bluuebunny/crossref_metadata_2025 huggingface dataset:
Parental Alienation Syndrome as a Consequence of Paranoid Contagion or Shared Psychosis
Authors: Ruiz-Tristan A. , Urricelqui J. , Gomez-De-Las-Heras V. , Crossley V.
Published: September 2022

Introduction

Parental Alienation Syndrome (PAS) was proposed by Richard A. Gardner in 1985. It is assumed to occur in some distressing marriage break-ups, when a parent “brainwashes” his children so they reject the other parent in an unjustified way. But, is it the result of a conscious act as Gardner suggests? Or could it also appear as part of a shared psychosis?

Objectives

To assess the possibility of the appearance of PAS as a consequence of paranoid contagion or shared psychosis.

Methods

We present the case of a 45-year-old patient and her 9-year-old daughter, who is allegedly assaulted by her father during visits, according to both. Mother and daughter continually request attention in the emergency department for this reason, with no obvious injuries. A bibliographic review is carried out on the PAS and shared psychosis. We compare the existing data with our case.

Results

A paranoid cognitive style is observed in the 45-year-old patient, and it is observed that her daughter stops rejecting the father when she spends time separated from her. The contagion of delirium is the nuclear mechanism of shared psychosis. It is known that children with PAS may have distorted memories and incorporate beliefs of others through suggestion. There is also an inverse relationship between the number of visits by the alienated parent and the undervaluation of the child. We have not found any studies linking shared psychosis with PAS.

Conclusions

The existing bibliography on PAS is scarce. The possibility of an existing paranoid contagion mechanism has not been addressed yet.

Disclosure

No significant relationships.
That song in my head: a review on Musical Hallucinations
Authors: Ramalheira F. , Conde Moreno M. , Romão J. , Vieira S.
Published: September 2022

Introduction

Hearing music inside our heads is frequent, however some hear it more vividly, constantly and involuntarily. Musical Hallucinations (MH), first described by Baillarger in 1846, are a complex type of auditory hallucination characterized by perception of melodies, music, or songs.

Objectives

This work aims to review the literature considering MH.

Methods

Pubmed and Google Scholar search using MeSH term “musical hallucinations”

Results

MH occurs in 0.16% of the population. They´re usually perceived as frightening or annoying. Proposed mechanisms include spontaneous activity triggered by sensory deprivation from hearing impairment, like in visual hallucinations in Charles Bonnet syndrome, and some authors even include MH as a subtype of this syndrome. Indeed, 60% of all patients with MH have hearing impairment or deafness. Other less frequent causes include focal brain lesions involving the auditory pathway and cortex, temporal epilepsy, metabolic or drug intoxication. Psychiatric conditions are uncommon but not impossible, especially in affective disorders. MH most frequently consist in familiar tunes, sometimes of personal significance, religious songs (especially in older patients), childhood songs, folk and popular songs from the radio - suggesting that musical perception is never unlearned but represents a “parasitic memory”, an unchangeable memory feature which can be experienced by relevant neuronal circuit stimulation. Most patients with MH were reported to have no extraordinary musical skills.

Conclusions

MH are rare and strongly associated with hearing loss, though investigation of other causes should be sought. Treating the underlying cause is important but remission is not guaranteed.

Disclosure

No significant relationships.
A Nightmare’s Lullaby: Exploring the concept and relevance of oneiroid cyclic psychosis through a clinical case and review
Authors: Compaired Sánchez A.
Published: September 2022

Introduction

Acute psychotic states characterized by clinical lability and dream-like qualities are a staple of classic psychopatology. An excessive focus on diagnostic criteria for bipolar or schizophrenia-spectrum disorders risks missing this particular set of patients; defined through their dynamic presentation as much as by any cluster of symptoms or types of course.

Objectives

To explore the concept and relevance of oneroid-like cyclic psychosis through a clinical case and review.

Methods

We report the case of a 37 year old woman with bipolar disorder (three previous instances of manic episodes with psychotic symptoms) and various gynecological issues that required hormone therapy. After a couple of days having difficulty sleeping, the patient developed a clinical picture consisting of wide and sudden oscillations between hyperactive and inhibited psychomotor activity, moods of dread and ecstasy, and states of disorganized thought and childlike activities with perplexity and mutism. Frequent behaviors as if experiencing visual alucinations and repeated allusions to feeling as if in a dream. These symptoms lasted for 2-3 weeks, after treatment with risperidone and lithium. A narrative review concerning the case was also performed.

Results

Kleist’s ‘innate instability’ permeates much of the previous literature. Similar entities highlight different issues closely related to various biological rhythms: atypical psychosis and epilepsy, puerperal psychosis and estrogen dysregulation, cyclic psychosis and sleep disorders, delirious mania and effectiveness of electro-convulsive-therapy, etc.

Conclusions

Our findings point to the clinical relevance of oneiroid cyclic psychosis as innate instability. Further studies on the role of biological rhythms and its repercussions on daily practice are required.

Disclosure

No significant relationships.
MURDEROUS MYTHOMANIA: Psychopathology of lying – Apropos a Clinical Case
Authors: Jesus S. , Costa A. , Simões G. , Almeida M. , Garrido P.
Published: September 2022

Introduction

The capacity for lying is a common human phenomenon with evolutionary explanations, in which one seeks to deceive usually to avoid harmful or undesired consequences. The spectrum of lies is vast and varies from the content to the motivation. Pathological lying has the potential to affect mental evaluations thus motivating an important discussion regarding this behaviour.

Objectives

The authors aim to explore the psychopathological concept and spectrum of pathological lies, from their underlying motives to their implications and challenges in psychiatric diagnosis with recourse to a clinical case example.

Methods

A review of pertinent literature on the topic with focus on that which is most relevant to the theme was included. The authors present the clinical case of a middle-aged female who presented with mythomania which included the fabrication of having attempted murder.

Results

The literature demonstrates a relationship between compulsive lying and personality disorders. Head trauma and other central nervous system issues may also play a role. Some traits may facilitate the detection of deception, such as dramatic and unmotivated constructs with a positive self-portrayal. The clinical case description correlates the personality factors associated with mythomania, namely antisocial personality disorder, differing from the typical presentation as her fabrications portrayed her negatively.

Conclusions

The implication of pathological lying is that it may interfere with mental assessment thus altering, by way of deception, the psychiatric evaluation as lies may be difficult to detect upon a first evaluation. The psychiatrist should be alerted to the possibility of fabrication when dealing with a patient with predisposing factors.

Disclosure

No significant relationships.
How to Manage Suicidal Risk at Digital Distance
Authors: Courtet P.
Published: September 2022

Suicide prevention remains very difficult to achieve for many reasons, notably because we do not have any indicator of risk prediction, short-term risk factors being little explored, and evaluations being retrospective they are biased. Furthermore, patients at risk are not followed up, because of their lack of confidence in care, stigma, shame. On the other hand, the gap observed during the covid19 pandemic between distress and less occurrence of suicides could be linked to more virtual contacts. Then, the smartphone might be a good tool to stay connected to a protective network. We will discuss the opportunity offered by the smartphone to monitor patients with ecological momentary assessment, allowing to better characterize their acute states and detect an increased risk in real time, and thanks to the ecological momentary intervention 24/7 availability, improve access to care and better coordinate resources, and encourage self-care. These tools while offering new solutions for an efficient real time suicide prevention, may also raise some ethical issues that should be addressed.

Disclosure

Fondamental Foundation supported the developement of the application EMMA
Misdiagnosis and therapeutic impasse in psychiatry
Authors: Zrelli M. , Bergaoui E. , Staali N. , Moalla M. , Melki W.
Published: September 2022

Introduction

We frequently receive patients with atypical psychiatric symptoms admitted in our department after consulting other psychiatrists and triying several treatments.

Objectives

To highlight the factors of misdiagnosis in patients of our department.

Methods

We recruited 70 patients during their appointment or during their hospital admission in our department between March and April 2021. We collected the patients’ socio-demographic and clinical data using a pre-designed questionnaire.

Results

Patients were aged between 17 and 68 years with a sex ratio (M/F) of 1. Mood disorders accounted for 24.6% of disorders (N=17) whereas schizophrenia 66.7% (N=46). Patients resided in urban areas in 88.6% of cases (N=69). The average number of hospitalizations was 2.7 with extremes ranging from 0 to 14. The average time between the onset of the symptoms and the first consultation was 1 year. The mean time from onset to hospitalization was 4.37 years. The rate of consulting a psychiatrist prior to admission was 42.8%. The diagnosis was corrected during the follow-up of the patients in 24.3% of cases. Conventional neuroleptics were prescribed as first-line treatment in 42.85% of cases. Due to poor tolerance or ineffectiveness of the treatment, 31.42% of patients had to change treatment.

Conclusions

Patients, who were desperate to find an adequate treatment for their disorders, put a lot of hope in the Razi psychiatric hospital. But after several years of evolution of their disease, we are faced with a therapeutic impasse. Raising awareness of mental illnesses is necessary for an early and adequate treatment.

Disclosure

No significant relationships.
How to deal with Substance Abuse in a Telepsychiatric Setting
Authors: Dom G.
Published: September 2022

Abstract Body

Alcohol and (illicit) substance abuse are among the most common psychiatric disorders within the general population and their impact can not be underestimated. Reputedly for these disorders, there is a large treatment gap and treatment delay, i.e. large numbers of afflicted individuals never receive appropriate treatment and if they do so often many years after the onset of the disorder. The Covid19 pandemic has only aggravated these gaps. In many countries, due to the Covid 19 pandemic and its associated restriction measures telepsychiatric tools have become increasingly implemented (and funded) as regular parts in the possibilities in delivering interventions. With respect to substance abuse treatment, a vast body of research already showed promises both in the field of telepsychiatry as broader the use of digitalization (e.g. the use of virtual reality designed treatment interventions, digital monitoring). In the current presentation, an overview will be presented of both telemental health interventions and digital tools/interventions in the field of substance abuse treatment.

Disclosure

No significant relationships.
Lymphocytic colitis in the course of a treatment with sertraline. A case report
Authors: Cerame A. , Cotillas A. , Coucheiro P. , Franco Soler A.
Published: September 2022

Introduction

Lymphocytic colitis is an unusual side-effect of the treatment with SSRIs particularly sertraline. According to several sources, this side effect could be underdiagnosed and underreported.

Objectives

We present the case of a 31-year-old female patient who presented watery non-bloody diarrhea for a month. The patient had been diagnosed with Persistent Depressive Disorder six years prior to the episode and was being treated with sertraline.

Methods

A case report is presented alongside a review of the relevant literature regarding Lymphocytic colitis, its differential diagnosis and treatment.

Results

The case was coordinated between the out-patient psychiatry department and the patient’s Family Medicine specialist. The patient underwent a complete panel of tests including blood and stool test, and colonoscopy. The biopsy showed results compatible with the aforementioned diagnosis. Since the only pharmacological treatment which could cause or trigger lymphocytic colitis was sertraline, it was removed and treatment with oral budesonide was started with good results.

Conclusions

Lymphocytic colitis in the context of the treatment with SSRIs, particularly sertraline, is a side-effect which is more prevalent than what was thought in the past. A close coordination between psychiatrists and GP is of vital importance for the adequate treatment of mental health problems and treatment’s side-effects. It is important to bear in mind this possible side-effect to increase patient’s safety.

Disclosure

No significant relationships.
Legal and Forensic Issues in Telepsychiatry
Authors: Goethals K.
Published: September 2022

Covid-19 has induced many changes to society, including some in the practice of medicine and psychiatry. Among them is increasing use of telecommunications. A previous editorial outlined the possible uses and dangers of telemedicine with prisoners (Gunn et al 2020). Forensic psychiatry is also concerned with providing expert evidence to courts and other arbitration bodies and, increasingly, these bodies too are relying on such technology. Further in addition to traditional paper-style records (many now held electronically rather than literally on paper) there is increasing use of video recording of interviews, of day to day behaviour on secure hospital units and by bodycams when intervening in a tense, potentially violent situation. To what extent are these being used in court? Is there a European framework for guiding us on how to proceed? How has this been interpreted to date in countries across Europe? In this paper these issues will be addressed.

Disclosure

No significant relationships.
Olanzapine and its use for methamphetamine-induced psychosis
Authors: Nazir S. , Talpur A. , Hassan N. , Sharif U.
Published: September 2022

Introduction

Over time the prevalence of methamphetamine associated psychosis (MAP) has increased globally including Asia and Europe. Shoptaw et al looked at an RCT and concluded that olanzapine is superior to haloperidol in terms of tolerability and the side effect profile as it causes fewer extrapyramidal symptoms. Another study by Xue et al compared the efficacy of olanzapine and haloperidol and found that they had comparable effects but the onset time in the olanzapine group was significantly earlier than the haloperidol group. Srisurapanont et al analyzed 6 RCTs and concluded that quetiapine and olanzapine are probably superior than aripiprazole and risperidone.

Objectives

The purpose of this review is to find out if olanzapine is better than other antipsychotics in treating methamphetamine-induced psychosis.

Methods

PubMed, SCOPUS, and Web of Science literature databases were screened and filtered by using specific search terms, inclusion/exclusion criteria. Texts of the selected articles and trials were reviewed and the search terms generated a total of 248 results from the databases. After applying the criteria 200 citations were left and 15 papers were reviewed.

Results

The literature review concluded that olanzapine can be used as an effective treatment for methamphetamine-induced psychosis. Olanzapine can help to reduce the psychotic symptoms in MAP with a quicker onset and lesser side effects.

Conclusions

Olanzapine can help in the treatment of methamphetamine-associated psychosis and can be considered as the first-line therapy. Research is further needed with a higher pool of candidates in the future to compare the efficacy and tolerability of different typical and atypical antipsychotics.

Disclosure

No significant relationships.
Co-occurrence of clozapine-related DRESS syndrome core clinical manifestations: results of a systematic review
Authors: De Filippis R. , De Fazio P. , Kane J. , Schoretsanitis G.
Published: September 2022

Introduction

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome refers to a cluster of clinical symptoms/signs related to drug hypersensitivity. The main clinical features include fever, skin rash, eosinophilia, enlarged lymph nodes, atypical lymphocytosis, and involvement of at least one internal organ. Clozapine-related DRESS syndrome has been rarely reported, but this may be due to a different clinical presentation pattern compared to DRESS for other culprit drugs.

Objectives

We aimed to assess clusters of main clinical features of clozapine-related DRESS.

Methods

We ran a network analysis for clinical manifestations in the pooled sample of all previous published cases of clozapine-related DRESS.

Results

We observed a triad of core symptoms (i.e., organ implication, fever, and eosinophilia) among DRESS criteria co-occurring in 59.3% (n=16) of 27 patients. The organs most likely to be involved in clozapine-related DRESS included lungs, liver, heart, and kidneys. Fever was also present in almost all cases (n=25 patients), while eosinophilia was observed in two thirds of the sample (n=18 patients).

Conclusions

Regarding clinical manifestations clozapine-related DRESS may differ from DRESS for other culprit drugs as skin reaction is not very typical; thus, clinicians need to consider DRESS as a potential diagnosis even in absence of a skin reaction. When managing clozapine-treated patients with the core triad of organ implication, fever, and eosinophilia clinicians should consider guidelines for DRESS treatment.

Disclosure

No significant relationships.
What if Cannabis has a medical relevance in psychiatric disorders?
Authors: Abassi B. , Khelifa E. , Nourchene K. , Maatouk O. , Mnif L.
Published: September 2022

Introduction

Cannabis was used as a medicinal plant in Asia before the Christian era. Nowadays, after 40years of a “war on drugs” with an illegal status, there is a big interest on the use of cannabis in some medical conditions. With more and more users revealing having used this substance to cope with certain psychiatric manifestations, researchers have tried to explore this substance in the psychiatric field where the actual pharmacological treatments and psychotherapy remain ineffective in some cases.

Objectives

To Explore the medical use of cannabis in psychiatric disorders.

Methods

A literature review was based on the PubMed interface and adapted for 2 databases: Science Direct and Google Scholar over the last 10 years.

Results

Giving the interactions between cannabinoids and specific neurotransmitters, it has been suggested that cannabis may have medical effect on some psychiatric illnesses. In this direction, a significant overlap has been demonstrated between PTSD and cannabis use. CBD a non-psychotomimetic cannabinoid, seemed to show promising results as an enhancer of fear extinction and therapeutic consolidation of emotional memories. Military veterans are increasingly using it for reducing induced nightmares although this residual symptom remains difficult to treat. No benefit for improving depression was proved. One isolated study indicated a potential efficacy for cannabinoid combined with terpene in ADHD.

Conclusions

Studies exploring the possibility of using cannabis in the treatment of psychiatric illnesses are promising but it is premature to recommend this drug for the moment especially since it requires gradual titration, regular assessment and precaution in certain diseases.

Disclosure

No significant relationships.
Antipsychotics and mood stabilizers on risk for hepatic failure in people with schizophrenia and bipolar disorder
Authors: Tascón Guerra M.F. , Pérez Fominaya M. , López Rodrigo M.V. , Osca Oliver A. , Palomo Monge M. , Costoso López A. , Ros Font V.
Published: September 2022

Introduction

Patients with severe mental disease have a considerably shorter lifespan than the general population. The majority of psychiatric drugs are metabolized by the liver. Cytochromes play a central role, interactions between drugs are expected. Neuroleptics are frequently associated with weight gain, steatosis development, elevation of liver enzymes and rare acute cytolytic hepatitis, particularly with clozapine and olanzapine. Mood stabilizers, like Valproate classically gives mitochondrial steatosis with potentially important damages, and also possible acute liver failure.

Objectives

This case presents a 56-year-old patient, previously diagnosed of schizoaffective disorder, with chronic psychotic symptoms that showed high drug resistance. She had been treated in the past with most common antipsychotic drugs with no clinical response. While being in treatment with valproate and olanzapine, she was started on clozapine while olanzapine removed. Two weeks later she developed Acute Pharmacologic Hepatitis with mild liver failure.

Methods

Physical examination was normal. Mental exam revealed presence of delusion. Blood tests showed: hyperbilirubinemia and mil coagulopathy. Clozapine dose was reduced and valproate was suspended.

Results

The patient showed a substantial improvement of hepatic damage. Delusions are active after 12 weeks of treatment with clozapine.

Conclusions

Psychiatric disorders and liver illnesses are entangled in multiple ways. Screening for liver diseases is essential in order to prevent liver complications in patients receiving psychotropic medications. Further investigation of combinations of agents such as mood stabilizers and atypical antipsychotics may yield valuable insights into the potential of combination therapies to enhance clinical outcomes in patients with Severe Mental Disease.

Disclosure

No significant relationships.
A new day, a new treatment. A case report
Authors: Galerón R. , Serván B. , Huete Naval M. , Herrero Pellón E. , Albarracin P.
Published: September 2022

Introduction

We present the case of a 21 year-old male, with history of a psychotic episode, currently with monthly follow-up in an outpatient facility, with a favorable clinical evolution after one year of intensive follow-up. In the context of abandonment of his medication and a problematic family situation, the patient starts to show suspicious, with insomnia and a progressive social isolation. Despite an attempt of ambulatory treatment with oral aripiprazole, showing good tolerance, the patient refuses such treatment, showing active clinical psychotic with great distress and behavioral repercussion, finally requiring hospital admission.

Objectives

To perform a literature review about the treatment initiation with two vials of aripiprazole long-acting injection.

Methods

Literature review of scientific articles using Pubmed as search engine. We considered articles published both in English and Spanish.

Results

During hospital stay, treatment with 2 intramuscular injections of 400mg of aripiprazole is started, combined with a single dose of oral aripiprazole 20mg on day 1, assuring correct dosing, with good tolerance and favoring therapeutic adherence. Progressively, the patient starts to feel calmer, adequate, collaborative and emotionally stable, recuperating chronobiological rhythms, with remission of the hallucinations and appearing more distant from delusions.

Conclusions

According to the currently available studies, the use of this posology could avoid the potential impact that lack of adherence to oral treatment could have in the therapeutic outcome, assuring a correct dosing and favoring adherence from day 1. Furthermore, this would help simplify the medication regiment for patients, physicians and caregivers.

Disclosure

No significant relationships.
The combination of long-acting injectable antipsychotics, a new key in resistant schizophrenia
Authors: Tascón Guerra M.F. , Osca Oliver A. , López Rodrigo M.V. , Palomo Monge M. , Pérez Fominaya M.
Published: September 2022

Introduction

Schizophrenia is a chronic disease that requires lifelong medical care and supervision. There is a high rate of relapse, mostly caused by poor adherence to oral antipsychotics. Long-acting injectable (LAI) antipsychotics have proved effective in schizophrenia and other severe psychotic disorders due to the stable blood levels, leading to a reduction of the risk of relapse. LAIs are associated with better functioning, quality of life, and patient satisfaction. In Treatment-resistant schizophrenia the combination of antipsychotics is a common practice. Nevertheless, the combination of two different long-acting injectable antipsychotics is not frequent.

Objectives

A case of a 34-year-old man is presented, previously diagnosed of Schizophrenia, with highly disabling chronic positive symptoms. With no in-sight and no will in receiving treatment. Has been stable for a year while being in treatment with paliperidone 525mg LAI/ 10 weeks, and aripiprazole 400mg LAI/28 days.

Methods

The patient was closely observed and given oral paliperidone, after 5 days long-acting paliperidone was introduced. He was discharged with mild improvement of his psychiatric symptoms. While being in treatment with Paliperidone 525mg, he kept vivid delusions and hallucinations. The patient still refused to take any oral medications. Long-acting aripiprazole 300mg was added to the treatment.

Results

He showed clinical improvement after a month. He has been stabilized for one year.

Conclusions

Treating resistant schizophrenia is among the most challenging clinical endeavors. A very helpful approach to improve adherence in schizophrenia is the use of long-acting injectable (LAI) antipsychotics. A major effort on scientific research of combination of LAI is needed.

Disclosure

No significant relationships.
Time of onset of hematological side effects with Clozapine
Authors: Ktari H. , Ouertani A. , Madouri S. , Aissa A. , Zgueb Y. , Ouali U. , Jomli R.
Published: September 2022

Introduction

Clozapine use is not deprived of serious complications that can condition treatment strategies, particularly hematological. Recognizing the time it takes for these effects to set, can therefore help to better screen their appearance, improving healthcare.

Objectives

To study the time of onset of hematological adverse reactions in patients treated with Clozapine.

Methods

A longitudinal, retrospective and descriptive study on a period of 20 years starting from the first of January 2000, at the psychiatry department A of the Razi hospital in Tunisia. This study was conducted on patients treated by Clozapine. The data was collected from patients’ medical files using a pre-established sheet.

Results

The studied sample included 64 patient. Hematological disorders were found in 21 patients (32.8%). The mean time of onset of hematological adverse reactions was 119.71±126.56 days. Indeed, some patients had presented more than one hematological disorder and this at different times. Mild to moderate neutropenia had a mean time of onset of 502.57±908.32 days. The time of onset of eosinophilia was 937.75±1725.87 days, 297.67 ± 444.93 days for thrombocytopenia, 741±1268.85 days for leukopenia, 69.25 ± 48.19 days for hyperleukocytosis and 183. 33±231.80 days for anemia. Two cases of agranulocytosis were noted: one case occurred 10 years and three months from treatment beginning and the second case occurred after 7 months of treatment onset.

Conclusions

The time of onset of hematological side effects with clozapine varies widely and cannot be predicted with precision. Early, more frequent and regular surveillance is therefore necessary in this population.

Disclosure

No significant relationships.
Hypertriglyceridemia induced by aripiprazol: about a clinical case
Authors: Jordán G. , San Miguel A. , García Jimenez J.
Published: September 2022

Introduction

41 years-old man diagnosed of schizophrenia and peripheral spondyloarthropathy HLA-B27 (-) in treatment with methotrexate. Psychiatric background: First psychotic episode at 18, with no further medical monitoring. In 2018 he underwent a new episode consisting in auditory hallucinations, delusional ideas and clinophilia of months of evolution. He was sent to a Psychiatric Rehabilitation Unit and prescribed aripiprazole 20mg. The routine blood analysis revealed triglycerides level of 414mg/dL, with previous normal levels (123 mg/dL), without no other cause to justify it.

Objectives

To study the relationship between aripiprazole treatment and acute hypertriglyceridemia.

Methods

A clinical case is presented and available bibliography about the relation between aripiprazole and acute hypertriglyceridemia is reviewed.

Results

Hypertriglyceridemia was confirmed in the second analysis, so we concluded it was due to the start of aripiprazole, after rejecting other potential causes. Aripiprazole was replaced by cariprazine 3mg because of its similar profile. The analysis was repeated after a month and the normalization of the triglyceridemia (159mg/dL) was verified, while cholesterol levels remain stable. Moreover, the patient experienced an improvement in akathisia and sedation.

Conclusions

Although metabolic impact is not expected with aripiprazole, after reviewing the bibliography we have found a clinical trial and a case series that described this adverse effect. Our case highlights the importance of closely monitoring of patients in whom an antipsychotic treatment is started due to the high mortality and morbidity related to cardiovascular diseases.

Disclosure

No significant relationships.
“Flexible Assertive Community Mental Health Teams for the Treatment of Psychosis in Extraordinary Circumstances during Pandemics and Earthquakes 2020/2021: are we Flexible Enough?”
Authors: Rojnic Kuzman M. , Medved S. , Bjedov S. , Kovac M. , Mihaljevic-Peles A.
Published: September 2022

During the ongoing COVID-19 pandemic, two regions in Croatia, Zagreb and Petrinja in the Sisak-Moslavina County experienced strong earthquakes, on the March 22nd 2020 and on the 29th of December 2020. Both earthquakes, but especially the later one resulted on severe damage of the regions and caused severe disruptions in (mental) health service delivery. In these circumstances, the RECOVER-E project (LaRge-scalE implementation of COmmunity based mental health care for people with seVere and Enduring mental ill health in EuRopE), which was ongoing in Croatia from 2018-2022 aimed to implement flexible assertive community treatment as the new health care service for persons with severe mental illness (SMI). Since the pandemic and earthquakes have significantly influenced the life circumstances of all RECOVER-E project participants with SMI, we wanted further to examine the impact of health care delivery on mental health and the response to stress caused by a pandemic and earthquake in the patients with SMI involved in the project, in the first and second wave of the COVID-19 pandemics. Additionally, using case series, we will demonstrate the community mental health teams’ contributions in managing SMI after a double disaster in providing feasible, comprehensive, and accessible mental health services.1

Disclosure

No significant relationships.
Employment status of patients with schizophrenia spectrum disorder treated with long acting injectable paliperidone palmitate: Real world mirror image study
Authors: Markovic M.
Published: September 2022

Introduction

Schizophrenia spectrum disorders may severely limit ability to achieve and maintain gainful employment of affected working-age individuals.

Objectives

Assess the employment status in patients with schizophrenia spectrum disorders treated with long acting injectable paliperidone palmitate after the switch from oral antipsychotics.

Methods

A single centre mirror image design study of 115 patients with schizophrenia spectrum disorder was conducted in a tertiary level psychiatric hospital. Data were collected for period of 12 months prior toand 12 months after switching from oral antipsychotic to long acting injectable paliperidone.Employment status for 6 enrolled patients was missing.

Results

Mean age of enrolled patients was 38,4±11,6 years. Of the 109 patients analyzed for employment status, 44,4% remained employed for 12 months after switching to long acting injectable paliperidone while 4,6% patients changed their employment status from unemployed to employed after the switch. No patient changed their employment status from employed to unemployed after the switch. 9,2% patients were already retired at the beginning of study period and 5,5% of patients maintained their student status. 36,7% patients remained unemployed for the whole study period. The correlation between employment status of employed and unemployed patients and duration of illness was borderline significant with p=0,049.

Conclusions

The data from this study suggest that use of long acting injectable paliperidone contributed to preservation of working ability of working-age patients suffering from schizophrenia spectrum disorders.

Disclosure

No significant relationships.
Clozapine induced myocarditis: a case report
Authors: López Isern M. , Paiva Pajares D. , Martínez Muelas A. , Arévalo Sánchez A. , Sánchez Pérez M.
Published: September 2022

Introduction

Clozapine is one of the most effective antipsychotic drugs. On the other hand, it can cause serious side effects which have to be monitored. An adverse effect is myocarditis, a type B Clozapine reaction that can be fatal if it is not early diagnosed.

Objectives

To report a case of a patient with Clozapine induced myocarditis.

Methods

A 48 years old women with a schizoaffective disorder was admitted to our Hospital due to a clinical decompensation. She had a manic episode with psychotic symptoms (persecutory delusions and auditive hallucinations). Clozapine was introduced after there were no improvement with Olanzapine, Risperidone and Valproic Acid. A dose increase was made reaching 100 mg/day the first week and 200 mg/day the second week. The third week she started with a 39ºC fever, decreased oxygen saturation, leukocytosis (9560 103/mm3), elevated PCR (210 mg/l) and elevated troponins (52,88 ng/l). EKG and other medical tests did not show alterations. There was not found a clear etiology, so Clozapine was retired as a cautionary measure. The differential diagnosis for etiology included viral infections, Clozapine induced myocarditis or idiopathic.

Results

A few days after the withdrawal of Clozapine, cardiac symptoms improved, suggesting it was the most probable etiology.

Conclusions

Although it is not very likely to occur, it is important to consider myocarditis as a sever Clozapine side effect.

Disclosure

No significant relationships.
Is the pursuit of happiness the pursuit of homeostasis? A review on the modulatory functions of endorphins on human behavior
Authors: Conde Moreno M. , Ramalheira F.
Published: September 2022

Introduction

Endorphins have been associated with analgesia and pleasurable activities. However, the so-called “happy chemicals” are far more complex than initially thought. Research shows that their impact on human behavior is modulatory, with the main goal not being “happiness” but a “return to the most desirable state” – which can be highly context-dependent.

Objectives

Review of the modulatory functions of endorphins on human behavior and their possible implications in psychiatric conditions.

Methods

Pubmed search consisting of the MeSH terms “Endorphins”, “Opioid Peptides”, “Behavior”, and “Psychiatry”.

Results

Endorphins elicit pleasure via stimulation of the release of dopamine from the ventral tegmental area to the nucleus accumbens. They are known to be involved in analgesia and stress response and social interaction. Endorphins can be released in a multitude of circumstances that may seem contradictory – having both inhibitory and stimulating roles in appetite, sexual response, and memory– but are modulatory effects depending on what constitutes homeostasis in each context. Peripheral levels of endorphins have been found low in depression and post-traumatic stress disorder. In schizophrenia, studies suggest that peripheral levels are high during psychosis, low in chronic disease and that naltrexone seems to improve auditory hallucinations. Endorphins may also have a role as markers of treatment response.

Conclusions

Endorphins have a complex role in behavior and homeostasis. These molecules could have implications in psychiatry- given that they are part of our stress response and are released to promote a more “desirable state”. Their role as a marker of illness or response to treatment needs further investigation.

Disclosure

No significant relationships.
The path to function: using eye-tracking in a real-world task to understand the performance gap for people with severe mental illness
Authors: Regev S. , Josman N. , Mendelsohn A.
Published: September 2022

Introduction

Individuals with severe mental illnesses (SMI) often present the knowledge about a task but in real-time do not perform it fully, or not as efficient as planned. This performance gap may be explained by difficulties with Executive Functions (EF).

Objectives

The aim of the presentation is to describe how people with and without SMI experience and perform grocery task. This, with considering this path from several directions including the subjects’ point of view using eye-tracking device during task performance.

Methods

Forty-three individuals had answered questions in regards to their shopping habits and performed the Test of Grocery Shopping Skills (TOGSS). The actual performance was accompanied by wearing an eye-tracking device which recorded the behavior and eye movement. We hypothesized that significant differences will be found between people with SMI and controls both in the routine grocery habits and in observed performance.

Results

No significant differences in age or gender. The groups differed significantly only in education, with the SMI group having fewer years of education. As a weekly routine, SMI subjects perform less frequent shopping (40%) than control group subjects (67%). TOGSS sub-outcomes indicated performance efficiency (time and redundancy) were significantly higher in the research group than in the matched control group (p <.01), with the SMI group spending a longer time performing the task and entering more aisles than required – redundancy.

Conclusions

These preliminary findings indicate that individuals with SMI spend more time dwelling while selecting ingredients. Besides the path in the supermarket, it might explain their performance in other everyday activities.

Disclosure

No significant relationships.
Exposure to body odours combined with the effect of mindfulness treatment in patients with depressive and social anxiety symptoms - A preliminary study
Authors: Vigna E. , Carli V. , Hadlaczky G. , Wasserman D.
Published: September 2022

Introduction

To understand the way chemistry influences human communication is important since the reaction to chemosignals has many implications for science and society. For instance, previous research showed a connection between olfaction and affective psychiatric disorders. Olfactory processing may be impaired in subject presenting depression symptoms (DEP). Furthermore, a heightened sensitivity to social odours has been shown in subject with social anxiety symptoms (SAD). This may be due to the partial overlap of brain areas which are involved in olfactory processing and the pathophysiology of these disorders. Yet, more detailed research on the olfactory processing is required.

Objectives

POTION is an EU funded project within the Horizon2020 initiative that aims to understand the nature of chemosignals in humans and their sphere of influence on social interaction. Within this project, we conducted a preliminary exploratory study examining whether the odours may be utilized to support positive outcomes of psychological therapy. It evaluates the catalyst effect of the odour conditions on the effectiveness of mindfulness meditation for SAD and DEP.

Methods

Thirty subjects per patient group (total=60) are randomly allocated to one exposure group (happy or fearful human body odour or clean air) and follow the intervention while being exposed to the odour. Psychological outcome is measured before and after the intervention through the State-Trait Anxiety Inventory and the Profile of Mood State questionnaires. Analysis of variance is performed to assess outcome differences between groups.

Results

Preliminary results on a subsample of 32 patients show a trend of deeper reduction of anxiety symptoms at post-treatment among odour-exposed groups compared to clean air (F(1,17)=11.08, p=0.004).

Conclusions

Final results on the complete sample will be available and presented at the time of the congress.

Disclosure

No significant relationships.
Taking Mental Health into Schools: The work of Headucate Student Society
Authors: Henderson N. , Selwyn V. , Howard R. , Bartolome I.
Published: September 2022

Headucate: University of East Anglia (UEA) is a student-led organisation aiming to raise awareness around Mental Health through their workshops and events. Events in the last year have included a 24-hour live stream TV fundraiser, UEA’s first Psychiatry and Mental Health conference, a mental health themed stand-up show, mental health assistance workshops, a suicide prevention evening and a variety of panels. Headucate has also collaborated with Beat, the UK’s leading eating disorder charity, to run training aimed at Norwich Medical School students, other healthcare students and Professionals. Headucate provides opportunities for their members, including research, education within the medical community, organising group projects, hosting poster competitions and by collaborating with likeminded initiatives. Workshops were designed to include common mental health conditions; wellbeing; advice regarding looking after yourself and others; ways to get for support and the impact of COVID-19 on our mental health. They are arranged and delivered by our members to school children and university students; they have been adapted to an online platform, which allowed us to reach a wider audience. Outcome measures demonstrating the impact of Headucate’s work were analysed via verbal, written and rated feedback, obtained from participants of workshops and events. Headucate workshops can help to improve mental health awareness and education in schools; however, it is only a local initiative. To educate schools outside of Norfolk, Headucate’s repeatable model can be used to create new branches of organisations that can spread nationwide; so mental health education in schools can be promoted across the UK.

Disclosure

No significant relationships.
Trends in ECT (Electroconvulsive Therapy) Utilization During Pregnancy and Post-Partum Period: National Inpatient Sample 2002-2015
Authors: Jaiswal S. , Trivedi C. , Shah K. , Bishay Elshokiry A. , Adnan M. , Tazin F. , Mansuri Z.
Published: September 2022

Introduction

The use of Electroconvulsive therapy (ECT) during pregnancy and in the post-partum period is a critical decision for both providers and their patients. ECT utilization during this critical period needs to be better understood to assess the need and allocate resources for this valuable treatment option.

Objectives

1) To evaluates baseline characteristics and analyze ECT utilization trends for pregnant and post-partum patients hospitalized in the US. 2) To provide insight into ECT use among inpatient pregnant women with different age groups with various comorbid psychiatric disorders.

Methods

The study used the 2002-2015 National (Nationwide) Inpatient Sample (NIS) data. Descriptive statistical and trend analyses were conducted to evaluate data.

Results

A study found that a total of 924 pregnancy-related hospitalizations required ECT treatment; 92.2% of these ECTs were conducted in urban hospitals. The mean age of women was 30.3 years, and the majority (71%) were of the White race. Mood disorders (major depressive disorder- 51.9% and bipolar disorder- 37.9%) accounted for the most common comorbid psychiatric illnesses. The payer source (Medicare/Medicaid vs. Private Insurance) was almost equal (47.9 vs. 46.8). Though not statistically significant, the trend analysis showed that the proportion of ECTs during pregnancy out of the total ECT performed for the year almost doubled (0.24% to 0.47%) from 2008 to 2015.

Conclusions

Though not statistically significant, the use of ECT in pregnant women has increased in 2015 compared to 2002. Results will help clinicians, policymakers, and various stakeholders to optimize ECT utilization, reimbursement and ultimately improve clinical outcomes.

Disclosure

No significant relationships.
Changes in the practice of electroconvulsive therapy at Semmelweis University before and during the COVID-19 pandemic
Authors: Herman L. , Fullajtar M. , Zsigmond R.I. , Réthelyi J.
Published: September 2022

Introduction

The Department of Psychiatry at Semmelweis University is the largest electroconvulsive therapy (ECT) centre in Hungary, where a total number of around 300 treatments are conducted every year. Certain changes were administered in 2018 and 2019 in our logistics and internal protocols that helped to increase the number of treated patients and improve quality of care. The COVID-19 pandemic caused serious disruptions in the Hungarian mental health care system , therefore there was a realistic fear that many patients who required ECT would not receive this form of tretament.

Objectives

Our goal was to assess the effects of the pandemic on our ECT service, and to analyse whether patients were able to receive treatment, despite the logistical difficulties.

Methods

We retrospectively gathered data from our internal documentation to compare the number of ECT treatments with the previous years. We also had to take into account the fluctuation in our general caseload of psychiatric patients, since our Department acted as a COVID-19 treatment centre for several months.

Results

Total number of ECT treatments decreased in 2020 after a peak in 2019, however the numbers were not much lower compared to the years before changes in 2018. Unfortunately, we see a more direct effect of the 3rd wave of the pandemic.

Conclusions

We can conlude that there is a decrease in the number of ECT treatments due to the pandemic, however, the fact that we still provided service in most parts of 2020 and 2021 for patients with the most severe conditions is a serious achivement.

Disclosure

No significant relationships.