bluuebunny/crossref_metadata_2025 huggingface dataset:
Dress syndrome following carbamazepine exposure: A very early onset
Authors: Kraiem M. , Charfi N. , Mhiri E. , Gassara I. , Omri S. , Smaoui N. , Feki R. , Zouari L. , Thabet J. Ben , Bouali M. Maalej , Maalej M.
Published: February 2022

Introduction

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous drug reaction characterised by both systemic and cutaneous clinical manifestation with a mean latency period of 3.9 weeks.

Objectives

To underline the importance of an early diagnosis of DRESS SYNDROME.

Methods

We reported a case of carbamazepine induced DRESS syndrome with atypical chronology of manifestations.

Results

A 43-year-old man with no previous known medical history was admitted in psychiatry. He experienced a relapse of schizoaffective symptoms. In the last three years, the patient was treated by Valproic acid as a mood stabilizer. Because of the unavailability of this molecule, carbamazepine was prescribed in combination with antipsychotics. Three days later, the patient developed a high fever, hypotension, a pruritus, a facial oedema, a skin rash associated to lymphadenopathy. Laboratory findings showed a lymphopenia, eosinophilia and elevated liver chemistries. In order to define the case, RegiSCAR scoring system was used, and our case is categorized as probable with a score of five. Carbamazepine was discontinued upon clinical manifestationsand the patient was treated with systemic antihistaminic treatment associated to methylprednisolone with a good outcome. After 3 weeks, clinical and biological improvement were noted.

Conclusions

Despite the absence of a delayed onset, typically between 3 weeks and 3months, we can diagnose dress syndrome 3 days after carbamazepine intake. This case highlights that psychiatrists should be aware of the risk of early onset dress syndrome associated with carbamazepine and they should monitor for warning symptoms from treatment initiation.

Disclosure

No significant relationships.
Psychedelics and psychiatric disorders: A emerging role
Authors: Peixoto C. , Santos F. Queirós , Rego D. , Medeiros H.
Published: February 2022

Introduction

Recently there has been renewal in interest of psychedelic research. Classic psychedelics such as lysergic acid diethylamide (LSD), psilocybin and mescaline act pharmacologically as agonists at the 5-HT2A receptor. The entactogens like methylenedioxymethamphetamine (MDMA), acts as a serotonin, dopamine and noradrenaline agonist. All of these drugs are potential candidates in the treatment of multiple psychiatric illnesses.

Objectives

The authors intend to review the literature on the clinical application of psychedelic drugs in psychiatric disorders.

Methods

Non-systematic review of the literature.

Results

In recent clinical trial the psychedelic is given with psychotherapeutic input. In a supportive setting, psychedelics produced immediate and significant anti-depressant and anxiolytic effects that were endured for several months. Randomized clinical trials support the efficace of psilocybin in the treatment of depression and those with anxiety and depression symptoms provoked by life-threatening cancer. There have also been studies showing efficacy in both alcohol and tobacco dependence. When administered safely LSD can reduce anxiety and have anti-addictive property. Randomized clinical trials support the efficacy of MDMA in the treatment of PTSD. Psychedelics were well-tolerated, few adverse effects have been reported. The most common adverse effects were transient anxiety, short-lived headaches, nausea and mild increases in heart rate and blood pressure, with no persisting adverse effects. Serious adverse events, such as persistent psychosis and suicidality, have not been demonstrated.

Conclusions

Psychedelics appear to be effective in multiple psychiatric disorders and are well-tolerated, although further evidence is required, to better see they therapeutic potential.

Disclosure

No significant relationships.
The sublingual use of atropine in the treatment of clozapine‐induced sialorrhea
Authors: Darriba H. Becerra
Published: February 2022

Introduction

Clozapine is a second-generation antipsychotic indicated in treatment-resistant schizophrenia. Patients taking clozapine are likely to experience an increase in salivation or sialorrhea. Clozapine‐induced sialorrhea (CIS) may lead to sleep disturbances or aspiration pneumonia. Treatment options include locally administered anticholinergic medication with atropine ophthalmic drops applied sublingually.

Objectives

To review the current evidence for the effectiveness, safety, side effects and dosage of sublingual application of atropine in reducing or resolving of CIS.

Methods

Systematic review. Data were obtained from PubMed/Medline, EMBASE, PsycINFO, Cochrane Plus, Trip Database, Science Direct and Scopus searches of English-language articles, without restriction for date of publication and study design, reporting the sublingual use of atropine in the treatment of CIS. Large clinical studies with appropriate statistical methods and recruited adults were preferred.

Results

12 selected articles (of 458 references) consisted entirely of case reports and case series. A total of 29 patients with CIS were reported, of whom 24 responded favorably to sublingually administered atropine drops 1% (1-2 drops a day). One limitation of its utilization is the dose-related dry mouth, which can be addressed by lowering the number of drops administered. CIS can occur at different clozapine doses, in various stages of treatment.

Conclusions

The reviewed articles suggest that the use of sublingual atropine is a promising local treatment for CIS. Oral anticholinergic and alpha-2 agonist medications have been used to treat CIS with variable efficacy, but can cause systemic anticholinergic side effects. Further experimental research is needed.

Disclosure

No significant relationships.
Differences in cognitive side-effects and seizure parameters between thiopental and propofol narcosis in ECT
Authors: Kavakbasi E. , Wieneke A. , Baune B.
Published: February 2022

Introduction

The standard anaesthetic for electroconvulsive therapy (ECT) in our hospital methohexital was no longer available from the beginning of 2019. A change to alternatives became necessary. We initially decided on thiopental and than switched to propofol after the suspicion of increased occurrence of cognitive deficits due to thiopental narcosis was expressed by clinicians.

Objectives

This retrospective study provides a comparison of the two narcotics in terms of side-effects and seizure parameters.

Methods

We performed a retrospective data collection from our clinical database and identified a total of 64 patients (w=60.9 %, m=39.1 %) got either thiopental (n=35) or propofol (n=29) for ECT narcosis.

Results

The mean age at the beginning of the ECT series was 56.0 years (20-82, SD 17.8, median 57.5). The groups did not differ in terms of age distribution. On average the depressive episode lastet for 9.0 months (SD 11.5, median 6.0) with no difference between the two groups. The mean EEG seizure time was significantly shorter in the propofol group (28.1 sec; 95%-CI: 23.8-32.4) than in the thiopental group (38.3 sec.; 95%-CI: 34.3-38.3). The mean EMG seizure activity was also shortler in the propofol group (12.0 sec.; 95%-CI: 8.0-15.0) compared with the thiopental group (21.5 sec.; 95%-CI: 18.3-24.8). The ECT series was interrupted due to cognitive side-effects in 20 cases. The majority of these cases (n=17) concerned the thiopental group, compared to 3 cases in the propofol group.

Conclusions

Propofol narcosis in ECT was assiosiated with worse seizure parameters, whereas thiopental narcosis was associated with increased risk of cognitive side-effects.

Disclosure

No significant relationships.
Understanding schizophrenia as a self-disturbance
Authors: Fredheim K. , Wynn R.
Published: February 2022

Introduction

Phenomenolgical theory has contributed to a renewed understanding of schizophrenia, as a supplemental perspective to contemporary operationalistic theories. Phenomenological research with patients suffering from schizophrenia emphasizes the nature of subjectivity and suggests that a basic disturbance of the self can be understood as a core phenotypic marker of shizophrenia.

Objectives

To briefly present and discuss the phenomenological theory of self-disturbance, illustrated through a case.

Methods

In this case study we briefly present the phenomenological theory for self-disturbance. We illustrate the theory by presenting elements from a case involving a patient that suffers from schizophrenia. Our focus in on how the self-disturbance is experienced by the patient and how the therapist can address this experience. The challenges in psychotherapy related to the phenomenon of self-disturbance and the implications for examination and treatment are discussed.

Results

The patient gives a detailed description of how he experiences a diminished basic sense of self. Central elements in his experience are a loss of a common-sense ability, hyperreflexivity, and a loss of a first-person perspective. He describes how this disorder creates difficulties in communication, relationships, treatment, and in coping with life. He also describes which elements of his treatment that he has experienced as the most helpful. The case underlines the importance of considering the concept of self-disturbance in psychotherapy.

Conclusions

In this case study, we draw on phenomenological theory to gain insight into a patient’s experiences relating to the concept of self-disturbance.

Disclosure

No significant relationships.
The relationship between mindfulness, depression, anxiety, and quality of life in individuals with schizophrenia spectrum disorders
Authors: Bergmann N. , Hahn E. , Hahne I.M. , Zierhut M. , Ta T.M.T. , Bajbouj M. , Pijnenborg M. , Böge K.
Published: February 2022

Introduction

Mindfulness-based interventions have received growing attention over the last years for the treatment of various mental disorders, including schizophrenia spectrum disorders (SSD), demonstrating their transdiagnostic validity. However, no study has examined the relationship of probable mechanisms underlying the therapeutic effects of mindfulness in SSD.

Objectives

The current study examines the relationship between mindfulness, depression, anxiety, and quality of life in individuals with SSD through quantitative measures.

Methods

A total of 83 participants with SSD were recruited at the in- and outpatient facility of the Charité – Universitätsmedizin Berlin in Germany. Participants completed the Southampton Mindfulness Questionnaire, Comprehensive Inventory for Mindful Experiences, and Freiburger Mindfulness Inventory, the Depression, Anxiety, Stress Scale, and the World Health Organization Quality of Life Questionnaire. PROCESS analysis examined the relationship between mindfulness and quality of life and the mediating role of depression and anxiety.

Results

Indicated a significant positive association between mindfulness and physical health, psychological and environmental quality of life. Depression and anxiety were found to mediate this relationship, with higher depression and anxiety scores being related to lower mindfulness and quality of life. In this relationship, however, depression was found to be the stronger predictor.

Conclusions

The findings of this study provide insight into the mechanisms of mindfulness. Initial evidence for the transdiagnostic and process-based clinical relevance of MBIs for SSD has been found and future studies can further explore the role of mindfulness for central therapeutic processes of change by employing longitudinal designs.

Disclosure

No significant relationships.
Predictors of psychosocial adaptation and mental wellbeing among people with chronic illness and disabilities in a chinese context
Authors: Siu A. , Chan S. , Cheung M. , Mo C. , Lai S. , Shek D.
Published: February 2022

Introduction

The process of adjustment to disability and illness among people with chronic illness and disabilities (CID) impacts on motivation for rehabilitation illness self-management, and psychological well-being. It involves a complex interplay of biopsychosocial factors, and was seldom examined in the Chinese context.

Objectives

Identify the predictors of mental well-being of people with from a set of variables including illness and social support, functional abilities, coping strategies, resilience. Examine how these factors interact in determining psychosocial adaptation and mental well-being by structural equations modelling (SEM).

Methods

We conducted a survey of people with CID, who were recruited from community-rehabilitation settings and self-help groups (N = 244). The research questionnaire collected basic demographic information, illness-related variables (e.g. pain, fatigue, functional limitations), and RIDI), social support, measures of resilience, coping, psychosocial ad as predictors, and mental well-being.

Results

Of General Linear Model (GLM) revealed that males have better adaptation than females. Resilience, social coping, & active problem solving are significant predictors of adaptation (Table 1), while age, breathing, pain, resilience, avoidance coping, are predictors of maladaptation (Table 2). A SEM was tested to examine the interaction among the predictors and outcome of adaptation and mental well-being (Figure 1), and the model fit was fair (CFI = 0.89; RMSEA = 0.09)

Conclusions

The results indicated that there are gender differences in adaptation. While all the hypothesized groups of variables contributed to mental well-being of people with CID. Resilience, illness variables, and some forms of coping are closely linked to adaptation and maladaptation.

Disclosure

No significant relationships.
The use of big data in psychiatry – the role of pharmacy registries
Authors: Gonçalves-Pinho M. , Ribeiro J.P. , Freitas A. , Mota P.
Published: February 2022

Introduction

Administrative databases (AD) are repositories of administrative and clinical data related to patient contact episodes with all sorts of health facilities (primary care, hospitals, pharmacies,…).The large number of patients/contact episodes with pharmaceutical facilities available, the systematic and broad register and the fact that AD provides Real-world data are some of the pros in using AD data.

Objectives

To perform a narrative review on the role of Big Data pharmaceutical registries in Mental Health research.

Methods

We conducted a narrative review using MEDLINE and Google Scholar databases in order to analyse current literature regarding the role of BigData pharmaceutical registries in Mental Health Research.

Results

Administrative variables like drug names and prices may be used and linked to other clinical variables such as patients disease, in-hospital mortality, length of stay,(…). The use of electronic medical records may also contribute to systematic surveillance approaches like local or national pharmacovigilance strategies, identification of patients at risk of developing complications and software pop-up warnings related to medication dosage, duplication and lateral effects. The use of Big Data pharmaceutical registries allows to create predictive epidemiological models regarding drugs lateral effects or interactions and may help to perform pharmacovigilance phase 4 clinical trials. Its use may be applied to the optimization of clinical decision, monitoring of drug adverse events, drug cost and administrative monitoring and as surrogate measures of quality care indicators.

Conclusions

Big Data use in pharmaceutical registries allows to collect large and important clinical and administrative data that may be later used in Mental Health care and research.

Disclosure

No significant relationships.
Efficacy of armodafinil on reducing excessive sleepiness in patients with shift work disorder: A systematic review protocol
Authors: Correia J. , Silva P. , Mendes F. , Ferreira A.R. , Fernandes L.
Published: February 2022

Introduction

Previous studies have demonstrated that night-shift work is associated with adverse effects impacting physical and psychological health, including the Shift Work Disorder (SWD). SWD is a circadian rhythm disorder characterized by sleepiness and insomnia, resulting from working a shift other than the traditional daytime-shift. Armodafinil, a modafinil longer-lasting R-isomer, is approved for SWD treatment. Due to its pharmacodynamic profile, it may result in more sustained wakefulness during night-shifts than Modafinil.

Objectives

To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the efficacy of Armodafinil vs Modafinil and/or placebo on reducing SWD excessive sleepiness.

Methods

Will follow PRISMA guidelines. A systematic search will be conducted on PubMed, Web of Science, Scopus and ClinicalTrials.gov databases. RCTs comparing Armodafinil with Modafinil and/or Placebo for SWD treatment will be included. No language nor date restrictions will be applied. Outcomes of interest are prespecified as follows: the primary endpoint will be objective sleepiness; secondary endpoints will include subjective sleepiness, adverse effects, awareness, reaction time, memory and cognition. Retrieved studies will be independently screened for eligibility by two reviewers. Disagreements will be solved by consensus or by a third reviewer. Primary studies methodological quality will be assessed and data extracted independently using a standardized extraction-form.

Results

Data will be described and reported as narrative text and summary tables. Heterogeneity of the included studies will be assessed and, if possible, a meta-analysis will be conducted.

Conclusions

It is expected that this systematic review and meta-analysis favours Armodafinil over Modafinil and placebo in the treatment of SWD.

Disclosure

No significant relationships.
Paraphrenia phantastica. A case report
Authors: Mata A. Hernández , Gómez A. Sotillos , Coscujuela P. Marco , Zulueta R. Pinilla
Published: February 2022

Introduction

Paraphrenia is a classic diagnostic entity characterized by an insidious development of a vivid and exuberant delusional system, more or less systematized, hallucinations and confabulations.

Objectives

Increase knowledge about paraphrenia, a classic diagnosis that no longer appears on international classifications.

Methods

Extensive research on the historical path of the paraphrenia diagnostic entity was carried out. Patient’s data is obtained from medical history and psychiatric interviews done during her hospitalizations.

Results

68 year-old patient attended the hospital emergency service due to a demonic possession delusion that emerged when she was 44 year-old, when she first consulted a psychiatrist because she believed someone introduced the demon inside her body. She described kinesthetic hallucinations as “movements of her brain” and an intense headache, both originated by the demon; as well as other types of hallucinations and confabulations. However, there was no deterioration in her personaliy or her intellectual capacity, as it could have been seen in a case of schizophrenia. This clinical case is considered a paraphrenia phantastica as it presents the typical features raised by the classic authors (mainly Henry Ey): paralogical thought dominance, megalomania, confabulation and integrity of relation with reality.

Conclusions

Current internacional classifications do not consider paraphrenia as a differentiated diagnostic entity, as it also occurs with other classical entities. This causes a loss of important tools that would achieve a better approach to the patient’s condition.

Disclosure

No significant relationships.
Neurocognitive function in patients with negative thought disorders
Authors: Fateev I. , Omelchenko M. , Pluzhnikov I.
Published: February 2022

Introduction

Negative thought disorders are found in various diagnoses in clinical practice. These symptoms may show a possible psychosis continuum and may be taken into account when assessing schizophrenic risk. Neurocognitive functioning of patients with negative thought disorders need to be clarified.

Objectives

Aim of the study is to identify and validate the differences of executive functions between patients with negative thought disorders and patients without thought disorders.

Methods

Used a standardized neuropsychological test battery. There were 15 patients with negative thought disorders (affective disorders, personality disorders, schizophrenic spectrum disorders) and 18 patients with depressive episode without thought disorders in the research. Patients aged 17-25 years. The Mann–Whitney U test and ANOVA were used for statistical analysis.

Results

Significant results were obtained from The Verbal Fluency Test, The Design Fluency Test, The Digit span, The Rey-Osterrieth Complex Figure and Bidstrup’s drawings (All tests have p-values less than 0.05). In the methods listed above, the results in the group of patients with negative thought disorders are significantly lower than in the group of patients without thought disorders.

Conclusions

The data indicate a violation of Executive functions among patients with negative thought disorders: inhibitory control, planning and regulation, working memory, difficulty switching, which related to left frontal lobe dysfunction. A lack of simultaneity and understanding figurative language, which is associated with right hemisphere dysfunction.

Disclosure

The reported study was funded by RFBR, project number 20-013-00772
A first psychotic episode with kinesthetic hallucinations. Report of a case
Authors: Moreno F. Cartas , Barea M. ValverDe
Published: February 2022

Introduction

It reveals a case that occurred in a patient with no previous history whose first manifestation was kinesthetic allucinations, subsequently appearing other psychopathological alterations

Objectives

24-year-old male. Truck driver by profession. No prior mental health story. Good operation prior to the consultation. He comes accompanied by his parents for having a sensation of having bugs under his skin. It has come to throw gasoline on top to eliminate the possible infection.

Methods

Exploration: He is concius, oriented, with scratching lesions. He wears a cap soaked in gasoline to ward off critters. He does not present in the foreground other psychopathological alterations. CT with normal results, thyroid hormones, and normal biochemistry are requested. Treatment with aripiprazole is initiated in ascending doses, as it presents in the beginning a torpid evolution with the appearance of delusions of injury to its boss.

Results

After that, he is currently psychopathologically stable and has returned to work with his father in the field.

Conclusions

Although not the most common, psychotic disorders can occur at the beginning with cenesthetic alterations. Organic screening should be performed and results treated accordingly.

Disclosure

No significant relationships.
Delusion of pregnancy: Clinical case
Authors: Guerra M.F. Tascon , Marqués B. Díaz , Ovejero G. Manrique
Published: February 2022

Introduction

Delusion of pregnancy has been described as a false and fixed belief of being pregnant despite factual evidence to the contrary. Pseudocyesis is a condition in which the patient has all signs and symptoms of pregnancy except for the confirmation of the presence of a fetus. There has been described symptoms as abdominal distention, cessation of menses, morning sickness, etc.

Objectives

The aim of this work was to distinguish between pseudocyesis and pseudopregnancy. This case presents a single 49-year-old woman, who developed the delusion of being pregnant after months of lonely confinement during Covid-19 quarantine.

Methods

She had missed her period for 10 months. She was convinced that she could feel the fetal movements. Her thought content revealed delusion of persecution, reference, and delusion of being pregnant. She did not reveal any hallucinations. Blood tests and brain imaging revealed no abnormalities. □The treatment was started with Paliperidone 100mg/month, and clonazepam 2mg/d.

Results

The patient showed a substantial improvement within 10 weeks of treatment. Pseudocyesis and delusional pregnancy have been rarely described on scientific bibliography. A distinction has been demonstrated based on the consideration of the associated psychotic features that might be present in delusions of pregnancy, which were described in the current case. On the other hand, pseudocyesis clinical presentation is centered on the false signs and symptoms of pregnancy.

Conclusions

Antipsychotics played a key role in the delusion of pregnancy. Psychodynamic and supportive psychotherapy could play a pivotal role in the management of pseudocyesis.

Disclosure

No significant relationships.
It’s never lupus: A case of atypical psychosis and neuropsychiatric lupus
Authors: Jesus S. , Costa A. , Alcafache J. , Garrido P.
Published: February 2022

Introduction

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease involving the production of autoantibodies with consequent involvement of multiple organ systems. Although not an uncommon condition, its pleomorphic neuropsychiatric manifestations imply consideration of SLE as a relevant differential diagnosis. As many as 50% of patients with SLE have neurological involvement throughout their disease course and it is associated with impaired quality of life, high morbidity and mortality rates.

Objectives

Case report study and discussion.

Methods

The authors present a case of a 50-year old woman without previous psychiatric history presenting to the psychiatric department with suicidal ideation in association with psychotic symptoms of rapid onset. She presented with various somatic symptoms including butterfly rash, alopecia, nail dystrophy and generalized myalgia and arthralgia. After conducting a thorough clinical investigation with subsequent unveiling of various alterations including those in the antibody panels and abnormal magnetic resonance imaging results, a diagnosis of neuropsychiatric lupus was established.

Results

Improvements in initial psychiatric symptoms were noted after completing pulse corticoid therapy for SLE with adjunct antipsychotic medication. On follow-up, the patient demonstrated a complete return to previous mental functioning with no reported relapses.

Conclusions

This case demonstrates the heterogeneous presentations that neuropsychiatric lupus can assume. The vast array of psychopathological signs and symptoms in SLE continue to exist as a significant diagnostic and therapeutic challenge. Timely identification resulting from a proactive approach in maintaining lupus as part of our differentials may prevent the significant morbidity and mortality commonly associated with the resultant central nervous system involvement in SLE.

Disclosure

No significant relationships.
Psychosis and homicide
Authors: Kolsi S. , Hentati S. , Baati I. , Masmoudi J.
Published: February 2022

Introduction

Violence and crime committed by individuals with mental disorders has been the focus of growing interest among mental health professionals.Added to psychopathological disorders, individual, socio familial and therapeutic factors can be involved in the criminogenic risk.

Objectives

To assess the characteristics of homicide in Tunisian patients with psychosis and to establish their sociodemographic, clinical and therapeutic characteristics.

Methods

We reported7cases of patients who attended Psychiatric department“A”at the Hedi Chaker university hospital in Sfax,Tunisia,between January2014 and September2019.They were hospitalized for committing homicide and penal irresponsibility was recognized.

Results

The homicide acts were matricide in 3cases, parricide in one case and conjugal homicide in one case.The homicide was not premeditated, committed by using knife weapon in 3cases and a blunt object in 4cases.The crime was done in the family home in the majority of cases(71.42%). The average age of patients was 34years. They were in almost cases(85.71%) male. Six patients (85.71%) had very low educational and income levels. They were mostly unmarried(71.42%)and unemployed(71.42%).Alcohol consumption was observed in3patients.However, we did not found any substance use. According to DSM-5,six patients were diagnosed with schizophrenia and one case with schizoaffective disorder.The majority(85.71%) had previous psychiatric folow-up. Furthermore, interruption of treatment was the rule.Five patients had a previous record of violent behavior towards the victim.Judicial history was notified among one patient.The persecution and influence delusion were found among 6cases.

Conclusions

Homicidal behavior is extremely rare.Evaluation of different variables of homicide’s act and offender is a fundamental issue for developing preventive and therapeutic strategies to deal with such criminal behavior.

Disclosure

No significant relationships.
Folie a deux. On the subject of a case identified during confinement
Authors: Dafonte A. Alvarado , Rodriguez L. Soldado , Cruz C. Coca
Published: February 2022

Introduction

Shared psychotic disorder or Folie a deux is an unusual mental disorder characterized by the transfer of delusions between two or more people who have a close relationship. An individual (inductor or primary) who suffers from a psychotic disorder, influences one or more individuals (induced or secondary). Delusional disorders or schizophrenia are the most commonly diagnosed disorders in the inductor individual.

Objectives

The objective of this study is to describe the clinical characteristics of an unusual entity such as shared psychotic disorder.

Methods

Description of a clinical case of shared psychotic disorder of a family treated in the emergency room during confinement.

Results

47-year-old woman, goes to the emergency room with her husband. No psychiatric history. Both the patient and her husband verbalize delusions of harm and surveillance from neighbors. They also report that two of their children hold this belief. The mother, unlike the rest of the cohabitants, presents disqualifying auditory hallucinations. Her husband decides to take her to the emergency room because he finds her distressed, “between two realities” and aggressive when she is confronted about hallucinations. We start treatment with oral paliperidone in the mother and a subsequent follow- up, and a total remission of symptoms in all cohabitants.

Conclusions

As in other mental disorders, the correct diagnosis and subsequent referral are essential. The separation of the inductor individual from the induced one is useful for the correct management of this disorder. With timely intervention and a regular follow-up, the Folie a deux has a good prognosis.

Disclosure

No significant relationships.
Pisa syndrome – a case report
Authors: Bicho M. , Coelho J. , Peixoto C. , Fontes H.
Published: February 2022

Introduction

Pisa Syndrome or pleurothotonus is a form of dystonia and often can arise as a side effect of antipsychotic treatment conditioning high morbidity and limiting management options. Despite the fact that the precise mechanism remains unclear, a neurochemical imbalance in dopaminergic and cholinergic transmission but also in serotoninergic and noradrenergic transmission can be a possible pathophysiologic mechanism, which can lead to changes in the axial axis with abnormal posture and marked lateral trunk flexion and abnormal gait.

Objectives

Regarding a clinical case, the authors intend to review the relevant and current literature on the relationship between psychotropic drugs and Pisa Syndrome.

Methods

Description of a clinical case by consulting databases of current and scientifically relevant articles.

Results

The clinical case reports a 48-year-old woman with a history of HIV and Substance Use Disorder, hospitalized for unspecific behavioral changes, characterized by mood changes, self-referential, persecutory and somatic delusional ideas, and delusions of the control of thought. She was medicated with antipsychotics and mood stabilizers, with subsequent development of an acute-onset dystonic condition, characterizing the Pisa Syndrome. In this context, the dose of antipsychotics was lowered and anticholinergics were introduced, with progressive improvement of the clinical picture.

Conclusions

Pisa Syndrome, previously seen as a rare adverse effect, can occur as a dystonic reaction related to the use of psychotropic drugs, so its use should be judicious. Further studies are needed to understand the extent of this association and its pathophysiological mechanisms in order to guide more rigorous therapeutic lines.

Disclosure

No significant relationships.
Estrogens in schizophrenia: What do we know?
Authors: Ferreira L. Paulino , Alves M. , Duarte M. , Gamito A.
Published: February 2022

Introduction

Schizophrenia is a chronic disease that significantly impacts cognitive functioning. Sex differences in incidence, onset and course of schizophrenia suggest estrogens have a protective role.

Objectives

Our aim is to review the state of the art on this matter.

Methods

Through a selection of the most relevant articles found on PubMed and ClinicalKey searching the keywords: “estrogens” and “schizophrenia”.

Results

Accumulating evidence has led to the hypothesis that estrogens act as a protective factor in women regarding the onset of schizophrenia as their increase in puberty may help delay the onset of symptoms. Also, the estrogens abrupt decline in menopause may account for a second peak of onset and greater severity of the symptoms. During the menstrual cycle, when serum estrogens are at their lowest, there is an increase in the number of psychotic episodes and an exacerbation of psychotic symptoms. Pregnancy leads to an improvement of psychotic symptoms, which then worsen in postpartum. Clinical trials testing the efficacy of estrogens have been promising, which suggest they might be a useful adjuvant treatment. Despite the evidence of clinical efficacy, health risks for women using estrogen therapy should be considered, as they decrease its acceptability as a viable treatment option. The use of selective estrogen receptor modulators (SERMs), as raloxifene, could be a favorable and safer alternative.

Conclusions

In conclusion, estrogens are proving to be a promising option as a complementary therapy for schizophrenia; however, further studies are needed to investigate whether they might be overall beneficial.

Disclosure

No significant relationships.
Development of psychosis following sexual abuse:rape of an adolescent: A case study
Authors: Sellami S. , Mami H. , Bouzid R.
Published: February 2022

Introduction

Several studies have mentioned the link between psychotrauma and psychosis. A direct causal link remains to be discussed.

Objectives

Evaluate the link between sexual abuse and psychosis.

Methods

We report the case of a male patient who developed schizophrenia following sodomy rape. We performed a literature review based on a PubMed search with the following keywords: “rape sodomy psychosis”.

Results

Mr. M., 26 years old, with a personal psychiatric history of chronic psychosis evolving for 10 years, consulted us for follow-up of his schizophrenia. When he was 16, the patient was raped by sodomy by a 40-year-old man under stabbing threat. After this incident, the patient did not verbalize this trauma, he isolated himself, became irritable and aggressive and has had olfactory hallucinations. The symptomatology worsened until the age of 24 when the patient presented a delusional syndrome with a theme of persecution, mysticism, bewitchment by a mechanism of interpretation and visual hallucinations. Then,he was hospitalized in psychiatry for psychomotor instability, verbal hetero-aggression. He had been diagnosed with schizophrenia evolving over 9 years. Treatment with an antipsychotic: risperidone and valproic acid was started. The evolution was quickly favorable but the patient currently presents blunted affect, a sexual disinterest and a strong desire for revenge from his rapist. Treatment adjustment and psychotherapy would be considered.

Conclusions

The onset of subsequent rape psychosis and the persistence of symptoms related to the trauma are arguments in favor of a direct causal link between sexual abuse and schizophrenia.

Disclosure

No significant relationships.
Clozapine prescribing during follow-up of a first-episode psychosis cohort
Authors: Rowntree R. , Fanning F. , Keating D. , Murray S. , Szigeti A. , Doyle R. , Mcwilliams S. , Clarke M.
Published: February 2022

Introduction

Of those with schizophrenia, one third develop treatment-resistant illness. Nearly 60% of these benefit from clozapine- the only antipsychotic medication licensed in this group.

Objectives

As treatment-resistant illness developed in the follow-up of a first-episode psychosis (FEP) cohort, clozapine was prescribed. This study retrospectively compared the clozapine prescribing patterns, within this cohort, to National Institute for Health and Care Excellence (NICE) guidelines. In addition, impact on hospitalisation, physical health monitoring and augmentation strategies employed following clozapine initiation were examined. Factors delaying initiation of clozapine treatment or contributing to its discontinuation were also explored.

Methods

The study included 339 individuals resident within an Irish community mental health team catchment area, referred with FEP from 1 January 2005 to 31 August 2016. Data were extracted from electronic medical records.

Results

Within the cohort, clozapine was prescribed to 32 individuals (9.4%). The mean number of adequate trials of antipsychotic prior to starting clozapine was 2.74 (SD 1.13; range 1–5). The mean time to clozapine trial was 2.1 years (SD 1.95; range 0.17–6.25). Following initiation of clozapine, mean hospital admissions per year fell from 2.3 to 0.3 (p=0.00). Mean inpatient days pre- and post-clozapine also decreased (147 vs. 53; p=0.00). In all, 18 patients ceased use of clozapine, 5 temporarily and 13 permanently.

Conclusions

Patients are being prescribed clozapine earlier than previously demonstrated. However, delayed treatment remains common, and many patients discontinue clozapine. Further research is necessary to describe and address factors which contribute to its discontinuation.

Disclosure

No significant relationships.
The usage of clozapine in a patient with schizophrenia and epilepsy: A case report
Authors: Karnickas M. , Bulotaite G. , Rutkauskas V.
Published: February 2022

Introduction

The usage of clozapine in patients with schizophrenia and epilepsy raises many challenges due to the epileptogenic effects of the drug. There is little data about using clozapine for treatment of treatment-resistant schizophrenia (TRS) accompanied by epilepsy.

Objectives

To present a case report illustrating a patient diagnosed with epilepsy and TRS, successfully treated with clozapine.

Methods

A literature review on “PubMed” database was conducted, using the keywords: clozapine, antipsychotics, epilepsy, seizures, psychoses. Information regarding the clinical case was obtained by consulting the patient’s file.

Results

We present a woman, 33 years old with mild intellectual disability and a 10-year history of schizophrenia. At the age of 24, the patient lost consciousness and experienced tonic – clonic seizure, but epilepsy was not diagnosed. The patient was hospitalized multiple times due to positive symptoms of schizophrenia and suicidal thoughts. Various combinations of neuroleptics and electroconvulsive therapy were used for treatment without therapeutic effect. At the age of 32, a diagnosis of TRS was established, leading to treatment with a moderate clozapine dose (400mg/day). At the fifth month of treatment with clozapine un episode of generalized seizures occurred, leading to a diagnosis of idiopathic generalized epilepsy. Since then, the patient was treated with levetiracetam and the dosage of clozapine was lowered to 275mg/d. The seizures did not re-occur and clinical response to the psychiatric treatment was positive.

Conclusions

This case report highlights how clozapine can be used safely and effectively for patients with TRS and epilepsy and how the epileptogenic effects can be moderated by using antiepileptics in the overall treatment scheme.

Disclosure

No significant relationships.
Impact of early use of long acting paliperidone (1 and 3 monthly) in a first-episode psychosis sample
Authors: Lopez P. Gil , Rodriguez J.M. , Fernandez L. Garcia , Martin E. Fernandez , Gayoso N. Fernandez , Estevez V. Sanchez
Published: February 2022

Introduction

Relapse prevention is a key objetive for patients with a First Episode Psychosis (FEP) and the low adherence to antipsychotic (AP) treatment is the main reason for relapse after a FEP.

Objectives

There are no clear recommendations about the early use of long-acting injectables (LAIs) in FEP. We review the impact on hospitalization rates of the early use (earlier than 1 year after the inclusion in our Early Intervention Service “Lehenak”) of LAI paliperidone in a FEP sample.

Methods

We evaluated in a naturalistic study a sample (N=384) of patients with a FEP. We carried out a mirror-design study to compare the numer of hospitalizations before and after the introduction of LAI paliperidone (1 and 3 monthly) in early users (<1 year) vs late users (>1 year).

Results

A total of 384 FEP patients with LAI paliperidone were assessed.Early Paliperidone LAI (n=201)Late Paliperidone LAI (n=173)Within groups comparisons t (p)
Hospitalizations pre-LAI mirror period (media, standard deviation)1.76 (1.97)2.22 (2.60)1,87 (0.06)Days in hospital pre-LAI mirror period21.42 (28.28)28.02 (38.27)1.87 (0.06)Hospitalizations post-LAI mirror period0.68 (1.61)0.80 (1.74)0.73 (0.46)Days in hospital post-LAI mirror period15.17 (40.58)18.78 (45.24)0.81 (0.42)

Conclusions

There was no difference between the early and late introduction of LAI Paliperidone in the number of hospitalizations after treatament. There was a trend to present more previous hospitalizations and days in hospital in late users. This could support an earlier use of paliperidone LAI to prevent an excess of hospitalizations due to late introduction.

Disclosure

The presenting author has received honouraria for lectures or advisory boards from Janssen, Otsuka, Lundbeck and Angelini in the last five years.
Schizoaffective disorder about 57 cases
Authors: Kammoun I.
Published: February 2022

Introduction

Schizoaffective disorder remains relatively unknown today compared to other psychiatric disorders. This disorder is however recognized by the international medical classifications DSM 5 and mainly affects many people.

Objectives

Describe the socio-demographic and contextual clinical characteristics of patients with schizoaffective disorder

Methods

We conducted a descriptive retrospective study including patients with schizoaffective disorder (DSM 5) in the psychiatric department G at Razi hospital and who were hospitalized for a period of 1 year from 1 January to 21 December 2020. We collected 57 patients.

Results

The average age of our sample is 40.16 years. The majority of patients (75.4%) were single and the school level did not exceed secondary studies in 64.9% of cases. Most of these patients were unemployed previously working as a day laborer in 47.4%. In addition, the type of schizoaffective disorder was dominated by the bipolar type (94.7%). These patients had a personality disorder in 26.3% mainly schizoid. The psychiatric interview of these patients revealed irritable mood in 47.4%, inappropriate affects in 59.6%, speech of a maniac in 52.6%, delusions of persecution and grandeur in 70.2% with intuitive mechanism (47.4%) and hallucinatory (auditory 45.6%). Disorganized behavior in 50% and catatonic behavior in 5.3% Mental automatism and morbid rationalism in 29.8% Insomnia: 94.7% and concentration disorder: 56.1% Type of treatment was the combination of atypical antipsychotics, mood stabilizers and benzodiazepines 33.3% with regular follow-up in 49.1%

Conclusions

Schizoaffective disorder is one of the most misdiagnosed psychiatric disorders in clinical practice and the need to know its characteristics is a necessity.

Disclosure

No significant relationships.
Deviations in psycho-sexual development of teenage girls and its legal consequences in modern society
Authors: Baranskaya L.
Published: February 2022

Introduction

When studying the multiple aspects of the problem of criminal offences of a sexual character committed by adult males towards teenage girls, the role of digital communication technologies is not taking into account.

Objectives

To reveal the negative aspects of social and family connections and the influence of digital communications on the formation of deviations in psycho-sexual development of teenage girls who had become victims of sexual delicts of a non-violent character.

Methods

We have studied the specifics of psycho-sexual behavior of seventeen teenage girls, aged 12-16 and their Internet and SMS correspondence with adult males by analysis of semantics and pathos-psychological markers.

Results

Intellectually, all the teenage girls are within normal age limits. They were bringing up in full, materially well-off families. Most of the girls’ parents experience a formal attitude towards them. The disrupted emotional ties of the teenage girls with mother or both parents leads to deviations in the development of normal teenage reactions, sexual attitudes. Their feeling of loneliness within the family, forces them to turn towards support to Internet-society or other adults of the opposite sex to their parents’ acquaintances. The desire to ascertain perfectionist expectations and self-assertion leads the teenagers to the realization of various forms of auto-destructive sexual behavior. They actively demonstrate in the Internet obscene photos of their genitals. While trying out their sexual importance, they persistently urge adult males towards sexual contacts.

Conclusions

Thus, the negative aspects of psycho-sexual development of teenage girls can disrupt their sexual behavior in adulthood.

Disclosure

No significant relationships.
Social representations of different generations about everyday life of homosexuals in modern Russia
Authors: Lianguzova V. , Rikel A.
Published: February 2022

Introduction

The problem of homosexuality is constantly in the spotlight of the mass media, social media and politicians. At the same time, the cultural and national specificity of attitudes towards the phenomenon of homosexuality seems obvious, as well as a significant polarization of opinions within Russian society itself. With significant attention to this issue, there are not many attempts to analyze the socio-psychological basis of representations about homosexuality. At the same time, in a number of foreign studies it was revealed that the modern Z Gen is distinguished by greater tolerance and freedom of views in terms of attitude towards traditionally segregated social groups.

Objectives

The purpose of this study was to identify representations about homosexuality among different generations of modern Russians.

Methods

The methodological basis of the research was the study of the structure of social representations (Vergesse methodique). The research methods implied the author’s questionnaire aimed at identifying representations about homosexuality and a modified version of the RAHI questionnaire. The sample was N = 444 (residents of Russia, age 16-65).

Results

There was shown a significant difference between the Z Gen in terms of tolerance of representations about homosexuality. So called ‘double standards’ were identified in terms of attitudes towards male and female homosexuality. The rooted concept of homosexuality as a relationship based, rather, on a sexual rather than a romantic-spiritual level of relationships, was stated.

Conclusions

Main hypothesis was confirmed: an inverse relationship between age and perceptions of homosexuality as normative was revealed.

Disclosure

No significant relationships.