bluuebunny/crossref_metadata_2025 huggingface dataset:
Inflammatory cytokines during a manic episode in bd patients and its correlation with cognitive and affective symptoms at follow-up
Authors: Guerra M. Estudillo , Suarez G. Torres , Mesia-Toledo I. , Pacheco-Barrios K. , Ramírez-Bemúdez J.
Published: February 2022

Introduction

Bipolar Disorder (BD) is a severe recurrent disorder with a complex biogenetic and psychosocial etiology. The immune system cytokines in interaction with the CNS play a role in the pathophysiology.

Objectives

To compare inflammatory cytokines between BD patients and controls during the manic episode; additionally, compare these cytokines with psychiatric symptoms and cognitive performance during follow-up.

Methods

We recruited 25 BD patients in mania with paired controls. We measured baseline IL-2, IL-4, IL-8, IL-10, GM-CSG, TNF- α, and TNF- γ in plasma. We used U-Mann-Whitney for group comparison and Spearman correlation between sub-group follow-up assessments and cytokines.

Results

We found a significant difference in IL-6 between subjects and controls (figure 1). During the follow-up, we found a correlation with psychiatric symptoms, cognition, and cytokines during manic episodes (Table 1). Table 1. Follow-up Correlation with cytokines during a manic episode.
BD
follow-up N=8CytokineMADRSBPRSSCIP-S
WMT-SCIP-SPST-SCIP-SIL-10(-) Rho=-.957 (p=<0.001 R2=0.14).IL-4(+) Rho=.78 (p=0.02 R2=0.09)INF- γ(+) Rho=.73 (p=0.03 R2= 0.48)(+) Rho=.751 (p=0.032 R2=0.53)(+) Rho=.737 (p=.037 R2=0.40)INF- α(+) Rho=.887 (p=.003 R2=0.53),(+) Rho=.830 (p=0.011 R2=0.59)

(+): positive correlation; (-): negative correlation. WMT: working-memory test, PST: Processing-speed test.

Conclusions

IL-6 was significantly different in patients with BD during a manic episode regardless of the treatment they were taking. IL-10 at manic episode was negatively correlated to general psychiatric symptoms, IL-4 positive correlated to depressive symptoms, and cognitive performance was positively correlated to TNF- α and TNF- γ at follow-up.

Disclosure

No significant relationships.
Psychogenic polidipsia in a patient with bipolar affective disorder (BAD)
Authors: Sarafopoulos A. , Antoniadis D. , Karpouza V.
Published: February 2022

Introduction

A 49 y.o. male patient was admitted to the male PICU with a manic episode. Upon admission he presented with mood elation, pressured speech, lack of sleep, agitation and polydipsia.

Objectives

To investigate the symptom of psychogenic polydipsia in mental health patients presenting with severe mania.

Methods

The patient was assessed regularly by the psychiatric team consisting of a CT doctor and one General Adult Consultant. Appropriate psychological assessments for mania and laboratory investigations took place. There was a referral to Endocrinology for further investigation of the symptom.

Results

The patient initially scored above 40 in the Young Mania Rating Scale (YMRS), establishing a diagnosis of mania. Upon admission he was treated with Paliperidone 9mg OD and Sodium Valproate 1gr OD. The daily dose of the sodium valproate was increased. Concerning the polydipsia, the investigations by the Endocrinology department indicated the specific weight in urine within normal range. The mental health team proceeded in a cross-titration of Paliperidone to Aripiprazole. On the 10th day since admission the management of the manic symptoms was considered satisfactory. Nevertheless, the polydipsia continued to a certain extend.

Conclusions

After ruling out organic and pharmacological causes of the polydipsia, the mental health team wondered about the cause of the symptom. Further investigation is required in order to clarify whether the polydipsia could actually qualify as a symptom in severe mania.

Disclosure

No significant relationships.
Treatment resistant manic episode with commorbidity with borderline personality disorder (BPD)
Authors: Sarafopoulos A. , Antoniadis D. , Karpouza V.
Published: February 2022

Introduction

A 47 y.o. female patient was admitted to the female PICU with a manic episode. Upon admission she presented with mood elation, psychosis, pressured speech, lack of sleep and agitation.

Objectives

To investigate negative prognostic factors such as the co-morbidity with a personality disorder in patients presenting with severe mania.

Methods

The patient was assessed regularly by the psychiatric team consisting of a CT doctor and one General Adult Consultant. Appropriate psychological assessments for mania and laboratory investigations took place.

Results

The patient initially scored above 45 in the Young Mania Rating Scale (YMRS), establishing a diagnosis of severe mania. She was treated with Olanzapine titrated up to 20mg OD and augmentation with Lithium treatment. Lithium plasma levels were at 0,6. Due to the treatment resistant manic presentation a second antipsychotic agent was administered and the patient was also treated with Zuclopenthixol depot 400mg every two weeks. Clinical improvement was observed after 16 days from admission.

Conclusions

The clinical team wondered about the clinical challenges of the case. According to the literature having a Personality Disorder diagnosis is a negative prognostic factor for patients with mania and this is relevant to this case as well.

Disclosure

No significant relationships.
Personality dimensions and coping strategies in remitted bipolar disorder
Authors: Mhiri E. , Messedi N. , Bouattour W. , Charfeddine F. , Aloulou J.
Published: February 2022

Introduction

The influence of personality on how people deal with stressful situations has long been discussed. In bipolar disorder, these two entities seem to have a role in the outcome of the disease.

Objectives

To study the relationships between coping strategies in stressful situations and personality dimensions in euthymic bipolar patients.

Methods

This is a cross-sectional, descriptive and analytical study of 30 patients followed for bipolar disorder in remission, at the psychiatric outpatient clinic at the Hédi Chaker Uuniversity Hospital in Sfax. We used a socio-demographic and clinical data sheet and the Ten Items Personality Inventory (TIPI) to evaluate personality dimensions and the Ways Of Coping Checklist (WWC) for the assessment of coping.

Results

The mean age of the patients was 43.77 years, the sex ratio was 0.5. Bipolar I disorder was diagnosed in 93% of patients. WCC : -Coping focused on the problem : 70% of the patients. -Emotion-centered coping : 20% of patients -Coping focused on seeking social support : 10% of patients. TIPI : Conciousness was the most represented trait of personality (36.7%), agreableness (30%) and extraversion (20%). Extraversion was associated with coping focused on the problem: (p=0.015). Agreableness was associated with coping focused on seeking social support:(p=0.033).

Conclusions

Our study showed that conciousness is the most common trait of personality in bipolar disorder patients. The coping focused on the problem is the most frequent strategy which correlated with extraversion, so, personality dimensions appear as a target for cognitive interventions.

Disclosure

No significant relationships.
Children’s psychiatric medical history. Review
Authors: Solis M.O. , Español F. Vilchez , Dafonte A. Alvarado , Barea M. ValverDe , Fernandez S. Jimenez
Published: February 2022

Introduction

The prevalence of mental disorders in children and adolescents varies between 5 and 22%, depending on the methodology, type of interview, samples and inclusion of the disability criterion. Between 4 and 6% of children and adolescents have severe mental disorders.

Objectives

Reason for consultation. Current disease Milestones of psychomotor development. The presence of abnormal behaviors, delays in motor development, speech and socialization will be specified. As the child’s behavior depends to a large extent on the context, specific methods should be used to evaluate the child’s behavior at home, at school and in the clinical situation. Complementary exams: Genetic testing. Blood and urine tests, including toxics. EEG, polysomnography and evoked potentials. X-rays, CT-scans, MRI.

Methods

The essential source of medical history is clinical interviews. The semi-structured format is the most recommended by the different authors, because it allows some flexibility in the realization of the story, while providing a baseline to develop the interview (J. Diaz Atienza).

Results

The diagnostic formulation must be individualized without assigning a categorial psychiatric diagnosis. (Doménech E et al).

Conclusions

The main and irreplaceable evaluation technique remains the medical history. It is important to take into account the reason for consultation and the context of both the child’s family and its ethnic, cultural and ethical characteristics. It is of the utmost importance to have and evaluate the stages of normal development and to adapt to the age that our patient has.

Disclosure

No significant relationships.
Have we forgotten about heller’s? a case report of childhood disintegrative disorder
Authors: Devan K. , Austin S. , Chakrabarti S.
Published: February 2022

Introduction

We report on the case of a 15 year old young person with a known diagnosis of autism presenting with a rapid and acute regression in functional abilities, decline in expressive speech and bizarre posturing. The symptoms first started during lockdown (April 2020) with anxiety related to school work followed by urinary incontinence, insomnia, muttering to self and incongruent smiling. Initial medical investigations including MRI, lumbar puncture and 24hour EEG were inconclusive, so she was referred to Paediatric Liaison for assessment.

Objectives

We demonstrate the value of a child psychiatry liaison service being involved with young people in an acute medical hospital

Methods

This young person had a thorough psychiatric assessment.

Results

Through daily psychiatric assessment and reviews with the young person, her parent, social care, wider community team, school and Paediatric Inpatient ward in order to expand on the understanding of the young person and develop a case formulation. She was started on oral Olanzapine 2.5mg which was gradually increased to 10mg OD with minimal improvement.

Conclusions

Childhood Disintegrative Disorder (CDD or Heller’s Syndrome) is a rare pervasive disorder presenting as a loss of previously acquired skills after at least two years of normal development. Despite no longer being included in DSM-V, it is important for Psychiatrists to have a working knowledge of CDD and consider other differentials when assessing young people.

Disclosure

No significant relationships.
Disruptive mood dysregulation disorder
Authors: Higueras P. Hervias
Published: February 2022

Introduction

Faced with a possible overdiagnosis of bipolar disorder in children and adolescents, a new diagnosis has been created in the mental illness classification system. This new diagnosis is named Disruptive Mood Dysregulation Disorder.

Objectives

We propose to carry out a bibliographic review on the new diagnostic category of Disruptive Mood Dysregulation Disorder.

Methods

We present the clinical case of a 10-year-old boy showing severe irritability symptoms.

Results

Disruptive Mood Dysregulation Disorder refers to persistent irritability and frequent episodes of extreme behavioral disturbance in children up to 12 years of age. Onset must occur before 10 years of age and the diagnosis should not be applied to children under 6 years of age. The clinical course of these patients in adolescence and adulthood tends towards unipolar depressive disorders or anxiety disorders rather than bipolar disorders.

Conclusions

The new diagnosis of Disruptive Mood Dysregulation Disorder allows us to differentiate between the classic episodic presentations of mania from the non-episodic ones of severe irritability.

Disclosure

No significant relationships.
Teenage pregnancies resulting from rape in Sri Lanka – lessons learned
Authors: Rohanachandra Y.
Published: February 2022

Introduction

Rape resulting in pregnancy warrants special attention due to the associated psychosocial and physical adversities. There are no guidelines for the management of teenage pregnancies resulting from rape in Sri Lanka.

Objectives

This case series aims to describe the experience of four teenagers who became pregnant as a result of rape in Sri Lanka.

Methods

This is a case series of 4 pregnant teenagers who became pregnant as a result of rape

Results

This case series highlight the deficiencies in services in Sri Lanka such as lack of legal framework to terminate pregnancy following rape, delay in legal procedure leading to prolonged institutionalization of pregnant teenager, not giving the teenage mothers the choice of breastfeeding and lack of awareness about the psychological consequences of rape and teenage pregnancy.

Conclusions

Formulating a national guideline on managing rape related pregnancy in teenagers in Sri Lanka, with the involvement of all stakeholders is a need of the hour.

Disclosure

No significant relationships.
Child psychiatry expertise in the context of parental separation
Authors: Regaya M. , Guedria A. , Brahim T. , Gaddour N. , Gaha L.
Published: February 2022

Introduction

Marriages’ dissolution phenomenon had increased in recent years in Tunisia. The impact of divorce on children depends on the interweaving of several factors and is not inevitably pathological. We have noticed in our daily practice a concomitant increase in the number of request for expert opinions concerning children.

Objectives

Determine the clinical children’s profile of separated parents carried out within the framework of legal expertise.

Methods

We carried out a retrospective study in the outpatient child psychiatry ward at Fattouma Bourguiba general hospital in Monastir, Tunisia. Including all the expert reports of children affected by parental separations during a period of two years (2017 to 2019).

Results

56 children were included in our study. The average age were (6.7 years) with a majority of males (58.2%). School failure concerned (24%). In most cases, the request for expertise was made in the context of mistreatment’s suspicion (60.7%), than following the parents’ separation (16.1%). Concerning the clinical picture: a normal psychiatric examination was found in the majority of cases (55.4%), anxiety symptoms concerned (32.1%). Cases of depression, global developmental delay and autism were also found.

Conclusions

According to our study, the vast majority of children presented a normal psychiatric examination. Moreover, a preponderant part of the symptoms seemed to result from educational errors. While parental separation poses risks for children, research shows that these negative effects are not the same for everyone. Several factors can reduce these risks and promote children’s resilience. Thus, first-line psychosocial care should be offered for families and children in seprations’ context.

Disclosure

No significant relationships.
Decrease in brain complexity with methylphenidate treatment in boys diagnosed with attention deficit hyperactivity disorder: An entropy-based qeeg analysis
Authors: Çetin F.H. , Usta M.B. , Aydın S. , Güven A.S.
Published: February 2022

Introduction

Attention deficit hyperactivity (ADHD) disorder is a common childhood neurodevelopmental disorder, and Methylphenidate (MPH) is a first-line therapeutic option for treating ADHD.However, how brain complexity and entropy changes with methylphenidate treatment the clinical implications of possible changes in entropy and the clinical implications of possible changes in entropy have yet to be studied.

Objectives

This study aimed to reveal how the MPH treatment affects the complexity in the brain of children with ADHD by entropy-based qEEG analysis. In addition, the presence of the relationship between possible neurophysiological changes to be detected with clinical variables and how they are two other important questions of this study to be answered.

Methods

During eyes-open resting, EEG signals were recorded from 25 boys with ADHD-combined type before MPH administration and at the end of the 1st month of the treatment. Approximate entropy (ApEn), sample entropy (SampEn), permutation entropy (PermEn) were used to analyse.

Results

A statistically significant decrease in entropy level was found with MPH treatment in the F4 channel according to approximate entropy (ApEn) and sample entropy (SampEn) analysis (p<0.05). In addition, according to permutation entropy (PermEn) analysis, the decrease in entropy with MPH treatment in the regions indicated by F3, F4, P4, T3, T6, and O2 channels was found to be statistically significant (p <0.05).

Conclusions

This is the first study to investigate how MPH treatment affects the complexity in the brain of children with ADHD. Entropy-based qEEG analysis may be a new method that can be used in diagnostic, clinical and prognostic predictions in ADHD.

Disclosure

No significant relationships.
Increase in brain connectivity with methylphenidate treatment in boys diagnosed with attention deficit hyperactivity disorder: A coherence-based qeeg analysis
Authors: Çetin F.H. , Gıca Ş. , Uytun M. Çıkılı , Babadağı Z. , Usta M.B. , Güven A.S. , Işık Y.
Published: February 2022

Introduction

Attention deficit hyperactivity (ADHD) disorder is a common childhood neurodevelopmental disorder, and Methylphenidate (MPH) is a first-line therapeutic option for treating ADHD.However, how brain connectivity changes with methylphenidate treatment have yet to be studied.

Objectives

This study investigates how the MPH treatment affects the connectivity in the brain of children with ADHD by coherence-based qEEG analysis during rest.

Methods

During eyes-open resting, EEG signals were recorded from 25 boys with ADHD-combined type before MPH administration and at the end of the 1st month of the treatment. Mutual Information (MI),Coherence Function (COH) and Phase Locking Value (PLV) were used to analyse the changes in brain connectivity.

Results

A statistically significant increase in connectivity level was found with MPH treatment between the F3-F4 channels, P3-P4 channels, F7-F8 channels and T5-T6 channels according to PLV, COH and MI analysis (p<0.001).

Conclusions

This is the first study to investigate how MPH treatment affects the connectivity of the brain of children with ADHD. Coherence-based qEEG analysis may be a new method that can be used in diagnostic, clinical and prognostic predictions in ADHD.

Disclosure

No significant relationships.
Use of the autism spectrum screening questionnaire for identification of autism spectrum disorders in 8-10 years old georgian children*
Authors: Zirakashvili M. , Mikiashvili T. , Chvamania G. , Mebonia N. , Gabunia M.
Published: February 2022

Introduction

Rising prevalence of autism spectrum disorders highlights importance of research priority of development of effective screening procedures for schoolage children.

Objectives

The study aimed to identify the prevalence of ASD among 8-10 y old schoolchildren in Republic of Georgia.

Methods

In 2019 a cross sectional survey in four main cities of Republic of Georgia was conducted, totally 3rd and 4th grade (8-10 y old) 16654 children from 211 public schools were included. The Autism Spectrum Screening Questionnaire (ASSQ), completed by parents and teachers, was used to determine children at risk for ASD.

Results

16654 (response rate 74%) parents were agreed to participate in the study. Parents and teachers rated 770 (5.0%) and 669 children (4.9%), respectively, as screen positive (in top five percentile). Cut-off scores for 99-95 percentiles (top 1-5%) was defined. Boys were more likely to be rated screenpositive than girls. Share of boys rated in the top 5% by parents is 5.6% compared to 4.3% of girls. Teachers place boys in the top 5% even more frequently – 6.4% versus 3.4% girls. Pairwise correlation coefficients (0.53) revealed moderate correlations between scores and according to p-values (< 0.05) all correlations were statistically significant.

Conclusions

The study defined the cut-off scores of ASSQ for 8-10 y old Georgian children and gender difference in prevalence of risk for ASD. Using the ASSQ was an effective instrument and could be used in school settings to identify children with special needs. *This work was supported by Shota Rustaveli National Science Foundation of Georgia (SRNSFG), grant - FR-18-304.

Disclosure

No significant relationships.
Estimation of prevalence of mental health problems in 8-10 years old georgian children by using the strengths and difficulties questionnaire*
Authors: Chvamania G. , Zirakashvili M. , Mikiashvili T. , Mebonia N. , Gabunia M.
Published: February 2022

Introduction

Mental health problems are frequent among children and seems to predict mental disorders in adulthood.

Objectives

The study aimed whether the gender differences affects the Strengths and Difficulties Questionnaire (SDQ) assessments performed by parents and teachers in Republic of Georgia.

Methods

In 2019 a cross sectional survey in four main cities of Georgia was conducted; Totally 8-10 y old 16654 children from 211 public schools were included. SDQ completed by parents and school teachers was used to determine emotional and behavioral problems among Georgian children.

Results

16654 (74%) parents out of 22553 were agreed to participate in the study. 1565 (9.39%) children were rated screen positive in top five percentile by either parent or teacher or both of them. Cut-off scores for 99-95 percentiles (top 1-5%) was defined. Boys were more likely to be rated screen positive than girls, especially by teachers: parents rated screen positive 7.5% of females, teachers - 7.2%, while males 9.4% and 11.5% respectively. Pairwise correlation coefficients (0.53) revealed moderate correlations according to p-values (< 0.05) between scores and all correlations were statistically significant.

Conclusions

The study defined the cut-off scores of SDQ for 8-10 y old children and a gender differences in prevalence of mental health problems in Georgia. SDQ could be used in primary healthcare and school settings to identify children with special needs. This work was supported by Shota Rustaveli National Science Foundation of Georgia (SRNSFG), grant - FR-18-304.

Disclosure

No significant relationships.
Testing the clinical application of the child psychosis-risk screening system (CPSS)
Authors: Hamasaki Y. , Matsuo M. , Sakaue Y. , Sanada R. , Nakayama T. , Michikoshi S. , Ueba S. , Kurimoto N. , Hikida T.
Published: February 2022

Introduction

Children in a prodromal state manifesting as truancy or social isolation (hikikomori) often complain of problems that are physical in nature and are subject to significant changes. We developed the Child Psychosis-Risk Screening System (CPSS) that incorporates childhood psycho-behavioral characteristics revealed through a retrospective survey of schizophrenia patients into its algorithm.

Objectives

Our research aimed to test the risk identification of pediatric and psychiatric clinic outpatients using the CPSS.

Methods

We conducted an epidemiological study involving 204 outpatients between the ages of 6 and 14 years who had been examined at a pediatric or psychiatric clinic using the CBCL and clinical data from medical charts. Logistic regression analysis and T-tests were performed using each clinical data variable to clarify the risk of the CPSS calculated from the CBCL data and contributing factors.

Results

The results of the logistic regression analysis demonstrated that the diagnostic category (physical illness or DSM-5 diagnosis) and chief complaint did not contribute to differentiate between the high-risk and low-risk groups. Meanwhile, the environmental factors of “abuse” and “social isolation” did contribute to the discrimination of the two groups.

Conclusions

The fact that the diagnostic category during childhood does not contribute to the discrimination of the high- risk group warrants attention. It is possible that the high-risk group only had a latent endophenotype that had not yet manifested during this period. The factors suggested to have an association with the high-risk group may be reflecting activators and the dynamic state of the critical period for psychosis.

Disclosure

No significant relationships.
Internet addiction disorder: When technology becomes a problem
Authors: Trigo M.
Published: February 2022

Introduction

Internet addiction disorder (IAD) is the compulsive and problematic use of the internet, resulting in significant functional impairment in several life domains. This happens when an individual engages in online activities disregarding daily responsibilities or other interests, and not realizing its negative consequences. Although not officially recognized as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), the relationships between digital media use and mental health has been under debate and discussion amongst experts due to presenting some features of excessive use, withdrawal phenomena, tolerance, and negative repercussions typical of many substance abuse disorders.

Objectives

To present an overview of theoretical considerations on IAD and its eventual inclusion in the next version of the DSM.

Methods

Review of the most recent literature regarding internet addiction disorder. The research was carried out through the PubMed, MedLine, SpringerLink and LILACS databases, using the terms “internet addiction”, “addiction disorders” and “social media”, until December 2020.

Results

There is controversy around the diagnosis of internet addiction, including whether it is a unique clinical entity or a manifestation of other underlying psychiatric disorders, raising complex questions of causality. Since there are no standardized definition, there is lack of evidence-based recommendations to its approach.

Conclusions

Research suggests that some individuals dealing with internet addiction are at significant risk, therefore merit professional care. Further research is needed, with carefully controlled studies, emphasizing incapacity, prognosis and response to treatment, in order to consider internet addiction as a disease, and include it in DSM’s next edition.

Disclosure

No significant relationships.
Categorical-dimensional approach to diagnostic of schizotypal disorder
Authors: Kotsiubinskii A. , Isaenko Y. , Kusnetsova S.
Published: February 2022

Introduction

The relevance of this research is determined by the fact that an important scientific task of the modern clinical classification of mental disorders is the productive combination of the most valuable for the practical use of categorial and dimensional (in terms of the weight and depth of each dimensia) of the characteristics in in a particular clinical picture of a disease.

Objectives

The goal of the research is to validate the new categorical-dimensional criteria necessary for the verification of schizotypal disorder.

Methods

The information base of the research included medical data on 150 patients with schizotypal disorder. Categorical characteristic used according to the systematics of schizotypal disorder (Kotsiubinskii A.P, 2018) published in the National Guide «Psychiatry», which includes the following syndromes: obsessive-phobic, dysmorphophobic, non-delusional hypochondria, heboid, histrionophoric, impulsive-dysfunctional, schizoaffective, dissociative-disintegrative, autistic, dismotivative, amotivative. Our systematics was used with following demensia: positive, affective, negative, cognitive, disordered behavior, dissociative and coenestesipatic. Guided by the principle of five-level representation of each dimensia (from «0» to «4») in accordance with DSM-V and the informative systematics of dimensia was developed with each of dimensia also has rate from «0» to «4».

Results

This diagnostic approach made it possible to correlate the categorial and dimensional characteristics, both to each other and to the criteria of the condition of the patients’ state with the prototype of schizotypal disorder (in the range of «1» to «5»).

Conclusions

This has made it possible to more accurately diagnose non-psychotic forms of mental illness, in particular: differentiate schizotypal disorder «sui generis» and schizotypal personality disorder.

Disclosure

No significant relationships.
Pain and gain of auditory intrusions with video game content: Game transfer phenomena in clinical cases
Authors: De Gortari A. Ortiz , Basche A.
Published: February 2022

Introduction

Studies about Game Transfer Phenomena (GTP) have demonstrated lingering effects of playing video games manifesting as sensory, cognitive, and motoric intrusions (e.g., seeing images or hearing voices from the game after playing), transient changes in perception and self-agency. GTP are common among non-clinical players, though those with mental disorders are more susceptible. Gamers tend to appraise GTP as pleasant. Distress has been reported when GTP are experienced frequently and with specific content.

Objectives

To show the interplay between GTP and patients’ symptomatology and the benefits of using the GTP framework in clinical contexts.

Methods

GTP were assessed via clinical interviews and with a validated GTP scale (three cases, males, 10-16 years old, playing time 6-10 h/day).

Results

The cases were characterised by i) incorporation of videogame content into hallucinations and delusions, ii) identification with a videogame character and subsequent distress provoked by hearing the character’s voice and iii) self-induced GTP as self-soothing behaviour when reducing playing time. Main GTP manifestations were in the auditory modality as sounds or voices. The primary clinical diagnoses were gaming disorder, depressive disorder, and psychosis.

Conclusions

On one hand, GTP can be pleasurable and a way to cope with withdrawal symptoms from gaming disorder, though it can lead to compulsive behaviours and dissociation. On the other hand, GTP can be interpreted negatively and fulfil delusions that provoke distress and compromise mental stability. The cases reveal that the GTP framework can be an effective psycho-pedagogic method and support differential diagnosis.

Disclosure

No significant relationships.
Cocaine bugs: A brief case report of cocaine-induced delusion of parasitosis
Authors: Quarenta J. , Martins S. , Teixeira T. , Ribeiro J.P.
Published: February 2022

Introduction

Delusional parasitosis (DP), also know as Ekbom syndrome and in some cases as Morgellons, was first described in the late 17th century in France. It is an obsessive phobic state in which the patient believes that the is infested by parasites. In the hallucinatory state, they frequently remove parts of the skin, identifying them as parasites. The cause of DP is unknown. Evidence supporting the dopamine theory defend that the inhibition of dopamine reuptake (for example cocaine and amphetamines) induce symptoms such as formication.

Objectives

Through the description of the following clinical case, we emphasize its clinical features and complexities.

Methods

Review of DP in light of a clinical case

Results

A 48-year-old woman was brought to the psychiatric emergency due to psychotic symptoms following cocaine use. She had a history of drug abuse. She was apparently asymptomatic until October 2019, when, in the background of vague sensation of something crawling under his skin, she developed a sudden onset belief that she had been infested by insects that crawled under his skin. Previous medical observation found no reason for a skin infection or infestation. Skin examination revealed itch marks and skin excoriations in the abdomen. Mental status examination revealed anxious and depressive affect, delusion of parasitosis, tactile hallucination and impaired insight. Routine hemogram and urinalysis was unremarkable, except for the detection of cocaine.

Conclusions

Delusional parasitosis often presents to nonpsychiatric medical professionals. An awareness of such ilness, with an early recognition and timely referral are management cornerstones in order to successfully diagnose and treat patients.

Disclosure

No significant relationships.
Gilles de la tourette’s syndrome and psychosis: A family case study
Authors: Konstantinova K. , Baidina K. , Losevich M.
Published: February 2022

Introduction

Tourette’s syndrome (ST) is a neuropsychiatric disorder that presents with combination of motor and vocal tics for at least one year time.Only few cases of comorbidity with psychotic disorder has been described.

Objectives

We present a case report of a patient with ST, obsessive compulsive disorder, posttraumatic stress disorder that resulted in chronic schizophrenia-like psychosis, and family hystory of tics and psychosis.

Methods

A case – based family study, literature review and statistic data analysis.

Results

The patient (male, born in 1997 otherwise healthy)presented at the age of 6 with spitting.He subsequently progressed with severe motor tics, vocalizations, coprolalia, impulsivity, destructivity, repetitive motor rituals.No treatment showed to be efficacious and safe. He dropped out of the school, the family has to move to the rural area; his social withdrawal was intensified by psychotrauma (assaulted by police officer due to seemingly disorderly conduct). At the age of late adolescence he started to make fantastic statements. Later on he admitted having visual and audial hallucinations and responding to them; the Kandinsky–Clérambault syndrome was detected. Symptoms and exitement are partially controlled by diazepam and clozapine; the patient needs assistance in all routines of self – care.The patient’s mother has a mild form of motor tics; her mother developed persistent delusions in her late thirties (without disorders of perception and social disfunction).

Conclusions

The study demonstrantes genetic interconnecting between TS, tics and psychosis; hyperactivity in the dopaminergic system of the brain may be involved in all three disorders. National statistics of TS have to be reviewed and improved.

Disclosure

No significant relationships.
European brain research area: The strategic level
Authors: Di Luca M. , De Witte E. , Aarts K. , Kramer S. , Iannone D. , Destrebecq F.
Published: February 2022

Brain research in Europe is a rapidly evolving field, and increasingly at the forefront of science. Although considerable amounts of knowledge and innovative approaches have been generated, the translation into new health interventions is hindered by excessive fragmentation. Effective and efficient collaboration and cooperation among the various initiatives are often identified as a key success factor to achieve brain research full impact. EBRA fully responds to these needs by bringing together the various stakeholders and major brain research initiatives, at European level and beyond. EBRA creates the conditions for real and effective cross fertilisation, dialogue, building consensus and exploiting research potential. At the strategic level, EBRA acts by fostering alignment and better coordination of research strategies across European and global brain initiatives. Therefore, an overview of the scale and scope of brain research activities funded in the EU framework programme and the funding initiatives of JPND, NEURON and HBP has been created. The results of the mapping exercise then underpinned the development of a Shared European Brain Research Agenda (SEBRA). The SEBRA focuses on research opportunities and research gaps to be addressed in the field, and priorities for action in the short- and long-term. It integrates pre-existing documents as well as expert (i.e., researchers, neurologists/psychiatrists, patient representatives) input that has been collected through surveys and in a dedicated expert workshop. The SEBRA will be used to provide recommendations on future areas for excellent, innovative, and translational research comprising those for maximized cooperation, reduced overlap, and fragmentation.

Disclosure

No significant relationships.
Which antipsychotics can we use for obsessive-compulsive symptoms in schizophrenia?
Authors: Aissa A. , Ghabi H. , Khattech D. , Meddouri S. , Ouali U. , Nacef F.
Published: February 2022

Introduction

Obsessive-compulsive symptoms (OCS) are common in schizophrenia, with a prevalence ranging from 12 to 25%. They affect negatively disease outcome. Patients with comorbid OCS present more frequently resistant psychotic symptoms. Besides, the appearance and aggravation of OSC are more commonly reported with atypical antipsychotics.

Objectives

To present through a clinical case and a brief literature review the treatment challenge of obsessive-compulsive symptoms in schizophrenia.

Methods

We reported the case of Mr. M.S., treated in our department since 2008 for comorbid schizophrenia and OCS, and discussed therapeutic alternatives through a literature review.

Results

Mr. M.S. a 34-year-old male diagnosed with comorbid schizophrenia and OCS at age 20. To control psychotic symptoms, the patient received several trials of anti-psychotics with little improvement. We concluded that it was resistant schizophrenia. The introduction of clozapine reaching 300 mg daily led to significant improvement of psychotic symptoms but worsened OCS. The adjunction of fluoxetine and cognitive-behavioral therapy (CBT) was unsuccessful to manage obsessive symptoms. We opted for the association of aripiprazole 20 mg daily and clozapine, the doses of which were gradually tapered down to 150 mg daily. This association has guaranteed the improvement of both psychotic and obsessive symptoms.

Conclusions

Conclusion This clinical vignette highlights the need for clinical awareness about the possible exacerbation of OCS with atypical antipsychotics in schizophrenia.

Disclosure

No significant relationships.
Huntington’s disease- a case of early psychiatric symptoms and suicide
Authors: Estalagem A. , Bastos H. , Cruz M.D.C.
Published: February 2022

Introduction

Huntington’s disease is typically an inherited neurodegenerative disorder with autosomal dominant transmission. Early disease symptoms can include depression and behavioral changes, while physical and cognitive symptoms become evident later. Suicide and suicidal ideation are more frequent in these patients than on the general population. We present the case of a 50-year-old female patient with a history of depression and suicidal intents previous to her diagnosis. The patient committed suicide approximately 20 years after the beginning of her psychiatric symptoms.

Objectives

To report a clinical case of early psychiatric symptoms and suicide in Huntington’s disease; To raise awareness for these comorbidities and for an adequate intervention in suicide prevention.

Methods

The information was obtained by interviewing the patient and her family and by reviewing past medical reports. A brief literature review using the keywords “suicide”, “Huntington´s disease” and “psychiatric symptoms” was performed on PubMed.

Results

The patient had a history of depression and five hospital admissions for suicidal intents during the ten years prior to the diagnosis. After the diagnosis and the beginning of physical symptoms, she maintained suicidal ideation until she committed suicide ten years later.

Conclusions

This clinical case underlines the importance of being alert for early psychiatric symptoms of Huntington’s disease, especially if considering the patients’ probability of developing it. It also reinforces the need for suicidal ideation regular assessment and for pharmacological and non-pharmacological targeted therapy. Further investigation should be taken to understand which factors increase the risk for suicidal behavior and which moments during disease progression are crucial for prevention.

Disclosure

No significant relationships.
Let’s talk about it: An atypical case
Authors: Ramírez A. Gonzaga , Martín Ó. , Valera G. Guerra , De Llano De La Viuda M. Queipo
Published: February 2022

Introduction

Cross-sectional studies report the high comorbility of substance use (SUD) with eating disorders (ED). This case report aims to describe a case of anorexia nervosa and alcohol use disorder in a 18 year old male.

Objectives

Based on the need to formulate protocols, we aim to conduct a systematic review on the recent literature research on this coexisting psychiatric disorders.

Methods

Relevant studies were sourced from published literature and reviewed.

Results

The prevalence of ED is higher in women than in men, with a ratio of 7:1; however it is the latter that present the most serious clinical pictures. It should be also noted that no all types of ED present the same comorbility, but rather those with bulimic symptoms are the ones that most resort to substance abuse, so the distinction between subtypes is highly relevant.

Conclusions

It is important that clinicians are aware of the severity of this combination and the need for a specific and careful management. Also important to taking into account the limited bibliography on the subject, it is especially important to expand research.

Disclosure

No significant relationships.
Relationship between suicide attempts of repetition and dependence to the cocaine: Report of clinical case
Authors: García M. Valtueña , García L. Lago , Fescina R. Combina , González A. Vázquez , Ludwig C. , Suarez A. González , Fernández J. López , Lora C. Huergo , León S. Ocio , Martino R. Arias
Published: February 2022

Introduction

People with borderline personality disorder are at higher risk of repeating suicidal behavior. At the same time, numerous publications have demonstrated the relationship between cocaine dependence and suicide attempts of repetition.

Objectives

Review the relationship between cocaine addiction, borderline personality disorder and repeated suicide attempts. Present through a clinical case the effectiveness of a comprehensive and multidisciplinary therapeutic plan with different mental health devices.

Methods

To review the psychopathological evolution of a patient with a diagnosis of borderline personality disorder; dependence to the cocaine; Harmful alcohol consumption and suicidal behavior from the beginning of follow-up in mental health services to the present. Review the existing scientific evidence on the relationship between cocaine addiction and repeated suicide attempts. Analyze the eficacy of the different treatments available.

Results

This is a longitudinal and retrospective study of the psychiatric history and evolution of a clinical case since the implementation of an individualized therapeutic program and the favorable results obtained. Intensive outpatient follow-up was carried out for high suicide risk and hospitalization in a psychiatric hospitalization unit, day care centre and therapeutic community.

Conclusions

At present, the patient remains in abstinence with remission of suicidal ideation. The literature has shown the usefulness of intensive mental health follow-up programs to achieve remission of suicidal ideation and maintain abstinence from illegal substances.

Disclosure

No significant relationships.
Cytokines status in multiple sclerosis patients with comorbid recurrent depressive disorder
Authors: Markova E. , Goldina I.
Published: February 2022

Introduction

The presence of some common immunological pathogenesis mechanisms in multiple sclerosis and depression suggests the possibility of comorbid depressive disorder formation in multiple sclerosis patients, which significantly worsens their quality of life and patient’s compliance. In this regard, the depressive pathology diagnosis in people suffering from multiple sclerosis acquires important scientific and practical value.

Objectives

The aim of the study was the cytokine status peculiarities identification in multiple sclerosis patients with comorbid recurrent depressive disorder (F33).

Methods

The cytokines content in patient’s blood mononuclear cells culture supernatants was carried out by ELISA. The recurrent depressive disorder diagnosis was established based on ICD-10 criteria. The depressive disorders symptoms severity was determined according to the M. Hamilton and A.T. Beck depression scales, as well as during the clinical interview

Results

A higher production of IL-6 was noted in multiple sclerosis patients with mild recurrent depressive disorder (F33.00), in contrast to patients without the affective symptoms. The IL-1β, TNF-α, IL-6 contents in the blood mononuclear cells culture supernatants of patients with severe recurrent depressive disorder (F33.2) exceeded the corresponding parameters of patients with mild depressive symptoms. A direct correlation between the depression severity and IL-1β, TNF-α, IL -6 spontaneous production by blood mononuclear cells of patients with multiple sclerosis was found.

Conclusions

The severity of recurrent depressive disorder correlates with a change in the parameters of the cytokine status: severe depressive symptoms are accompanied by a change in the functional activity of immune cells and an increase in the production of cytokines synthesized by type I T-helpers.

Disclosure

No significant relationships.
Implementation of balint group for a team who care patients with head and neck cancer in a service in Brazil: A proposal post qualitative research
Authors: Turato E. , Bispo A.C. , Rodrigues J.R. , Santos C. , Lima C.S.
Published: February 2022

Introduction

The Balint group emerged at the Tavistock Clinic in London in the early 1950s. Its creator was a doctor and psychoanalyst Michael Balint. It consisted of a group process, with meetings among general practitioners, in which non-conscious aspects of the professional-patient relationship were approached. We present how a proposal for implementation of a Balint Group has emerged, specifically for physicians and nurses who care for cancer patients. Is is a consequence of results obtained from a qualitative study conducted by a student of the professional master’s degree linked to a Clinical Oncology.

Objectives

To present a technical product, as required in a Brazilian professional master’s degree, as a result of research that studied reports of doctors and nurses who deal with usual difficulties of handling patients with HNC.

Methods

The group work is triggered by the report of a case brought by a participant, presenting a problem-situation in the management of his patient. The meeting leader seeks to understand the reactions reported by the presenter in the light of a psychodynamic approach.

Results

Expected results: the holding of a Balint group, perhaps monthly, in charge of a colleague who has knowledge in applied psychoanalysis, will allow insights to the participants who will bring them conditions to perceive “neurotic elements” in the relationship with their patient.

Conclusions

Final consideration: having accumulated decades of positive experience, Balint Groups must remain as an updated proposal for the work on emotional issues of professional teams, with emphasis on clinical services with the management of so-called “difficult patients”.

Disclosure

No significant relationships.