bluuebunny/crossref_metadata_2025 huggingface dataset:
Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT): A Review
Authors: Fernandes Santos C. , Gomes R.
Published: September 2022

Introduction

Lithium has a narrow therapeutic window. Frequent monitoring of both serum levels and clinical signs of toxicity is warranted because toxicity may be present even when concentrations are within the therapeutic range. Persistent neurological signs and symptoms of lithium intoxication gained clinical attention in the 1980s and were named Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT).

Objectives

To review the long-term neurological sequelae of lithium intoxication (SILENT) to highlight their clinical presentation, assessment, management and preventive measures.

Methods

Non-systematic review of literature through search on PubMed/MEDLINE for publications up to 2021, following the terms syndrome of irreversible lithium-effectuated neurotoxicity.

Results

Neurological manifestations of lithium poisoning may persist, even after effective removal of the drug – SILENT. The most frequent sequelae are cerebellum and brain stem dysfunction, extrapyramidal symptoms and dementia. They may last for weeks, months or years. Infection, dehydration, deteriorating renal function or the addition of other drugs may precipitate acute toxicity. Irreversible damage is difficult to treat. Some cases show spontaneous recovery that may be total, but in others, sequelae persist. Helpful measures include the avoidance of acute intoxications with lithium, long-term and continuous dose adjustment and serum level monitoring, stricter exclusion criteria for starting lithium, and aggressive treatment of acute neurotoxicity. Once the long-term neurologic sequelae have set in, the patient should be managed according to the impediment (physical rehabilitation, speech, cognitive training).

Conclusions

It is important to raise the awareness of SILENT so that clinicians are able to avoid it. There should be a low threshold for suspecting the existence of toxicity.

Disclosure

No significant relationships.
A case of trazodone induced prolonged hypogeusia
Authors: Tekdemir R. , Kandeğer A.
Published: September 2022

Introduction

Plenty of antidepressants have been reported to induce unpleasant tastes and/or odors as well as altered chemosensations when administered alone or in combination with other medications. Trazodone induced hypogeusia (decreased taste sensation) is a rare side effect. In this report, we would like to present a male patient with with hypogeusia after trazodona use and persisting for 3 months after the drug was discontinued will be discussed.

Objectives

A 52-year-old male, Trazodone 50 mg/day was started 4 months ago due to difficulty in falling asleep. On the 25th day of her daily treatment, her sense of taste began to decrease and gradually became more severe. So he stopped his treatment and he applied to the internal medicine and neurology polyclinics. Routine blood tests were within normal limits. To rule out the possibility of covid 19, 2 pcr tests were done and it was found negative. No recommendations other than chewing gum. The patient applied to the psychiatry polyclinic with the complaint of decreased taste sensation that in the 3rd month of his complaints.

Methods

CASE REPORT

Results

CASE REPORT

Conclusions

Chemosensory side effects due to drugs are frequently seen in the elderly and in polypharmacy. It is usually accompanied by a decrease in salivary secretion. It resolves shortly after the causative drug(s) are stopped. It is important that our patient is middle-aged, does not have additional medical diseases and does not use drugs, and his complaints continue for 3 months after the stopped of Trazodone.

Disclosure

No significant relationships.
Management of Emotional Dysregulation in Adult ADHD
Authors: Tavares F. , Viseu M. , Barbosa Pinto M. , Solana C.
Published: September 2022

Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by impairing symptoms of inattention and/or hyperactivity/impulsivity. Although Emotional Dysregulation (ED) is not current criteria for ADHD, several clinical, imaging and genetic studies have been suggesting its inclusion. ED seems to impair social and occupational capacities, leading to poor quality life. In this regard, managing this situation is fundamental.

Objectives

ED in ADHD review and its management, including pharmacological and nonpharmacological approaches.

Methods

Non-systematic review through literature using databases as Pubmed and UpToDate. Keywords used: Attention-Deficit/Hyperactivity Disorder, Emotional Dysregulation, management, pharmacotherapy.

Results

Literature refers to ADHD drugs, such as psychostimulants and atomoxetine, as the first line managing ED. However, some studies demonstrated that ADHD drugs have lower efficacy while treating emotional symptoms, when compared to attention or hyperactivity/impulsivity symptom control. Other medications, such as antidepressants or mood stabilizers, are not considered due to low efficacy and side effects (such as irritability or suicidality behaviour worsening). Regarding non pharmacological approaches, there have been results with cognitive behavioral treatment, and management techniques for anger, frustration and communication skills.

Conclusions

Although the majority of studies demonstrate psychostimulants and atomoxetine role, there is an important lack of information regarding management of ADHD emotional dysregulation. It is a multifactorial condition, and, as such, non pharmacological and pharmacological management are needed to address this issue. More research is necessary, in order to improve patients’ quality of life.

Disclosure

No significant relationships.
Ischemic colitis related to antipsychotics : A rare and serious entity to know
Authors: Moalla M. , Moalla M. , Boudabous M. , Tahri N.
Published: September 2022

Introduction

Ischemic colitis is a rare condition. It represents 3 to 10% of lower digestive hemorrhages. It preferentially affects the subject over the age of 50 with predisposing factors. Rare cases have been reported in young subjects with the use of cocaine, combined hormones or antipsychotics.

Objectives

This work aimed to study the potential side effects of antipsychotics

Methods

We report a case of ischemic colitis associated with antipsychotics.

Results

A 27-year-old patient, followed for 2 years for schizophrenia treated with antipsychotics (chlorpromazine and haloperidol) and an antiparkinsonian (Biperiden), consulted in the emergency room for rectorragies progressing for 3 days. The examination revealed the installation of diffuse abdominal pain associated with early postprandial vomiting which preceded the 7-day rectal bleeding. The physical examination revealed ascites without edema of the lower extremities. The stools were normal-colored on digital rectal examination. The biological workup revealed anemia and a biological inflammatory syndrome. The abdomino-pelvic scanner showed thickening of the entire colonic wall with signs of recent bleeding. The rectosigmoidoscopy showed an ecchymotic aspect of the sigmoid with less pronounced involvement of the rectum. Pathologic examination of the colonic biopsies concluded with ischemic colitis, showing hemorrhagic suffisions with numerous fibrinous thrombi of the vessels. The course was marked by the onset of multi-organ failure with acute renal failure, a picture of disseminated intravascular coagulation (DIC) and alveolar hemorrhage. Despite the resuscitation, the patient died 2 days after admission.

Conclusions

Ischemic colitis is a rare side effect of antipsychotics. Although rare, this entity should be evoked and diagnosed in time.

Disclosure

No significant relationships.
Valproate-induced hypothyroidism in schizoaffective disorder
Authors: Facucho-Oliveira J. , Espada-Santos P. , Fraga A. , Moura N. , Laginhas C.
Published: September 2022

Introduction

Valproate is widely used in the treatment of maniac and mixed episodes and is well known to be safe with side effects being mostly related to hepatic disorders and psychomotor retardation.

Objectives

Raising attention to valproate-induced hypothyroidism that despite the increasing evidence tends to be neglected.

Methods

Here, we report a case of a 55-year-old woman, with a previous diagnosis of schizophrenia, treated for many years with 200mg of zuclopenthixol triweekly and 2mg of risperidone daily. Patient developed a maniac episode characterized by elevated mood, sense of grandiosity, increased energy and psychomotor activity, disinhibition and insomnia. No laboratory abnormalities were detected and inpatient treatment was initiated with paliperidone up to 12mg/day and valproate 1000mg/day.

Results

Patient showed progressive clinical recovery attaining full remission within 2 weeks. Despite the absence of clinical side effects and the valproate serum levels of 74.9μg/mL (range 50–100μg/mL), laboratory testing found progressive reduction F-T4 down to 0.45ng/dL (range 0.8–1.5 ng/dL) and a concomitant upregulation of TSH to 73.99mUI/L (range 0.55–4.8mUI/L). Thyroid autoantibodies and thyroid echography were negative. Considering that patient was previously medicated with risperidone, it was suspected that her hypothyroidism was caused by valproate. Normalization of thyroid function was observed after 21 days valproate withdrawal. Patient is currently being treated with 150 mg paliperidone (monthly) with no recurrence of mood or psychotic episodes and maintain normal thyroid function.

Conclusions

Our case emphasizes the need for extended laboratory testing upon prescription of new pharmacological medications as severe analytic alterations can take place in the absence of immediate clinical manifestation.

Disclosure

No significant relationships.
Alternative starting regimen with aripiprazole long-acting treatments, a case report
Authors: Huete Naval M. , Serván B. , Expósito Durán M.E. , Albarracin P. , Herrero Pellón E. , Galerón R.
Published: September 2022

Introduction

Aripiprazole long-acting treatments can significantly control symptom, improve adherence and reduce the risk of relapse compared to oral drugs. An alternative start-up guideline has recently been approved in several countries that simplifies its administration.

Objectives

To present a case report of a patient with schizophrenia treated with alternative starting regimen of aripiprazole long-acting treatment.

Methods

Presentation of a clinical case supported by a non-systematic review of literature.

Results

We present the case of a 22-year-old patient diagnosed with schizophrenia, whose symptoms started after the birth of her son, 2 years ago. She has presented a poor clinical evolution, requiring several admissions to our inpatient service after discontinuation of her medication. The patient has taken different antipsychotics, including olanzapine and paliperidone long-acting treatment, which were suspended due to side effects (weight gain and increased prolactin levels). A switch to oral aripiprazole 20mg was made, which showed good response and tolerance. Given the persistence of irregular intake, it was decided to switch to aripiprazole long-acting treatment, applying an alternative initial regime consisting of two doses of aripiprazole long-acting treatments 400mg and one oral aripiprazole 20mg. The patient has since had no delusions or hallucinations and is living independently at home.

Conclusions

The administration of a simplified initial regime with aripiprazole long-acting treatments could improve therapeutic adherence while maintaining the same effectiveness and similar side effects.

Disclosure

No significant relationships.
“Setting up and Tailoring Early Intervention Teams in a Already Established Healthcare System: the Experience of the Greater Lyon”
Authors: Haesebaert F. , Franck N. , Haesebaert J.
Published: September 2022

The implementation of early intervention services (EIS) dedicated to first episode psychosis (FEP) remains a challenge in France. In 2016, the London School of Economics published a report in which France appeared as a poorly developed country in terms of early intervention services. Since the 1980s, the French psychiatric “sectorization” system offers access to general psychiatric care with a graduated intensity (outpatient consultations, day hospitalization, full time hospitalization) targeting territories (“sectors”) of approximately 70,000 inhabitants. While this system has advantages in terms of universal access to care, it leaves little room for specialized services. The Greater Lyon agglomeration (2.4 million inhabitants) is composed of several psychiatric sectors administered by 3 psychiatric hospitals and a psychiatric emergency system administered by a University Hospital. Since 2018, various hospital and university stakeholders, patient associations and international partners, have been working together to tailor, set up and organize a care system for FEP patients. We present here how we have federated workforce resources initially working within 11 general psychiatric “sectors” and covering a population of 850,000 inhabitants. A 3-step process of (1) field analysis, (2) the creation of a community of practice composed of healthcare workers, researchers and service users, and (3) confrontation of the already existing healthcare with the logic of “principal components” for FEP care, allowed the creation of the outpatient “PEPS” service, which now offers continuous case management, a functional recovery program and new pathways to care to more than 200 patients with a diagnosis of first episode psychosis.

Disclosure

No significant relationships.
Mydriasis caused by ESCITALOPRAM: Case report
Authors: Bouattour N. , Bouattour W. , Messedi N. , Charfeddine F. , Aribi L. , Aloulou J.
Published: September 2022

Introduction

Serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants thanks to the overall safety and tolerability spectrum. However, they can cause different side effects that not all of them are well identified.

Objectives

We intend to clarify the clinical presentation of mydriasis caused by Escitalopram.

Methods

Reporting the case of a patient suffering a major depressive disorder, that presented a mydriasis after adjusting her antidepressant medication. Then, we conducted a literature review using “PubMed” database and keywords “Mydriasis”, “escitalopram”, “SSRI”,” side effects”.

Results

A 29-year-old female with no past clinical history, presented in May 2021 a severe depression requiring an antidepressant treatment. Under 10 mg per day of escitalopram there was a partial remission of the symptoms, leading to increase the dose by another 10 mg. One month after taking 20 mg/day, she consults before the appointment suffering from a blurry vision and photophobia. Ophthalmologic examination showed a bilateral reactive half-mydriasis, eye pressure was 14 mmHg and fundus examination was normal. Iatrogenic origin of mydriasis was suspected. A gradual interruption of the medication lead to disappearance of the latter. A pharmacological investigation concluded to the suspension of escitalopram and to be vigilant if antidepressant medication would be needed.

Conclusions

Mydriasis is an uncommon side effect caused by SSRI that needs to be kept in mind by clinicians. Therapeutic patient education can help to detect abnormal side effects and treat them if needed.

Disclosure

No significant relationships.
Clinical experience with the new double aripiprazole depot regime in a psychiatric hospitalization unit
Authors: Moleón Ruiz Á. , Tenorio Villegas R. , Gómez Rebollo A.
Published: September 2022

Introduction

Nowadays, relapses are typical in patients with schizophrenia and may have serious implications due to most of them are caused by a lack of adherence to treatment.Therefore, numerous long-acting injectable antipsychotics (LAI) have been developed as aripiprazole depot who need a proper oral supplementation. Since November 2020, FDA approved a new treatment indication with a double injection start and a single dose of 20mg of oral aripiprazole, with the aim of avoiding oral supplementation during the next 14 days.

Objectives

The purpose of our study is to expose our experience with the new double injection start with aripiprazole LAI, regarding the rehospitalization rate.

Methods

A prospective study (n=17 patients) has been developed between November 2020 and October 2021 with the purpose of studying the rehospitalization and antipsychotic adherence after the new guideline of aripiprazole

Results

After an 11-month-follow-up, it is noticed a 65% non-rehospitalization rate and a 76% proper treatment persistence rate. The 94% did not present any kind of side effects, only one patient had a case report of bullous pemphigoid. Regarding the concomitant use of other antipsychotics, 82% of the patients remained in monotherapia. The average stay time was shortened (11 days) regarding the standard dose (14 days).

Conclusions

The new LAI regimen is well tolerated in our patients obtaining a high treatment persistence after several months of hospital discharge. It was already possible to shorten the time of rehospitalization, not having to add oral aripiprazole for 14 days. Most patients were discharged are on antipsychotic monotherapy and have not been rehospitalized in the short term.

Disclosure

No significant relationships.
Drug-induced liver injury in association with antipsychotics
Authors: Zeiss R. , Gahr M.
Published: September 2022

Introduction

Drug-induced liver injury is one of the leading causes for acute liver failure and drug withdrawal after marketing approval. One important risk factor is the extent of exposure of the hepatocytes to a substance, either by high doses or by long-term medication. In many psychiatric diseases, like schizophrenia long-term use of drugs is common. However, systematic data on the hepatotoxic potential of antipsychotics is scarce.

Objectives

To perform an explorative analysis of pharmacovigilance data on the risk of hepatotoxicity related to the use of antipsychotics.

Methods

We conducted an explorative case/non-case study based on data from VigiBase for 30 antipsychotics marketed in the European Union. Reporting odds ratios were calculated for antipsychotics associated with the SMQ “Drug related hepatic disorders - comprehensive search” and the SMQ “Drug related hepatic disorders - severe events only”.

Results

We found several associations of antipsychotics with drug-induced liver injury including associations with severe events. 17/30 antipsychotics were associated with “Drug related hepatic disorders - comprehensive search”, and for 10/30 substances were associated with severe hepatic events.

Conclusions

Several antipsychotics are associated with the risk for hepatotoxic side effects, even severe ones. Further research is warranted on patient and substance-dependent risk factors.

Disclosure

No significant relationships.
Neutropenia induced by Valproic Acid: A case report
Authors: Baldaquí N. , Anmella G. , Madero S. , Gutierrez F. , Pujal E. , Colomer L. , Giménez-Palomo A.
Published: September 2022

Introduction

Valproic acid (VPA) is considered a well-tolerated antiepileptic drug used in Bipolar Disorder as a mood stabilizer. Nevertheless, VPA has been related to several adverse effects. Neutropenia is included as a potential adverse effect, although in clinical practice it is not often measured with regularity.

Objectives

To report a case of a patient with Bipolar Disorder type 2 and Personality Disorder Cluster B treated with VPA with a neutropenia caused by VPA.

Methods

A 61-year-old woman assists to the outpatient psychiatric unit in order to a pharmacological treatment adjustment. A blood test is performed showing a decrease in the levels of neutrophiles in comparison with previous tests. Psychiatric history is revised finding and association between the prescription of VPA and the reduction of neutrophile levels. When this drug was removed, neutrophile levels had increased again up to normal levels.

Results

Due to the relationship between neutropenia and VPA treatment, we decided to discontinue this drug. At the beginning the patient doesn’t agree with the withdrawal of VPA treatment due to its effectiveness in her mood stabilization. Psychoeducation sessions are performed in order to explain risk and benefits of potentials treatment alternatives versus maintaining the same prescription. Finally the patient accepts the switch of the mood stabilizer treatment to oxcarbazepine with a good tolerability and effectiveness.

Conclusions

Periodical blood test monitoring is needed in order to study adverse effects as neutropenia in patients with VPA treatment.

Disclosure

The author has received support from Janssen-Cilag, Otsuka-Lundbeck, Italfármaco, Angelini Pharma and Casen Recordati; and declares no support related to the subject of this article.
“Contemporary Treatment in Multi-Professional Team of Acute Psychosis- Pros and Cons”
Authors: Jaudzema J.
Published: September 2022

The approach of a multi-professional team in the treatment of acute psychosis was started in 2018/2019 In Latvia, within the framework of the early intervention program. Until then, the patient was mostly examined and treated with medication in the inpatient phase of acute psychosis. After discharge, further treatment and rehabilitation in Latvia is still relatively limited and largely based on the initiative of the patient and relatives. Within the multi-professional team of the inpatient department of the Riga Psychiatry and Narcology Center, a psychiatrist, mental health nurses, nursing assistants, psychologists, occupational therapists, a physiotherapist, a visual arts and dance - movement therapist, as well as a social worker work together. The benefits of teamwork in the treatment of acute psychosis are undeniable, but during these few years, working in challenging conditions, various disadvantages have crystallized. Among the ’pros’ is a more successful, multifaceted outcome of recovery, better patient compliance and reduction of stigma among patients and their relatives (and thus in society as a whole). ’Cons’ are mainly due to limited availability of resources, from limited funding and infrastructure to a lack of professionals and time. It should also be noted that mental health literacy is still low in Latvian society, which means that patients often arrive late for help, which means that it is not possible to achieve good results in a limited time within the hospital. For these reasons, treatment is often discontinued after discharge, which increases the risk of rehospitalisation and adverse course of the disease.

Disclosure

No significant relationships.
Levetirazetam: antiepileptic-induced psychosis
Authors: Vilella Martín C. , García Vázquez P. , Barrera García Y. , Fernández Perea P. , Serrano García A. , Alonso De La Torre López M.Á. , Gómez Martínez R. , Franch Pato C.
Published: September 2022

Introduction

Levetirazetam is an antiepileptic drug with psychiatric adverse reactions. It includes psychosis, paranoia or hallucinations. The frequency is less than 1%.

Objectives

To describe a case of Psychosis produced by Levetirazetam

Methods

Retrospective review of clinical records and complementary test, including psychiatry, electrophysiology and neurology. Diagnosis schales such as Salamanca Questionnaire were used as suport.

Results

A 42-year-old woman diagnosed with tuberous sclerosis and undergoing treatment with levetirazetam acudes to the emergency department for behavioral disorders. She has presented an episode of aggression against a relative threatening him with a kitchen knife. The family reports that since the change in antiepilepticus 1 month ago, the patient has presented strange behaviors. Te Patient is conscious, uncooperative. Barely Approachable. Suspicious of her surroundings, with psychomotor restlessness, self-reference ideas and sparse speech. Auditory hallucinations seem to be present, as well as depressed and irritable mood. Psychic and somatic anxiety is found.

Levetirazetam is discontinued, being replaced by valproic acid. Risperidone is started at a 3 mg dose. Treatment is well tolerated, and clinical stability is achived. Cluster A personality traits are found. Complementary test Blood and Urine simples, Imaging tests (CT and MRI), electroencephalogram and Electrocardiogram show no alterations

Conclusions

Levetirazetam can cause psychiatric adverse effects. it is important to make a proper diagnosis before a first psychotic outbreak in later life. Drugs that can produce psychiatric side effects should be identified and patients should be inform.

Disclosure

No significant relationships.
Perceived stress and physiological consistency during mental stress exercises and controlled breathing
Authors: Vasquez D. , Mejia-Mejia E. , Torres R. , Restrepo D.
Published: September 2022

Introduction

The measurement of the physiological coherence, the order and the quality of the connection of complex systems such as the cardiac and the respiratory system, varies in situations of stress and relaxation.

Objectives

We aim to assess changes in physiological coherence and perception of stress during mental stress and directed breathing exercises.

Methods

Repeated-measures study in healthy adults without prior training in breathing techniques, aged between 18 and 65 years of both sexes who were evaluated in three situations: baseline, mental stress (Stroop test and successive subtractions), and directed breathing, during which were captured heart rate and respiratory signals to estimate physiological coherence and the participants rated the perceived stress at each moment.

Results

34 participants were analyzed, 59% women, with a median age of 36 years (Rq = 13). During mental stress tasks, the median for physiological coherence was similar to baseline coherence but increased significantly with five minutes of directed breathing exercises (38% vs. 63% p <0.0001). The highest perception of stress was during successive subtractions (Me 7, Rq = 4) and the lowest during directed breathing exercises (Me 2 Rq = 3.0). The correlation was sought between physiological coherence and perception of stress during each of the four moments of the study. Basal (Rho Spearman -0.05, p 0.54); Stroop (Rho -0.17, p 0.03); successive subtractions (Rho 0.50, p 0.77); and directed breathing (Rho -0.28, p 0.09).

Conclusions

A correlation was found between physiological coherence and perception of stress during the Stroop test; however, no association was found.

Disclosure

No significant relationships.
Non-invasive vagus nerve stimulation attenuates the burnout
Authors: Tukaiev S. , Pravda O. , Vysokov N. , Tarasenko A. , Toleukhanov D. , Komarenko V. , Danylov S. , Kravchenko V.
Published: September 2022

Introduction

Vagus nerve stimulation produces therapeutic effects for the treatment of psychiatric disorders, heart failure, and others.

Objectives

The aim of the current study was to evaluate the effects of the non-invasive vagus nerve stimulation on emotional burnout.

Methods

6 right-handed male volunteers aged 18-22 years participated in study. We used the combination of pleasant meditative classical music and a slow bi-polar wave (0.1-0.2 Hz) of electrical non-invasive transcutaneous auricular vagus nerve stimulation for 5 minutes. The set of 4 VNS was performed at intervals of 3 days. EEG was registered during the rest state (3 min, closed eyes condition). To measure the severity of emotional burnout in students, we used the 22-item Maslach Burnout Inventory (MBI).

Results

VNS significantly improve the depersonalization and reduction of personal achievements (components of the emotional burnout). Changes in the psychoemotional state of the respondents were accompanied by the increase in the theta-Fz/alpha-Pz ratio, that reflects an enhancement of the activation level. A set of non-invasive stimulation of the auricular branch of the vagus nerve leads to an increase in the level of activation (the ratio of beta / alpha rhythms). The changes in the power of the alpha rhythm may relate to improving of mental process, creativity, creative thinking. An increase in alpha rhythm may reflect internally oriented attention in creative activities.

Conclusions

The preliminary data suggests that the novel mastoid stimulation device may have a prolonged stimulating effect on the brain processes while attenuating the burnout at the same time.

Disclosure

No significant relationships.
Estradiol and Progesterone as key modulators of central systems implicated in schizophrenia
Authors: Ruiz-Tristan A. , Rivera-Clemente C. , Gomez-De-Las-Heras V. , Ávila S. , Molina J.
Published: September 2022

Introduction

It has been suggested that dysregulation of sex hormones is associated with schizophrenia. However, obesity and metabolic syndrome are very common between schizophrenic patients, and it can also dysregulate sex hormones so they could act as confounders.

Objectives

To determine if estradiol and progesterone are abnormally elevated regardless of obesity or metabolic syndrome in men with SCZ.

Methods

We measured serum levels of progesterone and estradiol in 56 schizophrenic male patients at treatment with a depot antipsychotic. Subsequently, we studied the association or independence of our results with obesity or metabolic syndrome by a Chi Square Test.

Results

66.07% of our patients elevated progesterone levels, 19.64% of our patients elevated estradiol levels, and 16.07% of our patients elevated both, progesterone and estradiol, simultaneously. We found no relationship between increased estradiol and / or progesterone with obesity and / or metabolic syndrome.

Conclusions

Estradiol and progesterone are abnormally elevated regardless of obesity and / or metabolic syndrome in male schizophrenic patients on depot treatment.

Disclosure

No significant relationships.
Suicidality during neuromodulation in the elderly depressed: study design
Authors: Van Daele A. , Zeeuws D. , Baeken C.
Published: September 2022

Introduction

Late life depression is a major global health issue, with an estimated 7% of older adults suffering from this mental disorder. Depression is one of the most important predictors for suicide in the elderly. However, it is often difficult to recognize and manage, making treatment-resistance a common occurrence. Treatment-resistant depression itself is also a known risk factor for suicide. Recently, non-invasive neuromodulation techniques have been used as a new treatment for depression and suicidality with promising results.

Objectives

This study aims to investigate the effect of adTMS (accelerated deep Transcranial Magnetic Stimulation) and tDCS (transcranial Direct Current Stimulation) on the suicidality of elderly, therapy-resistant depressed patients. The hypothesis is that suicidal ideation and risk of suicide will decrease after a treatment with adTMS and tDCS.

Methods

In this randomized double-blinded sham-controlled clinical trial, geriatric therapy-resistant depressive patients will receive adTMS treatment (See: Figure 1). Suicidality will be assessed before and after the active or sham treatment, through the Columbia Suicide Severity Rating Scale (C-SSRS) and Beck Scale for Suicide Ideation (BSI). After one week of rest, all patients will receive an at-home tDCS treatment for 3 weeks. Likewise, the suicide risk will be estimated before and after the tDCS. During the screening period, the severity of the patients’ depressive symptoms will be determined by using the 17-item Hamilton Depression Rating Scale (HDRS-17). In total, the trial will last for 5 weeks, and suicidality will be examined at five different time points (during screening, at T0, T1, T2 and T3).

Results

Not applicable

Conclusions

Not applicable

Disclosure

No significant relationships.
Paradoxical Neuroethical Crisis of Agency and Identity in an Obsessive-Compulsive Disorder Deep Brain Stimulation Patient
Authors: Carr B.
Published: September 2022

Introduction

Deep Brain Stimulation is an increasingly viable, well-established treatment for medication refractory obsessive-compulsive disorder. Yet, its neuromodulatory effects on the brain have led to varying and opposing neuroethical debates about its potential influence on a range of phenomena such as human agency, sense of nonauthenticity and identity.

Objectives

Establish the importance of maintaining the psychotherapeutic alliance in a long-term DBS patient who reported minimal device side effect and no brain-technology interface interpersonal issues; yet struggled with a paradoxical phenomenon of psychic distress surrounding issues of agency and identity, not through device implantation, but through morphology of cognitions from negativistic interpersonal dynamics and spousal victim-blaming due to the necessity for such a device.

Methods

Case-report of a 60+-year-old gentleman with a history of childhood-onset, treatment refractory OCD with a 15-year history of bilateral DBS lead placed via a ventral caudate/ ventral striatum trajectory through the anterior limb of the internal capsule to the nucleus accumbens.

Results

Years later he was only minimally improved above baseline; yet now with a few-years increasing degree of distress over a perceived atrophy of his capabilities that he felt was validated through what he described as his failure of artificial bionics. Extensive device setting re-optimization did not improve efficacy and with supportive therapy, the DBS device was weaned, and turned off.

Conclusions

The following year the therapeutic foci were on interpersonal identity, existential acceptance of breakthrough symptoms, and engagement of spouse into marital counseling leading to subsequent resolution of distress with improved quality of life.

Disclosure

No significant relationships.
Tinnitus as a comorbidity to depression and transcranial magnetic stimulation as a treatment for both - case report
Authors: Marinovic P. , Zivkovic M. , Bagaric T. , Skocic Hanzek M. , Mihaljevic-Peles A.
Published: September 2022

Introduction

Depressive symptoms are common in individuals with tinnitus, however, the mechanisms of their interaction are not fully understood. There is neurobiological evidence that might help understanding the interplay between tinnitus and depression which, in turn, helps in making the right choice for treating both conditions.

Objectives

This case report describes a 70-year old female patient that presented with tinnitus and depressive symptoms lasting for the past 5 years.

Methods

The patient showed limited treatment results with different antidepressants. The otorhinolaryngologist ruled out any possible somatic causes of her tinnitus. Tinnitus was causing her sleep disturbances, which worsened her everyday functioning that was already quite poor even further.

Results

After being administered with 30 rounds of TMS, her symptoms either completely resolved or at least reached a level that was adequate for her to start functioning normally on a day-to-day basis.

Conclusions

TMS is a technique that provides non-invasive cortical stimulation, more specifically, when used for depression treatment it stimulates the left dorsolateral prefrontal cortex, a brain region synaptically connected to the limbic system involved in mood regulation that is proven to be hypoactive in depression. The limbic system is where tinnitus-related brain networks and regions involved in the pathophysiology of depression overlap. Further research is needed to deepen the understanding of this topic.

Disclosure

No significant relationships.
Acceptance and Commitment Therapy for Psychosis. What’s the evidence?
Authors: Azevedo F. , André R. , Silva L. , Medinas R. , Almeida C.
Published: September 2022

Introduction

Cognitive behavioural therapy for psychosis as an adjuvant to pharmacological treatment has been been shown to be one of the most effective interventions for schizophrenia with benefits noted in even treatment resistant schizophrenia. Benefits have been mostly registered in the positive symptoms domain of schizophrenia. Acceptance and commitment therapy is a third generation Cognitive-Behavioural Therapy, empirically supported for a range of symptoms and conditions, including psychosis, with quickly increasing data. It targets experiential avoidance, which seems to be closely related with psychopathology. Its ability to also target affective symptoms can be an important advantage in the adjuvant treatment of psychosis.

Objectives

To critically review the evidence of acceptance and commitment therapy in psychosis.

Methods

Non-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “schizophrenia”, “acceptance and commitment therapy”.

Results

Very few studies have been published on ACT and psychosis, with even less controlled trials and systematic reviews. So far there is convincing evidence for ACT reducing the frequency of hallucinations, increasing the outcomes of traumatic events associated with psychosis and having measurable effects on anxiety and help seeking behaviour.

Conclusions

As Acceptance and Commitment therapy evolves and more evidence arises a new kind of therapy with possible effects on both affective and positive symptoms in schizophrenia can emerge, allowing us to know what works for patients with psychosis and through what mechanisms and permitting the improvement of treatment strategies.

Disclosure

No significant relationships.
Psychosocial interventions for cardiac surgery patients: continuity at clinical stages
Authors: Nikolaeva O. , Karavaeva T. , Nikolaev E. , Maksimova N. , Litvinova E. , Vasilieva E.
Published: September 2022

Introduction

More often, cardiac surgery patients (CSP) receive systematic psychological aid after surgery. However, their need for psychosocial interventions in the perioperative period is underestimated.

Objectives

The goal is to determine the stages of psychosocial interventions for CSP that could cover the whole period of their treatment and rehabilitation.

Methods

Analysis of scientific papers and practical experience gained in cardiologic clinic allowed dividing the system of psychosocial interventions for cardiac surgery patients into periods in accordance with actual stages of medical aid for CSPs.

Results

According to the principles of personalized approach, we determined six consecutive semantically different stages of psychosocial interventions: out-of-hospital pre-surgery, in-hospital pre-surgery, early post-surgery, in-hospital post-surgery, post-surgery rehabilitation, and out-of-hospital rehabilitation. They have different duration and cover the whole period of treatment and rehabilitation of CSPs beginning with the moment of indication to surgery up to the complete rehabilitation and full adaptation to their post-surgery somatic condition. Each stage has its own goals, main objectives and expectations. Duration of the stages is conditional and can change depending on the nature of every clinical situation.

Conclusions

Determination of clinical stages in the process of psychosocial interventions for CSPs gives ground for selecting optimal psychological methods and techniques for each stage and sets exact goals, achievement of which becomes possible only through a properly organised work of an interdisciplinary team of specialists.

Disclosure

No significant relationships.
Hospital environment and patient recovery – a review
Authors: Lourenço A. , Ribeiro M. , Lemos M.
Published: September 2022

Introduction

Since the second half of the 20th century, studies have been carried out that prove the benefits of the hospital environment in the improvement and recovery of patients. In this way, it would be important to understand what has already been done within the reality of Psychiatry Department.

Objectives

To review the literature about the documentation of hospital environment influence in patients’ recovery.

Methods

We performed a MEDLINE search using the key words: hospital environment influence and patients’ recovery or patients healing. We only included studies with full text published in English.

Results

In the selected articles, we only found studies developed in the Surgery department; in one of them, the authors tested the presence of plants in the patients’ rooms and assessed lower blood pressure values, less pain and less anxiety than the control group; in another, they tested the presence of music and landscape, although there was no difference in terms of pain assessment, there was an improvement in the assessment of the postoperative experience. A review pointed some other aspects that patients linked with their recovery, such as: audio and visual environment; specifically, in anxiety, pain and stress. On the other hand, other studies address the influence of the hospital environment on the satisfaction of health care providers.

Conclusions

Although hospital environment has already demonstrated an impact on the patient recovery, none (in our review) was developed directly in a Psychiatric Department; further studies are needed to understand the impact on this kind of service.

Disclosure

No significant relationships.
Evaluation of an Adaptive Implementation Program for Cognitive Adaptation Training for People With Severe Mental Illness: a cluster-randomized controlled trial
Authors: Van Der Meer L. , Van Dam M. , Van Weeghel J. , Castelein S. , Pijnenborg G.
Published: September 2022

Introduction

Cognitive Adaptation Training (CAT) is a psychosocial intervention focusing on reducing the impact of cognitive disorders on daily functioning in people with severe mental illness (SMI). Similar to many evidence based practices (EBP), implementation of CAT in routine care lags behind, despite the established effectiveness of the intervention. This so called ‘science-to-service gap’ is a widespread problem in mental health care. We developed an innovative implementation program to facilitate implementation of CAT and similar interventions in routine care.

Objectives

The aim of this study is to evaluate the effectiveness of the implementation program and to determine factors that impede or facilitate the implementation process.

Methods

We conducted a multicenter cluster randomized controlled trial comparing the implementation program to a single training program in four mental health institutions (a total of 21 rehabilitation teams) in The Netherlands. Focus groups, semistructured interviews and questionnaires were used at multiple levels of service delivery (service user, professional, team, organization). Assessments took place before, during and after implementation and at follow-up, adding up to a total duration of 14 months. Data were analyzed using multilevel modeling.

Results

Data collection is complete and analyses on the effectiveness of the implementation program are ongoing. Preliminary analyses show that team climate (p<.008) and organizational climate (p<.043) significantly predict the attitudes of mental health providers toward EBP.

Conclusions

This implementation research may provide important information about the implementation of psychosocial interventions in practice and may result in a program that is useful for Cognitive Adaptation Training, and possibly for psychosocial interventions in general.

Disclosure

No significant relationships.
Using the analytic hierarchy process to assess the severity of psychopathological states
Authors: Mitikhin V. , Solokhina T. , Tiumenkova G. , Kuzminova M.
Published: September 2022

Introduction

Currently, there are known problems of assessing the severity of psychopathological states based on psychometric (rank) scales [1]. The main problem: ranks are non-numeric information that does not allow the simplest mathematical operations (summation, average) [2] and, as a result, the impossibility of constructing correct models for evaluating states

Objectives

Development of algorithms for processing initial rank information about the severity of psychopathological states in order to obtain results in numerical form based on the Analytic Hierarchy Process (AHP) [2]

Methods

Clinical, statistical, algorithms of the AHP.

Results

The problems of assessing the patient’s states are multicriteria. They are solved within the framework of AHP by constructing numerical intensity scales when measuring the dimensions of disorders. This means a correct transition from the rank scale to the scale of relations, in which the estimates are numbers that allow any mathematical operations. The implementation of AHP procedures is based on the application of the AHP normative approach [2], which uses expert comparisons of ratings of the rank scale.

Conclusions

The fundamental difference between the results based on AHP and rank results is due to the fact that numerical estimates of the severity of states are obtained, which can be used for any mathematical processing and the construction of correct models of communication and prediction of the state of patients from many factors, taking into account their weight. References: 1. Zimmerman M., Morgan T.A., Stanton K. World Psychiatry. 2018;17: 258–275. 2. Mitikhin, V.G., Solokhina, T.A. S.S. Korsakov Journal of Neurology and Psychiatry. 2019; 119(2): 49-54.

Disclosure

No significant relationships.
Longitudinal association between exposome score for schizophrenia and clinical features: results from the Athens First-Episode Psychosis Research Study
Authors: Erzin G. , Pries L. , Dimitrakopoulos S. , Ralli I. , Xenaki L.-A. , Soldatos R.F. , Vlachos I. , Selakovic M. , Foteli S. , Kosteletos I. , Nianiakas N. , Mantonakis L. , Rizos E. , Kollias K. , Os J. , Guloksuz S. , Stefanis N.
Published: September 2022

Introduction

Previously, environmental vulnerability for schizophrenia assessed through exposome score for schizophrenia (ES-SCZ) was associated with the risk for psychosis development.

Objectives

The current study aims to investigate the longitudinal association between ES-SCZ and symptom severity in individuals with first episode psychosis (FEP) to understand how environmental exposures affect illness course.

Methods

Baseline and 1-month follow-up assessments were available for 225 individuals with FEP from the Athens FEP Research Study. The Positive and Negative Syndrome Scale (PANSS) was used to measure clinical features. In accordance with previous reports, the ES-SCZ was calculated by summing log-odds weighted environmental exposures (childhood adversities, winter birth, and cannabis use). To model the course of clinical features over time the effects of the ES-SCZ-by-time interaction, ES-SCZ, and time were analyzed with multilevel regression analyses. Age, sex, and education were added as covariates

Results

The analyses of change of PANSS total score over time indicated that clinical features decreased from baseline to the 1-month follow-up assessment. The association between ES-SCZ and PANSS total score were not statistically significant. The analyses of the PANSS total score over time indicated an ES-SCZ-by-time interaction (B = 2.82 [95% CI 0.28; 5.35], P-value = 0.029), meaning the decrease of the PANSS total score over time were dependent on ES-SCZ and individuals with high ES-SCZ showed less improvement

Conclusions

The findings show that the total environmental predisposition to schizophrenia (ES-SCZ) not only increases the risk for psychosis development but may also influences the illness course.

Disclosure

No significant relationships.