bluuebunny/crossref_metadata_2025 huggingface dataset:
Obsessive and compulsive symptoms in elderly: A litterature review
Authors: Kouki N. , Maamri A. , Hsayri M. , Kouki N. , Hajri A. , Zalila H.
Published: August 2023

Introduction

Obsessive compulsive symptoms may occur at any age. It was studied extensively in the youth contratry to the elderly that usually suffer for other health issues leading to misdiagnosis.

Objectives

We aim through this study to discover the particularities of OCD in elderly .

Methods

Our literature review was based on the PubMed interface and adapted for 2 databases: Science Direct and Google Scholar using the following combination ( obsessive compulsive disorder [MeSH terms]) OR (OCD [MeSH terms]) AND (elderly [MeSH terms]) OR (dementia [MeSH terms]).

Results

Our review revealed 39 articles from which we selected 4 articles.

We found that in aged adults over than 50 years experience mostly somatic symptoms, religiosity, and moral scrupulosity as obsessive thoughts.

We also found that OCD can occur as a primary disorder in older women, whereas in men it either persists from, younger years or arises in the context of another psychiatric or medical disorder

The relationship between Obsessional illness, brain mechanisms and Cognitive disorders are not fully understood.

Indeed, we noted a relative Impairment in executive function in older adults with OCD stressing the link with cognitive impairment. Moreover, Obessive compulsive symptoms may worsen cognitive functioning .

Conclusions

Obsessive compulsive disorder presence in the elderly may be described as a primary health condition or be related to organic mental health issues in particular dementia. The physiopathology remains unclear therefore further studies are needed for better understanding and management.

Disclosure of Interest

None Declared
Obsessive-compulsive disorder after traumatic brain injury: case report.
Authors: Sousa R. M. , Cunha N. , Morgado P.
Published: August 2023

Introduction

Although not the most prevalent clinical presentation, obsessive compulsive (OC) symptoms have been reported after TBI. Post-TBI OC disorder (OCD) cases are rare, so that OC symptoms in this setting are frequently described as OC personality disorders (OCPD).

Generally, the clinical features of post-TBI OCD are thought to be similar to those observed in idiopathic OCD, assuming the probable involvement of structures such as the orbitofrontal cortex, basal ganglia, limbic and thalamic systems in its pathophysiology, although no anatomical location clearly associated with post-TBI OCD being recognized.

Objectives

Brief systematic review of OCD post-TBI and case report.

Methods

Bibliographic research using Pubmed. Clinical interviews and file consultation, with patient informed consent.

Results

We present a case of a 63-year-old patient referred to the Psychiatry Consultation due to obsessive thoughts of dirt and contamination, accompanied by compulsive cleaning and sanitizing behaviors with at least 3 years of evolution with a history of TBI and right frontopolar hemorrhage 5 years ago. These behaviors significantly impaired his functionality (cleaning objects on average 300 to 700 times a day, spending hours in the shower). The patient had insight for the excessive behaviors and its daily impairment.

Conclusions

Psychopathology in the post-TBI context is not infrequent, however reported cases of post-TBI OCD are described as rare in the current literature. The short description of this phenomenon implies the need for more studies focused on the study of the phenomenology of post-TBI OCD. For example, while OCD and obsessive-compulsive symptoms tend to be recognizable psychiatric phenomena, neurobehavioral sequelae in a post-TBI context can present multiple manifestations and resemble OC phenomena, without actually constituting OCD.

Disclosure of Interest

None Declared
Charles- Bonnet Syndrome: a case review. The objective of this poster is to contribute a case to the existing series, and thus get closer to the knowledge of this clinical entity.
Authors: Huerga García L. , Careno Baez I. , Oropeza Hernández G. , Marcos Rodrigo A. , Delgado Torres C. , Garriga Rocío G.
Published: August 2023

Introduction

Charles-Bonnet syndrome was described in 1760 by the Swiss philosopher Charles-Bonnet, who reported that his grandfather’s visual hallucinations were due to eye disease rather than mental illness.

It is characterized by the presence of visual hallucinations, which are usually complex and structured, in elderly patients with preserved cognitive status, significant deterioration in visual acuity and no evidence of associated psychiatric or neurological disease.

Objectives

The objective of this poster is to contribute a case to the existing series, and thus get closer to the knowledge of this clinical entity.

Methods

To review the case, a search was made in Pubmed with the terms hallucinations and Charles Bonnet’s Syndrome.

Results

This is a 76-year-old man, in follow-up by the ophthalmology service in the context of bilateral cataract, which causes severe visual disturbance. He went to our hospital, accompanied by his wife, reporting that for some months he has had complex visual hallucinations of various animals, colors in space, as well as children playing around him. All this generates a lot of anxiety, although the patient makes adequate criticism of them.

The neurological examination performed was normal. The CT scan and laboratory tests were also within normal limits. Cognitive impairment was explored using the MMSE scale, which did not show any alteration. In addition, after a psychiatric evaluation, the patient does not meet the criteria for any disorder included in the DSM V. After reviewing the literature and taking into account the clinical picture described, the case is framed within a Charles-Bonnet syndrome.

Regarding the therapeutic plan carried out, it was decided to start treatment with Gabapentin up to a maximum dose of 900 mg/day, with a considerable improvement in the hallucinatory symptoms. In addition, given the repercussion at the affective level, especially with a predominance of anxious symptoms, it was decided to start sertraline at a dose of 50 mg/day, with an adequate therapeutic response.

Conclusions

Charles-Bonnet syndrome refers to hallucinosis, generally of a visual nature, that appear in patients with a sensory deficit associated with the type of sensory-perceptive alteration. It is important to take it into account in the differential diagnosis of the elderly patient with hallucinosis. There is no established treatment, although neuroleptics, benzodiazepines, antidepressants and antiepileptics are used.

Disclosure of Interest

None Declared
Sexuality and marital satisfaction in patients followed for breast cancer in a regional hospital
Authors: Zaouali F. , Abbes I. , Ben Slama A. , Belhaj Youssef I.
Published: August 2023

Introduction

Breast cancer is the leading cancer in women in developed and developing countries. Treatment strategies can affect sexuality in the short or long term.

Objectives

The aim of our study was to assess sexuality and martial satisfaction in patients followed for breast cancer.

Methods

Cross-sectional descriptive study including patients followed for breast cancer at the outpatient medical oncology consultation of Hadj Ali Soua regional hospital from January to March 2021. We passed the Female Sexual Function Index (FSFI) and the martial adjustment test (MAT).

Results

Fifteen patients were included with a mean age of 49.87 ± 8.48 years and a mean age at diagnosis of 46.73 ± 7.55 years. At the TNM classification, 66.6% of the patients had a T1 or T2 at the time of diagnosis and 80% had an N0. All patients received a surgical intervention, which was conservative in 53.3% of cases. No patient underwent breast reconstruction. Chemotherapy and hormone therapy were prescribed in 86.7% of patients. Radiotherapy and targeted therapy were prescribed in 12 and 2 case, respectively. Amenorrhea, hot flushes and vaginal dryness were noted in 98.7%, 26.7% and 7.6% of patients, respectively. Sexual disorders were found in 53.3% of cases, which settled in a chronic mode in 75% of cases and progressed in a continuous mode in half of cases. The assessment of physical and erotic life was revealed to be neat in 73.3% of the patients. The mean score of the FSFI questionnaire was 17.25 [2.6-31.9]. Eleven patients (73.3%) had sexual dysfunction. A low marital satisfaction was found in 34% of cases.

Conclusions

The medical consultation to identify sexuality disorders in correlation with the martial dissatisfaction in women followed for new breast cancer is crucial allowing a better management of this pathology.

Disclosure of Interest

None Declared
Mindfullness-Based Interventions for Anxiety and Depression
Authors: Mesquita B. L. B. , Ribeirinho Soares F. , Fraga M. , Albuquerque M. , Facucho J. , Espada P. , Paulino S. , Cintra P.
Published: August 2023

Introduction

Mindfulness refers to a process that leads to a mental state characterized by non-judgmental awareness of the present moment experience, including one´s sensations, thoughts, bodily states, consciousness, and the environment, while encouraging openness, curiosity, and acceptance.

Objectives

The purpose of this paper is to review the ways in which cognitive and behavioural treatments for depression and anxiety have been advanced by the application of mindfulness practices.

Methods

Brief non-systematic literature on the topic.

Results

Mindfulness has spread rapidly in Western psychology research and practice, in large because of the success of standardized mindfulness-based interventions, consequently research on mindfulness based interventions (MBIs) has increased exponentially in the past decade. The most common include Mindfullness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), which incorporate the essence of Eastern mindfulness practices into the Western cognitive-behavioral practice. MBIs have showed efficacy in reducing the severity of anxiety and depressive symptoms in a broad range of treatment seeking individuals. MBIs have also been showed to perform with not so different results to cognitive-behavioral therapy (CBT).

Conclusions

MBIs have been showed to be important co-adjuvants to pharmacological treatment and psychotherapy of depression and anxiety. To prove this point without doubts and create adequate guidelines that include these forms of treatment more research needs to be done on the matter.

Disclosure of Interest

None Declared
Burnout and associated psychological issues among teachers: A Scoping Review
Authors: Agyapong B. , Obuobi-Donkor G. , Burback L. , Wei Y.
Published: August 2023

Introduction

Worldwide, stress and burnout continue to be a problem among teachers, leading to anxiety and depression. Burnout may adversely affect teachers’ health and is a risk factor for poor physical and mental well-being. Determining the prevalence and correlates of stress, burnout, anxiety, and depression among teachers is essential for addressing this public health concern.

Objectives

To determine the extent of the current literature on the prevalence and correlates of stress, burnout, anxiety, and depression among teachers

Methods

This scoping review was performed using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Relevant search terms were used to determine the prevalence and correlates of teachers’ stress, burnout, anxiety, and depression. Articles were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica Data Base), APA PsycINFO, CINAHL Plus (Cumulative Index of Nursing and Allied Health Literature), Scopus Elsevier and ERIC (Education Resources Information Center). The articles were extracted, reviewed, collated, and thematically analyzed, and the results were summarized and reported.

Results

When only clinically meaningful (moderate to severe) psychological conditions among teachers were considered, the prevalence of burnout ranged from 25.12% to 74%, stress ranged from 8.3% to 87.1%, anxiety ranged from 38% to 41.2% and depression ranged from 4% to 77%. The correlates of stress, burnout, anxiety, and depression identified in this review include socio-demographic factors such as sex, age, marital status, and school (organizational) and work-related factors including the years of teaching, class size, job satisfaction, and the subject taught.

Conclusions

Teaching is challenging and yet one of the most rewarding professions, but several factors correlate with stress, burnout, anxiety, and depression among teachers. Highlighting these factors is the first step in recognizing the magnitude of the issues encountered by those in the teaching profession. Implementation of a school-based awareness and intervention program is crucial to resolve the early signs of teacher stress and burnout to avoid future deterioration.

Disclosure of Interest

None Declared
Reviewing the consistency of Dissociative Identity Disorder: a case report.
Authors: Herrero Pellón E. , Albarracín Marcos P. , Huete Naval M. , Galerón Guzmán R. , Mayor Sanabria F. , Montes Montero A.
Published: August 2023

Introduction

We present the case of a 22-year-old patient who has been followed up in a daytime hospital for personality disorders since June 2022. Of note is the presence of multiple personalities (in total of more than 20 have been identified), each of which has distinct physical and psychological characteristics.

Objectives

The objective is to present a clinical case of dissociative identity disorder and to review the existence of scientific evidence supporting this diagnosis.

Methods

Literature review of scientific papers over the last years and classic textbooks on the issue. We included references in English and Spanish languages.

Results

Numerous studies support that dissociative disorders are the result of psychological traumas that generally begin in childhood. This is a difficult category to diagnose, since they present symptoms that also appear in other disorders such as those of the schizophrenic spectrum.

One or more dissociative parts of the subject’s personality avoid the traumatic memories while others become fixed to these traumatic experiences and manifest symptoms. In the case of our patient, there are dissociative episodes with subsequent amnesia and auditory, visual and olfactory hallucinations, as well as impulsive behaviors in the form of self-injury and a flattened affect, with significant emotional distancing.

Conclusions

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The prevalence of dissociative identity disorder is higher than traditionally thought.

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Some theories develop how trauma essentially produces a degree of dissociation of the psychobiological systems that constitute the subject’s personality.

Disclosure of Interest

None Declared
What is the role of the primary care system in the initial management of psychotrauma?
Authors: Zineb B. , Aicha T. , Imane K. , Fouad L. , Abderrazak O.
Published: August 2023

Introduction

Post-traumatic stress disorder is common and the risk of developing it after a trauma is high. Its global management is long and complex.

The general practitioner, as a primary care provider, has a fundamental role in detecting it. They may have to take care of these patients both physically and psychologically, and may find themselves at a loss when faced with repercussions such as Post-Traumatic Stress Disorder (PTSD).

In some countries, the role of the general practitioner is different. More involved and better trained, they are actors in the pre-hospital system in case of psychotrauma.

Objectives

By means of a survey conducted among general practitioners in Morocco, we will first try to determine their place in the screening and management of psychotrauma, and then to evaluate their knowledge of EMDR therapy.

Methods

For this purpose, a questionnaire was developed and used as a basis for the study.

It included practical questions relating to the physicians’ activity, their practice in emergency consultations, their training, their management of physical and psychological trauma, and finally their knowledge of EMDR therapy,

Finally, we will attempt to propose concrete avenues for more effective, safer, and non-harmful management of psychotrauma in the basic health care system.

Results

the general practitioner was the first professional to receive a patient who was a victim of a physical or psychological trauma (road accident, rape, physical or verbal aggression), but the degree of knowledge and training for this type of care was low among our doctors.

Conclusions

Training sessions should be scheduled for general practitioners in order to optimize the management and prevention of post-traumatic stress disorder.

Disclosure of Interest

None Declared
Post-traumatic stress disorder (PTSD) and associated factors in the population victim of violence in Cordoba, Colombia
Authors: Cabas-Hoyos K. , Villamil-Benitez I. , Uribe-Urzola A.
Published: August 2023

Introduction

The Department of Cordoba is located in the north of Colombia and is a key territory for understanding the political violence that the country has experienced. Cordoba has suffered the armed conflict with various groups present in the area. In the category of victimizing acts, more than 30,000 victims of forced displacement have been reported and 4,621 for forced disappearance.

Objectives

The objective of this study is to evaluate the prevalence of PTSD and associated factors in a population victim of violence in Cordoba, Colombia.

Methods

Design: cross-sectional, using quantitative data. Participants: victims of forced displacement in Cordoba (n=95), of whom 42.75% (n=45) were men and 57.25% (n=50) were women. The mean age of the participants was 40.7 (SD 14.1) Instruments: Clinician-Administered PTSD Scale (CAPS) (Blake et al., 1990) was administered to check clinical symptoms of the Disorder; to assess the causes of symptoms was administered The PTSD Checklist PCL-C is a short version of the PTSD Checklist – Civilian version (Weathers, 1993). Additionally, the BDI was administered to assess depression and STAI to measure anxiety. Data analysis: a Student’s t-test was used to assess the difference by gender and age groups. Descriptive statistics were also used to identify clinical characteristics of the sample.

Results

In relation to the activation factor, it was found that the men in the sample presented significant differences compared to the women [Activation. F= (1.117) = .79; p = 0.00]. Meanwhile, PTSD was presented equally in both sexes and in all age groups with a prevalence of 26% of the sample. The most prevalent events assumed to cause the disorder were extreme human suffering and natural disaster. Depression levels were moderate in 33.3% of the population and state anxiety showed a level of 77.8% of the sample.

Conclusions

Our study finds that 26% of the population suffered from PTSD and in a significant percentage comorbidities were found with depression, anxiety, added to the vulnerability of those who have experienced these events, that is, revictimization, low access to social services, low schooling and poverty. It is important to consider the multifactorial nature of PTSD and its relationship with the presence of traumatic events (Bados, 2015; Kessler et al., 2014). In Colombia there is a challenge related to the intervention of this population, which constitutes future lines in our research.

Disclosure of Interest

None Declared
Exploring the associations between the Self-structure of personality and problematic smartphone use in an adult sample
Authors: Csibi S. , Csibi M.
Published: August 2023

Introduction

Positive psychology theory sustains that the construct of the Self and its components, such as self-evaluation, social self-esteem, and self-coherence, determine our behavior. Personal daily habits and lifestyle modalities lay on these personality components. Problematic and addictive behavior is also strongly influenced by our Self and its main elements.

Objectives

This study aims to determine those personality components related to the central Self-construct that actuates problematic smartphone use.

Our further objective is to identify targeted, self-enhancing activities that prevent problematic smartphone use.

Methods

Participants were teenagers and adults (N=147) from the 17-73 age group (mean age 37.5 years), 31 male and 116 female.

Respondents provided self-reported data on their demographic characteristics, perceived self-esteem, social self-esteem, sense of coherence, and problematic smartphone use through an online survey attainable on a web-based platform.

Instruments were the Core Self-Evaluation Scale (Judge et al., 2003), the MOS-SSS Social Support Assessing Scale (Sherbourne & Stewart, 1991), the Sense of Coherence Scale (Rahe & Tolles, 2002), and the Smartphone Application-Based Addiction Scale (Csibi et al., 2018).

Results

Respondents who reported being more familiar with smartphone applications and spending more time online scored higher on the problematic smartphone use scale. Our study found significant associations between age and problematic smartphone use, with those from younger groups scoring higher.

Participants characterized by lower self-esteem proved a more pronounced problematic smartphone use. In our sample, social self-image and social support did not show relevant correlations with the total score of problematic smartphone use.

However, a high sense of coherence showed a significant negative association with problematic smartphone use.

Conclusions

A more mature Self-construct characterized by a positive self-evaluation and increased sense of coherence act as protective factors against problematic smartphone use.

Providing adequate self-evaluation and social support among young through targeted activities will have a higher role in younger age groups, preventing problematic smartphone use.

Disclosure of Interest

None Declared
Effects of a physical activity program in stress management and motivation for the regular practice of physical activity of teachers from Portugal and Brazil
Authors: Amaral A. P. , Mariano L. , Simões H. , Pocinho M.
Published: August 2023

Introduction

Teaching is considered by the International Labor Organization as one of the most stressful professions, with consequences on the mental and physical health and on their professional performance. Intervention programs focused on physical activity usually present a significant decrease in the level of stress and an improvement in the quality of life of teachers. Physical activity is considered one of the main non-pharmacological strategies to reduce stress, generating a positive influence on mental health.

Objectives

To evaluate the impact of an intervention program based on the practice of physical activity on the level of stress and motivation for the regular practice of physical activity in teachers.

Methods

This study employed a pretest-posttest design. Measures: Portuguese versions of Stress Perception Scale and Motivation Inventory for Regular Physical Activity Practice. Sample: 33 teachers from Portugal and Brazil, 57,6% females, 54,5% from Portugal, 63,6% with age between 26 and 35 years. The intervention ran for 8 weeks, with a total of 40 sessions with cardiorespiratory conditioning exercises, muscle strengthening and stretching, relaxation and meditation techniques.

Results

On baseline we found significant relationship between “years of teaching experience” and the level of stress (p=.027). After the intervention, the level of stress significantly decreased in Portuguese teachers (p=.031). In 83% of the sample, there is a decrease in the levels of perceived stress. Concerning Brazilian teachers (p=.006), in 73% of the sample, there is a decrease in the levels of perceived stress. Regarding motivation, there is a significant increase in Portuguese teachers related to “stress control” (p<.001), “sociability” (p=.001), “competitiveness” (p<.001), and “esthetic” (p=.004). In Brazilian teachers there is an increase related to “stress control” (p=.003), and “competitiveness” (p=.001).

Conclusions

Both samples showed positive results, attesting the efficacy of the intervention based in physical exercises to reduce stress and increase motivation to practice physical activity regularly. After intervention, more motivational dimensions are changed in Portuguese teachers, comparing with Brazilian teachers.

Disclosure of Interest

None Declared
The wrinkles of the soul- a psychoneuroimmunological approach to aging
Authors: Oroian B. A. , Costandache G. I. , Salaru A. , Ionescu P. F. , Nechita P.
Published: August 2023

Introduction

Psychoneuroimmunology is a discipline that has emerged over the past decades as a broad interdisciplinary field that closely observes the relationship between the psychological state, the nervous system, the endocrine system, and the immune system. The natural aging process leads to alterations in the immune functions, involving lymphocyte dysregulation, and therefore leading to a higher risk of developing coronary artery diseases, infectious diseases or even cancer.

Objectives

The aim of our inquiry is to evaluate the existing body of work with a focus on studies that observed the intricate connections between psychosocial factors and immunity.

Methods

We performed a systematic review on PubMed and a targeted literature search concentrating on all the factors involved in immunosenescence and their consequences.

Results

The causality between emotional stressors (acute or chronic), lack of social support, adverse life events, coping mechanisms, personality traits, as well as endocrine changes and multiple age-related pathologies is often undeniable. Other relevant factors include nutrition, sleep, physical activity and substance use. As people grow older, they face a number of psychosocial stressors, such as retirement, social isolation, loss of independence, low income, a decrease in productivity and also somatic comorbidities. These factors, together with an age-related decline in immune function, can constitute not only a psychosocial disadvantage of the elderly, but also a risk factor able to trigger further deterioration of the immune system.

Conclusions

Age-associated alterations of the immune response represent a complex concept. Given that we are dealing with the phenomenon of aging in the general population, the field of psychoneuroimmunology can make a significant contribution in establishing the different mechanisms through which seniors can cushion the impact of stressors in regards to health and illness. Therefore, we can pave the way for an individualized approach and support for patients, as well as provide better therapeutic outcomes.

Disclosure of Interest

None Declared
PSYCHOSIS AS A MANIFESTATION OF LUPUS AND ANTIPHOSPHOLIPID SYNDROME. ABOUT A CASE.
Authors: Vílchez Español F. , Carrillo Molina R. , Alcántara Gutiérrez A.
Published: August 2023

Introduction

A lot of studies have determined the relationship between psychosis and autoimmune diseases. One of the classic examples is systemic lupus erythematosus and antiphospholipid syndrome.

Both are syndromes marked by a state of excessive inflammation and hypercoagulability, respectively. And psychosis is a frequent manifestation of these two diseases, so it is important to take it into account, because psychotic episode triggered by these diseases has a different therapeutic approach from that of primary psychoses.

Objectives

To raise awareness about this fact, we present the clinical case of a 43-year-old woman, diagnosed with systemic lupus erythematosus and antiphospholipid syndrome, who went to the Emergency Department due to agitation and delusional ideation of harm.

Methods

Given that the patient presented a recent altered cranial MRI, the aforementioned pathologies and an acute and poorly systematized clinical onset, we referred her for admission to Internal Medicine due to suspicion of a psycho-organic syndrome of probable autoimmune origin.

Results

After admission to Internal Medicine, corticosteroid treatment was prescribed. After three days, the symptoms remitted and the patient was discharged, starting outpatient follow-up.

Conclusions

It is important not to forget that psychotic symptoms may be due to causes other than merely psychopathological ones, and may belong to other aetiologies and, with it, other therapeutic attitudes.

Disclosure of Interest

None Declared
Differential diagnosis of cognitive dysfunction in a multi-morbid patient
Authors: Luna S. , González S. , Cortés R. J. , Kawas O.
Published: August 2023

Introduction

Patients with systemic lupus erythematosus (SLE) have cognitive dysfunctions as a neuropsychiatric manifestation, associated with disabling symptoms. However, the presence of other medical or psychiatric comorbidities can delay or lead to a misdiagnose.

Objectives

To present a case of a patient with diagnostic difficulty in the face of multiple medical and neurocognitive comorbidities.

Methods

Description of a case report.

Results

19-year-old female, Mexican, unemployed, with incomplete high school, with medical history of preterm birth by cesarean at 30 weeks due to placenta previa, history of early puberty, 4 years evolution of focal epilepsy, 1 year evolution of hypothyroidism and mild depression.

She began her symptoms 4 years ago, characterized by an abrupt onset of memory disturbances, decreased concentration, poor academic performance, infantile behavior, need for affection, alternated with irritability periods, verbal and physical aggression, repetitive and erratic behavior. She went to multiple specialists with different therapeutic approaches without clinical improvement. In 2020, she was referred to our service for evaluation, evidenciating a mild depressive episode and psychotherapeutic treatment was started.

Mental and neurological examination without alterations, normal vital signs, at physical examination: malar rash, oral ulcers, alopecia. Labs: increased erythrocyte sedimentation rate, normocytic anemia, leukopenia, rest normal. An electroencephalogram was requested, without alterations. Simple brain MRI was performed (Figure 1).

Psychological (figure 2) and Neuropsychological tests (table 1) were performed, showing alterations in memory recall and inhibitory control.

Due to the symptoms presented by the patient, SLE was suspected, and rheumatology evaluation was requested, integrating a diagnosis of incomplete SLE, and started treatment. The patient presented symptomatic improvement in cognitive symptoms and systemic signs. Likewise, a genetic evaluation was requested, without meeting the criteria for a genetic syndrome. The patient continues with symptomatic improvement and multidisciplinary treatment.Total scoresNaturalNormalizedDiagnosisOrbitomedial18083Mild alterationPref-Anterior22106NormalDorsolateral20788NormalBANFE total409104Normal

Image:

Image 2:

Conclusions

Neurocognitive alterations are one of the most frequent manifestations of neurolupus, although its diagnosis and treatment may be delayed in the absence of clinical suspicion, mainly in multi-comorbid patients.

In the case, the patient presented multiple diseases that can explain a picture of neurocognitive impairment, such as epilepsy, depression, hypothyroidism. However, in these cases, a multidisciplinary approach is imperative, requiring to rule out the different causes of the patient’s symptoms.

Disclosure of Interest

None Declared
A very musical psychopathology – from intrusive musical imagery, to musical obsessions and hallucinations
Authors: Morais A. S. , Martins F. , Casimiro P. , Henriques V. , Descalço N. , Diniz Gomes R.
Published: August 2023

Introduction

The semiological spectrum that encompasses musical imagery is a very confusing field, as it is often difficult to understand the nature of the underlying psychopathological phenomenon from the patient’s description.

Objectives

The purpose of the authors is to explore reviewing, distinguishing and organizing the concepts such as Intrusive musical imagery, musical obsessions, musical hallucinations, pseudohallucinations and musical palinacousis.

Methods

A brief non-systematized review is presented, using the literature available on PubMed and Google Scholar.

Results

Intrusive musical imagery (earworms, ohrwurms, or involuntary musical imagery) occur in more than 85% of general population, without pathology or ear disease. It involves the involuntary repetition of 15-30 seconds of a fragment of music/tune, persisting like a looping soundtrack, not being aversive.

Musical obsessions are a rare form of intrusive imagery, occurring either with other symptoms of Obsessive Compulsive Disorder or isolated (“The stuck song syndrome”). It is recurrent, persistent, intrusive, unintentional, time consuming and causes distress or functional impairment (although not as ego-dystonic and aversive as usually intrusive visual imagery are); preserved insight.

Musical hallucinations occur only in 0,16% in a general hospital; they can be linked to psychiatric diseases, but they are more common in neurological diseases (cerebral lesions, Parkinson’s disease, delirium, drug induced…). They are reported to with less controllability, less lyrical content, and lower familiarity, than other forms of inner music; are perceived to arise from an external source and are interpreted as veridical.

Musical Pseudohallucinations can arise after severe hearing loss, in hallucinogen intoxication and in psychotic or non-psychotic disorders (as dissociative states or in borderline personality disorder). They occur in inner/subjective space, but insight can fluctuate.

Musical palinacousis is associated with electroencephalogram and neuroimaging abnormalities, linked to structural brain pathology. There is perseveration (echoing) of an external auditory stimulus occurs after cessation of the stimulus.

Conclusions

A rash classification can lead to misdiagnosis (for e.g. interpreting obsessive symptoms as hallucinatory phenomena or rendering an organic pathology undiagnosed) and the institution of inappropriate therapy. It is important to carefully explore these musical imagery phenomena when patients present these complaints, taking some time to characterize them.

Disclosure of Interest

None Declared
Neutropenia induced by several second-generation antipsychotics :A case report
Authors: Zarouf H. , Chtibi M. , Belbachir S. , Ouanass A.
Published: August 2023

Introduction

Antipsychotic medications remain the mainstay of the treatment of various psychiatric disorders, particularly schizophrenia. However, this therapeutic class can induce a range of side effects. Although the treatment with second generation antipsychotics includes a lower risk for extrapyramidal symptoms as compared to first generation antipsychotics, there are numerous adverse events that can result from atypical antipsychotics. Since the introduction of clozapine, there has been increased awareness regarding antipsychotic-induced hematological side effects.

Objectives

The objective of this case report is to highlight the importance of the management of antipsychotic-induced neutropenia.

Methods

We report a patient with history of schizophrenia who developed neutropenia induced by Haloperidol, Chlorpromazine, Olanzapine, Amisulpride and Aripiprazole.

Results

We present a case of a 43-year-old male patient with a history of schizophrenia, admitted in our department for the management of a state of agitation in the context of a relapse of his condition. On admission, the patient experienced psychotic symptoms, including delusions and auditory hallucinations, in addition to negative symptoms, such as affective flattening, alogia, avolition and asociality. He was then started on 12 mg of Haloperidol and 200 mg of Chlorpromazine with a white blood cells count (WBC) of 5.98 x 109/L and absolute neutrophil count (ANC) of 2.52 x 109/L (WBC reference range: 4.0-10.0 x 109 /L; ANC reference range: 1.5-7.0 x 109 /L). The patient did not report adverse events on this medication.

15 days into hospitalization, a mild neutropenia was detected (WBC=3.92 x 109 /L and ANC=1.01 x 109 /L), leading to a discontinuation of the antipsychotic treatment. No signs of infection were found. After one month, the patient had a normal WBC and ANC. Aripiprazole was discussed as a first alternative and was begun at 5 mg/day and then at 10 mg/day. After one week of treatment with Aripiprazole, the patient’s WBC was normal, but the ANC decreased again leading to a moderate neutropenia (ANC=0.91x 109 /L). The antipsychotic treatment was once again discontinued and the hematological evaluation found no other identifiable cause. Afterwards, neither Olanzapine nor Amisulpride showed significant response to this adverse effect. Finally, the administration of Risperidone led to a positive outcome on the WBC and the ANC.

Conclusions

Awareness regarding the hematological side effects of antipsychotics should increase and clinical management of this type of adverse event should be a subject of interest among psychiatrists.

Disclosure of Interest

None Declared
Subcutaneous ketamine in the treatment of depression and suicide risk: case report.
Authors: Cigognini M. A. , Meene D. V. D.
Published: August 2023

Introduction

Several studies have shown that ketamine, an NMDA receptor antagonist, represents a promising alternative in treating depression and suicide. The intranasal or intravenous use of ketamine, currently used, has limitations in terms of cost and complexity. The subcutaneous (SC) route may be an affordable alternative for the treatment of depression and suicidality.

Objectives

To evaluate the response of SC ketamine (0,5 mg/kg) applications on depressive, anxiety, and suicide symptoms.

Methods

A patient with unipolar depression and suicide attempt was submitted to 3 sessions of SC ketamine (0,5 mg/kg). The applications had 2 days of intervals. Clinical evaluations were measured by BDI, BSI, and BAI. The vital signs were monitored under 2 hours after injections and the potential side effects.

Results

Changes in measurement instruments according to applications can be seen in Tab 1:BDIBSIBAIApplication 1261418Application 2030000Application 3020000

The average measurements of vital signs during 2 hours of monitoring for each application can be seen in Tab 2:BPHRRFOXECGNine measurements (average)123/8078,8617,5599%NP

Conclusions

The use of SC ketamine showed remission in BDI, BSI and BAI, respectively demonstrated safety in use.

Disclosure of Interest

None Declared
Rare adverse effects of Electro Convulsive Therapy
Authors: Licht C.
Published: August 2023

Introduction

ECT’s most common side effects are headache, memory impairment, and cardiovascular changes [1]. We report the unusual case of unilateral eyelid swelling and cheek flushing as a side effect of ECT in a depressed but otherwise healthy patient.

Objectives

The patient is a 53-year-old woman with a recurrent depressive disorder for 15 years with a current major depressive episode without psychotic symptoms. With therapy resistance to mirtazapine (60 mg/d) and lithium (675 mg/d; 0.75 mmol/l), an ECT series with a total of seven sessions were performed. Treatment was performed with right unilateral electrode placement according to d’Elia (RUL).

Methods

After the first session (Thymatron IV; energy: 20%; pulse width: 0.5; EEG: 45 s), marked hemifacial erythema and supraorbital lid swelling on the right side were evident. After each of the total seven sessions with adequate seizures in the EEG between 45 to 68 s, hemifacial erythema and supraorbital eyelid swelling were evident on the right side.

Results

Both supraorbital eyelid edema occurred immediately after seizure onset, and hemifacial erythema resolved spontaneously and entirely within 10 minutes after the termination of the respective seizure.

Conclusions

The right side of the face appeared normal before ECT and had no injuries or abnormalities. Trauma, allergic reactions to the anesthetic, or complications of manual ventilation were excluded. In the literature, only one case report with supraorbital eyelid edema [2] and one case report with hemifacial redness of the face [3] after ECT have been described so far. We evaluate the eyelid edema and erythema that occurred in our case as isolated benign complications, most likely due to autonomic activation of facial nerves due to electrical stimulation in RUL.

Disclosure of Interest

None Declared
Psychiatric role in physician-assisted death requests – a study protocol for a literature review
Authors: Barranha R. , Ferreira A. R. , Gonçalves E. , Fernandes L.
Published: August 2023

Introduction

The prospect of a medium-term approval of physician-assisted death in Portugal raises relevant ethical and deontological issues that need to be addressed, namely the framework of psychiatric assessments in this process. Such assessments are undermined by the lack of scientific precision in the methods used to determine decision-making capacity, making it possible for the final decision to be affected by psychiatrists’ personal beliefs. As such, outlining scientific evidence and legislation pieces defining the psychiatrists’ role and scope is of utmost importance to frame this debate.

Objectives

To synthetize the accumulated evidence worldwide regarding the psychiatrists’ involvement in the global process of physician-assisted death requests by reviewing scientific literature, published protocols, official reports and international promulgated or amended legislation related to hasten death practices.

Methods

PubMed, Scopus, Web of Science, PsycInfo and Google Scholar electronic bibliographic databases will be searched for eligible articles, as well as grey literature, using the following search terms: Psychiatry AND (Euthanasia OR (Suicide AND Assisted)). Official governments’ and countries health authorities’ websites will also be searched for relevant reports and legislation documents, as well as right-to-die organizations and akin associations. No language, date of publication, or geographical restrictions will be applied. The full text of potentially relevant results will be retrieved from the different sources for review after screening titles and abstracts. This two-stage process will be conducted independently by two researchers. Outcomes of interest will be the descriptions of psychiatric role in the process of physician-assisted death requests, assessment methods, and measurement techniques used.

Results

Given the fact that physician-assisted death is legalized only in a few jurisdictions, we believe the number of eligible results will be limited. Data will be extracted and a descriptive summary of the evidence will be provided. We anticipate finding a significant variability, but also to identify points of consensus. The findings will be published in a peer-review indexed journal and presented at national and international conferences.

Conclusions

To our knowledge, this is the first review of both, scientific published literature, and international legislation on the role of psychiatrists in physician-assisted death requests. We hope to provide an international overview to frame the public debate by pinpointing the most consensual assessment methodology, allowing to design an optimized assessment protocol before the implementation of the law in Portugal.

Disclosure of Interest

None Declared
Challenges in Treating Schizophrenia with LAIs – Analysis of Own Results
Authors: Todorov A. A. , Stoimenova M. Y. , Tzoneva T. R. , Tzankova V. S.
Published: August 2023

Introduction

Schizophrenia is a multifactorial and multifarious disorder with an unidentified etiology and pathogenesis, various clinical symptoms, unpredictable course and definite social significance. It’s social significance manifests in the long inability to work, the decrement of qualification and the burdening of family and social services. Patients find following therapy difficult; they often stop it altogether, which leads to new exacerbations and maintaining a vicious cycle.

Objectives

To present an analysis of the results of the treatment of patients with LAIs – Trevicta and Xeplion in General Psychiatry Ward of UMBAL "Dr. Georgi Stranski” - Pleven for the period October 2016 – October 2022.

Methods

Our retrospective research includes 17 patients treated in General Psychiatry Ward of UMBAL “Dr. Georgi Stranski”- Pleven. A treatment with LAI’s – Trevicta and Xeplion (Paliperidone palmitate) had been initiated in these patients. In consideration of the correct applications of the medication, they are always made by qualified personnel who received training for that purpose in the Ward. For assessment of the patients’ condition are used: Positive and Negative Syndrome Scale (PANSS) and Personal Social Performance (PSP). Standard statistic methods are used for processing results.

Results

Our research includes 17 female patients as the Ward’s profile is such, with the average age of 38.65 years at the initiation of the treatment with Xeplion. Some were later introduced to Trevicta. Of all who participated in the research, 12 patients continue their treatment with regular applications, 2 have changed their address and by unreliable data still continue their treatment and for the other 3 we have no information of their status of treatment. The average count of admissions in the Ward before the initiation of treatment with LAI’s is 3.88 against 0.88 after the initiation. Regarding the PANSS scale – all score in the interval 75-100 points before initiation as opposed to the scores marked after the initiation of the medication that vary in the interval 34-48 points with definite distinctions in P and G items. Regarding the PSP scale – all participants score between 50 and 70 points before the initiation of the treatment as opposed to the scores of 89-95 points after the initiation. During the regular check-ups the patients report of subjective improvement, coupled with reports of objective and positive improvement by family.

Conclusions

Treatment with LAIs – Xeplion and Trevicta has an unquestionable positive and lasting effect in the treatment of schizophrenia. Proof of that is the definite improvement of the symptoms, the increased social engagement and interpersonal communication. Everything mentioned is a valid reason to direct the treatment of schizophrenia in the direction of preservation of the personality of the patients.

Disclosure of Interest

None Declared