bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcranial Pulse Stimulation (TPS®) as a method for treating the central nervous system of patients with Alzheimer’s disease
Authors: Ziegenbein M. , Clark D. , Rößner-Ruff V.
Published: August 2023

Introduction

Dementia - one of the most common diseases in old age - is often only diagnosed at a late stage. Therefore patients with dementia have often a 1.4 to 3.6 times greater risk of treatment as an inpatient. Consequently it is highly relevant within the caring system to identify and treat the onset of dementia at the earliest possible opportunity.

Objectives

Part of a new treatment center, a psychiatric clinic in the Hanover area (Wahrendorff
) has concentrated on treating patients with a mild or moderate form of Alzheimer’s disease as early as possible on an outpatient basis. The method of transcranial pulse stimulation (TPS®) is used. Acoustic pulses generated outside the body are introduced specifically into the brain regions requiring treatment. The aim being the release of growth factors and an improvement in cerebral blood flow, as a means to maintaining and promoting cognitive performance for as long as possible. The poster contribution shows reports from clinicians, patients and relatives, using TPS®. The development of cognitive performance in the course of treatment is also considered.

Methods

The data collection for the quantitative study design will take place at the clinic in the period from 06/2021 to 10/2022 (N planned = 60). Cognitive performance is recorded using the Montreal Cognitive Assessment (MoCA test) and the experience reports via interview.

Results

Results of repeated measurement and analysis of the variance in terms of cognitive performance (MoCA test, baseline and follow-up measures) are presented. Field reports are considered and the suitability of TPS® as a method for treating the symptoms of dementia in Alzheimer’s disease is discussed in the form of a best-practice example.

Conclusions

Field reports are considered and the suitability of TPS® as a method for treating the symptoms of dementia in Alzheimer’s disease is discussed in the form of a best-practice example.

Disclosure of Interest

None Declared
Psychosis in Parkinson’s disease: a clinical biomarker of disease stage and prognosis
Authors: Pinho M. , Martins D. O. , Martins P. S. , Gomes L. , Carvalho S.
Published: August 2023

Introduction

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor and nonmotor symptoms, the latter contributing significantly to morbidity, mortality, nursing home placement and quality of life.

Objectives

We present a literature review about the impact of psychosis on PD’s prognosis.

Methods

A literature review is performed on PUBMED, using the next keywords: "Parkinson’s disease”, “psychosis” and “prognosis”. We focused on data from systematic reviews, clinical trials and meta-analysis published in English on last 10 years.

Results

Psychosis is a common feature of Parkinson’s disease, occurring in up to 30% of PD patients treated chronically with antiparkinsonian drugs. Visual hallucinations are the most common psychotic symptom observed, delusions being considerably less common and affecting only 5% of treated patients.

Positive symptoms in PD vary across its course: early in the disease, passage hallucinations, illusions and presence hallucinations occur; later, complete visual hallucinations, initially with good insight, then without insight.

Psychosis spectrum symptoms in early PD predict a decline in cognitive function at 2 years, especially visual hallucinations. There is an association between visual hallucinations and the subsequent emergence of dementia.

Conclusions

Current evidence highlights the role of PD psychosis as a clinical biomarker of disease stage, distribution and future progression. Early recognition and treatment of psychotic symptoms improves disease’s outcomes.

Disclosure of Interest

None Declared
Predictors of suicidal ideation among female residents in a community impacted by multiple natural disasters.
Authors: Agyapong B. , Shalaby R. , Eboreime E. , Y. W.  , Agyapong V.
Published: August 2023

Introduction

Suicidal ideation and thoughts of self-harm continue to be challenging public health problems. It’s presently unknown what the prevalence and correlates of suicidal thoughts and self-harm are in female residents of Fort McMurray, a city that has endured wildfires, flooding, and the COVID-19 pandemic in the last five years.

Objectives

This study aimed to determine the prevalence and correlates of suicidal ideation and thoughts of self-harm among female residents of Fort McMurray.

Methods

A cross-sectional study using an online survey questionnaire was used to collect sociodemographic and clinical information from the resident of Fort McMurray between April 24 to June 2 2021. Suicidal ideation and thoughts of self-harm among females were assessed using the ninth question of the Patient Health Questionnaire-9, a validated screening tool used to assess depression symptoms. Likely Generalized Anxiety Disorder (GAD), Major Depressive Disorder (MDD), Post-Traumatic Stress Disorder (PTSD) and low resilience were measured using standardized rating scales. Data were analyzed with SPSS version 25 using Chi-Square tests and multivariate logistic regression analysis.

Results

Among Fort McMurray residents, 249 accessed the online survey, while 186 ultimately completed it, yielding a survey completion rate of 74.7%. Of these, 159 (85%) were females. After controlling for other variables in the regression model, respondents who expressed a desire to receive mental health counselling were more than seven times more likely to report suicidal ideation and thoughts of self-harm compared to the respondents who didn’t desire to receive mental health counselling (OR: 7.29; 95% CI: 1.19 – 44.58). Similarly, respondents who reported having abused alcohol in the past year were nearly four times more likely to report suicidal ideation or thoughts of self-harm compared to the respondents who said they had not abused alcohol in the past year (OR: 3.91; 95% CI: 1.05 – 14.57).

Conclusions

High prevalence of suicidal thoughts and thoughts of self-harm were reported among female residents of Fort McMurray. Timely access to adequate mental health support should be offered to female residents of communities impacted by multiple natural disasters, particularly residents who self-report alcohol abuse or desire to receive mental health counselling

Disclosure of Interest

None Declared
A rare case of trauma related dissociative identity disorder
Authors: Ghrissi F. , Fekih-Romdhane F. , Stambouli M. , Abassi B. , Cheour M.
Published: August 2023

Introduction

Dissociative identity disorder (DID) is a debilitating and controversial psychiatric disorder with a lifetime prevalence estimated around 1,5%. It remains underdiagnosed despite recognition in international classification of mental disorders. In fact, based on the DSM-5 criteria, DID is characterised by two or more distinct personality states that coincide, with fluctuating consciousness and changing access to autobiographical memory. The aetiology of DID has long been debated with recent neuroimaging evidence supporting the trauma model of this condition.

Objectives

The aim of this presentation is to describe the case of a young female diagnosed with DID related to childhood trauma.

Methods

We also conducted a literature review in order to discuss the aetiology of the disorder. The following keywords were searched through the pubmed website: dissociative identity disorder, trauma, aetiology.

Results

We report the case of a 20 years old female with no past medical, nor psychiatric history. However, she had a family history of an uncle and an aunt with chronic psychosis. Her father died when she was 8, thus she lived with her mother and her brother and two sisters. She was a brilliant student and started engineering studies. She has no particular personality trait. She was raised within a strict religious family with little time dedicated to leisure activities. Importantly, since the age of 10, she was exposed to her mother’s religious extremist and threatening discourses, related to death and “grave’s torture” and comprising many cultural beliefs. She seeks for psychiatric care complaining of “soliloquy” that became remarkable by her relatives. On psychiatric evaluation she presented daily fluctuating consciousness during at least one hour, in which she switches identity toward the daughter of a famous singer. This alter was having pleasant activity with her mother and was singing and hanging out most of the time. No particular triggers were identified. The trouble started by the age of 14 then worsened gradually and became an unvoluntary phenomenon with significant distress. She had no depressive nor psychotic nor anxiety or obsessive symptoms. Her sleep and appetite were not disturbed. She met DSM-5 diagnostic criteria for DID and was referred to a trained psychiatrist for adequate psychotherapy management.

Conclusions

We exposed a rare case of a young student complaining of soliloquy since the age of 14 that was diagnosed with DID subsequent to a particular childhood trauma which consisted in exposure to threatening religious and cultural beliefs about life after death told by her mother. This unique case emphasises the trauma model of DID, where the nature of the trauma influences the clinical expression of DID. Given the recent neuroimaging evidence, DID can be framed as a chronic psychiatric disorder based on neurobiological, cognitive, and interpersonal non-integration as a response to unbearable stress.

Disclosure of Interest

None Declared
Leadership for Early Career Psychiatrists – A rough guide on theory, practice and what to avoid
Authors: Sartorius N.
Published: August 2023

The presentation will focus on elements of leadership that have been shown to be useful on local and more comprehensive levels. It will be based on experience gained in leadership positions in international and national organizations and during leadership and professional skills courses which were conducted in more than 40 countries over the past thirty years. Among the topics that will be addressed for discussion and further action will be the need to introduce leadership training in the course of postgraduate education and to provide career advice at the beginning and during early years of service.

Disclosure of Interest

None Declared
A Lesson into Decolonized Psychiatric and Psychoanalytic Practice: Demystifying the Works of Girindrasekhar Bose
Authors: Gairola V.
Published: August 2023

Introduction

The endeavor of practitioners of psychiatry and psychoanalysis has been to break the disciplinary silos and to re-think what practice is all about. There was a person who pioneered this aim of intradisciplinary and interdisciplinary synthesis. His name was Girindrasekhar Bose. He was a psychiatrist, psychologist, and psychoanalyst who challenged the Freudian universalism of the Oedipus complex.

Objectives

We have forgotten that the texts emanating from the land of India were profoundly psychological and can inform psychiatric/psychoanalytic practice. Bose’s exchange of letters with Sigmund Freud is known by many but read by only a few. He gave us a path to think about the psychiatric and psychoanalytic practice from India. The paper looks at his exchange of letters with Freud and his works on the Bhagavad Gita, Puranas, Yoga Sutras, and the Vedas, which he claimed, were immensely beneficial for psychiatric/psychoanalytic training and can help us to work through the way we perceive medical practice.

Methods

This research used primary sources like books and articles to re-think the works of Girindrasekhar Bose in terms of today’s medical practice.

Results

Can we imagine writing in our native language and being critically acclaimed for our work internationally? His writings in Bengali suggest that he was more decolonized in the 1920s than the Indian scholars of today. Keeping in mind the existential ground of the patient, a decolonized understanding of symptoms can revolutionize medical care.

Conclusions

Our aim in today’s times is to inform our practice where we could possibly reach an intradisciplinary and interdisciplinary unity. A re-discovery of Bose’s work can help us in this earnest endeavor.

Disclosure of Interest

None Declared
Post-traumatic stress disorder and restraint in patients followed at Arrazi Hospital
Authors: Azizi L. , Seyar O. , Baabouchi N. , Laboudi F. , Ouanass A.
Published: August 2023

Introduction

Post-traumatic stress disorder (PTSD) is characterized by intense, unpleasant, and dysfunctional reactions that appear after an overwhelming traumatic event. A life-threatening or serious injury event can cause lasting and intense suffering.

Hospitalization without consent, the use of isolation techniques, restraint or the obligation to take treatment are situations that can be perceived as traumatic.

Objectives

Our goal is: The search for the existence of psycho-pathological links and vulnerabilities between the state of post-traumatic stress and physical restraint. Consideration of the traumatic event in the development of appropriate care strategies.

Our goal is:The search for the existence of psycho-pathological links and vulnerabilities between the state of post-traumatic stress and physical restraint.Consideration of the traumatic event in the development of appropriate care strategies.

Methods

To meet this objective, we carried out a descriptive study which identified 200 cases collected in the psychiatric emergency department of the Arrazi Hospital in Salé from 2017 to 2021. An exploitation sheet was drawn up and the study was carried out using Meta-chart and Visuel-chart software.

Results

At the end of this work we found: The average age is 35 years +/- the sex ratio is equal to 1.42. 80% are single while 10% are divorced. Regarding professional activity, 70% are unemployed. 10% of patients have a level of education above the baccalaureate.

As for the history, 60% of the cases studied have a personal psycho-addictive history. 34.6% of the cases studied have a medical-surgical history.

The psychiatric pathologies that were found are: 10% suffer from depressive disorder, 80% have psychosis, 10% have attempted suicide.

Conclusions

During an acute episode, patients may be exposed to coercive treatments. Hospitalization without consent, the use of isolation techniques, restraint or the obligation to take treatment are all factors that can be perceived as traumatic. For example, patients recently exposed to a first psychotic episode confirmed the traumatic character of the psychotic episode itself, of the treatment or of both.

Disclosure of Interest

None Declared
Advances in the field of genetics and difficulties in the diagnosis of di george syndrome.
Authors: Menendez Gil I. E. , Maria Del Carmen M. L.
Published: August 2023

Introduction

The spectacular progress of the last decade in the field of genetics is allowing a new development of medicine and the ability to make a better diagnosis. A great example of this is the diagnosis of chromosome 22q11 deletion, which occurs in 1:4000 live births.

Objectives

This case wants to illustrate the difficulties in the diagnosis, despite technological advances.

Methods

Exhaustive review of the literature

Results

This is a 38-year-old male patient diagnosed with chromosome 22q11 deletion in adulthood.

Family history of medical problems: mother with genetic diagnosis of chromosome 22q11 deletion, in adulthood, after the diagnosis of her own son.

Personal history of medical problems:

- Psychiatry: he has been followed up intermittently in psychology since he was 6 years old, due to cognitive difficulties and behavioral alterations. He has had several hospital admissions in psychiatry during adolescence for behavioral disorders and intellectual disability, with possible psychotic symptoms. In treatment with antiepileptics and antipsychotics.

- Cardiology: aortic aneurysm and bicuspid aortic valve were detected. The patient underwent surgery in 2018.

- Genetics: he is diagnosed with chromosome 22q11 deletion in 2019. This is an inherited mutation of maternal origin that is detected later.

- Rheumatology: seropositive rheumatoid arthritis, non-erosive.

- Rehabilitation: treatment to improve psychomotor skills, from 6-12 years of age.

It is important to emphasize that the diagnosis was made at the age of 35 years, after a more deep study which had been carried out after the debut of the cardiac pathology. In addition, it is very striking that the diagnosis of his mother was made later than the one of the patient himself.

Currently, the patient presents serious difficulties in respecting the rules of coexistence at home and in understanding social norms, so that he has not been able to integrate in any environment and remains isolated at home. Serious behavioral alterations with tendency to physical and verbal heteroaggressiveness, difficulty in accepting limits and sexualized and uninhibited behaviors.

Clinical judgment: chromosome 22q11 deletion.

Conclusions

Early diagnosis is essential to be able to treat and, above all, prevent the possible complications that this syndrome may present. However, diagnosis is sometimes very complex, despite advances in molecular diagnostic techniques. Therefore, an integrative approach is very valuable, looking at the individual as a whole and not only by systems or medical subspecialties. In addition, it would be very interesting to establish a means of communication between specialties. Finally, it would be a real step forward to integrate all the medical information of each person in a single medical record, an apparently simple aspect, but so far from being possible.

Disclosure of Interest

None Declared
Community resilience and associated factors in Fort McMurray a year after the devastating flood
Authors: Obuobi-Donkor G. , Eboreime E. , Shalaby R. , Agyapong B. , Adu M. , Owusu E. , Mao W. , Agyapong V. I. O.
Published: August 2023

Introduction

A natural disaster like flooding causes loss of properties and evacuation and effective mental health. Resilience after natural disasters is a crucial area of research which needs attention.

Objectives

To explore the prevalence and associated factors of low resilience a year after the 2020 floods in Fort McMurray.

Methods

A cross-sectional study was conducted in Fort McMurray using online surveys. The data were analyzed with SPSS version 25 using univariate analysis with the chi-squared test and binary logistic regression analysis.

Results

The prevalence of low resilience was 37.4%. Respondents under 25 years were nearly 26 times more likely to show low resilience (OR= 0.038; 95% CI 0.004 - 0.384). Responders with a history of depression and anxiety (OR= 0.212; CI 95% 0.068-0.661) were nearly four to five times more likely to show low resilience. Similarly, respondents willing to receive mental health counselling (OR=0.134 95%CI: 0.047-0.378) were 7.5 times more likely to show low resilience. Participants residing in the same house before the flood were almost 11 times more likely to show low resilience (OR=0.095; 95% CI 0.021- 0.427), and support from the Government of Alberta was a protective factor.

Conclusions

The study showed demographic, clinical, and flood-related variables contributing to low resilience. Receiving support from the Government was shown to be a protective factor against low resilience. More robust measures must be in place to promote normal to high resilience among flood victims in affected communities.

Disclosure of Interest

None Declared
Psychiatric manifestations of Susac Syndrome: a case report
Authors: Gomes M. , Veloso P. , Monteiro E. , Faria R. , Freitas E.
Published: August 2023

Introduction

Susac Syndrome (SS) is an immune-mediated endotheliopathy that mainly affects young women. It is characterized by the typical triad: subacute encephalopathy, retinal vaso-occlusive disease, and hearing loss. Encephalopathy symptoms are varied and include memory loss, psychiatric disturbances, cranial nerve disorders, seizures, and dementia. The syndrome is considered a rare but important differential diagnosis in various neurological, psychiatric, ophthalmological, and ear-nose-throat disorders.

Objectives

Report a clinical case of SS to reflect on the relationship between psychiatric and neurological symptoms and on immune-mediated psychiatric symptoms.

Methods

Collection of clinical information from the patient described below. Review of the literature about SS.

Results

A 21-year-old woman presented to the Psychiatry Emergency Department in November 2021 for complaints of sadness, anhedonia and emotional lability, with one month of evolution. She also had insomnia and confusional periods, so she stopped driving and quit her work as a storekeeper. She was given sertraline 50mg/day and trazodone 50mg/day. In the past two weeks, the patient had episodes of headache and vomiting, with 8 kg weight loss. She started a fever (38.5ºC) two days before observation. The patient had a prior history of depressive symptomatology four years earlier related to her father’s grief and her medical and surgical history was unremarkable. She was brought in a wheelchair by her mother and was using diapers because she was confined to bed for the past week. Objectively, the patient was somnolent, tearful and confused, with scarce speech and psychomotor slowing. No focal signs were found on neurological examination. Collaboration of Neurology was asked. Routine laboratory studies showed a slight increase in leucocyte count (12 500/mm3) and CRP (17mg/dL). Cerebrospinal fluid analysis showed 15 cells/uL and protein of 2.64 g/L. Cerebral MRI showed multiple striatocapsular periventricular lesions involving the thalamus, the left midbrain, and the medulla oblongata, as well as focal bilateral hemispherical and cerebellar subcortical lesions. The lesions presented high signal in T2 and showed restriction in the diffusion study. She was admitted to the Neurology inpatient department and treated with pulse methylprednisolone 1000 mg/day for five consecutive days, after which cognitive function improved. Ophthalmology observation found cotton-wool exudate and arteriolar interruption in the right eye, supporting the diagnosis of SS.

Conclusions

This syndrome represents the importance of diligent cooperation among different medical specialties to improve diagnosis-making, treatment and recovery. Psychiatric symptoms are frequent in neurological syndromes, so a high degree of suspicion is needed.

Disclosure of Interest

None Declared
Bilateral pretibial edema associated with risperidone: A case report
Authors: Yildiz B. , Alioglu Karayilan F. , Ak I.
Published: August 2023

Introduction

Risperidone is a benzisoxazole derivative and is an antipsychotic drug that is frequently used in psychiatric disorders with high binding to 5HT-2A, D2, α1-adrenergic and α2-adrenergic receptors. It is a second generation antipsychotic and the most common side effects are known as extrapyramidal symptoms, weight gain, sedation, hyperprolactinemia, dizziness, insomnia, anxiety and nausea. Edema has been reported in a few cases as a side effect of risperidone in the literature.

Objectives

In this case report, we aimed to present a case of peripheral edema developed in a patient using escitalopram combined with risperidone and to review the literature on this subject.

Methods

A 48-year-old male presented to the outpatient psychiatry clinic with symptoms of difficulty in controlling his irritability and anger, damaging the things around him, depression, loss of interest and desire, sleep disturbance, fatigue, and feelings of worthlessness. The patient also applied to the psychiatry outpatient clinic with similar symptoms 5 months ago, and had been on sertraline 50 mg/day and quetiapine 25 mg/day since then. But it was learned that he did not benefit, so his treatment was adjusted as escitalopram 10 mg/day and risperidone 1 mg/day. The patient, who came to the outpatient clinic control after 1 month and did not describe a similar complaint before, described peripheral edema that developed approximately 2 weeks after he started using psychiatric medication. On examination, 3+ pretibial peripheral edema was detected. Since the patient had a previous history of escitalopram use, it was recommended to continue escitalopram 10 mg/day treatment, and risperidone 1 mg/day was discontinued and he was called for control.

Results

It was observed that the edema completely resolved within 2 weeks following the discontinuation of risperidone treatment.

Conclusions

In conclusion, risperidone is an antipsychotic frequently used in clinical practice, and edema is a rare but important side effect and can be encountered even at low doses. Despite the low incidence, this side effect should be considered by clinicians. There is a need for controlled studies that explain the relationship between risperidone and edema, elucidate the mechanism of edema and investigate its incidence.

Disclosure of Interest

None Declared
Use and experience with six-monthly paliperidone in the Campo de Gibraltar area. Descriptive study.
Authors: Gil Sánchez C. M. , Salomón Martínez J. A. , Corbacho Navarro E.
Published: August 2023

Introduction

Long-acting injectable antipsychotics have demonstrated advantages over therapeutic adherence and can reduce the rates of relapses and due to treatment discontinuation. The novel presentation of paliperidone palmitate six-month (PP6M) can simplify the treatment to two injections per year.

Objectives

The purpose of the present research is to describe the profile of patients receiving this novel treatment in our area. For this, a descriptive study has been carried out.

Methods

We have collected and analyzed data from a total of 8 patients from the global long-acting injectable nursing registry in our area. The data collection was from May 2022 to October 2022.

Results

ID PatientAge
GenderMedical comorbidities
Social supportAdherence to previous LAIEP001AGC52MNo-YesEP002EGA53MNoLowNoEP003ESL45FYes
HIV, HCV, dyslipidemia,EnoughYesEP004ACG60MYes
Hypertension, dyslipidemiaGoodYesEP005DCP52MYes
COPDEnoughYesEP006ATT47MNoEnough / LowYesEP007AH40FYes
Tension headacheEnoughYesEP008IAR66FYes
Type 2 diabetes mellitus, hypertension, hyperuricemiaEnoughYes
ID Patient
Diagnosis
Refractory positive symptoms
Last H.
Polypharmacy
Previous injection
Injection date / DoseH. / Side EffectsEP001AGCParanoid schizophrenia-08/03/2014NoPP3M
525mg17/05/22
1.000 mgNoEP002EGASchizoaffective disorderYes19/08/2022Yes
Valproic acid 1.000mgPP1M
150mg
(once)13/09/22
1.000mgNoEP003ESLParanoid schizophreniaNo17/04/2019Yes
Olanzapine 10mg
BZDPP3M
525mg10/08/22
1.000mgSedation (low)EP004ACGParanoid schizophreniaNo-Yes
Quetiapine 50mgPP3M
525mg16/09/22
1.000mgNoEP005DCPParanoid schizophreniaNo16/01/2004Yes
Olanzapine 20mg
BZDPP3M
525mg11/10/22
1.000mgNoEP006ATTPersistent delusional disorderYes-NoPP3M
525mg19/09/22
1.000mgNoEP007AHParanoid schizophreniaNo2017NoPP3M
525mg03/08/22
1.000mgNoEP008IARPersistent delusional disorderYes-Yes
BZDPaliperidone oral 9mg and later
PP3M
350mg
(twice)18/10/22
1.000mgNo

Fig. 1: Sociodemographic characteristics and Fig. 2: Clinical characteristics.

Conclusions

None of the patients required hospitalization at the time of the study, although this work team considers that it is early to make conclusions in this regard. No serious or minor adverse effects were reported in any of the cases during the time of the investigation, apart from one case of mild sedation.

The clinical characteristics of most patients were psychopathological stability and good adherence to previous treatment. Although this study shows that the drug was also used in patients who did not meet these characteristics, specially one case of poor social support. The data collected show that the profile of the patient in whom the drug has been prescribed can be varied and broad.

Disclosure of Interest

None Declared
Hepatotoxicity of Clozapine : Case report and brief Review
Authors: Askri F. , Aissa A. , Jedda S. , Mahfoudh K. , Zgueb Y. , Ouali U.
Published: August 2023

Introduction

Clozapine is an effective Atypical antipsychotic used in the treatment of resistant schizophrenia .However it can induce liver dysfunction from a simple transient asymptomatic cytolisis (30 to50 %) toa serious fulminant liver failure (0.001 %).

Objectives

To show the heptotoxicity potential of Clozapine and adress the importance of monitoring the liver function tests in clozapine titration to prevent sever conditions

Methods

A case report of a fifty-year old Tunisian male patient diagnosed with resistant schizophrenia who developed a hepatototoxicity under a low dose of clozapine within five days of treatment .

Results

Mr F is a 50 year old patient diagnosed with schizophrenia in 2018 . He had received various antypical and typical antipsychotic treatments including ( Haloperidol , Risperidone , Amisulpride , Olanzapine ) at effective doses and minimal periods of six weeks . He had no history of systemic diseases or substance use disorder . He smokes 10 cigarettes a day . He had a history of hepatotoxicity on olanzapine. These medications have failed to resolve the persecutory delusion and auditory hallucinations , and the trial of clozapine was institued . Baseline examination and laboratory tests were normal . The previous antipsychotic medication was not continued and a dose of 25 mg clozapine was administred . A marking drowsiness was present in the fisrt days , so we decided to keep the same dose . Five days later , he had high levels of Liver function test (LFT) : Elevated aspartate ( 5 times above normal) and alanine aminotransferase levels (4 times above normal ) , white blood cell count and bilirubine levels were normal . He had no fever or jaundice . The abdominal examination showed a mild sensiblity in the right upper quadrant . Clozapine was immediatly discontinuated . 24 hours later LFT continued to escalate to 5 times greater then normal . Then it decreased continueosly

Conclusions

Clozapine has a potential of hepatotoxicity even at lower dose . Screening liver function tests must be integrated in survey recommendations of clozapine treatment . Further researches must be conducted to understand the mechanism of this side effect in order to avoid sever conditions .

Disclosure of Interest

None Declared
ARIPIPRAZOLE-INDUCED OCULOGYRIC CRISIS (ACUTE DYSTONIA)
Authors: Rodriguez Andres L. , Vallecillo C. , Gallardo Borge L. , Capella Meseguer C. M. , Guerra Valera G. , Noval Canga C.
Published: August 2023

Introduction

Aripiprazole is a third generation atypical antipsychotic and a dopamine serotonin system stabilizer, effective against positive and negative symptoms of schizophrenia. Within the group of atypical antipsychotics, aripiprazole shows a relatively benign safety profile (e.g. lower metabolic impact, mild effect on cardiovascular parameters), although the reported rate of extrapyramidal side effects is measurable.

Oculogyric crisis (OGC) is a rare movement disorder characterized by a prolongued involuntary upward deviation of the eyes, lasting minutes to hours. In most cases, OCG is a drug-induced adverse event with acute or tardive onset often attributable to a functional impairment of dopaminergic neurotransmission.

Objectives

OGC is seldom reported in children and young adults during treatment with aripiprazole, althouh it is commonly used in youths.

Methods

We report a case of an aripiprazole-induced oculogyric crisis in a 19 year old girl who diagnosed with schizophrenia (paranoid).

Results

There was a complete remission of the OGC’s following aripiprazole dose reduction, suggesting the clinical manifestation was a dose-dependent phenomenon.

Conclusions

The present report should raise awarness among clinicians for this relevant possible adverse event, that can happen also with the use of aripiprazol, not only with typical or more antidopaminergic antipsychotics. Future research in the field should emphasize neurobiological dysfunctions as the basis of EPS/OGC in patients.

Disclosure of Interest

None Declared
Medical Orgone Therapy, a relic of the past or a technique for the future?
Authors: Foglia A.
Published: August 2023

Introduction

We introduce and present a psychotherapic technique initiated by Wilhelm Reich (1897-1957) in the 1920’s and thereafter expanded and refined with essential contributions by Elsworth Baker among others. We outline its theory and technical foundations and also provide an epistemologic interpretation of its peculiar body-mind representation based on character- and muscular armoring as a reaction to suffering; armoring of the ocular segment in the etiology of Bleuler’s schizophrenic splitting; and finally the consequences of armoring on the energetic functions as the logical development of Freud’s theory of libido, with significant theoretic, therapeutic and nosologic consequences.

Objectives

The goal of my presentation is to avoid extinction of a valuable technique for future psychiatrists; moreover, to catch the interest of young collegues to a technique that integrates Bleuler’s psychiatric discovery with Freud’s psychoanalytic contribution and demonstrates that the old nosology and theoretical achievements in the psychic field were not as obsolete as today many think.

Methods

Research, book summaries, practical experience

Results

Poster presentation

Conclusions

Poster presentation

Disclosure of Interest

None Declared
Obesity in secure hospital settings: Changes in BMI over time among a complete national cohort of forensic in-patients in Dundrum Hospital, Ireland
Authors: Iqbal M. U. , Waqar M. U. , Ogunnaike B. , Kennedy H. G. , Davoren M.
Published: August 2023

Introduction

There are high rates of treatment resistant psychoses and medical complexity among patients in secure forensic hospitals (Basrak et al., BJPsych Open (2021) 7, e31,1-7). Patients with schizophrenia in secure settings have a lower life expectancy compared to community peers of approximately 16 years. Evidence suggests patients in secure settings often gain significant amounts of body weight during their in-patient stays, many of whom develop complex obesity presentations.

Objectives

To ascertain changes in Body Mass Index (BMI) among patients in a secure forensic hospital setting over a 3.5 year period.

Methods

A prospective longitudinal study of repeated measures of BMI for all (n=91) patients in a National Forensic Mental Health Service (CMH Dundrum, Dublin, Ireland). BMI was measured six-monthly, giving up to seven time points for each patient. Generalized Estimating Equations (GEE) analysis was conducted to ascertain changes in BMI over time. This study formed part of the DUNDRUM Forensic Redevelopment Evaluation Study (D-FOREST) (Davoren et al., BMJ Open (2022) 12(7): e058581).

Results

A total of 91 patients were included in the study, mean age 33.46 years (SD 9.23). Mean length of stay was 8.09 years (SD 9.23). The most common diagnosis was schizophrenia (67%), followed by schizoaffective disorder (17.5%) and Autistic spectrum disorder (6.2%). Using GEE with BMI as the dependent variable, for the complete patient cohort, BMI changed significantly with diagnosis (Wald X2=5817.58, df=7, p<0.001). Those with severe mental illnesses (psychoses) had the highest BMI of the group, and BMI tended to increase over time (p=0.109). Among patients who were in the secure hospital for four years or less, their weight gain was significant over time (Wald X2 =10.0, df=1, p=0.002).

Conclusions

We have shown high rates of obesity particularly in patients with psychoses and we have shown weight gain is significant during the first four years after admission to a national forensic service. This is a significant health concern and an area of unmet treatment need which is likely generalizable across secure hospitals in the EU.

Disclosure of Interest

None Declared
Psychological Inflexibility in Depression with Psychotic Features: A Case Report
Authors: Akyildirim Cor S. , Yetkin S.
Published: August 2023

Introduction

Major depressive disorder (MDD) is a mood disorder that can last for weeks or even months, in which there is a depressed mood accompanied by anxiety, in addition to negative changes in cognitive functions, psychomotor movement and vegetative functions. Depression with psychotic features is a psychiatric syndrome that progresses with delusions as well as severe symptoms such as psychomotor retardation or agitation, depressive ruminations, deterioration in cognitive functions, and confusion. Compared to the subtypes without psychotic features, the symptoms are more severe, the age of onset is earlier, and the duration of the disease is longer. Feelings of guilt, worthlessness and suicidal thoughts and attempts at suicide are more common. The risk of exacerbation is greater. Diagnosis of bipolar disorder and schizophrenia is more common in first-degree relatives of these patients.

Objectives

An 18-year-old female patient with somatic delusions and psychotic persistence that started after a sexual trauma and persisted for 1 month was consulted after organic exclusions were made. It is understood from the anamnesis that the patient had a manic episode about 6 months ago and that his mother was followed up with a diagnosis of bipolar disorder. The patient’s current clinical picture was evaluated as depression with psychotic features, and after hospitalization, the treatment was adjusted as fluoxetine 20 mg/g, olanzapine 5 mg/g, and lithium 900 mg/g. Self as context, cognitive defusion and acceptance interventions were applied to the patient.

Methods

When the Cognitive Fusion Questionnaire(CFQ), Self-as-Context Scale(SACS), Acceptance and Action Questionnaire(AAQ-II) completed by the patient during hospitalization and in remission periods were compared, it was observed that there was a significant regression in the patient’s psychological inflexibility during the period of remission. Written informed consent was obtained from the patient whose clinical picture was presented in order to contribute to the scientific literature.

Results

Depression with psychotic features is another clinical picture in which psychological inflexibility increases, and it has been observed that interviews to increase psychological flexibility during the treatment process contribute positively to the treatment process. For this reason, the contribution to the healing process can be better clarified in further studies on interventions to increase psychological flexibility applied in addition to pharmacological treatments.

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Conclusions

Psychological inflexibility is an effort to control a person’s emotion, thought, behavior or experience in a dysfunctional way in the face of an undesired experience. It has been seen in studies conducted in recent years that; There is a significant positive correlation between high psychological inflexibility and somatization, depression, anxiety and other psychological disorders.

Disclosure of Interest

None Declared
Prospects for the use of artificial intelligence methods in autism spectrum disorders
Authors: Sidenkova A. , Litvinenko V.
Published: August 2023

Introduction

ASD is a heterogeneous group of pathological conditions.

Objectives

Sensory Functions in Children with Autism

Methods

A brief review of scientific publications is presented, formed by the search result for the keywords: autism spectrum disorders, artificial intelligence, machine learning.

Results

Patients with ASD respond to sensory information hyper-reactively and hypo-reactively. Patients, regardless of age and severity of ASD, have atypical information processing patterns in all sensory modalities. Atypical processing of stimuli correlates with social, cognitive and communication disorders.

Conclusions

To normalize sensory deviations, it is necessary to build corrective and prognostic models of the child’s connection with the environment. Machine learning models, Data Mining methods to make medical management decisions and develop personalized therapeutic strategies.

Disclosure of Interest

None Declared
Electroconvulsive Therapy for Neuroleptic Malignant Syndrome: A case report
Authors: Osca Oliver A. , López Rodrigo M. V. , Ros Fons V. , Palomo Monge M. , Osca Oliver A. , Tascón M. F.
Published: August 2023

Introduction

Neuroleptic malignant syndrome (NMS) is a rare syndrome observed in around 0.2% of psychiatric patients. This syndrome consists of the presentation of muscular rigidity, tachycardia, hyperpyrexia, leukocytosis and elevated levels of CPK. Any antipsychotic drug, including atypical ones, can cause this syndrome. This being an idiosyncratic response to dopamine receptor antagonist medications.

The use of ECT in patients suffering from NMS is very effective, seeing the progressive resolution of the picture in the first sessions.

Objectives

The patient was a 43-year-old man, whose somatic history only highlights hypothyroidism, and according to his psychiatric history, he was diagnosed of mental retardation and paranoid schizophrenia. He was a resident of a group home. And he was recently admitted to a mid-stay psychiatric unit. During this admission, the responsible doctor added haloperidol to his medication regimen. His other medications at the time were; valproic acid, risperidone and trazodone. A few days later, the patient began to present a dysthermic sensation (presenting a temperature of 39ºC) and drowsiness. A laboratory tests and a chest X-ray was performed, highlighting: leukocytosis and an increase in elevated creatine phosphokinase (CPK).

Due to his recent exposure to 2 different antipsychotics, with fever, rigidity, and elevated CPK, we considered NMS. Antipsychotics were withdrawn and supportive measures were started. Within the next 2 days, his CPK level began to decline and the fever and leukocytosis resolved. But without resolving muscle rigidity. At the same time, he began to exhibit staring, negativism and prejudice delusions. Therefore, electroconvulsive therapy sessions were started.

Methods

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Results

After the third session, his catatonic symptoms increased to better; he became more verbal, with less negativism and the psychotic symptomatology ceased. After the fifth session of ECT, he returned to his initial level and was able to walk to the bathroom without assistance and perform other activities of daily living.

Conclusions

It is extremely important that professionals specialized in psychiatry become familiar with ECT and consider this technique as treatment in cases of neuroleptic malignant syndrome.

Disclosure of Interest

None Declared
First psychotic episode due to inmunosupresor medication
Authors: Corrales A. , Unzue L. , Llovera L. , Cancelo N.
Published: August 2023

Introduction

48-year-old man from Spain who lived with his wife until he got divorced 4 months before starting the follow up in Mental Health. The debut was in September 2021 with a hospitalization in the Brief-acute hospitalization unit due to florid psychotic clinic-

He consumed several drugs in his twenties (cocaine, marihuana and heroin IV) and was diagnosed of HIV at the age of 29. He abandoned the use of drugs after the diagnoses and keep good adherence to the antiretroviral treatment (Abacavir + Lamivudine +Efavirenz).

At the age of 46 (January 2020), he was successfully transplanted a kidney. Afterwards, he started taking inmunosupresor medication to avoid transplant rejection

At the few months of the transplant and the beginning of the inmusosupresor medication, the patient became more irascible with moments of remarkable disinhibition and progressive abandon of the work obligations.

In January of 2021, he got divorced after months of difficulties with his wife, married 28 years before, due to the mentioned problems as well as moments of bizarre and disorganized conducts and suspicion towards his wife with probable delusional jealousy. He, therefore, lost his job, hose and marriage and started taking drugs again after 17 years of abstinence.

He was hospitalized in e Brief Acute Inpatient Unit in September 2021 with distrustful and hypervigilant attitude- He was suffering from delusional ideation of harm and persecution with high distress and emotional repercussion. He also presented disorganized conduct and probable auditory hallucinations. He was positive to amphetamines and cocaine After 3 days without consuming; there was no remission of the clinic.

Objectives

Discussing the association between the initiation of inmunsupresor medication and the beggining of psychotic clinic

Methods

First psychotic episode (FEP) has a likely consequence of the initiation and maintenance of Tacrolimus -due to a kidney transplant- with the concomitant abuse of amphetamines and cocaine as a trigger factor.

The psychotic clinic progressively remitted in one week after the administration of 3 mg/day of risperidone.

The antiretroviral treatment was changed due to the poor adherence during the disorganization period. The tacrolimus was not removed because of the good response to the neuroleptic and the risk of transplant rejection

Results

The patient started with prodromic symptoms of psychosis at the time he began with the inmunosupresor medication. Progresively, the psychotic clinic worsen wit the consequence of a biographical break with the consequence of a divorce, therlost of work and home and a drug relapse.

Conclusions

There is evidence of the association between psychotic episodes in people with no psychiatric history and the inmunosupresor medication for the kidney transplant (Above all, tracolimus). This case remarks the need of an exhaustive medical anamnesis in the diagnosis of psychiatric pathologies.

Disclosure of Interest

None Declared
Effectiveness and quality of life improvement in young adult schizophrenia patients treated with Abilify Maintena
Authors: Petrić D. , Kašelan A. , Brozan S. , Žuljan Cvitanović M. , Krnić D.
Published: August 2023

Introduction

Treating young patients with schizophrenia is a challenge, as these patients have much to gain from controlled pharmacotherapy and even more to lose with a possible relapse. Treating patients with long-acting injectable antipsychotics avoids the issue of non-compliance, the biggest risk factor for relapse, while also improving the quality of life. Receiving a drug once-a-month can provide greater flexibility and convenience to our patients.

Objectives

Aim of the paper is to assess the efficacy and quality of life in monthly dosing of long-acting injectable antipsychotic in young adult schizophrenia patients.

Methods

The research included 7 patients aged 19 to 25 years who were diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Patients were assessed eight times over two years using the following clinical scales: Positive and Negative Syndrome Scale, Clinical Global Impression – Severity and Improvement Scale, Treatment Satisfaction Questionnaire for Medication (TSQM-9) and Quality of Life Scale (QOLS).

Results

All treated patients achieved remission. There was a statistically significant improvement in measured scales in all patients. There were no side-effects reported during the study period, with no relapse or new hospitalizations

Conclusions

The monthly formulation of aripiprazole has proven to be effective and safe in our study and has great potential to improve patient quality of life as well.

Disclosure of Interest

None Declared