorder”

Results

The patient AJ, 57 years old, married, mother of 5 children; 4 sons and 1 daughter who also has BD. She is illiterate and a full-time mother. she has high blood pressure, a congestive gastropathy and hemorrhoids. She has been diagnosed with BD in 1987 (at 21 years old) and mainly had depressive episodes. She was put on Amitriptyline, carbamazepine, long-acting neuroleptics and benzodiazepines. Since 2006 the patient has been reporting persisting myasthenia even when she was euthymic. In 2009, she was hospitalized for persistent headaches, pain and a decrease in visual acuity in the right eye. An ophthalmoscopy, a cranial CT-scan and an MRI were performed with no anomalies. Then a fluctuant ptosis and an intense fatigability appeared. She then was hospitalized in a neurology ward where she was diagnosed with myasthenia. Changes in her treatment had to be made. Carbamazepine was switched to valproic acid, amitriptyline was switched to fluoxetine. And benzodiazepines were stopped.

Conclusions

It’s important to pay close attention to somatic diseases in our patients in order to insure appropriate medical care. Also, the association between somatic disorders and BD can be an interesting lead in elucidating the etiopathogeneses of BD.

Disclosure

No significant relationships.
Laterality disorder and its association with an axial hypotonia and body spatial integration impairments may involve slowness and attention disorder: A case series of patients
Authors: Vaivre-Douret L.
Published: September 2022

Introduction

Lateralization is a complex process that evolves during the development of the child leading to the organization of the functional dominance with a body side. However, laterality is poorly examined.

Objectives

The aim of this study was to explore the features of patients with a laterality disorder evidenced by a non-dominance affirmed of the handedness.

Methods

A retrospective review of 25 cases of patients (15 children of 8-9 years and 10 adults of 26-42 years old) presenting a laterality disorder. All patients were assessed with the standardized assessment of neuropsychomotor functions battery (NP-MOT).It enables physical assessment of muscular tone of limbs and axial tone (trunk), laterality (tonic, spontaneous gestural, psychosocial handedness, and usual with objects for hand, foot, and eye), body spatial integration (in relation to self, imitation, objects and map), auditory attention, and others motor functions.

Results

The study findings revealed poor level of the dominant laterality for all the patients (< 2DS) regarding the proximal tonic laterality (elbows) and the psychosocial subtests of mimed gestures (tending to ambidexterity). In addition, it was found a hypotonic trunk and difficulties in body spatial integration and in asymmetrical bimanual tasks with slowness and failures, similar dexterity performance right/left.Strong correlations between all these features and the personal history match the difficulties to focus a long time an attention holding posture without to move, and associated to a fatigability.

Conclusions

A deep standardized examination of the laterality and tone may explain some components of the behavior in relation with hemispheric dominance impairment.

Disclosure

No significant relationships.
Cannabis use and cognitive impairment in schizophrenia
Authors: Gonçalves M. , Romão J. , André R. , Félix F. , Andrade G. , Saraiva R. , Dornelles E. , Fernandes E. , Abreu M. , Chendo I. , Ismail F.
Published: September 2022

Introduction

Neurocognitive deficits amongst patients with schizophrenia are considered one of schizophrenia’s central features. These deficits appear to be present from the first episode of psychosis (FEP) and certain cognitive impairments could be components of a genetic vulnerability to schizophrenia. Regarding research on cannabis and cognition in schizophrenia, different studies have assessed neurocognitive functions: memory, attention/vigilance, processing speed, verbal learning, executive functions, and verbal fluency.

Objectives

The aim is to do a review of recent findings concerning the association of cannabis use with cognition in schizophrenia.

Methods

A literature review was conducted using the PubMed search database.

Results

Patients with schizophrenia and concomitant cannabis use are associated with worse performance in immediate verbal learning, and in some studies with worse working memory performance. There is an improvement of verbal memory when they cease the cannabis’ consumption. Regarding attention capacity and memory types assessed, the results are controversial. In FEP, heavy cannabis use during the previous year correlates with slower processing speed. Also, FEP-patients with cannabis use but no family history of psychosis perform worse in executive functions, while those with a family history of psychosis perform better.

Conclusions

The studies of psychosis, cannabis and cognition differ in relevant aspects, which might be connected to the result variability. Therefore, before solid conclusions can be reached, it is important to carry out longitudinal studies to understand the changes in the cognitive variables, which can depend on the pattern of cannabis’ use (concurrent or prior to the FEP). Possible confounding variables that might be present should be acknowledged.

Disclosure

No significant relationships.
Alexithymia In Multiple Sclerosis: Relationship With Depression
Authors: Ben Abdallah M. , Baati I. , Zouari A. , Guermazi F. , Hentati S. , Farhat N. , Masmoudi J.
Published: September 2022

Introduction

Alexithymia, the lack of words to express emotions, is a common problem in multiple sclerosis (MS) patients.

Objectives

To investigate the prevalence of alexithymia in patients with MS and to evaluate the factors related to it, including depression.

Methods

We conducted a cross-sectional, descriptive and analytical study, which took place in the neurology department in Sfax (Tunisia). It involved MS outpatients in remission phase. Data collection was done using a form exploring sociodemographic, clinical and radiological characteristics. We used the Expanded Disability Status Scale (EDSS) to evaluate neurological impairments, the Toronto Alexithymia Scale (TAS-20) to assess alexithymia, and the Hospital Anxiety and Depression Scale (HADS) to assess depressive symptoms.

Results

Our study included 93 patients. They were married in 57% of cases. The total number of relapses ranged from 1 to 30, with a median of 5. The EDSS score ranged from 0 to 8. A temporal lesion on brain imaging was found in 29% of cases. MS patients had alexithymia in 58.1% of cases and depression in 26.9% of cases. Alexithymia was more frequent in unmarried patients (p = 0.028). Among clinical and radiological factors, the number of relapses was higher (p = 0.035), and temporal lesion was more frequent in alexithymic patients (p = 0.045). In this study, alexithymic patients were more depressed (p < 10-3).

Conclusions

According to our results, depression and alexithymia were found to be significantly inter-related in MS. Future longitudinal studies might better clarify the nature of this relationship in MS patients.

Disclosure

No significant relationships.
Investigating causes of increased morbidity and mortality within psychiatric patients - Somatic comorbidities of inpatients in a german psychiatric community hospital
Authors: Theisen C. , Kieckhäfer C. , Röpcke F. , Meisenzahl E.
Published: September 2022

Introduction

The co-occurrence of mental illness and somatic comorbidities is a major cause of increased morbidity and mortality within psychiatric patients, compared to the general population. This may be caused by an unhealthy lifestyle, side effects of psychotropic drugs and systematic barriers in healthcare provision. The underlying mechanisms remain under-investigated.

Objectives

We systematically investigated relevant barriers and risk factors to the utilization of primary care among severe mentally ill outpatients.

Methods

In a cross-sectional analysis, the psychiatric as well as somatic diagnoses of inpatients of a German psychiatric community hospital were identified. Furthermore, somatic and psychiatric medication, blood values (HBA1C) and sociodemographic data of the patients were analyzed. The frequencies of the somatic diagnoses were presented according to psychiatric diagnoses. By a Chi-Square goodness-of-Fit Test the distribution of somatic diagnoses and drug classes were verified according to the total cohort as well as for each psychiatric diagnosis and in respect to sex.

Results

Our results provide an overview of common comorbidities with regard to the psychiatric diagnosis. The medication, in relation to the recorded somatic comorbidities, as well as the blood values, allow a conclusion to be drawn about the extent and success of the treatment.

Conclusions

For the first time, real-life data on the somatic diagnoses and treatment of patients with a severe mental illness in a German hospital is presented. Our results will be used to create low-threshold interventions for the most relevant somatic comorbidities and to improve primary care of psychiatric patients through linking the care systems.

Disclosure

No significant relationships.
“Dissolving Cartesian dualism”: using a novel student-lead podcast to explore the relationship between neurological and psychiatric illness
Authors: James S.
Published: September 2022

Introduction

Psychiatric conditions can be both a symptom and a consequence of physical disease. Although understanding of this is important for health care delivery, coverage of the relationship between physical and psychiatric illness in undergraduate medical education is sparse. This relationship is particularly pertinent in neurological disorders, where psychiatric symptomatology is commonplace. As part of a student project, the author was tasked with developing accessible teaching materials to increase interest and understanding among medical students, using podcasts.

Objectives

The aim was to develop podcasts which explored the relationship between psychiatric and neurological illness, for use in undergraduate psychiatric training.

Methods

Literature reviews were performed on podcasting in medical education to identify the optimal methods of production to maximise educational value, and on topics covered in podcasts to inform the interview questions. Experts in the relevant areas were contacted for recorded interviews, later used to create podcasts.

Results

Four interviews were conducted between the author and consultant neurologists specialising in the specific neurological condition. A podcast was produced for each of the following topics: depression in multiple sclerosis, frontotemporal dementia in motor neurone disease, Lewy body dementia, and dissociative seizures.

Conclusions

Psychiatric and physical illness are often intertwined. As the prevalence of psychiatric illness rises, it is becoming increasingly important that this connection is recognised, in order to improve patient experiences and outcomes. Novel teaching modalities, such as podcasts, can provide additional ways to support medical education on this important topic.

Disclosure

No significant relationships.
Identifying clinical and psychological characteristics of cardiac surgery patients
Authors: Nikolaeva O. , Karavaeva T. , Nikolaev E. , Petunova S. , Grigorieva N. , Lazareva E.
Published: September 2022

Introduction

Cardiac surgery patients (CSP) are cardiovascular patients who undergo surgery to treat their disease. Are their psychological characteristics different from those of other cardiac patients?

Objectives

The goal is to establish peculiarities of the clinical-and-psychological status of CSPs in different clinical groups.

Methods

According to clinical parameters, 152 CSPs were divided into three groups. The first group comprised patients with CHD indicated to an open-heart coronary artery bypass grafting, the second one included patients with heart failure who were to undergo aortic valve surgery, and the third group included CHD patients and those with heart rhythm abnormalities indicated to minimally invasive surgery.

Results

CSPs had a number of cardiologic complaints, mental disturbance manifestations and concomitant somatic diseases. They showed difference in the duration of the disease, previous occurrence of heart surgery or myocardial infarction, and in the degree of heart failure manifestations. Self-assessment of pre-surgery CSPs corresponded to the severity of their clinical condition, while indications of hope for recovery were at the maximum level. The second group showed a moderate level of depression, while the third one – slight depression. All the groups revealed a disharmonic profile of time perspective. Group 1 CSPs showed some manifestations of hostility. We saw different manifestations of CSPs’ personal adaptation resources. While hardiness had insufficient showings at the level of most components, social support was excessive in all groups.

Conclusions

CSPs as other cardiac patients revealed depressive disorders and hostility. At the same time, they have more social support, which testifies availability of good interpersonal resources.

Disclosure

No significant relationships.
Hypokalemia : what correlation with psychotic relapse ?
Authors: Abassi B. , Khelifa E. , Bouguerra I. , Nourchene K. , Mnif L.
Published: September 2022

Introduction

Hypokalemia is often detected on standard biological assessments of patients hospitalized for psychiatric disorders. Many explanations are advanced by clinicians like insufficient food intake or drug effects. But what if there was a relationship between this ionic disorder and psychotic relapses?

Objectives

To assess the frequency of hypokalemia in patients hospitalized for a psychotic relapse and to study its relationship with certain clinical characteristics.

Methods

This is a cross-sectional study conducted over a 3-month period (july-september 2021), including 37 male patients diagnosed with schizophrenia and hospitalized in a psychiatric unit for a psychotic relapse. Patients had blood collection before medication that was sent for a complete blood count and blood chemistry testing.

Results

Blood potassium level ranged from 2.92 to 4.87 mmol/L with an average of 3.74 mmol/l. Half patients ( 54.1% , N=20 ) had hypokalemia. Among them, two had electric signs on their ECG and two had physical symptoms. In patients with hypokalemia, the cause of hospitalization was the agitation in 80% of cases versus 58.8% in patients with normal potassium levels. The correlation was not significant between hypokalemia and the use of a restraint (p=0.160) or the somatic history (p=0.495).

Conclusions

hypokalemia is an ionic disorder that should be detected in patients with schizophrenia. It exposes the patient to the risk of a sudden death, especially with use of antipsychotics that are at a high risk for torsade de pointes.

Disclosure

No significant relationships.
Somatic Comorbidity of Anxious and Depressed Miners
Authors: Becarevic N. , Softic R. , Becarevic M.
Published: September 2022

Introduction

Depression is the leading cause of disability worldwide and is a major contributor to the overall global burden of disease. The prevalence of depression is rising and it often co-occurs with other physical diseases.

Objectives

The research aims to determine the comorbidity of depression and anxiety disorders with chronic physical diseases among employees of the „Brown coal mine Banovici“.

Methods

We conducted a retrospective study that included 117 employees from the disease registry who are being under the treatment of depression and anxiety disorder. We collected data from medical records of patients about sex, age, marital status, smoking status, physical diseases, types of antidepressants, and the other drugs they use.

Results

The study showed that there are 117 employees of the „Brown coal mine Banovici“ who are under treatment of depression and anxiety-depressive disorder. 22 (18,8%) of them are females and 95 (81,2%) males in an average life span of 48,3 years. The most commonly used antidepressant is Escitalopram. 62 (53%) out of 117 patients with depression have comorbidity with diseases of the circulatory system, 24 (20,51%) have comorbidity with diseases of the musculoskeletal system and connective tissue, 16 (13,68%) have comorbidity with endocrine, nutritional and metabolic diseases. 25 (21,37%) patients are not suffering from any other chronic physical disease. The most commonly used drugs besides antidepressants are antihypertensives.

Conclusions

The comorbidity rate of depression and anxiety disorders with cardiovascular diseases among employees of the „Brown coal mine Banovici“ is higher than with all other chronic physical diseases.

Disclosure

No significant relationships.
Paraphilic Disorder and Gender Dysphoria in a Case with High-Functioning Autism Spectrum Disorder
Authors: Altunoz U. , Krueger J. , Ziegenbein M.
Published: September 2022

Introduction

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized with difficulties in social interaction/communication, restricted interests, and repetitive behaviors. Sexual issues such as paraphilic behaviors in ASD have gained attention in recent years, however there is still a great paucity of research regarding this issue.

Objectives

The aim of this presentation is to draw attention to a crucial dimension through a case of ASD with paraphilic disorder (pedophilic tendencies) and gender dysphoria.

Methods

One case from an inpatient unit of a psychiatric clinic in Lower Saxony, Germany will be reported.

Results

Case: An 18-year-old male was referred to our acute psychiatric ward due to suicidal thoughts and other depressive symptoms. In further examination, he stated that he had pedophilic phantasies which he was trying to satisfy by using child pornography in the darknet. He had never been involved in any sexual relationship with a child and described this behavior as an addiction that he wanted to get rid of. Detailed psychiatric examination and developmental history yielded the diagnosis of high-functioning ASD. The compulsory paraphilic engagement is classified as a restrictive-repetitive interest in terms of ASD. In addition, the patient presented gender incongruence with moderate gender dysphoria, dressed in a skirt and wanted to be perceived and named rather gender-neutral, which was supported through the whole course.

Conclusions

Through systemic understanding of the high-functioning ASD structure and complex symptomatology, socio- and psychotherapeutic approaches were implemented which yielded an apparent stabilization. The detailed therapeutic process in the light of the present literature will be discussed.

Disclosure

No significant relationships.
Sleep Disorders and Dual Disorders
Authors: Fernandez Mayo L. , Baño Rodrigo D. , Barbero García E. , Agujetas Rodriguez M. , Falcón Torres I. , De Antonio Pérez V. , Medina Sanchez C. , Serrano García M.
Published: September 2022

Introduction

While it is well known that there is an interaction between sleep disorders and substance abuse, it is certainly more complex than was previously thought. The effects on sleep depend on the substance used, but it has been shown that both during use and in withdrawal periods consumers have various sleep problems, and basically more fragmented sleep. We know that sleep problems must be taken into account to prevent addiction relapses.

Objectives

To explain the different sleep disorders caused by substances such as alcohol and cannabis

Methods

As an example of this, two cases are introduced: the first one, a 17-year-old boy, who is diagnosed with ADHD with daily cannabis use since the age of 14. As a result of reducing consumption, he presents an episode of sleep paralysis that he had not previously had. The second one is a 50-year-old man diagnosed with a personality disorder and with dependence on cannabis and alcohol for years. He currently has abstinence from alcohol for months and maintains daily cannabis use. However, he has long-standing sleep pattern disturbances and frequent depersonalization phenomena at night.

Results

Alcohol at low doses has no clear effects on sleep architecture. At higher doses it decreases sleep latency, as well as awakenings. In chronic alcoholic patients, a decrease in deep slow sleep, and more fragmented sleep have been found. Cannabis withdrawal reduces sleep quality, increases latency, and produces strange dreams.

Conclusions

There is a positive relationship both between having a substance use disorder and suffering from a sleep disorder.

Disclosure

No significant relationships.
Adult attention-deficit/hyperactivity disorder and bipolar disorder: diagnostic and management challenges
Authors: Barbosa M. , Guedes R.
Published: September 2022

Introduction

Attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) are neurodevelopmental disorders that commonly persist into adulthood. ADHD in adults can resemble, and often co-occurs with, bipolar disorder (BD), which might lead to diagnostic errors, ineffective treatment and potentially serious adverse consequences.

Objectives

To review on the overlaps and differences in the psychopathology of the two entities and particularities of the management when they occur comorbidely.

Methods

The Medline database through the Pubmed search engine was used with the following keywords: “adhd” and “bipolar disorder”.

Results

ADHD has an estimated prevalence of 10-30% in adults with BD. Despite the symptomatic similarities, there are some important differences. In the ADHD/BD comorbidity, symptoms like attention-deficit, distractibility, irritability, impulsiveness and hyperactivity that may present in (hypo)manic and/or depressive episodes, tend to persist after clinical stabilization. While adult patients with ADHD typically experience ceaseless mental activity and wandering mind, BD patients may have racing thoughts and perceive them as making sense. ADHD patients may have poor socio-occupational achievement that may lead to low self-esteem, low self-confidence and depressed mood. Features like course of illness, psychiatric family history and treatment response may help differentiate the two entities. The treatment must start with mood stabilization and then proceed to the treatment of ADHD symptoms.

Conclusions

A complete clinical history, with particular focus in the neurodevelopmental history, is important but sometimes is not enough for an accurate diagnosis of this comorbidity. As so, clinicians should be aware of the high comorbidity rates to prevent misdiagnosis and provide the best care for both disorders.

Disclosure

No significant relationships.
Relationship between cannabis use and schizophrenia
Authors: Vazquez Vazquez J.J. , Gutiérrez Rodríguez M.M. , Corral Y Alonso M.D.L.A. , Moreno Menguiano C. , Garcia Sánchez F.
Published: September 2022

Introduction

Numerous studies have shown evidence that cannabis use increases the appearance of psychotic symptoms and disorders, and worsens the course of the disease in those with schizophrenia. However, a causal relationship between cannabis and schizophrenia has not been well established yet.

Objectives

In this presentation we try to review the relationship between cannabis use and prevalence of schizophrenia.

Methods

We performed a search of Medline looking for systematic reviews and methodologically robust studies in the field published in English in the last 5 years.

Results

A number of studies, both cross-sectional and prospective, find a prevalence of schizophrenia several times higher among cannabis users than in non-users. This association becomes stronger the lower the age of cannabis use onset, the higher the amount consumed and the higher the THC concentration are. Half of the patients with a cannabis-induced psychotic disorder turn into a diagnosis of schizophrenia within a few years. So far, it has not been possible to demonstrate a global increased prevalence of schizophrenia in relation to the increase of cannabis use in the population in recent decades.

Conclusions

Cannabis and schizophrenia have a complex relationship model; we still cannot clearly establish whether it is causal or the first works as a trigger for pathology in vulnerable subjects.

Disclosure

No significant relationships.
Resistant schizophrenia in a patient with oculocutaneous albinism successfully treated with clozapine
Authors: Jelti A. , N’Sabi F. , Kennab F. , Barrimi M.
Published: September 2022

Introduction

Several studies have shown an association between oculocutaneous albinism and several neuropsychiatric entities, including schizophrenia.

We present through this work the first case of resistant schizophrenia described in this type of patient.

Objectives

Demonstrate the safety of clozapine in albinos patients and discuss the linkage between the two disorders.

Methods

We describe the case of a 23-year-old patient with oculocutaneous albinism who developed treatment-resistant schizophrenia, successfully treated with clozapine.

Results

We received the patient referred by his private psychiatrist, after the absence of improvement despite the use of several first and second generation antipsychotics, alone and in combination, at therapeutic doses, with good compliance and for a duration of more than 3 months.

The onset of psychotic symptoms was at the age of 18 years, and the evolution was continuous.

On admission, the patient was agitated and assessment of thought content were difficult due to intellectual disorganization. The initial PANSS score was assessed at 120. The somatic examination was normal, except for generalized hypopigmentation and horizontal and rotatory nystagmus. A biological workup, MRI, and electroencephalogram revealed no abnormalities.

The diagnosis of resistant schizophrenia was retained and the patient was put on clozapine 12.5 mg/d with progressive titration to a dose of 400 mg at the 6th week, with marked improvement; the patient became motor calm, with understandable speech and adapted responses, the PANSS score at the 2nd month decreased markedly by 33 (from 120 to 87).

Conclusions

This case report suggests that clozapine can be safely introduced in patients with oculocutaneous albinism.

Disclosure

No significant relationships.
Neuroimaging Correlates of Post-Traumatic Stress Disorder in Traumatic Brain Injury: A Systematic Review of the Literature
Authors: Esagoff A. , Stevens D. , Bray M. , Bryant B. , Daneshvari N. , Jung D. , Rodriguez C. , Richey L. , Luna L. , Sair H. , Peters M.
Published: September 2022

Introduction

Neuroimaging has been a highly utilized technique for studying traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) independently of one another, however, neuroimaging has increasingly been identified as a useful tool in better understanding TBI-related psychiatric conditions, such as PTSD.

Objectives

To complete a systematic review of the literature examining neuroimaging findings in TBI-related PTSD and to highlight the current literature’s limitations in order to strengthen future research.

Methods

A PRISMA compliant literature search was conducted in PubMed (MEDLINE), PsychINFO, EMBASE, and Scopus databases prior to May of 2019. The initial database query yielded 4388 unique articles, which were narrowed down based on specified inclusion criteria (e.g., clear TBI definition, clinician-diagnosed PTSD, statistically analyzed relationship between neuroimaging and PTSD, quantified time interval between TBI and neuroimaging).

Results

A final cohort of 10 articles met inclusion criteria, comprising the findings of 482 participants with TBI. Key neuroanatomical findings among the included articles suggest that PTSD is associated with significant changes in whole-brain networks of resting state connectivity and disruptions in bilateral frontal and temporal white matter tracts, fronto-limbic pathways, the internal capsule, and the uncinate fasciculus (Figure 1).
Figure 1a:

Neuroimaging Findings in TBI-related PTSD.

Figure 1b.

Replicated Neuroimaging Findings in TBI-related PTSD in the Right Uncinate Fasciculus.

Conclusions

Additional inquiry with attention to specified imaging timing post-injury, consistent TBI definitions, clinician-diagnosed TBI and PTSD, and control groups is crucial to extrapolating discrepancies between primary and TBI-related PTSD. Prospective studies could further differentiate predisposing factors from sequelae of TBI-related
PTSD.

Disclosure

No significant relationships.
Behavioural disturbances as the clinical presentation of Wernicke Encephalopathy: a case report
Authors: Mayor Sanabria F. , Bermejo Pastor A. , Fernández Fariña M. , Expósito Durán M.E. , Regueiro Martín-Albo C. , Jiménez Cabañas M. , Ortiz Sánchez-Expósito C.
Published: September 2022

Introduction

Wernicke Encephalopathy (WE) is the best characterized neurological complication of thiamine deficiency. Its clinical presentation can be diverse, including hallucinatory or delusional symptoms, and not necessarily associated with the classical triad of WE. This correlates with higher rates of under diagnosis. We present the case of a 72-year-old man with a history of alcoholism who was admitted to the hospital due to behavioural disturbances and subacute delusional ideas of harm.

Objectives

To review the epidemiology and clinical features of WE, as well as its clinical management.

Methods

Review of the literature on WE clinical presentation and management, focusing on psychopathological symptoms, applying the information to this specific case.

Results

Classical triad of WE is only to be found in 10-17% of patients. The most common clinical presentation is changes in mental state (82%), varying from subtle changes in memory, apathy, subtle disorientation or indifference to more severe presentations such as delirium, stupor or coma. Other frequent symptoms include oculomotor dysfunction and gait ataxia. High dose thiamine supplementation therapy has proven effective in preventing clinical progression and permanent neurological damage.

Conclusions

- WE is the most prevalent complication of thiamine deficiency, being associated to alcoholism in 50% of cases. - Changes in mental state is the most frequent form of clinical presentation, not necessarily associated with the classical triad of WE. - WE is a medical emergency that requires high dose thiamine supplementation therapy to prevent permanent neurological damage.

Disclosure

No significant relationships.
Glaucoma and Psychotropics
Authors: Cavaco T. , Rema J. , Rodrigues C.
Published: September 2022

Introduction

Glaucoma is a heterogeneous group of conditions which result in optic neuropathy and visual defects, majorly linked with the increase of intra-ocular pressure (IOP). It is known that psychotropic drugs have been implicated in drug induced angle-closure glaucoma, mostly through its anti-cholinergic effect.

Objectives

Systematize the drugs most and least implicated in its appearance and worsening and understand the care needed on prescribing.

Methods

A search on Pubmed database was made having in consideration the Mesh Terms Glaucoma and Psychotropic Drugs and its different classes. Specific searches were made when appropriate on different platforms.

Results

Implications on the appearance and worsening of glaucoma are clear for tricyclic antidepressants. The evidence is not clear for SSRIs, SNRIs and mirtazapine, but they might be related with increased IOP. Other classes of antidepressants seem to be of lower risk. Antipsychotics do not seem to be greatly associated with angle closure, although there are some case reports. There are descriptions of the potencial use of haloperidol, anti-convulsive mood stabilizers, with exception of topiramate, melatonin and anti-dementia drugs on the treatment of this condition. In practice, benzodiazepines do not seem to precipate angle-closure. Methamphetamines are contraindicated. Eletroconvulsive therapy its an option.

Conclusions

Although not prevalent, angle-closure glaucoma can have serious implications and culminate in irreversible blindness. In patients with known risk-factors its important to have it on consideration at the time of the prescription and warn on seeking immediate help if having acute ocular pain, redness and/ or cloudy vision.

Disclosure

No significant relationships.