bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of new psychosocial stressors on the mental health of young people: Results from a national multicentric study in italy
Authors: Sampogna G.
Published: February 2022

Abstract Body

The COVID-19 pandemic with the related containment measures is having a negative impact on the mental health of the general population worldwide. This event has been described as a new form of trauma, which is influencing not only physical and mental health, but also the society as a whole. Among Western countries, Italy has been one of the first severely hit by the pandemic in terms of number of cases and mortality rates. In March, 2020, strictly restrictive measures has been issued in order to contain the spread of the disease. This period has been known as “Phase one” of the national health emergency, where all not necessary activities were closed, almost 30,000 people died and almost 100,000 people were home-isolated. In this context, the COvid Mental hEalth Trial (COMET) network, including ten university Italian sites and the National Institute of Health, has been established in order to promote a national online survey for assessing the impact of lockdown measures on the mental health of the Italian general population. In the COMET survey, it has been included a specific focus on young people, which are expected to be the most vulnerable to the consequences of the pandemic and of the strict containment measures. Findings from this study can be useful to inform national and international associations on the importance to provide adequate support to the mental health of the young people.

Disclosure

No significant relationships.
Lurasidone treatment in a delusional disorder patient with atrial fibrillation: A case report
Authors: Marini S. , Matarazzo I. , Gentile A.
Published: February 2022

Introduction

Psychosis itself may be associated with an increased risk of atrial fibrillation. Moreover, antipscyhotic treatment increases this risk. Recently D’Urso et al. reported aripiprazole-induced atrial fibrillation in a patient with concomitant risk factors.

Objectives

To the best of author’s knowledge no data has been published about the safety and the efficacy of lurasidone treatment in psychotic patient with comorbid atrial fibrillation.

Methods

A 68 years old patient with persistent atrial fibrillation and hypertension in treatment with amiodarone 100 mg/day, lurasidone 25 mg/day, rivaroxaban 15 mg/day, clopidogrel 75 mg/day, bisoprolol 1,25 mg/day, tamsulosin 0,4 mg/day presented delusional ideas of jealousy for not real betrayal by his wife, social withdrawal, reduced sleep. Blood pressure 130/80 mmHg, heart rate 70 bpm, Qtc 420 msec. The patient was drug-naïve for any psychotropic treatment. The authors decided to start lurasidone treatment at the dosage of 18,5 mg/day.

Results

After the first administration of lurasidone treatment sleep was resolved. After two weeks delusional ideas and social withdrawal were markedly improved. After one month of treatment, blood pressure, heart rate and Qtc remained almost stable. The authors decided not to increase the dosage of lurasidone because of the age of the patient and the comorbid cardiovascular pathologies.

Conclusions

Lurasidone has showed safety and efficacy in the treatment of this patient with delusional disorder and comorbid atrial fibrillation. This is a preliminary data that requires follow up and further studies to confirm the usefulness of lurasidone in psychotic patients with atrial fibrillation and cardiovascular risks.

Disclosure

No significant relationships.
From kraepelin to the present. Dementia praecox – a case study
Authors: Basto M.D.R. , Lopes L. , Miguel A. , Certo A. , Venâncio Â. , Horta A.
Published: February 2022

Introduction

In the late XIXth century Kraepelin described a new nosologic division for the psycothic disorders – Paranoia and Dementia Praecox. He emphasized that dementia praecox is a central nervous system disease, involving permanent lesions on cerebral cortex. Besides biological deterioration, it appears as the result of psychic degenerative process. From the mid-20th century onward, antipsychotic drugs had been robustly generalized, and in parallel to the current classifications, residual symptoms in schizophrenia tend to be rare but still prevail in our patients.

Objectives

The aim of our work is to report a clinical case of residual schizophrenia in parallel with the classic classification of Dementia Praecox and also do an overview of this disorder and its historical perspective.

Methods

We conducted clinical interviews with the patient and family members, reviewed clinical records and conducted a query in the MEDLINE database using the terms " Dementia Praecox ", “Psychosis”, “Paranoia”, “Kraepelin”, “History”.

Results

We present the clinical case of a 74-year-old man with onset of psychotic symptoms on his twenties and diagnosed with Schizophrenia. In the past years, after acute psychotic episodes it was increasingly difficult to return to prior levels of functioning. Currently, he was brought to psychiatric emergency ward presenting bizarre behavior, stereotyped movements and speech disturbances, which reveal disorganized thinking and inability to express his emotions.

Conclusions

Although these syndromes are nowadays relatively rare, it is important to keep them in mind, in order to understand the natural progression of psychotic diseases, improve their rehabilitative treatment and prognosis.

Disclosure

No significant relationships.
When psychosis follows obsession – a schizo-obsessive disorder case report
Authors: Pereira F. , Martins P. , Barros J.
Published: February 2022

Introduction

The relation between obsessive-compulsive symptoms and psychosis presents in different ways. While obsessive-compulsive symptoms can present as prodromes of schizophrenia, or in overlap with psychotic phenomenology, a new clinical entity as been proposed as a subgroup of schizophrenia: the schizo-obsessive disorder.

Objectives

The present review aims to emphasize the comorbility between schizophrenia and obsessive-compulsive disorder, bringing to light the importance of early detection and adequate treatment approaches.

Methods

The authors describe the patient’s disease progression and discuss the longitudinal dynamics between obsessive-compulsive disorder and schizophrenia, providing a brief and updated literature overview.

Results

The illustrated case addresses a 31-year-old male patient diagnosed with obsessive-compulsive disorder at the age of 16, who later developed delusional ideation compatible with a schizophrenia diagnosis. At the onset of disease, the patient developed obsessive-compulsive symptoms such counting and repetitive hand-washing rituals that later turned into sexual obsessions concerning homossexuality. Following his 25th birthday, the patient became increasingly disorganized with frequent agressive outbursts toward his family and the obsessive egodystonic ideation turned into delusional egosyntonic ideation. Over the years, the patient shows intermittent obsessive-compulsive behavior while sustaining schizophrenia symptoms, particularly the negative symptoms.

Conclusions

Despite the controversy associated with the recently proposed new subgroup of schizophrenia, the schizo-obsessive disorder, we believe the patient described fits the diagnosis. Clinicians managing patients of schizophrenia should evaluate the patients thoroughly for presence of comorbid obsessive-compulsive symptoms/disorder and must take the same into account while managing the patients.

Disclosure

No significant relationships.
Cotard syndrome in a patient with multiple sclerosis: A case report
Authors: Vieira S. , Marinho G.
Published: February 2022

Introduction

“Cotard syndrome” is a rare condition characterized by a constellation of clinical features, including hypochondriac and nihilistic delusions, the most characteristic of which are the ideas that one is dead or that their organs do not exist. It is more commonly associated with psychotic depression and schizophrenia but can also be found in several neurological disorders. In the clinical practice it generally appears as an “incomplete Cotard”, reduced to hypochondriac delusions attributed to the malfunction or occlusion of the organs, usually the digestive tract and abdominal viscera. Consequently it is common for these patients to reject food or medications. In literature it has been divided into three types, according to the clinical symptoms: psychotic depression, Cotard type I, and Cotard type II.

Objectives

Literature review on Cotard Syndrome and its link with Multiple Sclerosis, based on a clinical case.

Methods

Pubmed and Google Scholar search using the keywords Cotard Syndrome, Multiple Sclerosis.

Results

Hereby we present a clinical case of a 53-year-old female patient, with multiple sclerosis, who presented with hypochondriac and nihilistic delusions and refusal of food and medication. The patient was treated with olanzapine with rapid remission of delusional activity.

Conclusions

Multiple sclerosis is an immunemediated chronic disease, affecting predominantly the sensory and motor function. In addition, psychiatric comorbidity is very frequent with up to 50 % lifetime risk of depression. While various neurological disorders have been described in association with Cotard syndrome, its link with multiple sclerosis has been scarcely reported.

Disclosure

No significant relationships.
Improving health care response to domestic violence
Authors: Dowrick A.
Published: February 2022

Abstract Body

1 in 4 women in Europe will experience domestic violence and abuse (DVA) in their lifetime. Abuse can take many forms, including, psychological, physical, sexual, financial, and emotional abuse. There is growing recognition of the health consequences of DVA in public policy and academic research across Europe and the globe. These include but are not limited to: a negative impact on mental health; increased substance misuse; increased presentation in emergency departments; increased rates of abortion or miscarriage; and increased presence of any sexual health problem. International and national policy guidance indicates that healthcare professionals have important roles in responding to patients experiencing DVA, usually with regard to identifying abuse and referring for specialist support. Barriers to engaging in DVA relate to lack of confidence in recognising abuse or initiating conversations about it, stigma surrounding DVA, fears of exacerbating violence, limited awareness of the resources available to support patients, and limited training in providing trauma-informed medical care. This session will give insight into efforts to improve the healthcare response to DVA. It will draw together examples of healthcare DVA programmes from across the globe and bring together lessons learnt about what works and what does not work in addressing DVA in clinical settings, with specific insights for professionals working in mental health services.

Disclosure

No significant relationships.
What does static electricity has to do with schizophrenia?
Authors: Paraschakis A.
Published: February 2022

Introduction

The suspiciousness of a paranoid patient could reach extremes.

Objectives

To present the lessons learned after an interview with a similar patient.

Methods

Case report.

Results

Fifty-two year old woman suffering from paranoid schizophrenia (F20.0). Symptoms almost identical to her previous (two) hospitalizations: delusions of thought reading and of being surveilled by electronic equipment in her house/neighborhood. This time, though, she was additionally convinced of being the object of medical experiments and of being electronically surveilled even within the ward. Treatment: risperidone 12mg/day, lorazepam 3.75mg/day, biperiden 2mg/day. Three weeks after admission, the author noted a slight tremor in her hands (most certainly of extrapyramidal origin). I asked her to place both hands in front of her, fingers wide open, to assess it better. The patient followed with the fingers attached, though. Consequently, I approached my hands to hers -to show how it should be done correctly-, touching them lightly. Then, a spark was generated between our hands. Evidently, it was an electrostatic discharge (I was wearing a wool sweater that day; static electricity could easily accumulate on wool). She became outraged: “what kind of experiments are you doing to me?”, “what electronic devices are you using?”, “this is the proof of what I have been constantly saying”.

Conclusions

The symptoms of psychotic relapses could evolve over time. A clinician should refrain from any strictly unnecessary physical contact with an exceedingly paranoid patient, particularly when the latter claims that is the object of “medical experiments”. The elaborative “ability” of such patients could be, simply, astounding.

Disclosure

No significant relationships.
Achievement of remission after first-episode psychosis in youth
Authors: Kaleda V. , Tikhonov D.
Published: February 2022

Introduction

Dynamic assessment of remission achievement after first-episode psychosis (FEP) is necessary for early detection of post-psychotic depression, negative symptoms and changes in personality traits. The latter allows to decrease suicide risk and optimize treatment and social rehabilitation.

Objectives

We aimed to analyze achievement of remission after FEP in youth and to define prognostic criteria for psychosis outcome.

Methods

Fifty-six patients (16-25 y.o., mean age 19,8 ±2,5 y.o.) after FEP have been receiving follow-up outpatient visits for 3 years. PANSS was applied to assess psychotic symptoms. Depressive symptoms were assessed with HAMD-21.

Results

Remission achievement after FEP is a three-stage process. The stage of reduction and modification of psychotic symptoms is characterized by diminishing personality deterioration and decrease of leading positive symptoms. The second stage, stabilization, is defined through the presence of depressive symptoms with positive (HAMD-21 17,49 ± 7,49) and negative affectivity (HAMD-21 23,68 ± 9,24) with preponderance of emotional, volitional, and cognitive deficits as well as high suicide risk. The third stage, reintegration, is characterized by the combination of negative symptoms with preserved personality resources. There are three reintegration trajectories, with predominant affective or negative symptoms or personality deficits. Mean decrease of PANSS scores was 54,88 ± 6,17 during the overall remission. In the majority of cases (62,5%) the stage of reintegration was finished with the achievement of high-quality remission, coinciding with international remission criteria. The study was supported by RFBR grant 18-013-01214

Conclusions

Our approach to remission assessment allowed us to decrease suicide risk and to provide optimal treatment.

Disclosure

No significant relationships.
Religious delusions in adolescence and young adults: Features of psychopathology and clinic
Authors: Kaleda V. , Popovich U. , Romanenko N.
Published: February 2022

Introduction

Religious delusions is a complex psychopathological phenomenon. The delusional disorders with religious content in young age, the need for an additional detailed study of the conditions of their formation, patterns of the course and outcome of the disease determine the relevance of this study.

Objectives

To identify the psychopathological features, the conditions of formation, the characteristics of the course of psychosis with religious delusions in young age.

Methods

95 patients (62 male and 33 female) with religious delusions (delusion of sin - 33,7%, delusion of demonic possession (40,0%), messianic and antagonistic delusion - 18,9%, oneiroid with religious content – 7,4 %) in psychotic episode (F20, F25 according to the ICD-10) at a young age (16-25 years) were included in the study and examined with clinical-psychopathological, clinical-follow-up and psychometric (PSP, SANS) methods. The average duration of follow-up was 7.4 ± 2.3 years.

Results

In a post-psychotic period it is possible to preserve or form religiosity, as well as a complete reduction of the religious worldview in patients who had been indifferent to religious issues before the first episode of the disease. Though, the formation of residual psychotic symptoms with religious content were noted with greater frequency. The delusions of demon obsession in a psychosis episode is unfavorable prognostic factor.

Conclusions

General psychopathological features of psychotic states with religious delusions, according to the specificity of young age, were identified. A role of the previous religiosity, including overvalued religious ideas, was clarified.

Disclosure

No significant relationships.
Factors associated with real-world functioning in first stages of schizophrenia disorder
Authors: Martínez-Cao C. , García-Fernández A. , Valtueña-García M. , García-Portilla M.P. , Bobes J.
Published: February 2022

Introduction

Schizophrenia is one of the most disabling diseases affecting the patient’s ability to live independently, to be socially active and to work or study1,2. Therefore, identifying predictors of functioning in the first stages of the disease is important to prevent a negative progression of functional outcome in these patients3.

Objectives

To identify the factors associated with real-world functioning in patients with recent onset of the disease.

Methods

Secondary analysis of a cross-sectional, naturalistic study. 84 patients with Schizophrenia (F20), aged 18-71 in their first five years of the disorder under maintenance treatment. Assessments: PANSS, CDS, CGI-S, CAINS; functioning: PSP, cognition: MATRICS. Statistical analysis: student-t test, ANOVA, Pearson correlation and lineal regression.

Results

Mean age (SD): 31.30 (10.08); men: 62.8%. Statistical significant differences (p<0.05) were found in work status, benzodiazepines and antidepressants use. Furthermore, significant correlations (p<0.05) were found with depressive, positive and negative symptoms (avolition, anhedonia, alogia and affective flattening) and cognition. A significant predictive model was obtained that explains the 72.1% of the variance [F(5,74)= 20.952; p< 0.001]. This model included depressive symptoms (B= -0.940; p= 0.001), negative symptoms (B= -1.696; p< 0.001), avolition and anhedonia (B= -0.643; p= 0.001), affective flattening and alogia (B= 1.197; p= 0.003), and visual learning (B= 0.202 p= 0.039).

Conclusions

Negative and depressive symptoms are the main determinants of real-world functioning in patients with recent onset of schizophrenia. Visual learning also contributes to this outcome. On the other hand, the positive relationship between expressive domain and functioning needs furthermore investigation.

Disclosure

No significant relationships.
Training as a psychiatrist during a pandemic
Authors: Migchels C.
Published: February 2022

Abstract Body

Training is a crucial time in any psychiatrist’s career. It’s a time when you are faced with new responsibilities and challenges, both professionally and personally, and senior and peer support are indispensable. The Covid-19 pandemic has had an impact on all the essential needs of trainees: supervision, theoretical training, clinical care and contact with both patients and colleagues have been put under pressure and are no longer the self-evident part of training that they were before. Trainees are facing an unprecedented balancing act between their duties as physicians, their training needs and their dedication to the often vulnerable patients under their care, all whilst dealing with the personal consequences of the pandemic and the restrictions that have been put in place. Based on the experiences of the European Federation of Psychiatric Trainees (EFPT) we will have a look into what has changed in the lives of trainee psychiatrists globally since the start of the pandemic, the difficulties that have occured and the lessons that have been learned. Examples of ways of dealing with the above mentioned challenges and opportunities for the future will be discussed.

Disclosure

No significant relationships.
CT abnormalities in late-onset schizophrenia and schizoaffective disorder correlate with number of psychotic episodes and cognitive dysfunction
Authors: Savina M. , Bozhko O. , Savvateeva N. , Sheshenin V. , Pochueva V. , Cherkasov N.
Published: February 2022

Introduction

Late-onset psychosis is associated with development of dementia. Search for neuroimaging signs in these patients is important.

Objectives

This study aimed to assess CT abnormalities and their clinical correlations in late-onset psychosis.

Methods

Patients with DSM-V diagnosis of late-onset schizophrenia (LOS, n= 43, age 65.2±9.4, 90% females) and schizoaffective disorder (LOSAP, n=9, age 64.9±5.8, 30% females) underwent CT and cognitive examination before discharge. Atrophy and ventricles enlargement were ranged from 0 (abs.) to 3 (sev.); vascular pathology - from 0 (abs.) to 2 (mult.). Patients were compared with 16 controls (age 58.1±10.8, 50% females). Nonparametric statistic was used.

Results

Patients had more severe frontal (χ2 19.7, р=0.003), temporal (χ2 10.7, р=0.097), parietal (χ2 21.7, р=0.001), cerebellar (χ2 14.8, р=0.005) atrophy and ventricles enlargement (χ2 15.6 р=0.016). 29 % of LOS and 44% of LOSAP patients had leukoaraiosis. All findings correlated with age. In patients ventricular enlargement correlated with number of psychotic episodes (r=0.338, р=0.014), lower MMSE (r=-0.314, p=0.045), immediate (r=-0.508, р=0.002) and delayed (r=-0.404, р=0.016) verbal recall. Temporal atrophy correlated with number of episodes (r=0.439, р=0.001), lower MMSE (r=-0.327, p=0.037) and immediate verbal recall (r=-0.339, p=0.046); cerebellum atrophy - with lower MMSE (r=-0.338, р=0.036) and FAB (r=-0.407, р=0.01); leukoaraiosis - with number of episodes (r=0.503, р=0.001), prolonged hospital stay (r=0.345, p=0.024); vascular pathology – with number of episodes (r=0.336, р=0.015), lower visual recall (r=-0.399, р=0.019), performance time in TMT-B (r=0.404, р=0.024).

Conclusions

Correlations between CT pathology, cognitive dysfunction and number of psychotic episodes may reflect progression of brain pathology due to psychosis.

Disclosure

No significant relationships.
Dehydroepiandrosterone sulfate (DEHA-S), cortisol and adrenocorticotropic hormone (ACTH) levels in drug-naive, first episode patients with psychosis
Authors: Petrikis P. , Tigas S. , Christou M. , Brikos S. , Karampas A. , Georgiou G. , Hyphantis T.
Published: February 2022

Introduction

Impaired response to stress and a pathological activation of the hypothalamic-pituitary-adrenal axis have been implicated in the pathophysiology of schizophrenia

Objectives

To measure serum ACTH, cortisol and DEHA-S levels in drug-naïve, first-episode patients with psychosis.

Methods

Results are reported as mean (standard deviation, range). Paired t-test or Wilcoxon signed rank test were performed for group comparisons. The level of significance was set at p-value<0.05. Statistical analysis was performed with Stata 15.1.

Results

Data were included for 110 subjects (70 men, 40 women); 55 patients and 55 controls matched for age and sex. Mean age was 31.3 years (8.7, 18-48) in patients and 31.4 years (8.9, 17-49) in controls. Serum cortisol and Cortisol/DHEA-S ratio were statistically significantly lower in patients [12.6μg/dl (4.5, 3.5-24.5) and 5.3 (3.6, 1.3-19.5), respectively] compared to controls [15.5 μg/dl (4.9, 4.2-30.1) and 8 (4.7, 1.1-25.5), respectively] (p-value=0.0068 and 0.0005, respectively). Additionally, serum DHEA-S was statistically significantly higher in patients [306.5 μg/dl(165.4, 70-790)] compared to controls [240.1 μg/dl(113.5, 46-597)] (p-value=0.0114). ACTH was also higher in patients [28.5 pg/ml(15.7, 6.2-73.9)] than controls [26.5 pg/ml (15.3, 7-70.5)] but this difference wasn’t statistically significant (p-value=0.6359).

Conclusions

We report elevated DEHA-S, decreased cortisol levels and decreased cortisol/DEHA-S ratio in the patients’ compared to the controls’ group.

Disclosure

No significant relationships.
Psychosis in a 40-year-old man as debut of Alzheimer’s disease
Authors: Martín C. Vilella , Sanz M.Á. Heredero , Vázquez P. García , Rodríguez I. Gonzalez , Sevillano S. Nuñez , García A. Serrano
Published: February 2022

Introduction

Psychosis in Alzheimer’s disease has an incidence of ~ 10% per year. Recent work has focused on the presence of psychosis in people with mild cognitive impairment, as a risk factor for the development of Alzheimer’s disease.

Objectives

To study a case of Alzheimer’s disease presenting psychotic symptoms

Methods

Retrospective review of clinical records and complementary test, including psychiatry, electrophysiology and neurology.

Results

A 40-year-old goes to the emergency room due to hetero-aggression at home. He says that his father steals his money and prostitues have been hired in his house. The patient is oriented, partially collaborative and approachable. Psychomotor restlessness is observed. He has self-referral delusions, auditory hallucinations and insomnia. Provisional diagnosis of acute psychotic episode made and low dose risperidone was prescribed. During his stay on the hospital Ward, sedation, recent memory alterations, spatio-temporal disorientation lack of initiative and disorganized behaviors appear. Risperidone is withdrawn and complementary test are performed. Imaging tests show temporal and frontal atrophy. Increased TAU protein and low levels of amyloid in CSF are found. Brain biopsy is +. His mother died of Alzheimer’s disease with 36 years-old and another affected brother with 42 yeras-old. The definitive diagnosis is Alzheimer’s disease and genetic studies are currently being carried out.

Conclusions

Psychiatric symptoms may be present in Alzheimer’s desease. It is mandatory to carry out an adequate organic screening before a late first psychotic episode.

Disclosure

No significant relationships.
Stigma, insight and social anxiety in first episode patients with psychosis
Authors: Efthimiou M. , Petrikis P. , Toki E. , Siafaka V. , Fakitsa P. , Karampas A. , Georgiou G. , Hyphantis T.
Published: February 2022

Introduction

People with schizophrenia are considered to be within the most stigmatized social groups. Accurate and efficient detection of stigma and its correlates is essential in patients with psychosis.

Objectives

The purpose of this study was to assess illness insight, stigma, social anxiety and quality of life in patients with a first episode of psychosis and their possible correlations

Methods

The sample of this study consisted of 90 patients with a first episode of psychosis that fulfilled inclusion and exclusion criteria. Tools used for the purpose of this study were Schedule for the assessment of insight-Expanded version, Internalized Stigma for Mental Illness Scale, World Health Organization Quality of Life Assessment - Greek version, Liebowitz Social Anxiety Scale - Greek version. Data were collected and analyzed with SPSS v26.

Results

The study group had good insight (SAI-E score: 20.33±4.449), medium to high stigma values (ISMI score 50.93±7.854), a good enough quality of life (WHOQOL-BREF score: 86.08±10.010) and low levels of social anxiety (LSAS-Gr Fear score: 3.26±8.653; Anxiety score: 2,93±7,596). The results of this study show significant at the 0.01 level 2-tailed correlations as such: (i) a positive and significant relationship between ISMI and LSAS-Gr, (ii) a negative and significant relationship between ISMI and WHOQOL-BREF, and (iii) a negative and moderate relationship between WHOQOL-BREF and LSAS-Gr.

Conclusions

We report medium to high stigma levels, good insight and a good enough quality of life in a sample of first-episode patients with psychosis.

Disclosure

No significant relationships.
Effect of long-acting injectable paliperidone 3 monthly and aripiprazol 1 monthly on hospitalization rate in a first-episode psychosis
Authors: Lopez P. Gil , Sanchez J.M. Rodriguez , Fernandez L. Garcia , Estevez V. Sanchez
Published: February 2022

Introduction

Long-acting injectable antipsychotics (LAIs) can reduce relapse and hospitalization risk but they are not widely used in first psychotic episode (FEP) patientes.

Objectives

To examine the effcacy of two of the most used second generation LAI antipsychotics (paliperione 3 monthly and aripiprazol 1 monthly) to reduce hospitalization rates.

Methods

We evaluated in a naturalistic study a sample of patients (n=277) with a FEP. We carried out a mirror-design study to compare the number of hospitalizations and days in hospital before and after the introduction of LAI paliperidone (3 monthly) or LAI aripiprazol. In our Early Intervention Services (Lehenak) antipsychotic treatment is not protocolized and is established for each patient according to the psychiatrist criteria.

Results

We review the oucome of 277 FEP treated in our Early Intervention Service “Lehenak” with LAI paliperidone 3 monthly (n=156) or LAI Aripiprazol (n=121)Pre LAI Mirror PeriodPost LAI Mirror PeriodWithin group comparisons (paired t-test) t pAripiprazol LAI number of Hospitalizations (mean, standard deviation)2.31 (1.72)0.73 (1.23)17.4 (<0.001)Paliperidone LAI 3 monthly number of Hospitalizations number0,68 (0.93)0.15 (0.47)4.62 (<0.001)Aripiprazol LAI Days in Hospital30.26 (33.52)17.02 (38.19)2.93 (0.004)Paliperidone LAI 3 monthly Days in hospital12.63 (24.23)3.40 (14.18))7.5 (<0.001)

Conclusions

Both LAI paliperidone 3 monthly and LAI aripiprazol had a postive impact on hospitalIzation rate, decreasing them significantly after their introduction. These data also support a more extensive use of LAI paliperidone 3 monthly in FEP.

Disclosure

Presenting author has received honouraria for lectures or advisory boards from Janssen, Otsuka, Lundbeck and Angelini in the last five years
Schizophrenia long-acting antipsychotics initiation index (SLAAII)
Authors: Ifteni P. , Teodorescu A.
Published: February 2022

Introduction

Background In individuals with schizophrenia, long-acting injectable antipsychotics (LAIs) have been shown to be beneficial in preventing relapse. An important issue in these individuals is poor medication adherence, which can negatively affect outcomes. Although currently underutilized in comparison with oral antipsychotics, LAIs can be an important treatment option for addressing the high rates of poor adherence to medication in individuals with schizophrenia. There is a lack of published evidence and treatment guidelines on optimal strategies for the initiation of treatment with LAIs, which would at least partly explain why LAIs remain underutilized.

Objectives

Aims The aim of this report is to present an index for initiation of LAI in schizophrenia.

Methods

A restrospective chart review of a cohort of 1000 consecutive patients hospitalized with schizophrenia in Clinical Hospital of Psychiatry and Neurology Brasov, Romania, between 2011 and 2019. The number and reasons of LAIs initiation were evaluated.

Results

Rezults The results shows a reduced number of LAIs initiation and led to the realization of an index entitled Schizophrenia long-acting antipsychotics initiation index (SLAAII) with 6 domains (age, duration of illness, number of relapses, response to oral treatment and antipsychotic available formulation), each with 3 response variants rated with 5 points, 3 points and 1 point. The maximum posible score is 30 points and minimum 6 points. A score above 20 points is a strong indication for LAI initiation.

Conclusions

Schizophrenia long-acting antipsychotics initiation index (SLAAII) could be a very useful tool to facilitate the initiation of LAI treatment in patients with schizophrenia.

Disclosure

No significant relationships.
Innovative mental health policies, plans and interventions: How to manage consequences of economic crisis?
Authors: Caldas De Almeida J.M.
Published: February 2022

Abstract Body

Available evidence shows that countries may shield their population’s exposure and vulnerability to mental health risks during and after an economic recession by strengthening their policies and reorienting their budgets. Populations’ mental health protection during economic crises can only be achieved by the policies of different sectors. Social protection, social programmes and social safety nets proved to be fundamental buffers against inequalities in mental health. Several actions have proven to be effective in this area, including measures to improve social protection, reduce income inequalities, and mitigate the impacts of unemployment. To address the negative consequences of unemployment, active labour market programmes, including special programmes for unemployed young people and families, programmes to promote the employment of people with disabilities, and debt relief programmes should be implemented. The response of the health system is critical. During and after economic recessions, it is fundamental to ensure the responsiveness and effectiveness of the mental health system. To attain this goal, mental health services that are closer to the populations and that facilitate the early identification of mental health problems and the implementation of integrated interventions should be strengthened. The latter is a crucial approach to tackle the mental health problems that more often worsen in periods of economic instability, such as depression, suicidal behaviour and heavy drinking. A special attention should also be dedicated to strengthening the network of community-based mental health services, promoting the integration of mental health in primary care, and enhancing the coordination between mental health services and social care.

Disclosure

No significant relationships.
Cognitive impairment in first psychotic episodes: The role of cannabis
Authors: Boi S. , Sanz-Aranguez B. , Salvador M.T. González , Labrador R. Gutierrez , Ruíz C.M. Martín , Caballero L. , De Arce Cordón R.
Published: February 2022

Introduction

The role of cannabis on cognitive impairment in first-episode psychosis (FEP) is becoming more important, with multiple investigations on this regard, with heterogeneous results due to different methodologies.

Objectives

To evaluate the cognitive profile in patients who suffer a FEP, analyzing the potential effect of cannabis.

Methods

We present the preliminar results of a cross-sectional case-control study about the effect of cannabis on cognition, in patients suffering a FEP. We recruited a total of 41 FEP during the last two years. We investigated the theorical differences between those who were cannabis users (FEP-Cannabis+)(n=28) and not cannabis users (FEP-Cannabis-)(n=13). We included a control group with healthy subjects who were cannabis users (Healthy-Cannabis+)(n=24).Sociodemographic and clinical questionnaire was completed. The Screening Scale to evaluate Cognitive Impairment in Psychiatry(SCIP-S) and the Cannabis Abuse Screening Test (CAST) were used. The consumption pattern was also evaluated.

Results

In this study, cognitive impairment was found in FEP-Cannabis+,when compared with Healthy-Cannabis+.The most affected areas were immediate verbal learning (I-VL), delayed verbal learning (D-VL), processing speed (PS), and total score (TS). Significant differences were also observed in the cognitive profile of patients suffering FEP depending on their use of cannabis. FEP-Cannabis+) showed lower scores in PS, I-VL and TS.

Conclusions

Although several prognostic factors have been identified in FEP, to date there are no reliable markers for predicting the possible evolution of high-risk mental states to a FEP. More investigations are necessary in order to elucidate the role of cannabis in the cognitive impairment.

Disclosure

No significant relationships.
Historical path of paraphrenia
Authors: Mata A. Hernández , Gómez A. Sotillos , Coscujuela P. Marco , Méndez B. Ordóñez
Published: February 2022

Introduction

Paraphrenia is a psychotic disorder characterized by an insidious development of a vivid and exuberant delusional system, accompanied by hallucinations and confabulations, without a personality deterioration. It is considered to be an intermediate entity between the disorganization of schizophrenia and the systematization of a delusional disorder.

Objectives

Develop knowledge about paraphrenia as an individualized diagnostic entity and its historical path through the classical authors’ texts.

Methods

Extensive research on the historical path of the paraphrenia diagnostic entity was carried out, as well as the current situation of the term.

Results

In the German psychiatry it was Karl Kahlbaum who first introduced the term of paraphrenia. Later many authors of the German psychiatry delved into this diagnostic entity. Emil Kraepelin described four different subtypes of paraphrenia: paraphrenia systematica, expansiva, confabulans and phantastica. However, other authors such as Kleist or Bleuler, considered paraphrenia should not be judge as an individualized diagnostic entity as it should be considered inside schizophrenia, so the term disappeared in the German psychiatry. In the French psychiatry, unlike the German, the independence of chronic psychosis from schizophrenias was recognized, so the term had a longer path. Henry Ey recognized four important clinical features in this disorder: paralogical thought dominance, megalomania, confabulation and integrity of relation with reality.

Conclusions

Currently the term paraphrenia is no longer considered an individualized diagnostic entity. In fact, in today’s textbooks of psychiatry paraphrenia is considered a psychotic disorder that has nothing in common with the one described by the classical authors, and it is part of the late-onset psychosis.

Disclosure

No significant relationships.
Sexual and reproductive health (SRH) needs of women admitted to eileen skellern ward (ES1) psychiatric intensive care unit (PICU)
Authors: Rose E. , Blake L. , Covshoff E. , Sethi F. , Rathouse R. , Wilson A. , Bolade A. , Pittrof R.
Published: February 2022

Introduction

PICU inpatients are likely to be at increased risk of having unmet SRH needs due to barriers to accessing services. Since May 2018, an in-reach SRH assessment has been available to all psychiatric inpatients on ES1 ward, if referred. Analysis of referrals over 15 months identified only 24 had been made during this time.

Objectives

To assess the SRH needs of women admitted to ES1 PICU, the feasibility of providing a SRH in-reach clinic, and the acceptability of delivering a nurse lead referral programme.

Methods

A bi-monthly SRH in-reach clinic and a nurse led SRH referral pathway were implemented on ES1 over a seven-month period. A staff training needs assessment was performed followed by training, a protocol was developed, staff attitudes were explored, and patient engagement was sought.

Results

A total of 41% (32/77) of patients were referred, which was a 29% increase. 53.1% (17/32) of the total referrals had a true SRH need, equating to a 10% increase and 22% (17/77) of all PICU admissions. 90% of referrals were made by nursing staff. A staff focus group (n15) highlighted the acceptability and perceived importance of offering SRH care in PICU, if interventions were appropriately timed and the patient’s individual risk profile was considered.

Conclusions

Results identify that SRH needs for PICU admissions are greater than previously realised. Providing a nurse led referral pathway for an SRH in-reach clinic is acceptable, feasible and beneficial for PICU patients. This project has resulted in service improvements including offering asymptomatic STI testing to all PICU admissions.

Disclosure

No significant relationships.
Gender incongruence: A longitudinal perspective from childhood throughout adolescence
Authors: Borges L. , Riggi G.
Published: February 2022

Introduction

Gender identity is each person’s internal and individual experience of gender. Gender expression is how a person publicly expresses their gender. Gender incongruence (GI) is defined as a condition in which a person has a marked incongruence between the expressed or experienced gender and the biological sex at birth. Adolescence is a crucial period for the persistence or development of GI, due hormonal changes, peer relations and first romantic experiences.

Objectives

To make a revision of the literature about GI along childhood throughout adolescence.

Methods

Research in the literature with the words “gender identity”, “gender incongruence”, “gender dysphoria”, “childhood” and “adolescence” in scientific databases.

Results

GI is present in a small percentage of children, often provoking psychopathological distress. There is a high prevalence of autism spectrum disorders in these children, compared with the general population. In most cases the dysphoria does not persist until adolescence. There has been an increasing number of adolescents seeking for treatment at gender identity services. The studies show that after the onset of puberty, the probability of persistent GI is high and that adolescents submitted to hormonal suppression tend to continue the medical treatment.

Conclusions

Epidemiological formal studies about gender incongruence in children and adolescents are very few. Studies of prevalence in these populations are community studies and don’t reflect the true prevalence of GI, so it would be necessary to investigate its prevalence and persistence in different world populations. It’s also necessary to make more prospective studies about the long-term effects of the medical treatment of GI.

Disclosure

No significant relationships.
Analysis of risk factors in patients with alcohol delirium who have been treated at the riga psychiatry and narcology center in 2018
Authors: Kurzemnieks K.
Published: February 2022

Introduction

Alcohol abuse can be the cause for psychotic disorders. In the International Classification of Diseases (ICD10) they are coded F10.4-F10.9. One of the potentially life-threatening complications is the development of alcohol delirium. Mortality rates in patients with untreated alcohol delirium reach 15%. It is extremely important to identify the risk factors that contribute to the development of delirium in time to ensure the most effective treatment and to ensure the patient’s potential survival in the hospitalization and post-hospitalization phase.

Objectives

To analyze and evaluate the risk factors that have coused alcohol withdrawal with the development of delirium in patients admitted at the department of Narcology of the Riga Psychiatry and Narcology Center in 2018.

Methods

This study is a retrospectively conducted cohort study based on data from inpatient medical records for patients diagnosed with alcohol-induced delirium at the Department of Narcology of the Riga Psychiatry and Narcology Center in Year 2018.

Results

In the Riga Psychiatry and Narcology Center 113 patients were diagnosed alcohol caused delirium. That makes up to 8% of all inpatients in year 2018. Summary of the prevalence of the most significant risk factors in 2018 inpatients with alcohol delirium.High levels of aspartate aminotransferase95%Tachycardia76%High levels of alanine aminotransferase54%Low platelet count51%High systolic blood pressure50%High diastolic blood pressure46%Other somatic diseases45%Previous history of detoxification37%History of alcohol-induced seizures13%

Conclusions

The study indicated that some easily determined parameters are potential clinical predictors for the development of delirium tremens.

Disclosure

No significant relationships.
Predictors of smoking cessation treatment attrition in individuals with substance use disorders
Authors: Aonso-Diego G. , García-Pérez Á. , Weidberg S. , Secades-Villa R.
Published: February 2022

Introduction

Attrition rates in smoking cessation treatments are high, particularly in persons with substance use disorders. It is estimated that about 55%% disengage prematurely at treatment, meaning that a large portion will not benefit from smoking abstinence. So far, no previous studies have examined predictors of dropouts in a smoking cessation treatment with persons with SUD.

Objectives

The study was two-fold: 1) to analyze the percentage of
early-, late-dropouts and completers, and 2) to examine sociodemographic, psychological, and substance-related predictors of dropouts.

Methods

A total of 86 participants (69.8% males; Mage=43.84, SD=9.917) were randomly assigned to two psychological smoking cessation treatment: cognitive-behavioral treatment (CBT) (n=51) or CBT + contingency management (CM) (n=35). Interventions were delivered during eight consecutive weeks

Results

Of the 86 participants who completed the baseline assessment, 21 did not start treatment, 17 dropped out of treatment during treatment, and the remaining 48 completed the treatment. Predictors of early-dropout were younger age (B=-.234; p=.024; OR=.792) and lower number of days in SUD treatment (B= -.005; p=.026; OR=.995). Patients’ primary substance of use was associated with reduced early-dropouts; compared to cocaine users, alcohol (B=-1.827; p=.043; OR=.161) and opioids (B=-3.408; p=.018; OR=.033) related to improved attrition. Late dropout was directly related to higher number of tobacco use cessation attempts (B=.407; p=.039; OR=1.502).

Conclusions

Incorporating strategies to improve attendance and completion rates in SUD populations should be a priority. Mobile reminders, offering online therapies, or CM to reinforce attendance to therapy may be considered.

Disclosure

No significant relationships.
Precision medicine in psychosis: Translating findings from research into clinical practice
Authors: Galderisi S.
Published: February 2022

Abstract Body

Precision medicine is “an emerging approach for treatment and prevention that takes into account each person’s variability in genes, environment, and lifestyle” [1]. The terminology is increasingly used in psychiatry, and especially in research relevant to the prediction of psychosis onset, response to treatment and functional outcome. While this is an important step-forward for the discipline, at this stage it is very important to promote the translation of research findings into clinical practice, as much as possible. Nowadays the availability of machine learning and artificial intelligence tools, together with advances in data storage and data security, enable the integration of neuroimaging, biological, clinical and cognitive data. By overcoming current limitations in multiple domain data analysis these tools may lead to the identification of reliable diagnostic, prognostic and therapeutic markers in routine clinical care, as well as to the prediction of clinically meaningful outcomes (e.g., psychosis onset, symptomatic and functional outcome, and treatment response). Precision medicine in psychiatry is a developing science, deserving further large-scale research, translational approaches and refinement that, hopefully, will soon be an integral part of every-day clinical practice. However, challenges in pursuing this strategy should not be underestimated, and efforts should be made to constantly advocate for more investments in human and financial resources in psychiatry, and to concentrate on the use of widely available and not too expensive and time-consuming methods.1 Toward Precision Medicine. Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease. Washington, DC: National Academies Press; 2011.

Disclosure

No significant relationships.