bluuebunny/crossref_metadata_2025 huggingface dataset:
Kambó as a drug that can induce psychotic or manic symptoms. A case report
Authors: Arroyo Sánchez E. , Díaz Mayoral C. , Setién Preciados P.
Published: August 2024

Introduction

Kambó, also known as the “frog medicine,” is a traditional Amazonian medicine derived from the secretions of the Phyllomedusa bicolor tree frog. It has gained global attention for its purported therapeutic properties, including its use in addressing mental health issues. However, the psychiatric effects of kambó remain poorly understood, particularly concerning manic symptoms or psychosis.

Objectives

The primary objective of this review is to comprehensively analyze and evaluate the available literature regarding the connection between kambó use and psychosis or manic symptoms. Specifically, this review seeks to determine the prevalence of psychosis among kambó users, identify potential risk factors for the development of psychosis or manic symptoms in this context, explore the mechanisms underlying any observed psychiatric effects, and provide insights into the clinical implications of kambó use.

Methods

A case report of a 34-year-old man with chronic delusional disorder who presented to the emergency department with manic symptoms coinciding in time with the use of Kambó.

Results

The findings of this bibliographical review suggest that there is limited empirical evidence to establish a direct link between kambó use and psychosis. Most available studies are anecdotal or based on qualitative reports, making it challenging to draw definitive conclusions. While some case reports and interviews suggest that kambó use may be associated with transient psychotic-like symptoms, including visual and auditory hallucinations, more rigorous research is needed to confirm and characterize these effects. Several case reports and qualitative studies suggest that individuals who have undergone kambó ceremonies may experience transient manic-like symptoms, such as elevated mood, increased energy, and impulsivity. However, these reports lack systematic assessment and standardized measurement of manic symptoms. Mechanisms underlying these effects remain speculative, with some researchers proposing altered neurotransmitter systems as a potential explanation.

Conclusions

In conclusion, this review underscores the scarcity of scientific literature on the potential association between kambó use and psychosis or maniac symptoms. Although anecdotal reports and qualitative studies suggest a link, there is a notable lack of robust empirical research to support or refute this claim. Future research should focus on conducting controlled studies to elucidate the psychiatric effects of kambó, including its potential to induce psychosis and maniac symptoms, while also considering cultural and individual factors that may influence outcomes. Such research would contribute to a more comprehensive understanding of kambó’s psychopharmacological profile and its implications for mental health.

Disclosure of Interest

None Declared
Disconnecting from my heartbeat: About a case of derealization in a critically ill patient
Authors: Alario Ruiz C. , Oscar M. S. , Navarro Barriga N. , Beatriz R. R. , Claudia R. V.
Published: August 2024

Introduction

Depersonalization/derealization encompasses a series of symptoms that are difficult to describe by the patient, as well as complex to diagnose by the professional, and can go through multiple diagnoses prior to the diagnosis of certainty.

Objectives

It is proposed, through a clinical case, to know the characteristics of this disorder, evolution, differential diagnosis and therapeutic possibilities

Methods

62-year-old male, history of harmful alcohol consumption and a previous admission to a psychiatric short hospitalization unit for self-injury (superficial cuts in the context of severe mental illness of his wife) post-transplantation who is required by ideas of death, anhedonia and lack of collaboration in patient, The day before the evaluation, refusal to take oral treatment, selective mutism. Pre-transplant evaluation where no psychopathological alteration was observed.

Results

What is initially assessed and treated as a confusional episode of inactive type, through a correct psychopathological examination and with subsequent continuous interviews, with mood fluctuations throughout the admission, is subsequently oriented as an acute stress disorder, adaptive reaction with an anxious-depressive component and finally concluding that we are facing a dissociative disorder, highlighting the depersonalization/derealization on a dysfunctional personality base.

Conclusions

Characteristic of depersonalization is the great difficulty in describing symptoms, the feeling of being disconnected from one’s own body, emotions and reality. The latest studies on etiopathogenesis with MRI show an inhibitory response on the limbic system by hyperactivation of the ventrolateral prefrontal cortex as well as a decrease in the autonomic response, the initial result being the attenuation of the processing of emotions. Among the differential diagnoses: post-anxiety illness disorder, major depressive episode, other dissociative disorders, panic disorder, psychotic disorder, substance-induced disorder There are several partially effective treatments, although the results so far are poor. SSRIs, quetiapine and naltrexone have been tried. Partial efficacy with lamotrigine together with SSRIs and, if high levels of anxiety coexist, SSRIs together with clonazepam. There are studies where psychodynamic psychotherapy, behavioral therapy and hypnosis have obtained partially effective results.

Disclosure of Interest

None Declared
Pimozide as an effective treatment for obsessive symptoms related to physical discomfort in the context of somatoform symptomatology.
Authors: Del Sol Calderon P. , Izquierdo de la Puente A. , Fernández R. , García Moreno M.
Published: August 2024

Introduction

The patient was a 34-year-old male admitted to the psychiatric inpatient unit for high anxiety and suicide ideation due to severe toothache.

Objectives

To show how the antipsychotic pimozide can be an effective option for the treatment of anxiety and obsessive symptoms around physical complaints within the spectrum of somatoform disorders

Methods

Case report and literature review

Results

The patient comes to the emergency room with high anxiety and active self-harming ideation. He reports that for months he has been experiencing mouth pain that is becoming more and more intense. He has seen multiple professionals without finding a cause that justifies the pain. In the past she has a history of multiple ailments (knee, abdominal pain…). He is being treated with sertraline 150, clonazepam 3 mg per day and olanzapine 5 mg at night. During admission, treatment with pimozide up to 4 mg per day was started. The patient is progressively less distressed and with more distance from the ideas about pain, being able to carry out more activities during the day. There is remission of suicidal ideation

Conclusions

There is evidence in the literature that the use of pimozide was effective in different psychotic disorders. It has been seen to reduce the intensity of symptoms in cases of delusional disorders with delirum of somatic type or those such as delusions by parasitization. The use of pimozide has also been effective in the treatment of complex tic disorder. In this case it is effective and could be explained by the close relationship of osbsesive symptoms with psychotic symptoms.

Disclosure of Interest

None Declared
Lithium nephropathy in Bipolar Disorder: a clinical challenge
Authors: Alario-Ruiz C. , Arribas-Simon B. , Martinez.Gimeno P. , Calvo-Valcarcel M. , Martin-Santiago O.
Published: August 2024

Introduction

Lithium nephropathy can occur in long-term lithium-treated bipolar disorder patients. Key risk factors include duration of lithium exposure, cumulative dose, acute intoxication episodes, advanced age, and comorbidities such as hypertension, diabetes mellitus, hyperparathyroidism, and hyperuricemia, along with concurrent use of antipsychotics. The clinical presentation is gradual, with mild proteinuria, often accompanied by arginine vasopressin resistance. Histological studies show a correlation between interstitial fibrosis and cumulative lithium duration. Approximately 15 to 25 per cent of exposed patients may experience a gradual decline in glomerular filtration rate. The outcome after lithium discontinuation varies.

Objectives

This case study aims to analyze and document the clinical presentation, diagnosis, and management of lithium nephropathy in a patient with Bipolar Disorder.

Methods

We gathered data on the medical history, lab results, and treatment approach for a patient with Bipolar Disorder.

Results

The patient, a 50-year-old woman, had been under the care of Psychiatry since 2008 due to a diagnosis of Bipolar Disorder Type I. During this time, she had experienced depressive and manic episodes but had not presented significant symptom decompensation for the past 14 years, successfully managed with lithium at a current dose of 600 mg per day. However, on this occasion, the patient sought hospitalization due to recent behavioural disturbances, including restlessness, disinhibition, abrupt changes in behaviour, pressured speech, sleep problems, agitation, and aggression. The patient also reported an increased sense of polyuria and polydipsia. Evaluation in the emergency department revealed elevated lithium levels of 1.47 mmol/L and hypokalemia, that justified lithium withdrawal. After lithium levels decreased, an estimated glomerular filtration rate remained low. She was diagnosed with lithium nephropathy, an adverse effect of long-term lithium therapy. Treatment with lithium changed to sodium valproate. Treatment with asenapine started and sustained for two months. Over the following two years, the patient experienced four additional hospital admissions in Psychiatry due to manic episodes.

Conclusions

Long-term lithium therapy can lead to lithium nephropathy with symptoms such as polyuria, polydipsia, and acute kidney failure. Consistent monitoring of patients receiving lithium is crucial to detect potential adverse effects.This case highlights the challenges in managing bipolar patients, as discontinuing lithium exacerbated symptoms despite switching to sodium valproate for nephropathy prevention. Long-term lithium treatment, while effective for bipolar disorder, poses significant renal risks. We emphasize continuous renal function monitoring and assessing the risk-benefit of lithium treatment while actively researching lithium nephropathy and its impact on glomerular function.

Disclosure of Interest

None Declared
Multifactorial etiology of manic episodes. About a case
Authors: Valverde Barea M. , Vílchez Español F. , Soldado Rodríguez L. , Solis Correa M. O.
Published: August 2024

Introduction

Manic episodes have a multifactorial etiology, with frequent association with genetic factors, comorbidities such as systemic diseases or secondary to infectious diseases, and environmental exposure factors. The prevalence of bipolar disorder is markedly higher in patients with autoimmune disease. The risk of developing bipolar disorder in some studies has been seen to be higher among patients with rheumatoid arthritis, therefore chronic inflammation would be a potential mechanism and could be a modifiable risk factor for bipolar disorder. Growing evidence indicates that Sars-CoV-2 may also trigger the acute onset of mood disorders or psychotic symptoms.

Objectives

We present the case of a patient who presents symptoms compatible with an acute manic episode after an outbreak of rheumatoid arthritis and comorbid COVID infection.

Methods

52-year-old patient. She went to the hospital emergency room presenting affective symptoms compatible with a manic episode and psychomotor agitation. Personal medical history: rheumatoid arthritis, antiphospholipid syndrome. Psychiatric personal history: Depressive disorder under follow-up by a private psychiatrist under treatment with antidepressants. During the interview, the patient presented accelerated speech, with great emotional incontinence. Saltigrade thought and tachypsychia. She verbalizes delusional ideas of megalomaniacal and mystical and religious characteristics. She verbalizes that she is the reincarnation of the holy spirit, that God has taken her body and speaks through her. In the emergency room, a Sars-CoV-2 infection that the patient was unaware of was diagnosed. She is admitted to the hospital in the mental health unit, in the first interviews the patient maintains speech with delusional ideas “I notice the stigmata of Christ on my body”.

Results

The patient recovers after treatment for the COVID infection, remaining asymptomatic. It was decided to start lithium to stabilize mood and the patient presented good tolerance and treatment with antipsychotics. The patient presented a favorable response, remitting the psychotic symptoms of which she was critical and stabilizing the affective symptoms. The patient is diagnosed with Severe Manic Episode with Psychotic Symptoms, as the main diagnosis and we could conclude the diagnosis of Bipolar Disorder since she has presented 2 depressive episodes in the past that have required treatment and follow-up by psychiatry.

Conclusions

Manic episodes have a multifactorial etiology and require an individualized approach, and comorbid medical conditions must always be assessed in order to establish a therapeutic plan with patients.

Disclosure of Interest

None Declared
Sleep Disturbance in Bipolar Disorder. Treatment Implications
Authors: Jupe T. , Roumpou A. , Provi K.
Published: August 2024

Introduction

Relationship between sleep and bipolar disorder involves the following aspects: decreased need for sleep is a fundamental marker of the manic state, sleep deprivation is one cause of mania and may in fact be a fundamental etiological agent in mania, total sleep time is a predictor of future manic episodes, and total sleep time may be a marker of response as well as a target of treatment in mania.

Objectives

This e-poster aimed to summarize evidence regarding the sleep disturbance in Bipolar Disorder.

Methods

Bibliopgraphical review was performed using PubMed platform. All relevant articles were found using the keywords: sleep disturbance, bipolar disorder, mania.

Results

Sleep disturbances are frequent in BD patients in different phases of illness, including the euthymic state and remission. These sleep aberrations are represented not only by insomnia but also by sleep–wake rhythm disorders, especially delayed sleep–wake phase disorders. During the manic state, most patients experience a reduced need for sleep and longer sleep onset latency. Likewise, in the depressive state, insomnia and hypersomnia are commonly observed. Meta-analyses of trials conducted on remitted BD patients demonstrated prolonged total sleep time, increased awakenings after sleep onset, greater variability of sleep–wake variables, and reduced sleep efficiency.

Conclusions

Overall, all kinds of sleep disorders and parasomnias are very common especially in youth patients with BD. Thus, compared to the general population, youth with BD exhibit lower sleep efficiency, longer slow wave sleep, and reduced REM sleep, features that could affect the genesis and prognosis of the disorder. Sleep disturbances may also be used as predictors of the onset of BD in a subset of high-risk young subjects.

Disclosure of Interest

None Declared
Manic episode in a patient with pancreatic adenocarcinoma: a case report
Authors: Mena Garcia J. I. , Andreu H. , Salmeron S. , Ochandiano I. , Cesari E.
Published: August 2024

Introduction

Psychiatric comorbidity is common in cancer patients, emphasizing the need for comprehensive care. While depressive symptoms in pancreatic cancer (PC) have been studied, there is limited attention given to manic symptoms. This case report aims to contribute to the knowledge of PC psychiatric comorbidities by describing a case of a 61-year-old patient with stage IV PC, with no personal or family psychiatric history, who presented a sudden onset manic episode.

Objectives

Our goal is to contribute to the growing knowledge of psychiatric comorbidities of PC focusing on manic symptoms by describing the case of a patient with stage IV PC without previous psychiatric history who presented a sudden onset of a manic episode.

Methods

We describe the mentioned clinical case. We also searched for previous case reports of maniac episodes in pancreatic cancer using a PubMed query.

Results

The patient, a 61-year-old male with stage IV PC, presented at the Emergency Room with abrupt behavioural changes suggestive of a manic episode of two weeks of evolution. The patient had been undergoing chemotherapy and short 3-day cycles of corticosteroids for the past 9 months but had been off this treatment for 20 days when the episode began. Acute organic causes were ruled out. The patient was admitted to the psychiatric unit, where organic screening was expanded and treatment with antipsychotics and a mood stabilizer was initiated with subsequent remission of symptoms after two weeks.

This article describes the case of a man with a PC diagnosis who had no prior psychiatric history and was admitted to the inpatient psychiatry unit due to a manic episode involving high-risk behavioral disturbances and megalomaniac psychotic symptoms. Several factors may have contributed to the onset of these symptoms, including corticosteroid use after chemotherapy and certain chemotherapy agents. However, due to temporal factors, these factors do not fully explain the episode.

The exact biological mechanisms behind the manic symptoms remain unknown, but hypotheses include gene-environment interactions in bipolar disorder and immunodysregulation related to the production of inflammatory cytokines. We found in the literature four cases that have reported new-onset mania as an initial symptom of PC, but the causal relationship is unclear.

Conclusions

Notably, this case differs from others due to the rapid remission of symptoms and the use of lithium therapy. While the underlying mechanisms are still unclear, this case contributes to understanding this rare complication of PC and may help in developing consensus on clinical management. Future research will further explore the pathophysiology of psychiatric symptoms in PC and appropriate therapeutic approaches.

This case shows a manic episode as a rare psychiatric complication in PC. In the literature reviewed, four other similar cases have been observed.

Disclosure of Interest

None Declared
Specific intervention program for ARFID comorbid with ASD in a Children’s Youth Autism Day Hospital
Authors: Alvarez A. , Santamaria N. , Bote V. , Medina R. , Sanchez B. , Mendez I. , Monreal J. A. , Hervas A.
Published: August 2024

Introduction

Children and adolescents with ASD are more likely to have eating problems compared to the general population of the same age, one of the disorders whose prevalence is increased in people with ASD is avoidant/restrictive eating disorder Food (ARFID) ARFID is characterized by a lack of interest in eating or avoidance of food intake, which in the case of people with ASD is usually related to impaired sensory processing and cognitive rigidity. For this reason, the Autism Day Hospital carries out a specific food intervention program.

Objectives

To retrospectively evaluate the results of the Food Program of the Autism Day Hospital during the year 2022.

Methods

A retrospective analysis of the cases of patients admitted to the Food Program of the Autism Day Hospital during the year 2022 is carried out. Results of the sensory pattern and presence of genetic alterations of each one of the patients are compared. And the results of the intervention are evaluated by quantifying the new foods introduced into the diet at the end of the admission.

Results

The sample is made up of a total of 5 children (4 boys and 1 girl) aged between 7 and 12 years. All of them meet diagnostic criteria for Autism Spectrum Disorder and present comorbidity with ARFID. Of the total sample, 1 of the patients presented in the genetic study a microdeletion S. in 15q13.3, duplication in 2q13 and duplication in 5p12-p11, with the genetic studies in the rest of the patients in the sample being normal. Regarding the results of the sensory pattern (Infant/Toddler Sensory profile test), all the patients presented differences in relation to other children of their age in the oral sensory pattern, this difference being definitive in 3 of the 5 patients in the sample. All the patients included in the program presented a satisfactory evolution, introducing at least 15-20 new foods into their usual diet, including different textures and consistencies.

Conclusions

The therapeutic approach to ARFID in children with ASD carried out from a multidisciplinary perspective; sensory integration, behavioral approach and, if necessary, psychopharmacological, has shown, based on the results obtained from the food program of the ASD Day Hospital, a favorable evolution of the eating disorder. For this reason, we consider the detection of this typical comorbidity of ASD and its referral to specific therapeutic programs to be of special importance.

Disclosure of Interest

None Declared
Effective Use of Clozapine in Managing Treatment-Resistant Conduct Disorder in an Adolescent Patient: An Unconventional Approach
Authors: Yerlikaya Oral E.
Published: August 2024

Introduction

This case report elaborates an unconventional approach to the management the use of clozapine, typically used in treatment-resistant Schizophrenia, in a 17-year-old female patient with treatment-resistant Conduct Disorder, Attention Deficit and Hyperactivity Disorder and Intellectual Disability.

Objectives

The aim is to demonstrate the potential effectiveness and applicability of clozapine in treating severe, treatment-resistant behavioral problems associated with Conduct Disorder, even without the presence of psychosis, by detailing the clinical course, treatment strategy and outcome of this unique case.

Methods

A 17-year old female patient was referred to inpatient clinic due to escalating aggression towards her family members and risky sexual behaviors despite undergoing treatments before as risperidone, haloperidole, olanzapine, lithium, clonidin or aripipirazole. She was running away from home repeatedly and under the risk of sexual abuse. After comprehensive clinical and psychopathological assessment, a decision was made to initiate treatment with clozapine, closely monitoring the patient for adverse effects, and assessing its impact on the patient’s aggressiveness and other behavioral problems. During her stay, clozapine dose titrated to 250 mg/day in addition to her current treatment as amisulpiride 800 mg/day and valproic acid 500 mg/day. Atropine solution as mouthwash used for salivary hipersecretion. No other side effects observed. Cognitive and behavioural therapy interventions made for anger management and impulsivity. Also focused on family-based interventions about establishing healthy boundaries.

Results

A significant reduction in aggressive behavior was noted under the treatment of clozapine. The patient’s overall conduct and interaction with family improved remarkably. The treatment was well-tolerated except sialorrhea, leading to a successful integration back into her family and community.

Conclusions

This case highlights the potential of clozapine as a viable treatment option for managing severe, treatment-resistant behavioral problems in patients with conduct disorder, even in the absence of psychosis. A randomized-controlled trial showed that clozapine was more effective than risperidone in conduct externalization factors, delinquency trait and global functioning in children and adolescents(Juárez-Treviño et al. Clin Psychopharmacol Neurosci. 2019;17(1):43-53). While it necessitates careful monitoring due to its side-effect profile, this unconventional use of clozapine may open up new avenues for the management of treatment-resistant conduct disorder, thereby improving patient outcomes and quality of life. Further controlled studies are warranted to ascertain the safety and efficacy of this approach.

Disclosure of Interest

None Declared
Assessment of Sleep Habits and Problems in Children Aged 7 to 10: An Observational Study.
Authors: Camilo J.
Published: August 2024

Introduction

Appropriate sleep habits play a pivotal role in the physical and psychological development of children. However, sleep deprivation or sleep problems can have a significant impact on children’s mental health and daily functioning. This study investigates the sleep habits and problems in children aged 7 to 10 who attend the Child and Adolescent Psychiatry Service at CHTMAD, Vila Real, Portugal.

Objectives

The primary objective of this study is to assess the sleep habits and problems in children aged 7 to 10, aiming to establish data that can guide the development, implementation, and reevaluation of future interventions tailored to this age group.

Methods

This study is observational in nature and involved the participation of 21 patients from the Child and Adolescent Psychiatry Service at CHTMAD, Vila Real, Portugal, throughout the year 2022. Questionnaires related to sleep habits were administered to this population. Parents were invited to complete the Children’s Sleep Habit Questionnaire (adapted from the Children’s Sleep Habit Questionnaire by Prof. Owens, 2000), while the children (patients) were asked to fill out the Sleep Self Report-PT (adapted from Owens 2000 Research Version) and the Strengths and Difficulties Questionnaire (SDQ-Por, by Robert Goodman, 2005).

Results

As of now, the results of this study are still being processed. The data collected from the questionnaires will be analyzed to gain insights into the sleep habits and issues of children aged 7 to 10 years attending the Child and Adolescent Psychiatry Service in Vila Real, Portugal. Findings will be discussed, and any significant observations or trends will be highlighted.

Conclusions

This research aims to provide valuable insights into the sleep patterns and problems experienced by children in the specified age group. By understanding these issues, we can develop and implement targeted interventions to improve sleep quality and overall mental well-being. The conclusions drawn from this study will contribute to the development of evidence-based strategies for enhancing the sleep health of children in the Child and Adolescent Psychiatry Service at CHTMAD, Vila Real, Portugal.

Disclosure of Interest

None Declared
A multidisciplinary approach to the treatment of children and adolescents with Beckwith-Wiedemann syndrome
Authors: Tripković M. , Bakija I. , Horvat D. , Lederer P. , Begovac I.
Published: August 2024

Introduction

Beckwith-Wiedemann syndrome (BWS) is a rare and complex congenital disorder characterized by a spectrum of symptoms and somatic findings. The prevalence of classic BWS is 1:26,000 births in Europe, and is equal in both sexes. The causes of the disorder are complex and are related to alterations in the expression of one or more genes in the region of chromosome 11. The heterogeneity of the clinical picture results in a spectrum of clinical features, the most common of which include: excessive growth of one side or certain parts of the body, macroglossia, abdominal wall deficits such as umbilical hernia, hypoglycemia, enlarged abdominal organs and an increased risk of developing certain types of tumors in adulthood.

Objectives

The aim of this article is to highlight the importance of an early multidisciplinary approach in the management of children and adolescents with BWS.

Methods

Using clinical practice and a review of the existing limited literature, we examined the complexity of the disease and the importance of psychiatric, psychotherapeutic, and psychological interventions in the treatment of children and adolescents with rare diseases such as BWS.

Results

According to our clinical practice, a number of uncertain physical symptoms and possible complications may in some children with BWS lead to psychomotor retardation and lack of self-confidence due to the often impaired physical appearance. Affected children and adolescents are more likely to be exposed to abuse at school, show more behavioral and learning difficulties, difficulties in social adjustment, and resultant emotional difficulties. After initial genetic and pediatric treatment and subsequent regular monitoring, it is necessary to pay additional attention to the development of psychological sequelae in order to involve them and their families in psychotherapeutic treatment, and intervene in a timely manner so that they can achieve or maintain psychological stability and functionality. Many adolescent patients with BWS do not have significant somatic difficulties that would require pediatric intervention, but often present with symptoms of mental illness.

Conclusions

Psychological stress in children and adolescents suffering from rare somatic diseases represents a negative experience of an emotional and social nature, which affects the course of the disease and interferes with the treatment. Due to a number of possible physical manifestations and outcomes of such diseases, extensive psychological support and care by child and adolescent psychiatrists and the entire medical team is required. A multidisciplinary approach is crucial in the treatment of these patients and results in improved functionality and quality of life.

Disclosure of Interest

None Declared
First episode psychosis in a young person with a diagnosis of Autistic Spectrum Disorder: A Case report
Authors: Raghvani P. , Inogbo C. , Damle V.
Published: August 2024

Introduction

Psychotic disorders are significant comorbidities in young people with Autistic Spectrum Disorder (ASD). Evidence suggests that ASD & psychosis present with overlapping clinical features & cognitive symptoms leading to misdiagnosis (Trevisan et al. Front.Psych 2020;11:548). Clinicians encounter diagnostic dilemma during assessment of psychosis in adolescents with ASD.

Objectives

To discuss the clinical challenges in the assessment & treatment of young people with ASD & comorbid psychosis.

Methods

A case report of a young girl with ASD & comorbid psychotic illness.

Results

A young girl with ASD was admitted to CAMHS inpatient Unit with unusual beliefs & perceptual disturbances. She reported hearing the voice of ‘Hydrogis’ who was talking to her about his girlfriend. She made a voodoo doll & tried to set it on fire, as she believed that this would kill the girlfriend. She also heard voices of characters from a TV show, discussing her in third person. She absconded from home due to the distress associated. She attempted suicide by tying a ligature. She was seen responding to external stimuli, laughing incongruously & was thought disordered. Despite never being to USA, she spoke in American accent. She lacked insight & struggled to differentiate reality from fantasy. The aim of admission was to determine if the symptoms were part of ASD or a psychotic disorder. She had medication free assessment but continued to be very distressed. We commenced Aripiprazole which was optimised. She responded well to the treatment & was discharged to the care of Early Intervention in Psychosis team with partial remission of symptoms.

Conclusions

Historically psychotic illnesses & ASD were thought to be closely linked. Research suggest that they are two separate disorders with specific onset, progress, signs & symptoms. ASD might be misdiagnosed as psychosis as difficulties in communication may resemble thought disorder, ‘melt down’ may mimic catatonia & difficulties in recognising others’ intentions may mimic paranoia. Our patient was experiencing first episode psychosis in late adolescence. This age of onset is consistent with research findings. A study to differentiate between ASD & psychosis found that positive symptoms like hallucinations & delusions were suggestive of psychosis while odd emotional gestures, stereotyped speech & restricted interests indicated ASD. Our patient predominantly had positive symptoms of delusions, hallucinations & thought disorder, hence our diagnosis of psychotic episode. In some cases, it is difficult to differentiate childhood fantasies from delusional beliefs (Ribolsi et al. Front.Psych 2022;13:768586). Bleuler explains that children with ASD replace imperfect realities with imaginations & hallucinations but Michael Rutter claims that autistic children lack fantasy. There are varying views on this subject & this is the challenge we faced when treating this young person.

Disclosure of Interest

None Declared
Prevalence and comorbidities of disruptive mood dysregulation disorder
Authors: Riam S.
Published: August 2024

Introduction

Following the release of DSM-5 in 2013, a newly introduced diagnostic category emerged in psychiatric classification—the disruptive mood dysregulation disorder (DMDD). DMDD is a depressive disorder that begins in childhood and is marked by a consistently irritable or angry mood, frequently accompanied by temper outbursts that are notably severe.

Objectives

It is to study the prevalence and comorbidities of DMDD in Morocco, specifically at Arrazi University Psychiatric Hospital

Methods

Data were collected from youths aged 6 to 18 years who underwent a systematic assessment of symptoms. This assessment was extended to all patients consulting at Arrazi Hospital in Salé within the pediatric department over a period of four months (sample accrued from July 2023 to October 2023). The diagnosis of DMDD was established utilizing the diagnostic criteria outlined in DSM-5

Results

About 31% of the young participants met the operational criteria for DMDD. Those with DMDD exhibited increased comorbidity rates with attention-deficit/hyperactivity disorder (ADHD), another Depressive disorder and conduct disorder compared to those without DMDD. Additionally, they displayed elevated symptoms of aggressive behavior, rule-breaking, social issues, anxiety/depression, attention problems, and thought problems in comparison to all other participants without DMDD. It’s noteworthy that youth with DMDD presented with at least one psychiatric comorbidity.

Conclusions

Given that DMDD is accompanied by other comorbid psychiatric disorders, particularly depression and anxiety, and appears to impact familial and occupational status in adulthood, the early detection and subsequent effective treatment of DMDD symptoms are of utmost importance.

Disclosure of Interest

None Declared
Attitudes on pharmacotherapy among parents of children with autism spectrum disorders
Authors: Mandic Maravic V. , Vlaisavljevic M. , Lestarevic S. , Vasic J. , Grujicic R. , Pejovic Milovancevic M.
Published: August 2024

Introduction

Parent-mediated interventions for children with autism spectrum disorder (ASD) have beend recognized as very valuable (1). There is a significant effect of parental attitudes towards treatment on treatment outcomes (2).

Objectives

To evaluate parental attitudes and need for professional support regarding pharmacological treatment of children with ASD.

Methods

We interviewed 67 parents (83.6% mothers) of children with ASD who are regularly treated at our institution. We created a questionnaire with sociodemografic information, clinical characteristics of the child, and parental experience/attitudes on pharmacological treatment.

Results

The average child age was 20.06±4.43; 80.6% were male. The child clinical characteristics and parental sociodemographics are shown Table 1.
Table 1.

Clinical characteristics of children with ASD/parental sociodemographics

Clinical characteristics – childrenNValid %XSDSpeech - 4 words or more3552.2Epilepsy1319.4Intellectual dissability2131.3Parental sociodemographicsCurrent age of parent (informant)50.936.91Parent (informant) education
Primary and secondary school
Attended/finished university or postgraduate degree25
4237.3
62.7Parent (non-informant) education
Primary and secondary school
Attended/finished university or postgraduate degree31
3547
53

Parental attitudes and feelings when child is treated with medication are shown in Graph 1.

Graph 1. Parental attitudes on medication

We also examined what would help parents in reaching the decision on pharmacotherapy for their children (the results shown in Graph 2).

Graph 2. Parental need of support for decision on medication

In our further analysis, it was shown that the feeling of guilt and helplesness was significantly more present in parents who feared side-effects of medication (p=0.016 and p˂0.001, respectively).

Image:

Image 2:

Conclusions

A significant number of parents battle with feelings of helplesness and guilt when medication is introduced in the treatment of their children. There is a great need for information provided by the clinicians as well as psychological support in reaching shared decisions regarding pharmacological treatment of children with ASD.

References:

1. Wang F, Lao UC, Xing YP, Zhou P, Deng WL, Wang Y, et al. Parents’ knowledge and attitude and behavior toward autism: a survey of Chinese families having children with autism spectrum disorder. Transl Pediatr. 2022 Sep;11(9):1445-1457.

2. Hock R, Kinsman A, Ortaglia A. Examining treatment adherence among parents of children with autism spectrum disorder. Disabil Health J. 2015 Jul;8(3):407-13.

Disclosure of Interest

None Declared
Experience in the Psychotherapeutic Treatment of Eating Disorders in Children and Adolescents: A Brief Approach and EMDR Outcomes
Authors: López Gómez-Miguel L. , Herranz Núñez L. , Santolaya López L. , Benavides Rivero F. , Privado Aranda A. , González San José M.
Published: August 2024

Introduction

This study is based on our experience at public hospitals and private clinics of Toledo and Madrid, where we have addressed the treatment of children and adolescents presenting with Eating Disorders (EDs). Our intervention focuses on the application of brief psychotherapy, with particular emphasis on the effectiveness of Eye Movement Desesitization and Reprocessing (EMDR) in these cases.

Objectives

The primary objective of this study is to determine the benefits of applying EMDR in cases of pediatric and adolescent EDs in comparison to other psychotherapeutic techniques.

Methods

Over a period of one year, brief psychotherapy sessions were conducted with children and adolescents diagnosed with EDs. An integrative approach was used, combining family sistemic therapy, cognitive-behavioural therapy techniques, and brief psychodynamic approaches, along with EMDR sessions. Pre and post treatment assessments were conducted to measure changes in symptoms and patients’ quality life.

Results

The results obtained reveal significant improvements in patient symptomatology, including a notable reduction in food-anxiety, dietary restriction and compensatory behaviours. Furthermore, improvements were observed in body image perception and patiends’ overall quality of life. Incidence of relapse cases was minimal.

Conclusions

Our experience suggests that the application of a brief psychotherapy approach, combined with EMDR sessions, can be highly effective in treating children and adolescents with EDs. Early intervention and individualized adaptation of therapies are essential for achieving positive and lasting outcomes in this patient group. These findings underscore the importance of considering integrative approaches in the care of EDs in young population.

Disclosure of Interest

None Declared
The Psychosocial Impact of Climate Change and natural disasters
Authors: Ghosh Dastidar D. B.
Published: August 2024

Introduction

In this study we have studied the impacts of natural disaster yash on the development of PTSD in a rural hamlet of West Bengal.

Objectives

Correlation of natural calamity and trauma ie post traumatic stress disorder in exposed population.

Methods

Setting of the study was a relief camp operated for victims of climate change and natural disasters ie cyclone yash 2021.Tool for data collection - PCL 5 questionnaires, socio demographic pro forma, data was analyzed by using statistical SPSS.

Results

Analysis shows that there is statistical correlation between post traumatic stress disorder and subjects exposed to climate change events such as cyclone Yash.

PCL-5 cut-off score between 31-33 is indicative.

Conclusions

Our study clearly demonstrates the impact of climate change and natural disasters on the development of post traumatic stress disorder in the study group.

Disclosure of Interest

None Declared
Treatment strategies in eating disorders with comorbid conditions and in under-represented clinical populations
Authors: Paslakis G.
Published: August 2024

Eating disorders (EDs) have long been thought to be conditions that only or mainly affect women, especially young, affluent, skinny girls and women in Western cultures. Mostly over the last decade, we have come to realize that EDs may affect individuals of all genders, ages, sexual orientations, ethnic, and socio-economic backgrounds. This, in turn, has implications for ED presentation and assessment, and the necessity for adjustments in the provided care according to diverse treatment needs. Here, we present and discuss current advances in ED-related research in underrepresented groups as well as the need to further incorporate diversity aspects in clinical care and research within the ED realm.

Disclosure of Interest

None Declared
Eco-anxiety, how can the awareness on fighting global warming is becoming a mental health problem
Authors: Barbosa M. , Fonseca A. R.
Published: August 2024

Introduction

Although the issue of climate change usually brings thoughts of environmental impact and physical health concerns to our consciousness, climate change also affects people’s mental health. Nowadays there is an emerging condition about climate change anxiety (CCA), defined as negative responses associated with global warming, with apprehension and stress related to the anticipation of threats to the ecosystem and our species. It may include cognitive, emotional, and behavioral responses, for example, persistent worries, psychological distress, or sleep difficulties related to long-term consequences of climate change, and can result in functional impairment.

Objectives

A literature review to analyse the evidence, to be aware of individuals overconcerned about global warming, bring awereness and promote an appropriate seek of professional help when needed

Methods

Using the Medline database through the Pubmed search engine was used, with the keywords: “climate change anxiety”, “eco-anxiety”.

Results

Despite the lack of studies, CCA affects a substantial proportion, especially the younger population, aged from 16 to 25 years old worldwide. As a result of ecoanxiety, people are becoming anxious about their future and the future of the planet as we currently know it, the terrifying and at some extent uncertainty of it. It is documented the importance of green and blue spaces (water places) specially in urban areas for mental wellbeing – as our environment is quickly changing with the global warming, the reduction/disappearing of these areas are ongoing; besides this direct consequence, the disruption of these places results in feelings of loss due to changes to personally significant places a phenomenon known as ‘ecological grief’. Additionally, the occurrence of natural disasters like heatwaves, hurricanes, flooding, wildfire, and drought, raising concern and the socially-mediated impacts of forced migration and conflict caused by it. Self-reported presentations may include panic attacks, insomnia, obsessive thinking, and/or appetite changes caused by environmental concerns. If prolonged symptoms, depressive, anxious disease, post-traumatic stress disorder, among others can develop.

Conclusions

To reduce eco-anxiety individuals can take steps to reduce their carbon footprint, engage in activism and advocacy, bringing more awareness to the subjects and thus taking measures to mitigate the effects of climate change and protect the environment. It’s equal important to consider and address the mental health impacts of climate change, this additionally includes providing adequate emotional and psychological support to those affected.

Disclosure of Interest

None Declared
Comorbidity of mental disorders in synthetic cannabinoids abuse: clinical dynamics, behavior, adaptation
Authors: Selivanov G. , Bokhan N.
Published: August 2024

Introduction

The study of the phenomenon of deformation of mental disorders, clinical dynamics, behaviors, and adaptations in case of abuse of synthetic cannabinoids is of relevance.

Objectives

To study the phenomenon of deformation of mental disorders, clinical dynamics, behaviors, and adaptations in case of abuse of synthetic cannabinoids

Methods

Catamnestic, clinical-psychopathological methods (PANS, SANS, CGI, MMPI, CGI, STAI, LSI, TPA, ICD-10), statistical (Python 3.11.0).

Results

291 men (age from 18 to 35 years) were examined: 240 - F12.2xx, of which 98 - F60.xx-F62.xx, 142 - F20.xx and 51 - F20.xx without substance abuse. The study took place from 2018 to 2023 based on psychiatric institutions of the Russia, Tomsk region, St. Petersburg, Noyabrsk and Nizhnevartovsk.

Conclusions

The phenomenon of abuse of synthetic cannabinoids is a factor in the deformation of mental disorders. Persistent exogenous visual and delusional disorders contribute to the symptoms of exacerbations of schizophrenia; schizophrenic symptoms are included in psychotic episodes in personality disorders. In remission of schizophrenia, there is a quasi-adaptation from socio-professional environments, mostly addictive and criminalized, a pronounced smoothing of emotional impoverishment, a stigmatizing symptom is mainly a volitional defect, as well as frequent rehospitalizations not indirectly related to drugs. In remissions of drug use in patients with personality disorder, persistent schizophrenia of behavior. In patients with schizophrenia and patients with personality disorders, there is a distortion of behavior with a predominance in patterns of inclinations to delict, nonconformity, isolation in an addictive environment, suspiciousness. Drug abuse may initiate auto-aggression predominantly in individuals with personality disorders and to a lesser extent in patients with schizophrenia. True suicides in drug users include only episodes with depressive symptoms.

Disclosure of Interest

None Declared