bluuebunny/crossref_metadata_2025 huggingface dataset:
Aripiprazole induced reversible ptosis anda oromandibular dystonia
Authors: Ilgin S. E. , Yanartaş Ö. , Özgenç Biçer Ç. I.
Published: August 2024

Introduction

Aripiprazole is an atypical antipsychotic orally indicated for the treatment of schizophrenia, bipolar I, major depressive disorder. It is also indicated as an injection for agitation associated with schizophrenia or bipolar mania. Aripiprazole exerts its effects through agonism of dopaminergic and 5-HT1A receptors and antagonism of alpha-adrenergic and 5-HT2A receptors (Cosi et al., 2006). Ptosis is known as the drooping of the upper eyelid, and the patient usually presents with the complaint of the defect in vision and cosmesis (Shahzad & Siccardi, 2023). Orofacial dyskinesia and oromandibular dystonia are uncommon neurological disorders with involuntary, mainly choreic (dance-like) movements, or excessive, involuntary and sustained or repetitive muscle contractions that may involve the face, lips, tongue, and/or jaw (Bakke, 2016).

Objectives

The aim of this study is to present a case of ptosis and orofacial spasm, which are neurological side effects that may be very rare side effects of aripiprazole.

Methods

The 22-year-old woman was referred to the psychiatric service via the emergency service, due to thoughts of harming herself and irritability. The patient was planned to be hospitalized due to decreased sleep, increased speech, and persecution delusions for the last days. After the patient stayed in the service for 25 days, the patient was prescribed olanzapine 10 mg for discharge. At the follow-up appointment, it was learned that the patient had gained weight due to olanzapine and was switched to aripiprazole on 4th of July. The patient’s aripiprazole dose was gradually increased to 10 mg/day. The patient’s relatives gradually noticed drooping eyelids, involuntary oral movements, and impaired speech due to aripiprazole. Cranial MRI and cranial MRI angiography performed to rule out organic pathologies resulted normal. Accordingly, the aripiprazole dose was reduced to 5 mg/day by his mother, and at the last follow-up appointment on August 4, aripiprazole was stopped and paliperidone was started, and the neurological symptoms completely resolved 4 days later.

Results

Since aripiprazole is frequently used in the field of psychiatry, its side effects are often wondered about. Extrapyramidal system side effects of antipsychotics are more common than ptosis. And In terms of the incidence of various extrapyramidal side effects, overall, no significant effects of age, sex, mean dose, study duration, or measuring method could be demonstrated. It is very important to distinguish between organic pathology and drug side effects, especially since ptosis accompanies neuromuscular diseases, ischemic, demyelinating brain lesions and intracranial aneurysms.

Conclusions

As a result, patients who are started on antipsychotics should be closely watched for side effects to increase patient comfort and drug compliance. Also organic pathologies must be excluded before making a final decision that it is a drug side effect.

Disclosure of Interest

None Declared
Vagus nerve stimulation (VNS) as a long-term adjunctive treatment option in patients with difficult-to-treat depression (DTD)
Authors: Kavakbasi E. , Bauermeister H. , Lemcke L. , Baune B. T.
Published: August 2024

Introduction

VNS is a long-term adjunctive treatment option in patients with DTD. It has been shown that patients with VNS as add-on to treatment-as-usual (TAU) have higher response and remission rates than TAU alone. Data on the impact of VNS on the other complex concomitant treatments are limited.

Objectives

In this study we evaluated changes in drug load from baseline to 12 months as well as the impact of previous ECT response status at baseline on changes in mean depression severity after 12 months of VNS.

Methods

We included n=20 DTD patients (mean age 52.6 years) in the prospective, observational, naturalistic Restore-Life study, who have been treated with adjunctive VNS as add-on to treatment as usual. The RESTORE-Life study is a multi-center study. In this analysis, we report on exploratory results from a single tertiary center. An index has been calculated for each drug by comparing the actual dose with the standard dose of the drug. The drug load for each patient has been constructed by summing up the indices of all agents prescribed for the patient.

Results

We observed a slight decrease in mean drug load from 4.5 at baseline to 4.4 at 12 months (p=0.594). The drug load was lower in previous ECT-responders than in ECT-non-responders at both timepoints. There was a significant decrease in mean MADRS score from 27.3 at baseline to 15.3 at 12 months (p=0.001). Patients with a history of ECT response at baseline have experienced significantly greater improvement in mean MADRS score at 12 months (p=0.013). Number of maintenance electroconvulsive therapy (ECT) and esketamine sessions decreased from 37 ECT and 58 esketamine sessions in the first six months to 17 ECT (-54%) and 29 esketamine (-50%) sessions between months 6 and 12. VNS-related adverse events were present in 50 % of patients at 12 months (voice alteration/hoarseness 45%, dyspnea and pain during stimulation each 5%). There was no discontinuation of VNS due to adverse events.

Conclusions

Overall, VNS was associated with significant decrease in mean MADRS score at 12 months, whereas we did not detect any significant change in medication load. A more extended observation period might be necessary to observe changes in medication load. There was a reduction in the need of maintenance treatment sessions of ECT and esketamine. History of ECT response may be predictive for greater improvement of depression severity in VNS patients.

Disclosure of Interest

E. Kavakbasi Grant / Research support from: The Sponsor of the Restore-Life study is LivaNova. Our institution received fees from LivaNova for study visits of the Restore-Life study. LivaNova had no influence on the content of this work., H. Bauermeister: None Declared, L. Lemcke: None Declared, B. Baune: None Declared
Transient Febrile reaction after Electroconvulsive Therapy : A case report in an adult man with Ultra-Resistant Schizophrenia
Authors: Abdessattar K. , Hkiri A. , khiari H. , Youssef O. , Ghachem R.
Published: August 2024

Introduction

Electroconvulsive therapy (ECT) is a therapeutic method that induces artificial seizure by electrical stimulation to resolve various psychiatric symptoms. ECT is particularly effective in resistant schizophrenia and may improve response to medication despite the presence of potential adverse side effects. Post-ECT delirium and Headaches are some of the most frequent side effects presented in literature. Fever is yet another unexplained reaction, however there are a few case reports and retrospective studies that report on it.

Objectives

We aim to illustrate through a clinical case and a review of literature the prevalence of post ECT fever as well as the possible explanatory mechanisms.

Methods

In this study we report the case of a man with ultra-resistant schizophrenia who was treated successfully with ECT despite the development of transient febrile reaction and we present a review of literature on pubmed using the following key words : ECT, fever,resistant psychosis, mechanisms.

Results

Our patient is a 48-year-old man with a psychiatric history of schizophrenia evolving since the age of 34. He has a history of matricide in 2021 resulting in his hospitalisation in a forensic psychiatric ward. He underwent trials of classic and atypical antipsychotics that weren’t efficacious thus he was diagnosed with resistant schizophrenia in 2022. He was treated initially with clozapine 500 mg per day and then with the association (clozapine + amisulpride) yet it wasn’t effective on his persecutory delirium and fratricide ideas. Plus, there was no reduction in his PANSS (Positive and Negative Syndrome Scale) scores. The diagnosis of ultra-resistant schizophrenia was established. The staff indicated the adjunction of ECT to Clozapine. In the inpatient unit, hours after his fourth ECT session he developed a fever (40°C), his blood pressure (120/80 mm Hg), pulse(85 beats per minute),and respiratory rate(20 breaths per minute) were normal. Blood samples, including cultures, were drawn, which showed normal blood cell count and CPK(140U/L) but CRP was elevated (31 U/L), a chest x-ray showed no acute pulmonary disease, and his urinalysis result and Covid test were negative. His fever resolved then spontaneously after two hours. The same transient febrile reaction occurred again 3 times. It was postulated in literature that fever may be due to inadequate muscle reaction. Data also suggested the potential influence of ECT on the hypothalamus that is a key region in regulating body temperature.

Conclusions

Further studies are required in order to establish the real prevalence of this side effect and its possible causes.

Disclosure of Interest

None Declared
Optimizing Outpatient Mental Health Services: A REBT-Infused Approach to Empowerment and Well-being
Authors: Milutinovic M. , Mitrovska S. , Novotni L.
Published: August 2024

Introduction

Rational Emotive Behavior Therapy (REBT) fundamentally posits that our thoughts, beliefs, and interpretations exert substantial influence over how we perceive and react to life’s occurrences. Central to REBT is the process of recognizing and disputing irrational, self-defeating beliefs, in favor of adopting rational and constructive perspectives.

Objectives

This presentation endeavors to introduce the foundational principles of REBT, elucidate its applied techniques, demonstrate its efficacy through compelling case studies, and delineate its spheres of applicability.

Methods

Case Studies:

1.

Overcoming Social Anxiety: Illustrating the transformation from debilitating social anxiety to enhanced social functioning.

2.

Managing Work-related Stress: Exemplifying the alleviation of chronic stress in a high-pressure work environment.

3.

Overcoming Depression: Demonstrating the journey from persistent despondency to restored vitality and engagement.

Results

In total, REBT furnishes a methodical and pragmatic approach to therapy, affording individuals agency in steering their emotional well-being towards positive and enduring transformation. It is imperative to acknowledge that the suitability of REBT hinges on the idiosyncratic needs, inclinations, and circumstances of each patient.

Conclusions

By internalizing and applying these foundational principles, REBT empowers individuals to identify and dispute irrational beliefs, paving the way for more adaptive emotional responses and an enhanced overall state of mental well-being. It equips individuals with tangible tools to navigate life’s challenges with heightened resilience and emotional equilibrium.

Disclosure of Interest

None Declared
The association between trajectory of change in social functioning and psychological treatment outcome in university students: a growth mixture model analysis
Authors: Barnett P. , Saunders R. , Buckman J. E. , Naqvi S. A. , Singh S. , Stott J. , Wheatley J. , Pilling S.
Published: August 2024

Introduction

Attendance at university can result in social support network disruption. This can have a negative impact on the mental health of young people. Demand for mental health support continues to increase in universities, making identification of factors associated with poorer outcomes a priority. Although social functioning has a bi-directional relationship with mental health, its association with effectiveness of psychological treatments has yet to be explored.

Objectives

To explore whether students showing different trajectories of change in social function over the course of treatment differed in eventual treatment outcome.

Methods

Growth mixture models were estimated on a sample of 5221 students treated in routine mental health services. Different trajectories of change in self-rated impairment in social leisure activities and close relationships (Work and Social Adjustment Scale (WSAS) items 3 and 5) during the course of treatment were identified. Associations between trajectory classes and treatment outcomes were explored through multinomial regression.

Results

Five trajectory classes were identified for social leisure activity impairment (Figure 1), and three classes were identified for close relationship impairment (Figure 2). For both measures the majority of students remained mildly impaired (Class 1). Other trajectories included severe impairment with limited improvement (Class 2), severe impairment with delayed improvement (Class 3), and, in social leisure activities only, rapid improvement (Class 4), and deterioration (Class 5). There was an association between trajectories of improvement in social functioning over time and positive treatment outcomes. Trajectories of worsening or stable severe impairment were associated with negative treatment outcomes.

Image:

Image 2:

Conclusions

Changes in social functioning impairment are associated with psychological treatment outcomes in students, suggesting that these changes may be associated with treatment effectiveness or recovery experiences. Future research should look to establish whether a causal link exists to understand if additional benefit for students can be gained through integrating social support within psychological treatment.

Disclosure of Interest

None Declared
Right to attention to sexuality for people with mental disorders: bridges between health and social services
Authors: Campillo Sanz M. T. , Vallve Elias M. , Casals Arnau A. , Marti Bonany J. , Garcia Hernandez D. , Sanchez Gonzalez R.
Published: August 2024

Introduction

The expression of sexuality in the adult with mental disorders depends on the early incorporation of factors for promoting social inclusion. It is fundamental that sexual educators and advisors, in addition to working with the clients, also work with close family members. Intervention programs should establish objectives for developing a positive attitude towards sexuality in people with mental disorders and improving self-esteem (Katz G,Salud Publica Mex. 2008;50 Suppl 2:s239-54).

Challenge

Achieving support for people with mental health problems and/or substance use disorder admitted to the Social Rehabilitation Process of a psychiatric hospital so that they develop their sexuality satisfactorily. The right to privacy must be taken into account.

Objectives

Promoting a healthy and satisfactory development of sexuality in people with severe mental disorders. Raising awareness among healthcare teams, families and legal representatives regarding the need and suitability for support. Introducing the concept of sexuality as a dignifying perspective. Promoting sexual education that avoids disadvantages and situations of abuse in the target group. Coordinating the continuity of the project with non-health social services after discharge.

Hypothesis

Possibility of receiving support in the development of sexuality through training, information and improvement in the management of emotions/feelings in people who express the need or willingness to receive it, will contribute to overcoming limitations or difficulties.

Methods

Detecting people who during 2021 wish to work on the objectives through the care team. Searching for community resources aimed at attending sexuality issues in people with mental health problems. Proposing the hospital a collaboration with a non-profit entity that develops a specialized program for attention to sexuality in disability. Coordination between Treatment team and Entity. Quantitative and qualitative assessment of one year of experience according to the parameters of the entity.

Results

2022People includedPercentage of people admitted
to the Income Unit (65)Detection concern sex-affectivity
57,69%Verbalized concern34,61%Referral to the entity program23,07%

Conclusions

All patients included have a diagnosis of psychosis. Experience was very positive for the participants. Community intervention projects that lead to an education in healthy and respectful relationships in the field of sexuality and affectivity are necessary. This would allow to prevent behaviours and situations at risk of abuse as well as social and emotional instability.

Disclosure of Interest

None Declared
Mental health competencies are stronger determinants of well-being than mental disorder symptoms even in psychiatric samples
Authors: Zábó V. , Erát D. , Vargha A. , Harangozó J. , Iváncsics M. , Vincze Á. , Farkas J. , Balogh G. , Cowden R. , Pongrácz F. , Bognár J. , Nagy E. , Purebl G. , Gonda X.
Published: August 2024

Introduction

Exploring the positive psychological and behavioural dimensions of people living with mental disorders can establish a firm ground in a therapeutic alliance for setting up positive life goals.

Objectives

The present study aimed to explored whether the strength of the mental health capacities and the severity of mental disorder symptoms and the interaction of the two differ in the strength of their associations with several dimensions of well-being on Hungarian adult psychiatric and non-clinical community samples.

Methods

The psychiatric sample (129 patients (44 male, 85 female)) was collected in four Hungarian healthcare facilities using a cross-sectional design. The non-clinical community sample (253 adults (43 male, 210 female)) was collected online using a cross-sectional design. All the respondents completed the Mental Health Test, six well-being and mental health measures, and the Symptom Checklist-90-Revised.

Results

Including both the mental health competencies and mental disorder symptoms variables in one regression model in both samples can predict patients’ well-being even more accurately. Mental health competencies related positively; mental disorder symptoms connected negatively to subjective well-being. In all models and both samples, mental health competencies were found to be a stronger determinant of well-being than the mental disorder symptoms. The interaction of mental health functioning and mental disorders is no more predictive of well-being in either psychiatric or non-clinical samples than when the effects of each are considered separately.

Conclusions

The assessment of mental health competencies has an important predictive value for well-being in the presence of psychopathological symptoms and/or mental disorders.

Disclosure of Interest

None Declared
Use of Intranasal Oxytocin to Treat Adult Autism Spectrum Disorder: A Randomized Double Blind Controlled Trial
Authors: Faraji Niri S. , Alaghband-rad J. , Motamed M. , Hojjati S. A. , Seyed Alipour S. , Mohebbi N.
Published: August 2024

Introduction

Autism Spectrum Disorder (ASD) is characterized by impairments in social interaction and restricted interests. It has been reported that oxytocin may improve processing of social cues and emotions in adults with ASD.

Objectives

The aim of this study was to evaluate the therapeutic effects and safety of intranasal oxytocin in this population.

Methods

Thirty-nine patients with ASD were randomly assigned to two groups: one group received intranasal oxytocin and the other group received a placebo, with 24 units administered every 12 hours for 8 weeks. The patients were evaluated using the Autism Quotient (AQ), Ritvo Autism Asperger Diagnostic Scale – Revised (RAADS-R), Social Responsiveness Scale (SRS), Clinical Global Impression (CGI), and World Health Organization Quality of Life-BREF (WHOQL-BREF) questionnaires at weeks 0, 4, and 8.

Results

The intervention group showed clinical improvements in RAADS-R (P=0.010), social communication subscale of SRS (P=0.002), CGI (P=0.000), physical (P=0.004), psychological (P=0.006), and social relationships (P=0.046) domains of WHOQL-BREF. Improvements reached their maximum at week 4 and were maintained until week 8 (Table 1).Table 1.

Effect of group, time time-group interaction and the effect size

TimeGroupTime-Group Interaction
F
P-Value

Effect Size (Partial Eta Squared)
F
P-Value

Effect Size
(Partial Eta Squared)
F
P-Value

Effect Size
(Partial Eta Squared)AQ19.440.0000.3440.3910.5360.012.630.0790.066RAADS-R
12.680.0000.2550.9440.3380.0257.2500.0010.164SRS23.630.0000.3900.0500.8230.0017.820.0010.175WHOQL-BREF -Physical Health6.340.0030.1460.1150.7370.0035.70.0050.134WHOQL-BREF -Psychological Health8.310.0010.1830.0480.8280.0016.140.0030.142WHOQL-BREF -Social Relationships7.720.0010.1731.0520.3120.0283.640.0310.090WHOQL-BREF -Environmental Health4.870.0100.1160.1620.6900.0042.690.0740.068CGI22.080.0000.3742.280.1390.0589.420.0040.203

AQ : Autism Spectrum Quotient, SRS : Social Responsiveness Scale, SCI : Social Communication Interaction, RRB : Restricted interest and repetitive behavior, WHOQL-BREF : World Health Organization Quality of life-BREF, CGI : Clinical Global Impression

Conclusions

The findings of this study suggest that nasal oxytocin therapy can significantly improve social skills and quality of life in individuals with ASD. Further research is needed to determine the timing and scope of oxytocin’s effects across the lifespan.

Disclosure of Interest

None Declared
Treatment resistant FEP (first episode of psycosis) with neuroanatomical findings
Authors: Papageorgiou K. , Retsou I. , Papadopoulou E. , Antoniadis D.
Published: August 2024

Introduction

Presentantion of the first psychotic episode of a young man and the investigation of the efficacy of treatment with olanzapine and after cariprazine.

Objectives

Assessing the response to treatment of cariprazine in a psychotic patient with relevant neuroanatomical findings.

Methods

A 25-year old man was admitted to the psychiatric intensive care due to his agggressive behavior and verbal abuse, threatening to kill them both. His medical history included long periods of negatively affected mood, social isolation and talking to himself according to his family

Results

Whent the patient was admitted he was very anxious, alert and extremely aggressive. During the interview he admitted auditory and visual hallucinations alongside delusional ideation with a particular aggression towards his father.

Upon admission his PANSS score was 121. positive scale score was 23.

The patient was treated initially with monotherapy olanzapine, gradually increased up to 20mg OD. Olanzapine caused asymptomatic transaminasemia, a relatively common adverse effect. At this point a change in medication was made and olanzapine was stopped and cariprazine was added gradually increasing its dose from 1,5mg to 6mg OD.

Interestingly the medical investigations (brain CT scan) indicated a calcification in falx cerebri.

After a period of 48 days since admission the patient was clinically improved and was discharged. His PANSS score was 72. Positive scale was 10.

Conclusions

The use of cariprazine as a treatment for a first psychotic episode of a young male improved his PANSS score after a 22-day treatment. According to the literature neuroanatomical findings have been associated with poor prognosis regarding the course of the illness. There needs to be further investigation on the efficacy of the long term treatment for this patient.

Disclosure of Interest

None Declared
Challenges of Sexuality Expression in Individuals with Autism Spectrum Disorder
Authors: Figueiredo M. M. , Afonso P. , Vila Nova V.
Published: August 2024

Introduction

Sexuality, although an essential component of human health, remains a controversial topic shrouded in stigma, particularly in the context of neurodiversity, which includes autism spectrum disorder (ASD), where the expression of sexuality presents unique challenges. Autism and sexuality is a complex and multifaceted topic that involves understanding the unique ways in which individuals on the autism spectrum experience and express their sexuality.

Objectives

The purpose of this work is to address the complexity of the biopsychosocial sexuality components of people with autism, promoting a shift in the medical perspective, societal attitudes, and supporting greater inclusion of these individuals in current discussions regarding this area of human behavior and experience.

Methods

Evidence-based review, through research conducted on PubMed and selection of the most relevant studies on this topic, published in the last decade.

Results

Sexuality in autism is now recognized as a normative and integral aspect of development and functioning. Existing research suggests that most individuals with ASD display a clear interest in sexuality and relationships, with a study reviling that 96% of the ASD sample expressed an interest in sexuality. Individuals with high autistic traits tended to identify themselves more times as bisexual or presented a sexuality not definable within the categories of heterosexual. The relationship between autism and gender dysphoria is an area of ongoing research and discussion. Studies have suggested a higher prevalence of gender diverse identities and experiences within the autism community compared to the general population. Various hypotheses have been proposed to explain the increased gender and sexual diversity among individuals with autism. People with ASD may face unique challenges when it comes to their sexuality. The impairments in social skills and communication central to ASD potentially impact an autistic individual’s expression and experience of sexuality by affecting their abilities to understand and interpret social cues, emotions, and nonverbal behaviors of others. Importantly, such individuals may be more vulnerable, as they may have different or even limited understanding of boundaries and consent. To address these challenges, it is important to acknowledge and respect the diversity of sexual experiences and desires among individuals with neuro(bio)logical differences. This can be done by providing accurate and inclusive sex education, creating safe spaces for such individuals to explore and express their sexuality, and working to address discrimination and abuse in intimate contexts.

Conclusions

Recognizing and respecting this diversity and fostering inclusive and accepting environments, we can help individuals with neurological differences to fully express and explore their sexuality and have satisfying sexual lives.

Disclosure of Interest

None Declared
The Challenge of Lorazepam Failure: Malignant Catatonia Treated Successfully with Valproate
Authors: Kim J. , Garrels E. , Zamiri A. , Tran K. , Francis A.
Published: August 2024

Introduction

Despite the unclear nature of catatonia, the treatment response of catatonia to benzodiazepines is widely known for its typical, dramatic recovery. The neurobiological correlates of this phenomenon regarding specific receptors and neurotransmitters are unclear, as are the potential treatment options. This is important to consider when the most commonly recommended treatments of catatonia with Lorazepam or Electroconvulsive Therapy (ECT) are unavailable or unsuccessful. In this report, we describe a case of severe, malignant catatonia and psychosis mostly unresponsive to Lorazepam during two different hospitalizations, but with eventual return to baseline after successful treatment with Valproate.

Objectives

-

To describe a unique case of malignant catatonia that was unresponsive to Lorazepam

-

To illustrate the potential utility of Valproate as an alternative treatment strategy for catatonia

Methods

This is a case report.

Results

A 19-year-old Hispanic male presented to our hospital initially with family reports of severe and sudden depression with bizarre behavior. Prior to this admission, the patient had been discharged recently from another tertiary hospital following a 2-week admission for severe catatonia. Chart review from that admission scored the patient’s Bush-Francis Catatonia Rating Scale (BFCRS) at 16, which remained mostly unchanged after numerous additional intramuscular doses and standing oral doses of Lorazepam, with a reduction of BFCRS the next day of only 2. During the patient’s admission at our hospital, the patient endorsed bizarre, guilt-related delusions, and his catatonia was more severe and malignant with a BFCRS of 19, with tachycardia and diaphoresis. The patient was initially given a total of seven doses of a mix of intramuscular and oral Lorazepam (total 18mg), with a minimal 2-point reduction in BFCRS. As ECT was unavailable, Lorazepam was discontinued in favor of a trial of oral Valproate 500mg twice daily, and after his catatonia subsided (with a serum level of 60.8), he was started on oral Risperidone 0.5mg once at night, titrated up to 3mg twice daily, and eventually returned to baseline as confirmed by his family members.

Conclusions

The treatment of catatonia with Lorazepam is usually reliable and has been found to be up to 80% effective, but when the recommended use of benzodiazepines and ECT fail or are unavailable, there are few studies exploring the viability of alternative treatment options. With the use of Valproate, previous studies have shown it can treat even severe catatonia (KrÜger, J Neuropsychiatry 2001; 13:303-304), or can actually be its cause (Lauterbach, Neuropsychiatry, Neuropsychology, and Behavioral Neurology. 1998 Jul;11(3):157-163). As such, this case report highlights the importance of exploring alternative treatments for catatonia, including Valproate, in order to better tailor the management of this unique syndrome.

Disclosure of Interest

None Declared
Artificial intelligence and virtual reality applied to the clinical care of women with schizophrenia: A systematic review.
Authors: Paolini San Miguel J. P. , Natividad M. , Seeman M. V. , Palacios B. , Balagué A. , Román E. , Bagué N. , Izquierdo E. , Cachinero H. , Monreal J. A. , González Rodríguez A.
Published: August 2024

Introduction

Artificial intelligence (AI) and virtual reality (VR) are useful tools that can improve precision medicine and can prove useful in the clinical care of patients with psychosis.

Objectives

Our aim was to determine whether AI and VR have been applied to the prediction of clinical response in women with schizophrenia.

Methods

A systematic review was carried out in PubMed and Scopus from inception to September 2023 by using the PRISMA guidelines. Search terms: (“artificial intelligence” OR “intelligent support” OR “machine intelligence” OR “machine learning” OR “virtual reality” OR “intelligent agent” OR “neural networks” OR “virtual reality” OR “digital twins”) AND (“schizophrenia” OR “psychosis”) AND (“women” OR gender”). Inclusion criteria: 1)English, French, German or Spanish language, 2) reporting treatment response in schizophrenia (as long as information in women was included), and 3) including AI and VR techniques.

Results

From a total of 320 abstracts initially screened (PubMed:182, Scopus:138), we selected 6 studies that met criteria.

-

Prediction of treatment response. (1) Clinical information, genetic risk score and proxy methylation score have been shown to improve prediction models. (2) Graph-theory-based measures have been combined with machine learning.

-

Therapeutic drug monitoring. (1) A machine learning model has been useful in predicting quetiapine blood concentrations.

-

Pharmacovigilance. (1) Machine learning has connected prolactin levels and response in olanzapine-treated patients. (Zhu et al., 2022).

-

Treatment-resistant schizophrenia (TRS). (1) Women with TRS have been found to receive clozapine less frequently than men (adjusted for sociodemographic, biological and clinical factors). (2) Statistical learning approach: Women have been found to respond better to clozapine than men.

Conclusions

AI, including machine learning, show promising results in the prediction of treatment response in women with schizophrenia. As of yet, digital twins have not been investigated to test specific interventions or to personalize treatment in women with schizophrenia.

Disclosure of Interest

None Declared
Differential diagnosis of acute psychosis after cocaine consumption: a case report
Authors: Gimillo Bonaque J. , Arroyo Sánchez E. , Setién Preciados P. , Díaz Mayoral C.
Published: August 2024

Introduction

Psychosis is a common clinical presentation of mental disorder in many psychiatric patients, however, an etiological diagnosis is important when it occurs for the first time in a patient. Regarding a case seen in the Emergency Department recently, with major depression and acute cocaine use, a differential diagnosis was made after adequate organic screening. When presenting delusion of infestation after the consumption of the substance, the main hypothesis was what we call Ekbom syndrome. However, among other possibilities we consider a toxic psychosis or a major depression with psychotic symptoms.

Objectives

Review the different causes of acute psychosis and the importance of a good clinical history to achieve a specific diagnosis. Perform a differential diagnosis between the main causes of psychosis in a patient with depression who has recently consumed cocaine.

Methods

Presentation of the case and review of the available literature on the risk of developing psychosis after cocaine use and depression concomitantly.

Results

There is a low number of reported cases of delusional infestation after acute cocaine use, being more likely toxic psychosis or major depression with psychotic symptoms. A good anamnesis, with systematic questions about toxic habits, can lead us to a more accurate main hypothesis.

Conclusions

We mark the importance of a systematic anamnesis to achieve a better diagnosis, as well as a correct study by the clinician of the specific syndromes described in phenomenology such as Ekbom syndrome, to make a correct association of ideas in the differential diagnosis.

Disclosure of Interest

None Declared
Grading of Recommendations of psychological interventions in the rehabilitation of patients with schizophrenia
Authors: Vazquez-Noguerol Mendez R. , Garcia Pineiro S. , Perez P. G. S. , Puime Miguez M. , Cinos Galan C. , Veiga Candan M. J. , Suarez Baldomir M. , Soriano Garcia M.
Published: August 2024

Introduction

As part of the intervention, patients with severe schizophrenia who are cared for in psychiatric rehabilitation units need psychological treatments. However, there is great variability within the psychotherapy alternatives that are proposed for rehabilitation in schizophrenia, and it is necessary to know which are the most efficient interventions in order to prioritize their inclusion in intervention programs.

Objectives

To know the level of evidence of the existing psychotherapy alternatives for the rehabilitation treatment in schizophrenia through the systematic review of recently published studies.

Methods

Consecutive systematic searches in the scientific literature were used in a sensitive and specific way, aimed at identifying the existence of documents in databases and clinical practice guidelines based on evidence of psychological treatment in schizophrenia. Psychosocial and social approaches and family members interventions were excluded, and the search was limited to the last 5 years. The PICO format has been used, and a subsequent critical reading using the AGREE II tool, considering the inclusion criteria of presenting a score >60% in 4 domains.

Results

The following interventions have been found to be therapeutically effective: Level 1B (Early intervention in Psychosis; Patient and Family psychoeducational intervention; Basic ando social skills training; Social cognition and Metakognition training; Cognitive Remediation; Cognitive Behavioral Individual Therapy; Assertive Community treatment; Supported employment). Level 2B (Family Problem Solving Therapy, Dynamic Psychotherapy; Cognitive Behavioral Group Therapy); Level 2C (Horticultural, Art, Music, Animals Therapies).

Conclusions

Several psychotherapy alternatives are proposed for rehabilitation in schizophrenia, with known level of evidenca in order to prioritize their inclusion in intervention programs.

Disclosure of Interest

None Declared
‘De Novo’ Psychosis following anterior temporal lobectomy: A case report
Authors: Yoldas S. , Yıldırım I. , Usta Sağlam N. G. , Özkara Ç.
Published: August 2024

Introduction

Surgical treatments for people living with epilepsy have the potential to provide patients with an opportunity to achieve relief from seizures, thus improving their quality of life, but they are not free of complications. The psychiatric consequences are a significant concern because of the potential risks; however, psychotic illnesses have not received adequate research compared to anxiety and depression.

Objectives

To better identify the psychiatric side effects that can develop following epilepsy surgery, especially psychosis, and to take preventive measures to mitigate its occurrence.

Methods

Presentation of a patient’s case and reviewing existing literature regarding de novo psychosis following epileptic surgery.

Results

The case of interest is a 31-year-old male patient who, or his relatives, has had no history of psychiatric disorders. From age 21, the patient had focal to bilateral seizures, which were preceded by olfactory auras and could occur up to 4-5 times a week and was then diagnosed with epilepsy. In June 2021, the patient underwent a right anterior temporal lobectomy for his medically resistant seizures after a presurgical evaluation and had a notable decrease in the number of seizures, occurring only during periods of sleep every six months. In the fourth month following the operation, the patient began experiencing auditory hallucinations characterized by negative and judgmental voices. After that, he engaged in an aggressive act by holding a knife and assaulting another person in a public area. He was admitted to an inpatient psychiatry service for 12 days with a diagnosis of a psychotic episode. His symptoms significantly improved, and he was discharged with paliperidone 6 mg/daily treatment. After five months, he discontinued the medication, subsequently experiencing a recurrence of auditory hallucinations and aggression. The patient was admitted to the inpatient psychiatric clinic in June 2022 as a result of experiencing paranoid delusions and engaging in a suicide attempt by self-inflicted wrist laceration using a razor blade, which was consistent with the patient’s delusional beliefs. Following 13 days of hospitalization, he was discharged with amisulpride 800 mg/daily in addition to his antiepileptic treatment. After 15 months of discharge, he showed no signs of active psychotic features, and his functioning was moderate to good.

Conclusions

Current research and reporting of psychiatric outcomes are limited, and the predictive factors and prognosis of psychiatric symptoms in these patients remain obscure. Long-term follow-up is crucial, especially considering the possibility of psychiatric symptoms developing in the months following surgery, as demonstrated by the current case. In addition, preoperative and postoperative assessments may facilitate the management of psychiatric symptoms.

Disclosure of Interest

None Declared
Menstrual Psychosis with Premenstrual Onset: A case presentation
Authors: Turkan S. , Kara E. , İlhan R. S. , Yalcın Sahiner S. , Saka M. C.
Published: August 2024

Introduction

Menstrual psychosis has an acute onset and is characterised by confusion, stupor and mutism, delusions, hallucinations, or a manic syndrome lasting for a brief duration, with full recovery. These symptoms maintain periodicity in rhythm with the menstrual cycle. The symptoms may appear in the premenstrual phase or may begin with the onset of menstrual flow (catamenial psychoses). Usually, menstrual psychosis has a polymorphism of both psychotic and affective symptoms (Brockington I. Menstrual psychosis. World Psychiatry. 2005;4(1):9-17.). In this article we present a case of menstrual psychosis with premenstrual onset.

Objectives

A 26 years old, nulliparous single female with one mentally ill relative on her mother’s side (her grandmother) presented with an episodic illness characterized by mood swings, irrelevant speech, irritability, suspiciousness and thought disorder related to her menstrual cycles. She had earlier suffered prolonged attacks of mania, developed a recurrent episodic illness which returned every month for five years. Her menses began at 15. She presented with the history of a few episodes of manic illness starting five days before and ending suddenly with the onset of the menses.

Methods

On mental status evaluation during the index episode, the patient was agitated, had labile affect, grandiose and referential delusions and erotomania. A detailed physical examination, routine biochemistry, and gonadal hormonal assay were unremarkable.

Results

She was started on olanzapine 10 mg/day, lithium 1200 mg/day and low-dose clonazepam. Although the severity of the psychotic and affective symptoms gradually reduced during the future menstrual cycles, they did not completely resolve.

Conclusions

The pathophysiology of menstrual psychosis is not exactly understood, but it has been postulated that fluctuation of the sex hormones occurring during the menstrual cycle is responsible. Previous studies have reported the association of psychosis with estrogen withdrawal (Mahé V, Dumaine A. Oestrogen withdrawal associated psychoses. Acta Psychiatr Scand. 2001;104(5):323-331.). Treatment strategies for menstrual psychosis include the use of oral contraceptive pills for the regulation of hormones during the menstrual cycle, in our case patient did not want to use oral contraceptive pills.

Disclosure of Interest

None Declared
The role of resilience and coping behavior in schizophrenia in the prevention of psychosis relapse
Authors: Mitikhin V. , Kuzminova M. , Alieva L.
Published: August 2024

Introduction

According to scientific sources, personal resources in the form of resilience, stress coping skills play an important protective role in the prevention of psychosis recurrence. Weakening the psychological capacity of the patient and increasing stress are risk factors for psychosis.

Objectives

To study the protective role of such personal resources as resilience and coping with stress in schizophrenia, as well as the influence of negative symptomatology and psychosociorehabilitation intervention on these factors.

Methods

Clinical-psychopathological, statistical, and psychometric methods were used (Alfimova-Golimbet’s resilience scale, Amirkhan’s coping strategies questionnaire, and PANSS). Patients of two groups participated in the study: 1 - members of a community organization (OO), n=49, who in addition to psychopharmacotherapy were given comprehensive long-term psychosociorehabilitation (3.7±2.5 years), 2 - patients of the medical-rehabilitation department of a psychiatric hospital (MRO), n=48, in whom the psychosociorehabilitation intervention was shorter (40.3±6.5 days).

Results

The results of the study showed that significant predictors of a favorable course of the schizophrenic process were high indicators of resilience, coping behavior, and a small degree of negative symptomatology. Analysis of the data regarding patients’ coping with stress shows that constructive coping strategies are more frequent in both groups. Thus, “problem solving” (24.3 points in GS and 22.9 points in MPO) and “search for social support” (23.0 points and 22.7 points, respectively), that is patients of both groups are generally oriented to a productive way of coping with difficult situations and are ready to seek help from others in a difficult situation. Notably, the strategy of “problem avoidance” is less pronounced (18.5 points and 19.4 points, respectively). The high resilience scores in the GS group (32.5 points), comparable to the norm in the population (33.1 points), are explained by long-term comprehensive psychosociorehabilitation, while the resilience scores in the MPO group are lower - 28.7 points. Negative symptoms of schizophrenia were equally pronounced in both groups, manifested by difficulties in communication (2.6 points each), passive-apathetic social withdrawal (2.7 points each). Such negative symptoms as blunting of affect and emotional indifference were more pronounced in the MPO group - 3.2 points each vs. 2.8 points in the group from the GS.

Conclusions

High levels of resilience and ability to cope with stress as a result of psychosociorehabilitation intervention allow patients to overcome difficult life circumstances more flexibly. They are associated with less pronounced negative symptoms, which generally helps prevent psychosis relapses and contribute to a more favorable course and prognosis of schizophrenia.

Disclosure of Interest

None Declared
Hydroxychloroquine in systemic lupus erythematosus and psychosis. A case report
Authors: Martínez Grimal M. , Morales Rivero A. M. , Rivero Rodríguez P. , Morales Castellano E. E. , Molina Pérez N.
Published: August 2024

Introduction

Hydroxychloroquine, an antimalarial drug, is an important therapeutic tool in the management of rheumatic diseases such as Systemic Lupus Erythematosus (SLE) due to its anti-inflammatory action. SLE is a chronic autoimmune inflammatory disease that affects the connective tissue of multiple organs. Neuropsychiatric disturbances in SLE are common; however, lupus psychosis is rare, occurring in 2 to 11% of patients. The literature has described the emergence of neuropsychiatric symptoms as an adverse effect of hydroxychloroquine use, with some patients experiencing clinical depression, anxiety, suicidal ideation, and psychotic symptoms.

Objectives

The aim of this work is to review the available evidence regarding neuropsychiatric symptoms secondary to the use of hydroxychloroquine.

Methods

The case of a 50-year-old woman diagnosed with SLE, with no other relevant medical history, has been evaluated. She was brought to the emergency department due to paranoid and persecutory ideas, as well as self-referentiality, coinciding with the introduction of hydroxychloroquine in her treatment. She was admitted to the University Hospital of Gran Canaria Doctor Negrín with a diagnostic orientation of a first psychotic episode.

Results

The presence of neuropsychiatric symptoms in patients diagnosed with SLE is so common that they constitute a diagnostic criterion for the disease. On the other hand, the medications used for therapeutic management of this disease can lead to the emergence of new neuropsychiatric symptoms or exacerbate preexisting neuropsychiatric clinical manifestations.

Conclusions

The study of this case highlights the challenges in establishing a differential diagnosis between primary SLE symptoms that require an increase in hydroxychloroquine and those caused by its own treatment. It underscores the need for further studies to explore the risk of psychiatric symptoms associated with the use of hydroxychloroquine, as well as its impact on the course of underlying mental disorders.

Disclosure of Interest

None Declared