bluuebunny/crossref_metadata_2025 huggingface dataset:
AIDS dementia complex and neuropsychiatric symptoms : a case report
Authors: Fernández Fernández R. , del Sol Calderón P. , Izquierdo de la Puente Á. , Rodríguez Rodríguez A.
Published: August 2023

Introduction

HIV infection presents complications that may include neuropsychiatric symptoms and whose management is important to avoid misdiagnosis and mistreatment.

Objectives

This case aims to highlight the importance of assessing HIV comorbidity in patients with psychiatric onset pathology.

Methods

Case report and literature review.

Results

We present the case of a patient diagnosed with HIV in 1985, who after 20 years of disease with irregular adherence begins to present delusional ideation of harm and self-referential, control experiences, thought diffusion phenomena, and possible auditory hallucinations, with poor evolution despite the establishment of numerous antipsychotic treatments, which evolves over the years towards a confabulatory character and with progressive neuropsychological deterioration. After numerous admissions, and despite several treatments, the patient developed over time memory failures, bradypsychia, gait disturbances, and difficulties in self-care, which further aggravated his condition by hindering therapeutic adherence, which ended with the patient’s chronic institutionalization. Diagnosis was AIDS dementia complex.

Conclusions

HIV hardly replicates in the central nervous system but generates antigenemia which, in turn, generates an inflammatory infiltrate that can cause diffuse involvement, predominantly subcortical and limbic system. Usually, the dementia-AIDS picture is insidious and develops in patients with poor control of the primary disease. It is recommended to optimize antiretroviral therapy and neuroprotective agents, as well as symptomatic treatment by psychiatry.

Disclosure of Interest

None Declared
BORDERLINE PERSONALITY DISORDER: ATTITUDES OF PSYCHIATRY AND FAMILY MEDICINE
RESIDENTS
Authors: Olfa B. , Sana O. , Syrine A. , Rim F. , Najeh S. , Imen G. , Nada C. , Jihen B. T. , Lobna Z. , Manel M. B. , Mohamed M.
Published: August 2023

Introduction

Patients with Borderline Personality Disorder (BPD) require a significant amount of
time and effort on the part of general practitioners and psychiatrists, resulting in longer
visits and complex medical records, with a poor resolution of both physical and mental
symptoms.

These patients are likely to express feelings of anger and violence, compared to other
patients which makes it difficult to deal with them.

Objectives

To determine attitudes toward patients with BPD among psychiatry and family medicine
residents in Tunisia. To understand in addition the challenges that these professionals
encounter in their everyday practice

Methods

An online anonymous questionnaires was distributed through social networks to
psychiatry residents and family medicine resident.

The attitudes of health professionals towards people with BPD was used to assess
clinicians’ attitudes towards people with BPD.

Results

Thirty three clinicians were in the study. A high proportion of respondents (81.8%)
were females .The age of the participants ranged from 25 to 34 years, with an average age of
28 years and 3 months (SD = 2.23).In our study 34% reported that they often see patients with
borderline personality .The half of the participants (51.5%) reported a feeling being on
guard when meeting borderlines while 36.4% were empathetic and neutral. The feeling of anger
and frustration was reported with 12.1 % of the participants.

The most frequent cause of these feelings was the difficulty of taking care of
patients with BPD.

The majority of the participants (51.5%) reported avoiding working with them. However,
only 39.4% reported asking a colleague to replace them in their follow-up.

The results of Attitudes of health professionals towards people with BPD Scale
indicate that clinicians generally present a positive attitude towards patient BPD with a
mean score 94.94(SD=18.60)

Conclusions

Working with patients with BPD can be challenging. Professionals’ attitude can create
obstacles to effective communication and successful treatment.

Therefore, all clinicians should receive more specific training to be able to deal
with this condition.

Disclosure of Interest

None Declared
Challenges in the Borderline Personality Disorder diagnostic in clinical practice in community: results of a pilot study
Authors: Chumakov E. , Charnaia D. , Petrova N.
Published: August 2023

Introduction

Borderline personality disorder (BPD) has a significant presence in outpatient psychiatric practice worldwide, but data on the clinical features of patients with BPD in Russia are limited. Clinicians experience a number of difficulties in diagnosing BPD, which is also due to the high comorbidity of BPD with other mental disorders (affective, anxiety, other personality and addictive disorders).

Objectives

The aim of this pilot study was to investigate clinical characteristics of mental health care for patients с BPD in real clinical practice in community in Saint-Petersburg, Russia.

Methods

Fifty patients (72% female; n=36; mean age 22.4±4.3) who were treated in an outpatient community care were included in the study. Diagnosis was made according to the ICD-10 criteria (F60.31), as it does in clinical practice in Russia. Research methods included a clinical-catamnestic method.

Results

The age of onset of BPD symptoms was 14.9±2.7. It was found that 50% of patients had previously received inpatient (20%, n=10) and outpatient (30%, n=15) psychiatric care unrelated to the current mental condition, that is, not due to the BPD. 16% of patients (n=8) referred for the first time for psychiatric care in adolescence. The vast majority of patients (86%; n=43) were not diagnosed with BPD when they first consulted a psychiatrist. Prior to the diagnosis of BPD, patients were diagnosed with mental disorders due to organic brain injury (4%), affective disorders (44%), schizophrenia spectrum disorders (12%), anxiety disorders (20%) and other personality disorders (6%). On average, it took 7.5±4.0 years from the date of first psychiatric assessment before the diagnosis of BPD was confirmed. At the time of inclusion in the study, patients were diagnosed with the following comorbid mental health conditions: affective disorders (12%), anxiety disorders (6%), eating disorders (4%), and addictive disorders (2%).

Conclusions

The hypodiagnosis of BPD in the early stages of the disorder has been identified, making it challenging to obtain high quality mental health care in a timely manner. The frequent comorbidity between BPD and other mental disorders has been confirmed. The study demonstrates the relevance of introducing programs (including education) to improve the diagnosis and study of comorbidity of BPD in real clinical practice. The pilot study results provide the basis for a project to investigate approaches to differential diagnosis and evaluation of treatment strategies for patients with BPD.

Disclosure of Interest

None Declared
Mechanisms of the formation of psychological disadaptation in combatants with a distinction based on the signs of adjustment disorders and PTSD
Authors: Mykhaylov B. , Mishiev V. , Grinevich E. , Omeljanovich V. , Kudinova O.
Published: August 2023

Introduction

Contemporary for combatants with signs of adjustment disorders (AD) consists of “distorted” thoughts about the displacement of the value of one’s role, the loss of a certain significant position. This can be seen from the analysis of complaints about the feeling of anxiety, tension, asthenia, mood swings, lack of emotional regulation and the assessment of well-being criteria.

It is important to understand what is a preventer of maladjustment, and what is a predictor of the formation of psychological adaptation disturbances in combatants with a distinction based on the signs of AD and PTSD.

Objectives

Based on the analysis of violations of the psycho-emotional sphere, peculiarities of perception of the social environment, understanding of one’s role in traumatic events, and personal adaptation potential, predictors and preventers of violation of psychological adaptation among combatants are determined.

Methods

The clinical investigation based on psychiatric examination with the narrative motivation interview,psychological examination by Mississippi Scale for Combat-Related Posttraumatic Stress Disorder.

Results

The predictors of impaired psychological adaptation in combatants withAD: Low indicators of moral normativity, which structure thoughts and help in the interpretation and analysis of negative experienced events of a stressogenic level.Preventers of violation of psychological adaptation in combatants with AD:Communicative potential, which lies in the structure of personal adaptation potential. This indicator indicates the presence of a need in the social environment and opportunities for realization, that is, as a resource of the individual. The ability to receive from the social environment a sense of support, reinforcement of self-esteem, motivation for activity, determination of the goals of future projects. Predictors of impaired psychological adaptation in combatants with PTSD: Low communicative potential, which, under the significant influence of stressogenic factors, isolates from close social interaction and does not allow family members to influence the emotional state. Family support is diminished and perceived as a trigger for anger. Fixation on the intensity of emotional experiences, maintaining the tone of negative manifestations, as a form of receiving punishment. Keeping under control one’s values in the life system and an attempt to reorient oneself to the future.

Conclusions

Relying on preventers as the resource base of the personality of combatants and predictors as targets of psychocorrective intervention in the tasks of the medical and psychological rehabilitation program, algorithms for further psychocorrective intervention were determined.

Disclosure of Interest

None Declared
Caesarean section and post traumatic stress disorder
Authors: Chebli H. , Chtibi M. , Azraf F. , Laboudi F. , Ouanass A.
Published: August 2023

Introduction

Childbirth can be a very painful experience, especially vaginally. It can have many complications. The obstetrical complications of caesarean section are well studied but its psychological complications are little mentioned. Most women recover quickly after giving birth, but others seem to have more difficulty. Researchers have attempted to identify perinatal risk factors for the development of post-traumatic stress disorder in parturients and caesarean section seems to be one of the predictors.

Objectives

The objective of our study is to detect post traumatic stress disorder in women after vaginal delivery.

Methods

This is a cross-sectional descriptive study conducted among women from the general population who have given birth vaginally. The information was collected using a questionnaire distributed on social networks. Symptom severity was quantified using the PTSD checklist for DSM-V (PCL-5).PCL-5 is a 20-item self-assessment that measures the 20 DSM-5 symptoms of PTSD. She rates each symptom from 0 (not at all) to 4 (extremely). The score varies from 0 to 80. A threshold of 33 allows screening for post-traumatic stress disorder.

Results

61 women took part in this study, 81.5% of whom gave birth vaginally between the ages of 20 and 30.70.3% of the participants gave birth vaginally once, 44.4% twice and 7.3% of the women in our sample had a caesarean three times.Regarding the indication of the high way in our sample: the narrowing of the pelvis and fetal distress were in 22.2%. Exceeding term was in 18.5% of cases.In our sample, 59.3% of the women had planned their vaginal delivery and 40.7% had given birth urgently.Regarding the results of the PCL-5 scale (PTSD checklist for DSM-V), the score varies between 0 and 48 with a median score equal to 12. 3.7% of the participants had a score greater than 33.

Conclusions

Post-traumatic stress disorder can accompany childbirth, especially when it is high and in an emergency. Postpartum post traumatic stress disorder affects the mother-child relationship and can be complicated by depressive disorder. Medical monitoring of pregnancy, good medical and family support for the parturient and preparation for childbirth are necessary to better start the maternity experience.

Disclosure of Interest

None Declared
Knowledge Attitudes and Sense of Self-Efficacy of Primary Education Teachers towards Students with Insulin-Dependent Diabetes Mellitus
Authors: Detsis D. , Vlachou E. , Adamakidou T. , Zartaloudi A.
Published: August 2023

Introduction

The positive attitude towards students with Diabetes Mellitus type 1(DM1) and the teacher’s knowledge seem to be important conditions both for the practical support of children with type 1 ED in primary education and for the self-efficacy of teachers in the school context. Self-efficacy involves the belief that a person has the ability to create change through personal actions.

Objectives

To investigate the level of knowledge of Primary Education teachers about DM1, their attitudes towards students with insulin-dependent diabetes, as well as their levels of self-efficacy in the management of diabetes in the school environment.

Methods

This is a cross-sectional study, where the sample consisted of 150 teachers working in Public Primary Schools of Athens, the capital of Greece. The following questionnaires were used to collect the data: (a) socio-demographic characteristics questionnaire, (b) primary education teachers’ knowledge and attitudes questionnaire about insulin-dependent diabetes, and (c) the generalized self-efficacy scale.

Results

24.7% of participants were male and the mean age was 43.79 (±10.11). The average percentage of correct answers to the knowledge questionnaire was 86.00 (±9.01), also, the average score of perceptions about the role of the school nurse was 90.53 (±9.39), for the role of students with DM1 89.17 (±11.42), for the readiness of teachers/educational system to manage students with DM1 48.10 (±13.22), and of the self-efficacy was 30.71 (±13, 67). The questions with the lowest percentage of correct answers were: “What is the normal range of blood sugar values when we are fasting?” (62.70%) and “If you find a child with DM1 unconscious what should you do immediately?” (52.70%). The percentage of correct responses was found to have a positive statistically significant correlation with self-efficacy score (p=0.05), years of service (p=0.003), age (p=0.014), teachers who had at some point students with DM1 in their classroom versus those who did not (p=0.045).

Conclusions

Experienced and qualified staff could effectively support students not only practically by assisting them with daily activities but also by creating an environment based on understanding and acceptance.

Disclosure of Interest

None Declared
Appropriate Therapeutic Disclosures in Improving Client Engagement in Mental Health Management
Authors: Myers L.
Published: August 2023

Introduction

As psychiatrists, we are taught not to disclose and to present a blank canvas to the client

Should mental health professionals be reconsidering this stance if aiming to effectively manage their clients who live in a world that promotes vulnerability and lived experience as powerful therapeutic strategies?

Objectives

Promote mental health and remove the shame and stigma limiting client engagement by advocating for ‘real’ psychiatrists

Methods

-

Discuss therapeutic disclosure and its history

-

The impact of social media and current trends in mental health promotion

-

Suggestions for improving client engagement through reclaiming the expert role in mental health promotion and the value of sharing lived experience within professional boundaries. To

Results

-

Clients improve communication and openness

-

Mental health engagement promoted and encouraged

Conclusions

Clients respond favourably to psychiatrist vulnerability and authenticity with therapeutic disclosures

Disclosure of Interest

None Declared
Weight gain as a secondary effect of Olanzapine, and its interference in treatment adherence: a case report.
Authors: Setién Preciados P. , Arroyo Sánchez E.
Published: August 2023

Introduction

Olanzapine is a second generation antipsychotic that is approved for the treatment of schizophrenia, bipolar disorder type 1 as monotherapy, or as an add-on to lithium or valproate (manic or mixed episodes), and it is also used off label for acute anxiety, insomnia… It is one of the most effective antipsychotics but concerns remain due to its significant metabolic adverse effects. Olanzapine has one of the highest rates of weight gain among all antipsychotic drugs, which challenges patient’s adherence to treatment.

Objectives

Review how much influence Olanzapine has on weight gain, its influence in treatment adherence and alternatives in clinical practice.

Methods

Presentation of a patient’s case and review of existing literature, in regards to Olanzapine and its repercussions on weight gain and the old and new alternatives available right now.

Results

Olanzapine is an effective antipsychotic, however, it causes secondary effects that complicate treatment, especially weight gain. In the case presented, the patient does gain weight with Olanzapine and adherence is compromised. In these cases, professionals try to look for alternatives, either to try another drug or use adjunct treatment. In this patient, a change to lithium was made. In the last few years, adjunct treatment has gained traction, like for example: metformin and topiramate. The latest discovery in this matter are opioid antagonists: single dose oral tablet Olanzapine/samidorphan.

Conclusions

Even though Olanzapine is one of the most effective antipsychotics and medications in mental health, its impact on patients’ weight hinders treatment continuity. The use of other already known medications and the appearance of new ones, that reduce weight gain probability, are the possible ways forward.

Disclosure of Interest

None Declared
Quality Improvement Project - Initial survey of a new Mental Health of Intellectual
Disabilities Service established in Ireland in January 2022
Authors: Curtin A.-M. , Fitzgerald B.
Published: August 2023

Introduction

A new mental health service specialising in intellectual disabilities in Ireland was
set up in January 2022. Its current compliment of staff includes is a Consultant
Psychiatrist, Trainee Psychiatrist, Social Worker and Administrator. The current National
Directive in Ireland is to prioritize Mental Health of Intellectual Disabilities
services.

Objectives

The aim of the project is to establish the current baseline level of diagnostics and
interventions within the new service. Our aim is to develop this service by implementing and
following the gold standard guidelines and determine what extra resources does the service
need.

Methods

The first fifty case notes of patients assessed by the new service were inspected. The
reviewer looked for evidence of the following clinical descriptions:Diagnosis of Intellectual
Disabilities and its severity; Mental Capacity; Psychiatric Diagnoses; Physical health
diagnoses; Medications and evidence of a Positive Behavioural Support Plan to manage complex
challenging behaviours.

Results

The fifty patient audit contained 38 (76%) men and 12 (24% women) . One patient had
Mild Intellectual Disabilities (ID), 39 (78%) had Moderate ID and 10 (20%) had Severe ID. All
patents were very vulnerable and had limited or lacking Mental Capacity. Common diagnoses of
the following were recorded in the following numbers and percentages; - Autism diagnosis 30 (
60% ); Epilepsy 19 (38%); & Down Syndrome 9 (18%). A Formal Psychiatric diagnosis was
identified in 26 (52%) of patients. Challenging Behaviour (severe and complex) was identified
for 41 ( 82%) of the patients. The full breakdown of psychiatric diagnoses was ‘Psychotic
illness’ – 9 (18%); Anxiety – 7(14%); Bipolar Affective Disorder 5 (10%): Depression – 4(8%);
Attention Deficit Hyperactivity Disorder (ADHD) 3 (6%); Obsessive Compulsive Disorder (OCD) –
2(4%); Dementia – 2(4%): Post Traumatic Stress Disorder (PTSD) – 1 (2%); &
Schizoaffective Disorder 1(2%). A Positive Behavioural Support plan (PBS) was available to
support 33 (66%) of patients.

42 (84%) of patients were prescribed antipsychotic medication. 12 (24%) were
prescribed more than one antipsychotic. 20 (40%) were prescribed an antipsychotic without a
formally documented diagnosis of a psychotic disorder. 12 (24%).

Conclusions

The results of this first survey highlight areas in which the service can be
improved. The service has requested funding for a Community Nurse and a Psychologist.
Psychological evaluations and Positive Behavioural Support plans are essential for people
with complex challenging behaviours. A Community Nurse should assist with Health Promotion
and help supervise patients requiring Depot Antipsychotic medication or Clozapine. We also
plan to set up a joint clinic with the Consultant Neurologist on a regular basis.

Disclosure of Interest

None Declared
Do we have an “anti-stigmotic”? – Addressing Mental-Illness Related Stigma as the main issue
Authors: Cabaços C. , Andrade J. , Pocinho F. , Carneiro M. , Santos G. , Loureiro D. , Macedo A.
Published: August 2023

Introduction

For people with mental illness, internalized stigma, also referred to as self-stigma, is characterized by a subjective perception of devaluation, marginalization, secrecy, shame, and withdrawal. It has many adverse effects on individual’s psychological well-being and clinical outcomes. The iatrogenic effects it has during psychotherapeutic treatment can significantly reduce utilization of mental health care services, reduce quality of life and increase avoidant coping. Overall, internalized stigma is considered a risk factor for poorer mental health prognosis. Although some interventions have recently been developed to specifically intervene on this target as part of psychological recovery goals over the course of treatment, most clinicians are not yet aware or empowered to correctly address this.

Objectives

Description of a clinical case illustrating the relevance on addressing internalized mental illness related stigma during the recovery process.

Methods

Clinical case report and review of the literature on the subject.

Results

We present the case of a 47-year-old female patient, C.S., single, graduated in social work (currently unemployed), who was admitted at the Psychiatry Day Hospital, where she was referred by her Psychiatry Assistant because of abulia, social withdrawal and isolation, depressed mood, thoughts of shame, guilt and self-devaluation and work incapacity. She had been admitted in the Psychiatry ward one year earlier for a first psychotic breakthrough, presenting persecutory and grandiose delusions and auditory hallucinations. After three weeks of inpatient treatment with antipsychotics, a full remission of the symptoms was achieved, without any posterior relapse. Before that first psychotic episode, the patient had been taking anti-depressive medication (escitalopram 20 mg id) for many years, prescribed by her General Practitioner, for mild to moderate depressive symptoms. After being discharged from the Psychiatry ward, C. kept following an outpatient treatment with anti-depressives and behavioural activation-based psychotherapy. She started to believe she was mentally ill and therefore weak, uncapable, and less deserving than her peers or her previous self. These self-stigmatizing ideas were enhanced by the lack of family support and the beliefs that were fostered by her mother, with whom she started to live after the hospitalization. These factors led to a dysfunctional internalization of an illness behaviour, jeopardizing the patient’s ability to reach full recovery.

Conclusions

This case reinforces the importance of targeting mental illness related stigma during the recovery process. Also, involving the family is of extreme importance to achieve support and address shared beliefs and the interchange between social and internalized stigma.

Disclosure of Interest

None Declared
Evaluation of the effectiveness of psychosocial treatment of patients with schizophrenia at different stages of its rendering
Authors: Mitikhin V. , Tiumenkova G. ?. , Solokhina T. , Alieva L.
Published: August 2023

Introduction

Currently, there is an active introduction of modern types of psychosocial treatment (PST). At the same time, an important direction is the evaluation of the effectiveness of PST, the identification of factors affecting it, which determines the urgency of research in this area.

Objectives

To evaluate the effectiveness of psychosocial treatment of patients with schizophrenia at different stages of psychiatric care; to build regression models to identify factors that influence the effectiveness of psychosocial treatment.

Methods

Clinical and psychopathological, statistical, as well as a battery of tests: PANSS, CGI; Drug Attitude Inventory (DAI, Hogan T.P. et al., 1983); Insight Scale for Psychosis (ISP, Birchwood M., 1994); «SF-36 Health Status Survey» (SF-36, Ware J.E. et al., 1993); URICA (McConnaughy E.A. et al., 1983); The Social Adjustment Scale-Self (SAS-SR, Weissman M, Bothwell S.,1976); PSP (Morosini P.L. et al., 2000) and a number of other scales. 90 patients with schizophrenia in the community, inpatient department of psychiatric hospital, day hospital participated in the basic PST program, which included psychoeducation, motivational training, social and cognitive skills training. At each stage, PST was received by 30 patients who did not differ significantly in age and other socio-demographic characteristics, but were characterized by different quality of remission, the duration of the PST program was 3 months. The assessment of the patients’ condition was carried out before and after the rehabilitation program.

Results

A significant improvement in the indicators on the PANSS scale was found in patients of all three groups, as evidenced by a reduction of more than 10 points in the total score of the scale. As a result of the PST program, patients of all three groups have improved to varying degrees their awareness of the disease understanding of the need for drug treatment, increased motivation, and have shown a tendency to improve a number of cognitive functions. The participants of the program demonstrated an increase in the level of activity and purposefulness of activity, as well as the ability to master new social skills and implement them. Correlation and regression analysis, during which more than 100 factors were studied, allowed us to identify the most significant factors that positively or negatively affected the effectiveness of PST: severity of the condition, duration of illness, age of onset of the disease, age of referral to the service, number of hospitalizations, type of remission, observation group, level of education, marital status, family support, family relationships, having friends, having income.

Conclusions

The effectiveness of the basic PST program has been shown. However, the work on evaluating the effectiveness of the PST should be continued, especially for the development of information criteria and a tool for its evaluation.

Disclosure of Interest

None Declared
Parasuicidal behavior in early stages of psychosis
Authors: Serván Rendón-Luna B. , Montes Montero A. , Gómez Merino P.
Published: August 2023

Introduction

Psychotic experiences (PE) are strongly associated with non-suicidal self-harm (NSA). NSA are present throughout life, but are more frequent during adolescence and young adulthood. Early psychotic episodes (PEP) are a particularly vulnerable group compared to later phases of psychosis psychosis.

Objectives

Analyze risk factors for suicide attempts and NSA, in order to improve early detection and prevention of suicides in adolescents and young adults with PD

Methods

Review in the literature of the different risk factors associated with parasuicidal behaviors in early psychosis

Results

•

Presence of positive psychotic symptoms: auditory hallucinations, Delusional ideation.

•

Social isolation

•

Longer duration of untreated psychosis.

•

Comorbid symptoms: irritability, depression, anxiety, psychotic distress, insomnia.

•

Traumatic events in childhood

•

Difficulty in regulating emotional, impulsivity and sensitivity to reward.

•

Consumption of substances.

•

Psychosocial stress.

Conclusions

We consider essential the inclusion of early intervention programs aimed at the prevention of suicide and NSA, evaluating all risk factors for suicide and NSA among individuals with a PEP and high-risk mental states.

Initial assessment and ongoing assessments of suicide risk and parasuicidal behaviors, positive psychotic symptoms, depression, and the other related risk factors mentioned are required. Integrating trauma management into PEP care is critical.

Bibliography:

1.- Honings S, et al. Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and meta-analysis. Psychol Med. 2016;46(02):237–51. doi: 10.1017/S0033291715001841

2.- Honings S, et al. Psychotic experiences and incident suicidal ideation and behaviour: Disentangling the longitudinal associations from connected psychopathology. Psychiatry Res. 2016;245:267–75. doi: 10.1016/j.psychres.2016.08.002

3.- Nishida A, et al. Risk for suicidal problems in poor-help-seeking adolescents with psychotic-like experiences: Findings from a cross-sectional survey of 16,131 adolescents. Schizphr Res. 2014;159(2–3):257–62. doi: 10.1016/j.schres.2014.09.030 39.

Disclosure of Interest

None Declared
Anxiety and depression in natural caregivers of patients with schizophrenia
Authors: Znaidi F. , Ellouze S. , Ghachem R.
Published: August 2023

Introduction

Natural caregivers of patients with schizophrenia constitute a main source of care as they have to shoulder a multitude of caregiving responsibilities and are then confronted with considerable difficulties while providing care. As a result, natural caregivers, often described as “the hidden patients” usually suffer from psychological consequences such as anxiety and depression.

Objectives

This study aimed to asses anxiety and depression among natural caregivers of patients with schizophrenia and to identify risk factors for developing such disorders.

Methods

We conducted a cross-sectional, descriptive and analytical study, including 80 natural caregivers of patients with schizophrenia. We used the Hospital Anxiety and Depression Scale (HADS) to evaluate anxiety and depression.

Results

The typical caregiver profile was consistent with a 55-year old married illiterate first degree relative (mostly parents or spouses) with a low socio-economic level.

The mean anxiety score was 10.6± 5,1 and the mean depression score was 11.6± 6.2. Depression and anxiety were diagnosed in 66% of caregivers.

Anxiety and depression scores were significantly higher among female illiterate unemployed caregivers, those with organic history and among parents and correlated with the caregiving duration.

Anxiety scores were higher when patients in charge had poor therapeutic adherence and aggressive behavior and correlated with the age of caregivers and the number of other sick persons in charge.

Caregivers reported higher levels of depression when patients in charge were not married, unemployed and had a history of suicide attempts.

Anxiety score were significantly correlated with depression scores.

Conclusions

Caregivers of patients with schizophrenia, although thought to be a privileged source of emotional and social support, are hardly taken into account following the deinstitutionalization movement.

Disclosure of Interest

None Declared
Acute psychosis with compulsive behaviour caused by hypothyroidism: a case report
Authors: Ilgen Erdem I. , Alioglu Karayilan F. , Kalay Demirci B.
Published: August 2023

Introduction

Hypothyroidism is a common problem in clinical practice which can be seen with diverse psychiatric manifestations.

Objectives

Here we report a case of psychosis with compulsive behavior in a 46-year-old man who had no previous history of psychiatric disorder was brought to the emergency department by his family.

Methods

During his evaluation, he described visual and auditory hallucinations. In addition, it was observed that dermatitis developed on her hands and around his mouth due to compulsive washing behavior. It was learned that he was diagnosed with hypothyroidism 2 months ago but he was not taking his medication. He was admitted inpatient clinic for 39 days and consulted to an endocrinologist. Inpatient treatment was initiated with haloperidol 10mg PO and levothyroxine. Given the persistence of irregular intake, it was decided to switch to haloperidol long-acting treatment.

Results

After only requiring both antipsychotic drugs and thyroxine replacement our patient showed progressive clinical recovery attaining full remission within 5 weeks.

Conclusions

It was clear that physicians should be aware of the possible different manifestations of endocrinologic disorders. All patients presenting with a first episode psychosis and compulsive behavior should be screened for thyroid dysfunction

Disclosure of Interest

None Declared
How sexuality is affected and managed in patients under antipsychotic drugs
Authors: Ribeirinho Soares F. , Mesquita B. , Fraga A. M. , Albuquerque M. , Facucho J. O. , Santos P. E. , Sousa D. E. , Moura N. , Cintra P.
Published: August 2023

Introduction

Sexual dysfunction (SD) is a prevalent side effect of antipsychotic drugs (AP), and it impairs patients’ quality of life. Because of the distress caused by it, it should be borne in mind when prescribed since it is responsible for treatment nonadherence or discontinuation. SD affects about 45- 80% of males and 30-80% of females that take it. In SD, all phases of the sexual response cycle may be compromised.

Objectives

This non-systematic review of the literature aims to better understand the antipsychotic-induced SD and its management to better compliance of AP-treated patients without compromising their quality of life.

Methods

A semi-structured review on PubMed linking SD as a side effect of AP drugs.

Results

All AP drugs can cause SD. It seems related to their mechanism of activity at receptors D2, 5-HT2, α1, H1, and M, which are also involved in sexual function. They do it by diminishing arousal, decreasing libido by blocking motivation and reward system and orgasm indirectly, provoking erectile dysfunction by vasodilatation, and decreasing woman lubrification. Hyperprolactinemia is a significant cause of sexual dysfunctions. Haloperidol, Risperidone, and Amisulpride (prolactin elevating AP) are more likely to cause SD than Olanzapine, Clozapine, Quetiapine, and Aripiprazole (prolactin sparing AP). Although psychotic disorders (Schizophrenia and other psychotic disorders) can impact sexual functioning, according to evidence, there is no denying the role of AP in this issue. Aripiprazole, a D2 partial agonist, has been associated with lower rates of SD and seems to reduce the rates of SD in patients previously treated with other AP. Other AP with the same potential dopamine agonist activity, such as Cariprazine and Brexpiprazole, can probably have the same effect. The management of SD induced by AP drugs should include measuring serum prolactin and modifying risk factors like hypertension, smoking, hyperglycemia, and hypercholesterolemia. In that regard, waiting for spontaneous remission, reducing the dose of the AP prescribed, or switching to Aripiprazole are all viable strategies, if possible. Although the evidence supporting the addition of symptomatic therapies is weak, adding dopaminergic drugs (amantadine, bromocriptine, cabergoline) or drugs with specific effects on sexual functioning (such as phosphodiesterase inhibitors or yohimbine) may be helpful in selected cases.

Conclusions

Although all AP drugs can cause sexual dysfunction, it is difficult to determine its true prevalence accurately. AP-induced sexual dysfunction can adversely affect compliance and is one of the factors that must be considered when selecting treatment. In summarizing, Aripiprazole has shown to be the AP with the most favorable profile concerning SD. Cariprazine and Brexpiprazole, being also D2 partial agonists, may cause less SD.

Disclosure of Interest

None Declared
Aggressive behavior in patients hospitalised for a psychotic relapse
Authors: Bouguerra I. , Khelifa E. , Abaza H. , Ben Othman F. , Adouni A. , Ben Ammar H. , Mnif L.
Published: August 2023

Introduction

Patients in psychotic relapse may exhibit violent behavior towards objects, themselves or others. These behaviors, although usually unconscious, are a common reason for hospitalization and a source of rejection and stigmatization by family and society.

Objectives

The objective of this study was to evaluate the presence of aggressive behavior in relapsed inpatients with schizophrenia in the F psychiatry department at the Razi Hospital in Tunisia.

Methods

This was a descriptive, cross-sectional study of fifty male patients hospitalized for a psychotic relapse who were naïve or discontinuing treatment for at least two months. Patients were assessed using a semi-structured questionnaire and the Overt Aggression Scale (OAS).

Results

The age of the patients included ranged from 17 to 65 years, with an average of 36.4±11.51 years. More than half of the patients were without occupation (58%, N= 29). For personnal history : Seven patients (14%) had attempted suicide ; Eight patients (16%) showed evidence of self-harm ; Thirteen patients (26%) had a history of arrests of which eleven (22%) were incarcerated.The OAS score ranged from to 0 to 35 with a mean at 9.7+/- 10.3. Twenty-seven patients were aggressive (54%).

Conclusions

Preventive strategies should focus more on predicting the aggressive potential of patients with schizophrenia and its socio-professional implication. Perhaps when using a less holistic approach to the disease and when approaching aggressive behavior as a symptom in its own right, we will be able to find other alternative options.

Disclosure of Interest

None Declared
The relation between electroconvulsive therapy and dopamine
Authors: Ciobanu C. A. , Ionescu L. , Geafer L.-M. , Niculae C.-P. , Ciobanu A.-M.
Published: August 2023

Introduction

The use of electroconvulsive therapy (ECT) as a treatment for psychotic disorders is well-documented and effective. Despite the fact that ECT is often used, the precise neurobiological mechanisms supporting its effectiveness are still incompletely understood. Over the pastyears, extensive research on primates, rodents, and humans has begun to clarify the effects of electroconvulsive seizures (ECS) and ECT on neurotransmission systems such the dopaminergic system.

Objectives

The aim of this paper is to search evidence in the literature regarding the effects of ECT on the dopamine system.

Methods

In order to write this article, we searched for information in the most important scientific articles from the Google Scholar and Pubmed databases regarding the effects of ECT on the dopaminergic system.

Results

ECT and electroconvulsive shock are linked to enhanced dopamine release and dopamine receptor modification. Human studies show that ECT activates the dopamine system. In a study by Rudorfer et al., it was discovered that ECT increased the amount of homovanillic acid (HVA), a marker of dopamine turnover, in the cerebrospinal fluid (CRF). One important study indicates that monkeys given a brief clinical course of ECT (six sessions only) exhibit significant changes in dopaminergic presynaptic neurotransmission, with baseline function returning to quadratic (‘inverted U’ shape) by six weeks of the last ECT treatment. According to single-unit electrophysiological methods, repeated electroconvulsive shock to rats causes a subsensitivity of dopamine autoreceptors in the substantia nigra. Since effects identical to those reported with repeated treatment were also detected when a single electroconvulsive shock was followed by an acceptable treatment-free interval, this decreased sensitivity is time-dependent.

Conclusions

The results support the idea that ECT boosts the dopamine system and can be an effective strategy in the management of psychotic disorders.

Disclosure of Interest

None Declared
I don’t know where I’m going or where I come from. Self-disorders in schizophrenia.
Authors: Vallecillo Adame M. D. C. , Rodríguez Andrés L. , de Andrés Lobo C. , Jimenez Aparicio T. , Queipo de Llano de la Viuda M. , Guerra Valera G. , Gonzaga Ramirez A. A. , Fernández Lozano M. , Mateos Sexmero M. J. , Navarro Barriga N. , Rodríguez Rodríguez B. , Pando Fernández M. P. , Calvo Valcárcel M. , Martínez Gimeno P. , Andreo Vidal M. A. , Santos Carrasco I. D. L. M.
Published: August 2023

Introduction

In the early stages of schizophrenia the person experiences feelings of strangeness about themselves, difficulty in making sense of things and difficulty in interacting with their environment. Based on this, self-disorder assessment instruments have been developed and empirical studies have been conducted to assess people at risk of developing a schizophrenia spectrum disorder. These studies show that self-disorders are found in pre-psychotic stages and that their manifestation can predict the transition to schizophrenia spectrum disorders.

Objectives

We present the case of a patient with multiple diagnoses and mainly dissociative symptoms who, after years of evolution, was diagnosed with schizophrenia.

Methods

Bibliographic review including the latest articles in Pubmed about self-disorders and schizophrenia.

Results

We present the clinical case of a 51-year-old woman with a long history of follow-up in mental health consultations and with multiple hospital admissions to the psychiatric unit, with several diagnoses including: dissociative disorder, histrionic personality disorder, adaptive disorder unspecified psychotic disorder and, finally, schizophrenia. The patient during the first hospital admissions showed a clinical picture of intense anxiety, disorientation and claiming to be a different person. The patient related these episodes to stressors she had experienced, and they improved markedly after a short period of hospital admission. Later, psychotic symptoms appeared in the form of auditory and visual hallucinations and delusional ideation, mainly of harm, so that after several years of follow-up and study in mental health consultations and in the psychiatric day hospital, she was diagnosed with schizophrenia and treatment with antipsychotics was introduced, with a marked clinical improvement being observed.

Conclusions

It is important to take into account this type of symptoms (self-disorders), as they allow the identification of individuals in the early stages of the disorder and create the opportunity for early therapeutic interventions.

Disclosure of Interest

None Declared
EXPERIENCE OF PHARMACOGENETIC TESTING IN THE TREATMENT OF ANTIPSYCHOTICS
Authors: Kaydan M. , Zakharova N.
Published: August 2023

Introduction

One of the promising methods for optimizing treatment in order to achieve high-quality remissions is a personalized approach to prescribing therapy in the form of pharmacogenetic testing, the feasibility of which has already been substantiated and proven in a number of clinical guidelines. By the beginning of 2022, several influential regulatory and expert organizations recommend considering the results of genetic testing when prescribing therapy. Thus, personalization of antipsychotic therapy is being introduced in the world practice.

Objectives

To establish the significance of pharmacogenetic markers that determine the efficacy and safety of antipsychotic therapy in patients with schizophrenia in clinical practice.

Methods

The study included 264 patients (141 men, 123 women; 27.3 ± 4.5 years) from among the first hospitalized in a psychiatric hospital in the period 2018-2020, meeting the inclusion criteria (psychosis within the schizophrenia spectrum disorders; consent to participate in research). Non-inclusion criteria - signs of organic brain damage; alcohol or substance abuse; somatic pathology in the stage of decompensation). The examination took place in three stages - in the first days of hospitalization at the peak of the acute condition and during the formation of remission - after 6 and 12 months. Genetic analysis was performed using high-density biochips from Illumina CoreExome Bead (Illumina Inc, USA). During the follow-up observation, some patients dropped out due to refusal to undergo examination, change of diagnosis or change of place of residence. After 6 and 12 months, it was possible to trace the dynamics of the state of 91 patients (50 men, 41 women; 24.9 ± 4.6 years).

Results

Based on the follow-up results, two types of schizophrenia dynamics were identified - with a relatively favorable and unfavorable course. The formation of a relatively stable remission corresponding to the criteria proposed by the working group was noted in 47 patients (51.6%), carriers of gene polymorphisms: DRD2 rs1799732 (del); COMT rs4680(GG); BDNF rs6265 (CC); ANKK1 rs1800497 (GG); MC4R rs489693 (AA); ABCB1 rs1045642 and ABCC1 rs212090 (GG). An unfavorable course with the ineffectiveness of antipsychotics was found in 48.4% of cases in patients with DRD2 rs1799732 (G/del) carriers; COMT rs4680(AA); BDNF rs6265 (TT); ANKK1 rs1800497 (AA); MC4R rs489693 (GG); ABCB1 rs1045642 and ABCC1 rs212090 (AA).

Conclusions

After analyzing the results of genetic testing and clinical and dynamic characteristics of the course of schizophrenia, we can talk about the relationship between the establishment of high-quality remission in the presence of polymorphisms in the genotype, whose role has been proven in terms of the effectiveness and safety of antipsychotics.

Disclosure of Interest

None Declared