bluuebunny/crossref_metadata_2025 huggingface dataset:
Schizophrenia and OCD, association and treatment. Literature review
Authors: Tbatou A.
Published: August 2023

Introduction

Worldwide epidemiological studies estimate that around 1% of the world population suffers from schizophrenia and 2 to 3% from compulsive-obsessive disorder (OCD). Moreover, a significant percentage of schizophrenia patients present an OCD comorbidity.

These statistics testify to a close relationship between the two pathologies, which sometimes causes difficulties in differentiating between the two diagnoses, complicated by the fact that many schizophrenia patients can suffer from obsessive and/or compulsive symptomatology similar to OCD.

Objectives

This literature review aims to explore the frequency of association between schizophrenia and OCD and the administrated treatment through articles exploration.

Methods

We conducted a literature review about the association frequency between schizophrenia and OCD and the administrated treatment, which implies scientific literature exploration and selecting several articles treating this topic.

For our review, keywords used to search in Scopus and PubMed were: “schizophrenia and OCD” and “schizophrenia and OCD treatment” found more than 1500 results between 1988 and 2022. With the application of exclusion criteria, we included approximately 40 recent articles treating the frequency of association between schizophrenia and OCD and administrated treatment.

We organized These articles by counties, association frequency, and the administrated treatment.

Results

Our review of these articles and studies finds mostly a percentage between 10% to 30 % worldwide (countries from Asia, America, Africa, and Europe) of schizophrenia patients suffering also from OCD. The difficulty of diagnosis between schizophrenia and OCD, and the frequency of existence of obsessive and/or compulsive symptoms in schizophrenia remains one of the most relevant challenges for diagnosis and treatment in these countries.

We also found that administrated treatment was commonly pharmacological with psychotherapy association sometimes.

Conclusions

Our review explored the frequency of schizophrenia and OCD association and the administrated treatment. We found significant comorbidity between the two pathologies. With these findings, we may suggest systematic research for OCD with adapted scales in every schizophrenia case.

Disclosure of Interest

None Declared
Mania induced after corticosteroid treatment: a case report
Authors: Arroyo Sánchez E. , Sanz- Giancola A. , Setién Preciados P. , Romero Gerechter I. , Martín Velasco M. , Díaz Mayoral C.
Published: August 2023

Introduction

Corticosteroids are drugs widely used in clinical practice for their anti-inflammatory and immunosuppressive properties. Despite their beneficial effects, a high association of these drugs with neuropsychiatric adverse effects such as psychosis, mania, depression, delirium or increased risk of suicide, among others, has been observed. We present the case of 54-year-old man who started treatment with hydroaltesone 20 mg/8h after undergoing surgery for a pituitary macroadenoma who began with maniform clinic.

Objectives

To know the prevalence, risk factors and treatment of mania as a side effect of corticosteroid drugs.

Methods

Presentation of the case and review of the available literature on the risk of developing mania after corticosteroid treatment.

Results

Several studies confirm that the incidence of psychiatric adverse effects after the use of corticosteroids is around 6% if we refer to severe reactions; 28% moderate reactions; and 72% if we consider milder reactions. The direct relationship between these drugs and affective symptoms ranges in rates between 1-50% of cases, the most frequent being depression and mania. The risk of mania after treatment with corticosteroids is 4-5 times higher than if we compare it with a group of population not exposed to these drugs. There is a dose-response relationship, increasing the risk from a daily dose of 40 mg/day, with an average duration of symptoms of around 21 days. Female sex seems to be a risk factor in relation to the fact that diseases requiring this type of treatment are more common in this gender. As first-line treatment for mania secondary to corticosteroids, a decrease in treatment dose or its interruption, whenever possible, is proposed. Adjuvant treatment may be required, with atypical antipsychotics being the first choice.

Conclusions

Corticosteroid therapy has a direct dose-response relationship with the presence of psychiatric adverse effects such as mania. Dose and sex have been studied as possible adverse effects. Therefore, the pharmacological treatment of choice consists of a reduction in the dose of corticosteroids administered or withdrawal, if possible, and may be combined with an atypical antipsychotic such as olanzapine, quetiapine or risperidone. Re-evaluation is recommended until complete resolution of the clinical picture and then antipsychotic treatment can be progressively withdrawn.

Disclosure of Interest

None Declared
Cushing’s disease and bipolar disorder: study of medicopsychiatric intricacies from a clinical vignette
Authors: Chamsi F. Z. , Abrebak H. , amine T. , El ammouri A.
Published: August 2023

Introduction

Cushing’s syndrome is a relatively rare condition that results from chronic hypercortisolism. This syndrome is characterized by the presence of various psychiatric manifestations that can accompany it at all its stages of evolution. They can either inaugurate the clinical picture, or appear during the course of the disease, as they can persist even after the resolution of the syndrome. of Cushing. Through a clinical vignette, we report a case of Cushing’s syndrome in a 52-year-old patient who presented with a picture of melancholic depression as part of a bipolar disorder and who had preceded the discovery of Cushing’s disease.

Objectives

establish the relationship between Cushing’s syndrome and bipolar disorder and identify the main pillars of care.

Methods

It was proposed to present the clinical case of a 52-year-old patient in whom psychiatric manifestations of the psychotic and thymic types preceded the discovery of Cushing’s disease, to recall the main psychiatric symptoms that can be encountered during such endocrine disorders and their possible entanglement with psychiatric pathologies.

Results

Mrs. F. is 52 years old. married and mother of 3 children, without social security coverage for medullary carcinoma of the thyroid, having benefited from thyroidectomy with radiotherapy, admitted for treatment of paraneoplastic Cushing’s syndrome. The beginning of his troubles goes back to 6 months before his consultation with psychiatry. The initial symptoms were typical of a progressive weight gain noticed by the entourage. There was the installation of thymic symptoms such as an elation of mood, self-esteem, multiple projects. One month before admission to the internal medicine department, the patient presented with a depressed mood, anhedonia , a disgust for life, and dark thoughts. She had stopped all drug treatment.

Cushing’s disease is the most common cause of endogenous hypercortisolism (>85%). Corticotropic micro-adenomas , are the most frequently observed, i.e., in 90% of cases, and are sometimes not visible on magnetic resonance imaging . Its first-line treatment is neurosurgical with trans-sphenoidal excision. In its second intention, it uses drugs whose targets are pituitary or adrenal, as well as radiotherapy.

Conclusions

we present the case of a patient with a picture of bipolar mood disorder and Cushing’s disease. Thymic and psychotic psychiatric symptoms preceded the discovery of endocrine disease whose symptoms were not apparent at first. The hypotheses of comorbidity or rather of the inauguration of the endocrine disease by a psychiatric picture, in particular bipolar mood disorder, remain advanced and the limits between

Disclosure of Interest

None Declared
LAMOTRIGINE INDUCED LEUCOPENIA IN A PATIENT WITH TYPE 2 BIPOLAR DISEASE
Authors: VATANSEVER S. , USTA SAGLAM N. , BESTEPE E.
Published: August 2023

Introduction

Lamotrigine(LTG) is a widely used medication for bipolar disorder(BD) maintenance treatment, bipolar depression, epilepsy, trigeminal neuralgia.1The well-known common side effects of LTG are rash,fatigue, gastrointestinal symptoms,dizziness,headache,insomnia.2While one of the most refrained side effects of LTG is Steven Johnson’s syndrome, there have been reports of blood dyscrasia,such as agranulocytosis, neutropenia, pancytopenia.3,4Unfortunately, the exact mechanism of the blood dyscrasias isn’t fully explained.Here we report a case of LTG-induced leucopenia in a patient with BD type 2 patient.We obtained the patient’s consent.

Objectives

We report a case of a 56-year-old female patient, brought to the emergency unit with complaints of feeling unhappy, hopeless,having trouble sleeping and suicidal thoughts for two months.She attempted suicide a few days ago,had multiple suicide attempts in the last two years.She had 3 psychiatric hospitalizations due to depressive episodes and 1 hypomanic episode.Her mood was depressed.She had psychomotor retardation,no psychotic feature.Due to active suicidal ideation,we admitted her to the inpatient unit with the diagnosis of BD type 2.

Routine blood tests were within the normal range.We increased quetiapine XR 300 mg and venlafaxine 300 mg,which she had already taken;discontinued her aripiprazole treatment and added LTG 25 mg/d. 8 after initiation of LTG,there was a decrease in white blood coun(WBC) from a baseline level of 5.18x109/L to 3x109/L,while neutrophil count decreased from 3.8x109/L to 1.15x109/L in 12 days.Her medical records showed no sign of leucopenia.No pathology was detected in the peripheral smear or ultrasonography performed with the haematology consultation.Considering leucopenia might be an adverse drug reaction associated with LTG, we discontinued LTG treatment on the 9th day of administration. 9 days after discontinuation WBC was up to 4.22x109/L,neutrophil count was 2.78x109/L. We started valproate 500 mg/d and on the 27th day of her stay, she was discharged with a euthymic mood, having no depressive symptoms or suicidal thoughts.Her last treatment was venlafaxine 225 mg, quetiapine XR 300 mg, quetiapine IR 100 mg, valproate 500 mg, lorazepam 1 mg daily.

Methods

It is a retrospective review.

Results

In this LTG naive patient,the WBC values were within the normal range at admission.There was a significant temporal relationship between the initiation of the LTG and the decrease in WBC values.The absence of other factors in the laboratory tests and examinations,the rapid increase of WBC levels after the LTG was discontinued suggests the observed effect may be a side effect of LTG.

Conclusions

Blood dyscrasies aren’t a very common side effect of LTG, but it might be helpful to see CBC, especially in older populations, on patients with polypharmacy regimens and with severe mental illness that may interfere with patient’s ability to express any subtle side effect.

Disclosure of Interest

None Declared
How to adapt message to adolescents about sexuality?
Authors: Ghabi H. , Aissa A. , Askri F. , Jedda S. , Zgueb Y. , Ouali U.
Published: August 2023

Introduction

A mature and fulfilling sexuality is based on appropriate sexual education. The message must be adapted to the level of knowledge and practices of young people. Old studies dating back more than 15 years have been published.

Objectives

The objective of this study is to assess adolescents’ knowledge and attitudes about sexuality.

Methods

This is a descriptive cross-sectional study conducted among 80 adolescents using an anonymous online questionnaire.

Results

The average age of the participants was 18 years old 45% had had at least one sexual intercourse, they are mostly male. Only 9% had used a method of contraception. Most of them had heard of contraceptive techniques. Young age, male gender, lack of dialogue with parents, low socio-economic status and lack of sex education were significantly associated with a low level of knowledge about sexuality.

Conclusions

The results show that adolescents had risky practices with a lack of information. More studies are needed to approve these results and improve sexual health of these teenagers thanks to targeted sensitization.

Disclosure of Interest

None Declared
Young Adults’ New Cognitive Formations and the Feeling of Becoming an Adult
Authors: Markish O. V. , Churbanova S. M. , Chesnokova O. B.
Published: August 2023

Introduction

In adolescence, the person transitions from the reality of childhood, where he is mostly dependent on his parents, to the reality of adult life, which necessitates the acquisition of adult role systems, established autonomy, and ability to accept responsibility. The most important feeling during that time is that of maturation into adulthood.

Objectives

This study was designed to investigate the impact of new cognitive formations on the maturation of young adults’ self-consciousness from the perspective of a subjective evaluation of the experience of becoming an adult, particularly its cognitive component.

Methods

The study was based on Akimova’s Adult Practical Thinking Scale (Akimova et al., 2008), Zack’s Theoretical Thinking Scale (Zack, 2010), Personal Differential Test (Bazhin & Etkind, 1983), Szustrowa’s Egocentric Associations Scale with content analysis applied (Szustrowa, 1976), The Feeling of Becoming an Adult Expression Scale (Andriushchenko et al., 2014) and included 64 participants aged 18-22 years. The approbation group had 12 participants and the core group had 52 participants.

Results

The IBM SPSS 22 statistical rank correlation analysis provides support for: negative moderate correlation between (1) the reflective type of theoretical thinking and personal egocentrism (rs=-.31; p=.024), (2) adult practical thinking level and awareness of a new position in adolescents-adults relations self-consciousness component (rs=-.28, p=.048); positive moderate correlation between (1) social intelligence and the feeling of becoming an adult expression degree (rs=.39; p=.004), (2) orientation to autonomous educational and intellectual activity (self-consciousness component) and subjective attitude towards oneself and other people (rs=.29, p=.04), orientation to autonomous educational/intellectual activity and Egocentrism Index (rs=.37, p=.007).

Conclusions

According to the study’s findings, there is a strong correlation between young adults’ cognitive traits (such as content-related reflection for formal operational thinking and social intelligence), their expression of the feeling of becoming an adult, and some aspects of self-consciousness. It indicates that the feelings of becoming an adult manifest themselves as an orientation to autonomous educational and intellectual activity and new forms of cooperation with adults that develop step by step through time, but not as a process of individualization based on egocentric attitudes.

Disclosure of Interest

None Declared
Use of cariprazine as an impulsivity regulator in an adolescent with non suicidal self-injury and suicidal attempts. Case report
Authors: Del Sol Calderon P. , Izquierdo de la Puente A. , Fernández Fernández R. , García Moreno M.
Published: August 2023

Introduction

Adolescents with emotional dysregulation are at risk for self-injury. Antipsychotics are often used to manage these symptoms.

Objectives

The aim of the present case is to show the use of cariprazine as an effective drug for emotional dysregulation and impulsivity in a 17-year-old adolescent girl

Methods

Case report

Results

The patient was a 17-year-old female admitted to in patient psychiatric unit for a self-harm attempt due to sertraline overdose. She was being followed up for self-injury, anxiety and eating disorder symptoms. Her treatment was sertraline 200 mg, diazepam 20 mg per day and olanzapine 15 mg per day. With this medication she had gained up to 7 kgs in 4 months. A progressive change was made with cariprazine up to 3 mg and olanzapine was reduced to 2.5 mg at night. With this adjustment the patient did not present worsening in anxiety levels, with adequate impulse control and being able to perform emotional regulation strategies.

Conclusions

Although it has no indication in patients under 18 years of age, it shows a case of good tolerance and efficacy for the management of impulsivity by improving emotional regulation. Cariprazine is an atypical antipsychotic that works through partial agonism on dopaminergic receptors, serotonin 5-HT1A receptors and an antagonist at the 5-HT2B receptors, with moderate affinity for adrenergic, histaminergic, and cholinergic receptors reducing the likelihood of side effects

Disclosure of Interest

None Declared
Motivational Interviewing Technique As a Means of Decreasing Vaccine Hesitancy in Children and Adolescents During the COVID-19 Pandemic
Authors: Bidkhanian P. A.
Published: August 2023

Introduction

Vaccine hesitancy is a known phenomenon predating the COVID-19 pandemic. Vaccine hesitancy is a significant factor effecting the control and spread of the COVID-19 Virus. Hesitancy of parents choosing not to vaccinate their children is studied here. Also studied is the effect of a brief motivational interviewing intervention on the parent’s decision to vaccine their child, or not. What was found was a myriad of beliefs and values in the parents, and varied reactions and outcomes in response to the motivational interviewing.

Objectives

The aim of our study is to determine whether motivational interviewing techniques can be used as an effective tool to educate patients and their families about the benefits of vaccination against COVID-19 and increase vaccinations rates. In our urban community hospital-based child and adolescent psychiatry outpatient clinic, we found a high level of vaccine hesitancy among our patient population. As motivational interviewing is an evidence-based approach to addressing ambivalence and behavior change, we sought to engage parents with this approach.

Methods

This is a quality improvement project where chart review of all pediatric patients currently enrolled in our clinic was performed to determine which patients are unvaccinated for COVID-19. Telephone contact was made to reach parents to obtain verbal consent and to deliver the intervention consisting of standardized motivational interview techniques followed by brief educational points about the vaccines. Follow up calls were made one week later to determine whether there was any change in readiness to consider vaccination on a scale from 1-10. We reached a total of 29 parents on initial outreach, and 11 parents during the follow up phase. Many were lost to follow up due to unavailability or refusal to participate further.

Results

Parents (N = 11, 5- African American, 6- Hispanic) reported on their decision to have their child (mean age=12.2, 55% Female) receive the covid-19 vaccine. Preliminary findings show an increase in readiness on a scale from 1-10 to receive the vaccine following a one week interval post intervention (t(10)=2.096, p=.06), with the most common barriers that subjects endorsed being fear of side effects, skepticism regarding the speed at which the vaccines were developed, and wanting to allow their children to decide for themselves.

Conclusions

We found that there was an overall improvement in vaccine hesitancy following our intervention, though it did not cross the threshold of statistical significance. We also identified common reasons given for hesitancy within our community. Motivational interviewing is a promising intervention to address vaccine hesitancy. Further study is warranted as expanding the reach of such interventions could lead to more robust data as well as broader vaccine acceptance.

Disclosure of Interest

None Declared
psychiatric manifestations of corticosteroid therapy
Authors: El Maataoui Z. , H. B.
Published: August 2023

Introduction

Children and adolescents treated with corticosteroids (CS) may experience psychiatric side effects, including psychotic symptoms. These can occur at any time during treatment, including withdrawal. There is evidence in the adult literature that higher doses of CS increase this risk. However, the dose-response relationship is not clearly identifiable. This is probably a reflection of the complexity of the effects of CS on the central nervous system and the body.

Objectives

the objective of this study is to discuss the psychiatric manifestations secondary to corticosteroid therapy

Methods

This is a descriptive study of 10 children with a history of somatic pathologies for which they were placed on oral, nasal, or intravenous corticosteroid therapy and who during the course of this corticosteroid therapy presented with various psychiatric manifestations.

Results

The majority of the children studied were male, i.e., 7 boys to 3 girls, six children either 60%, were on nasal corticosteroids; 20% on intravenous corticosteroids, ., 20% orally.

The psychiatric manifestations noted were represented by : depressive disorder in 8 childrens Anxiety in 7 childrens a psychotic disorder in one child ADHD in 3 childrens.

Conclusions

A causal role of corticosteroid therapy in the development of mental disorders in children and adolescents has been widely discussed but the results are controversial with respect to the route of administration, the relationship with the dose and the chronology of the development of mental disorders.

Disclosure of Interest

None Declared
Hepatitis B Vaccination in Psychiatric patients in Morocco
Authors: Zineb B. , Aicha T. , Imane K. , Fouad L. , Abderrazak O.
Published: August 2023

Introduction

Severe mental illnesses such as schizophrenia, bipolar disorder and depressive disorder are common worldwide and often have a chronic course.

Due to psychiatric ( for example : substance use disorders ) and somatic ( for example : obesity, cardiovascular disease, diabetes ) comorbidities, mortality is higher in these patients than in the general population.Viral diseases are, in addition to cardiovascular diseases and metabolic alterations, among the most common somatic comorbidities in people with severe mental illness.

Objectives

The objective of our work was to study the prevalence of vaccination against the viral hepatitis B virus in these patients.

Methods

For this purpose, we conducted a cross-sectional study of 200 patients hospitalized in the emergency department of our training center. First, we collected sociodemographic and clinical data on patients admitted to psychiatric emergencies: sex, age, diagnosis, duration of evolution, history (medical and surgical, psychiatric, suicide attempts, problematic substance use, previous incarceration). In a second step, we tested for anti-HBS antibodies.

Results

the majority of our patients were male, the first diagnosis was schizophrenia.

92% of our patients had a substance use disorder, mainly tobacco, followed by cannabis and then alcohol.

Several patients reported having unprotected sex.

58% of patients were vaccinated against hepatitis B, these patients were young for the most part. the majority of our patients were male, the first diagnosis was schizophrenia.92% of our patients had a substance use disorder, mainly tobacco, followed by cannabis and then alcohol.Several patients reported having unprotected sex.58% of patients were vaccinated against hepatitis B, these patients were young for the most part.

Conclusions: Disclosure of Interest

None Declared
Cyclic voltammetry as a measuring tool in Parkinson’s disease and associated psychiatric commorbidities
Authors: Ciobanu C. A. , Ionita I. , Mihailescu A.-I. , Ciobanu A.-M.
Published: August 2023

Introduction

Despite the rapid increase in disability and death due to Parkinson’s disease and associated psychiatric comorbidities (psychosis, depression, cognitive impairment, anxiety), the quest for a clear pathophysiological mechanism and treatment remains elusive. Numerous studies aim to identify a metabolomic fingerprint for PD and new, promising biomarkers are discovered with implications beyond neurodegenerative diseases, such as novel markers as predictors of bipolar type in depressed patients.Changes in neuronal microenvironment employ electrochemical techniques, such as cyclic voltammetry, used in both animal and human models of PD to monitor dopamine (DA) alterations in vivo, with high spatial and temporal resolution.

Objectives

Our aim is to investigate the latest scientific literature on PD and associated neuropsychiatric disorders and review the applications cyclic voltammetry has in recent technological advances in the field.

Methods

To gain a broad understanding of the subject, we have consulted multiple scientific literature databases (PubMed, Google Academic, Science Direct) using the keywords “cyclic voltammetry, Parkinson’s disease, psychiatric disorders, dopamine” and included original research articles published in the last 10 years

Results

The first in situ measurement of DA release in the human brain has been demonstrated in a sequential investment task, with implications for future research in decision-making behavior.

One study combines cyclic voltammetry and wireless telemetry for in vivo recording of changes in extracellular levels of DA, with high temporal and spatial resolution.

Disulfide nanorod-graphene-β-cyclodextrin nanocomposites biosensors have been succesfully used in detecting DA in rodent brain and human blood serum samples, with implications for minimally invasive measuring techniques.

Animal studies use cyclic voltammetry to monitor changes in DA levels in cerebrospinal fluid and plasma of mouse models of PD and investigate DA metabolism, release, uptake and receptor sensitivity in Knock-out mice, with implications for the diurnal variation of extracellular DA tone and release.Furthermore, a human alpha-synuclein-expressing mouse model of PD exhibited increased extracellular DA concentrations, decreased DA uptake and relieved paired-stimulus depression.

Conclusions

Cyclic voltammetry is a powerful tool in the expansion to humans of electrochemical recording techniques in PD. The final aim is to investigate DA neuron physiology before neurodegeneration onset and to measure neurotransmitter release in real time.

Disclosure of Interest

None Declared
Perceptions about Graves’ Disease: A qualitative study on reports of patients in Euthyroidism and with Ophthalmopathy under a Brazilian university specialized outpatient follow-up
Authors: Turato E. R. , Zantu-Wittmann D. E. , Reis J. C. A. , Valladão L. S.
Published: August 2023

Introduction

Knowing mental representations about the phenomenon of illness and medical care allows the clinical team to have better emotional handling of their patients, with gains in greater adherence to treatments. Graves’ Ophthalmopathy is an inflammatory disease with primary involvement of the extraocular muscles and orbit, being the most frequent extrathyroidal manifestation of Graves’ Disease. Many patients have psychological status changes even after successful treatment of hyperthyroidism, especially when the disfiguring signs of ophthalmopathy are predominant. An understanding of the symbolic aspects linked to this condition help doctors and nurses to have a relationship more harmonious with them.

Objectives

To interpret emotional meanings in reports of patients with euthyroidism and with ophthalmopathy under follow-up at a specialized university endocrinology outpatient follow-up, discussing contradictions perceived between a stigmatized body and clinical-laboratory euthyroidism.

Methods

Clinical-Qualitative design of Turato. Data was collected using Semi-directed interviews with open-ended questions in-depth, carried out with patients at a university hospital specialized outpatient service in South-eastern Brazil. The interview material was audio-recorded and fully transcribed. The interviews were treated by Clinical-Qualitative Content Analysis described by Seven Steps’ Faria-Schützer. It is based on psychodynamic concepts from the Medical Psychology theoretical framework, whose main author is Michael Balint. The sample was closed by the Theoretical Saturation of Information studied by Fontanella and cols. The finding validation has occurred by peers at the Laboratory of Clinical-Qualitative Research, State University of Campinas, San Paolo.

Results

The sample was composed by 10 patients. From the search of nuclei of meanings in the reports, four categories of analysis were constructed: 1) “No, this is not normal, I must have cancer”: psychodynamics of the doctor-patient relationship in Graves’ Disease; 2) Types of illness according to their manifestations and auto-perception: silent illness and non-silent ones; 3) “The eyes are everything”: the impacts of the disfiguring alterations of ophthalmopathy; 4) The contradiction perception between clinical and laboratory normality the stigmas of ophthalmopathy.

Conclusions

The patients with severe exophthalmos, maintained emotional distress despite being euthyroid, manifested by various emotional meanings reported in the interviews. The clinical-laboratory diagnosis of Graves’ Disease alone is not sufficiently capable of responding to the psychological demands of the patients. Proper listening to emotional symbolic meanings attributed by patients can help physicians and nurses in handling this setting

Disclosure of Interest

None Declared
Fahr’s Disease: a case report of a patient with neuropsychiatric symptoms
Authors: Perez-Sagaseta I. , Yelmo-Cruz S. , Cardenes-Moreno C. , Torres-Tejera L. , Crisostomo-Siverio A. , Dorta-Gonzalez J. , Tascon-Cervera J. J. , Paniagua-Gonzalez M. , Canessa S. , Cejas-Mendez M. R.
Published: August 2023

Introduction

Fahr’s disease (FD) is a rare disorder consisting of bilateral and symmetrical calcium deposits in basal ganglia and cerebral cortex. These lesions are associated with neurological and psychiatric symptoms such as a rigid hypokinetic syndrome, mood disorders and memory and concentration abnormalities. It can be idiopathic or secondary to endocrine disorders, infectious diseases or mitochondrial myopathies.

Objectives

To highlight the importance of considering organic causes when evaluating patients presenting atypical psychiatric symptoms and claim the role of neuroimaging.

Methods

Case report and non-systematic review of literature: sources obtained from Pubmed database.

Results

A 69-year-old man, native of Syracuse (Italy), was admitted to the Psychiatry Unit in February 2022 presenting behavioural disturbances and irritability. In July 2021 he presented the same symptoms, being mistakenly diagnosed with Bipolar Disease type I. He has no previous psychiatric history. He started with changes in his personality, short-term memory loss, aggressiveness and disorganized behaviour at the age of 66. At admission he was talkative and hyperfamiliar, presenting delusions of grandiosity, exalted affectivity and insomnia. Neurological examination showed short-term memory problems, signs of frontal disinhibition and abnormal glabellar tap sign. Blood tests, CT brain and MRI were performed to rule out organic underlying causes. Neuro-imaging found bilateral and symmetric calcifications in globus pallidus, thalamus and corpus striatum, in favour of FD. Secondary causes (abnormalities in the PTH, vitamin disorders and infectious diseases such as HIV, brucellosis or neurosyphilis) where discarded, allowing us to conclude it was probably a primary case of FD. Valproate was started as a mood stabilizer and anticonvulsant. Genetic tests were indicated.

Conclusions

FD should be considered as a differential diagnosis in the evaluation of psychiatric symptoms, especially when atypical and/or presented with neurological symptoms. The role of neuro-imaging is essential.

Disclosure of Interest

None Declared
MALIGNANT CATATONIA IN MEDICAL WARDS: A BROAD DIFFERENTIAL DIAGNOSIS
Authors: Arbelo N.
Published: August 2023

Introduction

Catatonia is an uncommon and heterogeneous psychomotor syndrome. It can be not only the manifestation of a psychiatric disorder but also a wide range of medical conditions. The malignant catatonia is a subtype of catatonia which includes dysautonomic signs such as hyperthermia or hemodynamic instability, and because most of the affected patients are taking antipsychotics or antidepressants previously, it can be confounded with medical conditions such as neuroleptic or serotonin syndrome.

Objectives

To present a case of malignant catatonia admitted in a medical ward

Methods

The present study is a case report of a patient admitted with initial diagnosis of serotonin syndrome in a medical ward of our hospital and referred to the consultation and liaison psychiatry (CLP) unit. We also searched previously case reports, series and systematic reviews about catatonia secondary to medical conditions and hyperthermia catatonia.

Results

Ms. TN is a 71-year-old woman, with prior history of major depressive disorder. One month ago she was admitted in a psychiatric ward of another hospital for a depressive episode with psychotics features, and was treated with escitalopram 10mg/day, vortioxetine 10mg/day, mirtazapine 15mg/day, trazodone 50mg/day, quetiapine 700mg/day and haloperidol 5mg/day. She had a worsening of depressive symptoms with suicidal thoughts, negativism and psychomotor retardation, and subsequently hyperthermia, rigidity, mydriasis, tachicardia and increased bowel sound. She was tranfered to our medical ward, and diagnosed of serotonin syndrome. She was stopped all the psychiatric drugs and was treated with dantrolene and support measures. After 10 days without antidepressants or antipsychotics she maintened the same symptomatology and was referred to our CLP unit. The psychopathological evaluation showed stupor, mutism, waxy flexibility and negativism, and she responded to a challenge test with intravenous clonazepam 0,5mg. She was diagnosed of malignant catatonia and was started oral clonazepam 2mg/day. Although there was a partial response, she did not tolerate higher doses because of sedation and finally was treated with electroconvulsive therapy (ECT). She dad a remission of catatonic symptoms after only two sessions of ECT.

Conclusions

Malignant catatonia can be confounded with other medical conditions such as serotonin or neuroleptic syndromes. All of them can have catatonic signs, and it is important to recognize them (a challenge test with a benzodiacepine can be helpful). The key to distingish malignant catatonia from them is that some of the catatonic signs (negativism and psychomotor retardation) happened before the dysautonomic signs. Also, it is uncommon that a serotonin syndrome persisted more than 3-5 days after the suspension of antidepressants. Consultation and liaison psychiatrists can help for the differential diagnosis and management of patients with suspected catatonia in medical wards.

Disclosure of Interest

None Declared
SEROTONIN SYNDROME AFTER HIGH DOSAGE QUETIAPINE INTAKE: CASE REPORT AND BRIEF LITERATURE REVIEW
Authors: Fountas P. , Kasimis D. , Goulas K. , Niamonitos N. , Basdekis A. , Thanasas E. , Charitakis G. , Koumpis M.
Published: August 2023

Introduction

Serotonin syndrome is a potentially life-threatening condition due to increased serotonergic activity in the CNS. Its most well-known causes are the ingestion of large amounts of serotonergic drugs or the inappropriate combination of two or more serotonergic antidepressants. Rarer causes of serotonin syndrome have been reported in the literature.

Objectives

The aim of this paper is to highlight, through case presentation, rarer causes of serotonin syndrome.

Methods

Case presentation (woman, 39 years old) who was hospitalized with clinical presentation of Serotonin syndrome, after pharmaceutical self-poisoning with a large amount of quetiapine (>20g). The search of the case data (clinical and paraclinical examination findings) was performed from the medical records and files of the 3rd Internal Medicine Clinic and the Liaison Psychiatry Department of our hospital. A literature search of similar cases (through PubMed) was performed.

Results

A patient with a history of mood disorders, under treatment with venlafaxine, lamotrigine, quetiapine and aripiprazole, was admitted to the hospital ICU due to a decreased level of consciousness (GCS 11/15). Ingestion of approximately 100 tablets of Quetiapine 200mg was reported. The patient developed upper and lower limb myoclonus, supraventricular tachycardia (130bpm), nystagmus, bilateral mydriasis with normal photomotor reflexes, increased tendon reflexes, excessive sweating, upper limb muscle rigidity and abdominal flatulence with the presence of loud bowel sounds. Gastric lavage was performed and admission to the Internal Medicine department followed. Intravenous diazepam was administered, 30mg on the 1st 24 hour period and 20mg on the 2nd, with gradual tapering. From the very 2nd 24 hour period of hospitalization, her clinical condition showed significant improvement, with complete remission of symptoms and recovery of a satisfactory level of consciousness.

Conclusions

Serotonin syndrome can be effectively treated if early recognition of symptoms is made. Clinicians should be particularly alert and suspect the possibility of serotonin syndrome in a patient with compatible symptoms by clinical examination, especially in case of overdose of a drug, with or without a serotonergic mechanism of action.

Disclosure of Interest

None Declared
A Complicated Case: Presenting Neuropsychiatric Symptoms After COVID Infection
Authors: Evecen A. , Bülbül A. , Karaytuğ M. T.
Published: August 2023

Introduction

The COVID-19 pandemic has affected millions of people worldwide. Among a large number of deaths, COVID-19 has caused significant health-related sequelae involving many systems of the body. Some results include increased anxiety, depression, insomnia, and other distress symptoms. Additionally, there are reports of sudden onset of psychosis in patients with no psychiatric history following COVID-19.

Objectives

Emphasizing the importance of Covid 19 causing many psychiatric diseases, although its etiology is not yet known.

Methods

Report of a clinical case

Results

We report a 68-year-old previously healthy woman with no personal or family history of mental illness who was hospitalized due to COVID-19 and then started to have psychiatric complaints. She had complaints such as refusal to speak, eat and drink, fear of death which started after her discharge from the hospital due to COVID-19.

On 14.07.2021, she applied to the psychiatry outpatient clinic of our hospital for the first time. In addition to the existing complaints, we have considered the preliminary diagnoses of dementia and psychotic depression due to the increasing fear of being alone, going out alone, confusion in the interim periods, and thoughts that someone will harm her and her family. We consulted the neurology clinic and she was admitted to the neurology service with a preliminary diagnosis of encephalitis. During her hospitalization, the patient’s EEG and MRI were taken, LP was performed, and no pathology was detected in the examinations. Her current psychiatric treatment (escitalopram 10mg/d, medazepam 2mg/d, and olanzapine 2,5mg/d) continued throughout her hospitalization in the neurology service, but her complaints did not change. She was fed formula with an NG tube, IV hydration was provided, and a urinary catheter was inserted.

After ruling out neurological disease on 12.08.2021, the patient was admitted to our psychiatry service with a prediagnosis of catatonic-psychotic depression. Electroconvulsive therapy was planned because the visual hallucinations and persecutory delusions persisted. Total of 7 sessions of ECT were received. The patient’s oral intake started with the current treatment, and her fluent speech began. Olanzapine dose was increased to 7.5mg/d, and escitalopram dose was increased to 20mg/d due to persistent depressive and psychotic symptoms. The patient was discharged on 02.09.2021 with the current treatment. Her complaints had improved before she was discharged.

Conclusions

COVID-19 remains an emerging disease with unknown psychological sequelae. Caution should be exercised regarding psychiatric symptoms and associated risks in patients with a recent diagnosis of COVID-19. Cytokine storm may also be involved in the etiology, in addition to many psychological factors such as fear of illness, uncertainty, and isolation. Potential risk factors and underlying biological mechanisms should be investigated.

Disclosure of Interest

None Declared
COVID-19 vaccination rate in patients with mental illness in a psychiatric hospital: a cohort study
Authors: Areias D. , Portela C. , Dionísio R. , Sousa S. M. , Pereira E. G.
Published: August 2023

Introduction

Individuals with severe mental health problems are at greater risk of COVID-19 infection and increased risk of hospitalization and mortality. Vaccination against COVID-19 has demonstrated its importance in preventing and reducing these negative outcomes.

Objectives

This study aims to assess the vaccination rate of people with mental illness in comparison with the general population.

Methods

We will conduct a retrospective evaluation of vaccine uptake in a sample of patients admitted to a psychiatric hospital between the 1st of July of 2021 and the 30th of June of 2022 in the Porto region. According to their vaccination plan, all patients were offered the possibility vaccination. Statistical analysis will be performed to analyse the data.

Results

We expect to assess over 1500 patients. Regarding other studies on the same subject, although in different countries, we may predict that the vaccination rate in our sample will not, statistically, differ from the general population.

Conclusions

Some studies have shown higher resistance and hesitancy towards the COVID-19 vaccination in mental health patients, however others did not find differences between these patients and the general population. Therefore, this study will allow us to better understand the impact of mental illness in the vaccination rate in our population.

Disclosure of Interest

None Declared
First wave of psychological impact and associated factors in hospitalized COVID-19 patients; cross sectional study in supra tertiary hospital in Thailand
Authors: Na Bangxang J. , Wongkulab P.
Published: August 2023

Introduction

The Severe Acute Respiratory Syndrome Coronavirus (COVID-19) pandemic not only impacted on physical but also mental health of the patients. We investigated the prevalence and associated factors of depression, anxiety among hospitalized patients with COVID-19. Rajavithi hospital is a supra-tertiary hospital which was the frontline in the first wave and gets referral SARS CoV-2 cases from other parts of Thailand.

Objectives

We investigated the prevalence and associated factors of depression, anxiety among hospitalized patients with COVID-19.

Methods

A cross-sectional study was designed to evaluate prevalence of depression, anxiety and associated factors among 93 hospitalized COVID-19 patients between 1 July 2020 – 31March 2021. Depression and anxiety were measured with Thai Hospital Anxiety and Depression (Thai HADS).

Results

Prevalence of depression was 5.4 %, prevalence of anxiety was 2.2 % Depression was associated with age greater than or equal to 60 years old (p-value = 0.028) and requiring supplemental oxygen therapy (p-value = 0.021).

Conclusions

This study shows low prevalence of depression and anxiety in hospitalized patients with COVID-19. Depression was significantly related with elderly and supplemental oxygen therapy. Elderly is vulnerable to depression during treatment and patients who require supplemental oxygen therapy. Severity of the disease might affect neuroinflammatory responses which can relate to depression. Furthermore, severity of disease puts patients in more isolation or guilt that might lead to depression.

Disclosure of Interest

None Declared
Burnout and its associated factors in healthcare workers during the COVID-19 pandemic
Authors: Halouani N. , Koukane M. , Elleuch O. , Turki M. , Samet A. , Jemil F. , Ellouze S. , Aloulou J.
Published: August 2023

Introduction

Due to the COVID-19 pandemic, our health system had to face new challenges such as Burnout (BO), particularly among healthcare workers (HCWs).

Objectives

Our study aimed to examine the prevalence of burnout among HCWs, as well as to identify the sociodemographic and professional factors associated to it.

Methods

This was a cross-sectional descriptive and analytical survey, conducted during the fifth wave of COVID-19 between December 2021 and February 2022, among the healthcare workers of 3 hospitals in Djerba city. We used an online questionnaire to collect their sociodemographic and professional data. Maslach Burnout Inventory (MBI) was used to assess their burnout level.

Results

Our population consisted of 95 HCWs with a sex ratio of 0.46. Most of them (75%) had an age of less than 40 years. Among our participants, 56.8% were paramedics and 71.6% had a working experience of less than 10 years. A rate of 56.8% worked full-time with a minimum of 36 hours per week and more than 5 on-calls per month in 56.8%.

In our study, 76% of the HCWs were affected by BO. The mean emotional exhaustion, depersonalization and professional accomplishment scores were 35.74 ±12.16, 11.84 ±8.08 and 27.32 ±6.95, respectively. A rate of 69% had a high level of emotional exhaustion, 42% had a high level of depersonalization and 41% had a low level of personal accomplishment.

The subgroup analysis showed that BO was associated with: an age of less than 30 years (p=0.007); having no children (p=0.030); a work experience of less than 10 years (p=0.001); a number of working hours greater than 36 hours (p=0.030) and a number of on-call duties greater than 5 per month (p=0.007).

Conclusions

Our study shows the burden of BO in the HCWs of Djerba, especially among the youngest ones, the least experienced and those with the highest workload. Thus, a special attention must be paid to this condition, and the implementation of a prevention strategy is essential.

Disclosure of Interest

None Declared