bluuebunny/crossref_metadata_2025_split huggingface dataset:
Case-series of patients treated with anti-NMDAR encephalitis at Semmelweis University
Authors: Herman L. , Réthelyi J. M. , Sipos I. , Zsigmond R. I. 
Published: August 2024

Introduction
Anti-NMDAR encephalitis is an autoimmune disorder, characterized by neuropsychiatric symptoms, such as mood instability, psychosis, catatonia, dyskinesia, seizures and vegetative lability. Psychiatric symptoms usually occur in the initial phase, therefore almost half of the patients are first observed at a psychiatric unit, however in later phases the patients’ condition often show progression with the characteristic neurological symptoms, such as perioral dyskinesia and seizures. Although, early recognition and treatment is essential to reach good outcomes, delay in the diagnostic process often happens due to the unspecific early symptoms and the lack of knowledge of this disorder amongst psychiatrists.
Moreover, there are cases, where neurological symptoms do not appear, which can lead to diagnostic failure and mismanagement of these patients. Since anti-NMDAR encephalitis is a rare condition, it is important to treat such cases in specific centres, where sufficient knowledge and multidisciplinary approaches are available.ObjectivesOur aim was to gather all patients’ data treated with anti-NMDAR encephalitis at two departments (Neurology and Psychiatry) of Semmelweis University. We wanted to analyse psychiatric manifestations of the disorder in details and follow these symptoms long term, with special interest on the cognitive symptoms.One of our aims was to follow-up these patients and measure antibody titres in their serum, to be able to asses, whether there was any association between prolonged serum positivity and cognitive impairment.MethodsWe have retrospectively analysed data of previous cases and prospectively followed up recently hospitalised patients.Neurocognitive assessment had been conducted by the same psychologist, all the patients were followed up by the same interdisciplinary team, including a neurologist and two psychiatrists. Laboratory tests (autoimmune antibody essays) were conducted by the Immunological Laboratory at Semmelweis University.ResultsAltogether, 13 female patients were treated with anti-NMDAR encephalitis in the past ten years at Semmelweis University. All of them received plasma exchange, iv. steroids and azathioprine. 8 out of the 13 needed ventilation and intensive care treatment. 2 of these patients have mild psychiatric symptoms as residual symptoms, and 1 of them is still in the recovery stage, currently experiencing mild cognitive symptoms.Only two patient had ovarian teratomas out of the 13, which is a lower number than expected from previous studies.
4 out of 12 had positive antibody titre at follow up, one patient is still at recovery stage, however her antibody titres are still very high.ConclusionsSemmelweis University is one of the largest centre treating patients with anti-NMDAR encephalitis in Hungary. We had altogether 13 patients in the last ten years, with very good outcome, since all of them recovered, although 2 have residual symptoms.Disclosure of InterestNone Declared
Clinical and immunological features of prolonged and chronic endogenous manic and manic-delusional states in the structure of endogenous diseases
Authors: Zozulya S. A. , Rumyantseva E. B. , Sizov S. V. , Oleichik I. V. , Klyushnik T. P. 
Published: August 2024

Introduction
The relevance of studying the clinical and immunological characteristics of prolonged and chronic endogenous manic and manic-delusional states is conditioned by their high prevalence, insufficient understanding of pathogenetic mechanisms, and the need to develop adequate therapeutic approaches.ObjectivesTo study the clinical and biological correlations between inflammatory markers of blood plasma, the severity of manic symptoms and psychopathological characteristics of patients with prolonged and chronic endogenous manic and manic-delusional states.Methods70 female patients aged 18 to 55 years (mean age 33.6±5.9 years) with prolonged and chronic endogenous manic and manic-delusional states within different nosologies (F31.1-2, F25.01, F25) were examined. Psychometric assessment was performed using the PANSS, YMRS, and GAF scales. The control group consisted of 55 mentally and somatically healthy women of the corresponding age.
Leukocyte elastase (LE) activity, α1-proteinase inhibitor (α1-PI) activity, and the autoantibody levels to astrocytic protein S-100B and myelin basic protein (MBP) were determined in blood plasma.Results
The increase in the level of immune system activation of different degrees (according to the complex of inflammatory and autoimmune markers) associated with the severity of the patient’s condition within the examined nosologies was revealed.
The highest level of immune activation, characterized by an increase in the activity of both LE and α1-PI (p<0.01), and the level of autoantibodies to S-100B and MBP (p<0.05), was characteristic of patients with chronic endogenous manic and manic-delusional states in the framework of schizophrenia. Manic symptoms within different nosologies had clinical features, however, no differences in the severity of these symptoms on the YMRS scale were revealed (p>0.05).Positive correlations were found between LE activity and the PANSS subscale of general psychopathological symptoms (R=0.3, p=0.006) and the PANSS total score (R=0.3, p=0.03). The level of antibodies to S-100B correlated with the PANSS negative subscale score (R=0.3, p=0.04). A negative correlation was found between LE activity and the level of social functioning of patients according to the GAF scale (R=-0.3, p=0.02).ConclusionsThe immune profile of patients with prolonged and chronic manic and manic delusional states within endogenous psychiatric disorders is determined mainly by nosologic affiliation, which is also related to the clinical features of manic states.Disclosure of InterestNone Declared
The Application of Pharmacogenetic Testing in Psychiatry for Treatment-Resistant Disorders: Optimal Timing and Implementation, a literature review
Authors: Pjevac M. 
Published: August 2024

IntroductionTreatment-resistant psychiatric disorders present a significant clinical challenge, often requiring trial-and-error approaches to find effective therapeutic interventions. Pharmacogenetic testing has emerged as a promising tool to guide medication selection and dosing, potentially reducing the time to achieve remission and alleviating the burden of persistent symptoms. However, the optimal timing and integration of pharmacogenetic testing into psychiatric practice remain underexplored.ObjectivesPharmacogenetic tests can identify individuals with genetic variants that may predict their response to psychotropic drugs, thus enabling a more personalized approach to treatment. Evidence suggests that early application of pharmacogenetic testing, particularly after the first failed medication trial, can substantially improve outcomes for patients with treatment-resistant disorders. Such timely intervention can inform drug choice and dosing, averting protracted periods of ineffective treatment and minimizing exposure to unnecessary side effects.MethodsThis review synthesizes current literature on pharmacogenetic testing in psychiatry, with a focus on its application in treatment-resistant mood disorders, schizophrenia, and other non-responsive psychiatric conditions. We examine the genetic polymorphisms that influence drug metabolism, efficacy, and the risk of adverse effects, particularly considering cytochrome P450 enzymes and receptor gene variations.ResultsPharmacogenetic testing holds significant promise in psychiatry, especially for treatment-resistant disorders, by aligning genetic profiles with medication selection to enhance therapeutic efficacy. While cost and access remain barriers, the benefits of early testing support its integration into standard care protocols. Further research is needed to establish clear guidelines and to expand the genetic targets relevant to psychiatric pharmacotherapy.ConclusionsAdoption of pharmacogenetic testing after the initial treatment failure offers a pragmatic balance between the practical limitations of universal screening and the clinical imperative to alleviate the substantial morbidity associated with treatment-resistant psychiatric conditions.Disclosure of InterestNone Declared
Successful treatment of Premenstrual dysphoric disorder with irritable bowel syndrome using sulpiride
Authors: Alageel A. A. 
Published: August 2024

IntroductionPremenstrual dysphoric disorder (PMDD) is prevalent, more severe than premenstrual syndrome(PMS), and a challenging disorder. The first line of treatment is pharmacotherapy. Non-pharmacological therapy includes aerobic exercise, consumption of complex carbohydrates and frequent meals, relaxation training, light therapy, sleep deprivation, and cognitive-behavioral therapy could be helpfulObjectivesTo our knowledge, there have not yet been any studies on this treatment option for PMDD with IBSMethodsa case reportResultsA lady suffering from PMDD and irritable bowel syndrome (IBS) did not respond to antidepressants, painkillers, and melatonin. She used to sit at home and in her room these days, waiting for the PMDD severity to decrease. Her condition reached remission after taking a small dosage of sulpiride and stopped on the last day of the period. The patient is satisfied with the result since concerns about antidepressants are addressed and avoided. This case provides a new approach to using low-dosage sulpiride temporarily every month in patients with both PMDD and IBSConclusions
Premenstrual dysphoric disorder is a challenging condition. The symptoms of PMDD are not continuous, and somatic symptoms are a significant component of both the diagnosis and the patient’s suffering. Choosing a suitable medication based on pros and cons contributes to successful treatment and patient satisfaction. This case provides a new approach to using low-dosage sulpiride in patients with both PMDD and IBS, but more studies are needed to confirm its efficacy and safety.Disclosure of InterestNone Declared
Hyperammonemic encephalopathy in a 46 year old patient treated with valproic acid as treatment for borderline personality disorder: a case report.
Authors: Setién Preciados P. , Arroyo Sánchez E. , Díaz Mayoral C. , Gimillo Bonaque J. 
Published: August 2024

Introduction
Valproic acid (VPA) has been used in clinical practice since the 60’s, with a relatively favourable safety and efficacy profile. Pancreatitis, hepatotoxicity and teratogenicity are the most significant adverse drug reactions. VPA is also known for causing hyperammonemia, which may be asymptomatic or can present with encephalopathy. VPA-induced hyperammonemic encephalopathy (VHE) is a serious but reversible condition, which requires high clinical suspicion for diagnosis. It may occur acutely or after chronic use of VPA.ObjectivesReview how frequent is for valproic acid to cause hyperammonemic encephalopathy, signs to watch out for and how it can be treated.MethodsPresentation of a patient’s case and review of existing literature, in regards to encephalopathy caused by valproic acid as a result of ammonia elevation.ResultsIn the case displayed here, the patient is diagnosed of hyperammonemic encephalopathy after being treated with valproic acid as treatment for borderline personality disorder.
Reviewing literature, cases of hyperammonemia are rarely reported as VPA-induced, probably because this increased level of ammonia in blood can vary between asymptomatic, and clinically relevant levels. Symptomatology due to VPA-induced hyperammonemia include: lethargy, impaired consciousness, focal neurological signs and symptoms and increased seizure frequency. More rare described symptoms are: aggression, ataxia, asterixis, vomiting and coma.
There are multiple treatment modalities for patients diagnosed with VHE, the primary treatment being the discontinuation of VPA. Other treatments frequently used are Lactulose and Carnitine.Conclusions
VHE is a rare occurrence, however can have fatal outcomes if not recognized and managed in time. Physicians should be vigilant while initiating Valproate therapy to patients. Clinicians should consider the possibility of VHE in patients with unexplained altered mental status, regardless of the duration of VPA therapy. A timely diagnosis is essential to prompt effective treatment, thus ensuring the patient’s safety and decreasing the length of hospitalisation and the cost of care in hospitals.Disclosure of InterestNone Declared
Non MRI Guided Accelerated Intermittent Theta Burst Stimulation is Effective in Patients with Treatment Resistant Depression and Suicidality
Authors: Zayed A. E. , Bassiony M. M. , Youssef U. M. , Salah Eldeen G. M. , Elgohary H. M. , Sehlo M. G. , Hefny O. A. 
Published: August 2024

IntroductionThe U.S. Food & Drug Administration (FDA) has cleared SNT (Stanford Neuromodulation Therapy) for treatment of major depressive disorder (MDD) in adults who have failed to achieve improvement from at least two prior trials of antidepressants. SNT protocol requires both structural and functional connectivity MRIs which is limited by high cost and lack of availability, its use without neuronavigation is still considered an off label use and need more investigation.Objectives1-To investigate efficacy of SNT like accelerated off-label protocol without Neuronavigation in treating patients with TRD and suicidality.2-To investigate durabiliy ( up to one month ) of SNT like accelerated off-label protocol without Neuronavigation in treating patients with TRD and suicidalityMethods
Two cases diagnosed as treatment resistant unipolar depression with suicidal ideations received accelerated intermittent theta burst stimulation (a iTBS); with figure of eight coil administered to the left dorsolateral prefrontal cortex (DL-PFC) determined using Beam method. Stimulation was at 90% MT for 1800 pulses with an intersession interval of fifty minutes. Patients received ten sessions every day for five consecutive days for a total of fifty sessions (90,000 pulses). The following scales were applied at the baseline and at the end of each day of five treatment days:The Montgomery and Asberg Depression Rating Scale (MADRS) The Beck Depression Inventory, Columbia Suicide Severity Rating Scale (C-SSRS) and Young Mania Rating Scale (YMRS).ResultsThe two cases at the end of the fifth day were completely improved regarding both suicidal ideations and depression without emerging of hypomania. Follow up was done weekly for one month with durable results.ConclusionsSNT protocol without neuronavigation needs to be well investigated in suppressing both suicidality and depression in patients with TRD.Disclosure of InterestNone Declared
Multifamily group evaluation with Score 15 questionnaire
Authors: Gamo Bravo B. , Gonzalez Laynez M. E. , Bañon Gonzalez S. M. , Ogando Portilla N. 
Published: August 2024

IntroductionThe multifamily group that has been underway since April 2019 in Alcobendas, Madrid is described. A group that serves people diagnosed with mental disorder and their families, with the aim of improving their health and quality of life. It is about facilitating and improving the basic communication of relational aspects and healthy bonds. It is intended to offer a space where you can think together about the experiences lived in your own family with the rest of the groupObjectivesAssess the evolution and improvement of the patient and family members with the Score 15 questionnaire, The Score is a way of giving users a voice about the therapy process, not about the contents of their problems, but about their perception of the effectiveness of therapeutic work and for professionals it is an opportunity to obtain important feedback from their work.MethodsUsing the Score !5 questionnaire on all participants in the group at time zero and after 12 sessionsResultsImprovement in the family description items, and in the quantitative improvement in scoring of the following questions: What degree of severity would indicate? Do you think therapy will be helpful/has it been helpful to you?ConclusionsFamily therapy in the modality of Multifamily Groups provides an improvement in intrafamily communication, its links and therefore in the rest of social communication, facilitating the exit from loneliness and misunderstanding and in turn broadens the understanding and understanding by therapistsDisclosure of InterestNone Declared
Family systemic therapy in patients with eating disorders
Authors: Setién Preciados P. , Díaz Mayoral C. , Arroyo Sánchez E. 
Published: August 2024

Introduction
Eating disorders are a group of pathologies in which negative beliefs about food, body type and weight are associated with conducts that include food restriction, binge eating, excessive exercise, induced vomiting and the use of laxatives. They can be really severe, affecting quality of life and lead to multiple physical and psychiatric complications, even with a deadly fate.ObjectivesPresentation of a patient’s case with an eating disorder and the intervention with her family, as well as, doing a review of the family interventions in these kinds of patients.MethodsPresentation of a patient’s case and review of existing literature, in regards to the use of family therapy in patients with eating disorders and its effects.ResultsAs in the patient’s case, there are a lot of studies that support the evidence of improvement using family therapy in patients with eating disorders. However, the difficulty to isolate the necessary variables in order to do studies about psychological treatments, complicates finding scientific evidence that supports the clinical evidence that we see in our patients day by day with these types of interventions.ConclusionsThere are studies that support the efficacy of these types of family interventions. However, there needs to be a more thorough investigation with the objective of finding the more precise optimal family intervention, and specifically, determining for who and under what conditions, certain types of family interventions would be more effective.Disclosure of InterestNone Declared
REVIEW OF MEDICATION INCIDENTS IN MENTAL HEALTH SERVICE
Authors: Gomes T. C. 
Published: August 2024

IntroductionIn this review, medication incidents accross different mental health care facilities was reviewed and nuances, challenges, and advancements in the administration and management of psychiatric medications was noted. Through gaining a better understanding of the complexities surrounding these incidents, valuable information can be gathered that will enhance patient safety, improving healthcare practices, and fostering a deeper understanding of the critical intersection between mental health care and medication management.ObjectivesTo identify the most frequent types of medication errors or patterns of medication errors in a mental health service accross different settings including inpatient, outpatient, liaison and long term residential unitMethodsThis is a multicentre project as it covers medication incidents in mental health care in a regianal area in Ireland. It includes an acute psychiatric Unit, the General Hospital and patients admitted in medical and surgical wards and as well long term residential care. Using the National Incident Management System we collected National Incident Report Forms (NIRF) relating mental health care provided and medication prescribed within a region in Ireland. From these we selected the ones were medication hazard was noted. Data collection happened between July 2020 and July 2021. A statuystical analysis was then performed to identify any patterns to medication errors.ResultsA total of 22 incidents were included. On review of these, it was noted, among other findings, that here was a significant increase in the frequency of medication errors during the month of December. It was also noted errors ranged from medication being given to the wrong patient, medication being given twice and medication being missed.ConclusionsMinimising medication errors requires a comprehensive, multidisciplinary approach that involves healthcare providers, patients, and healthcare systems. Healthcare organizations should foster a culture of safety where medication errors are seen as preventable and where providers are encouraged to report errors without fear of retaliation.Disclosure of InterestNone Declared
The level of consciousness and mental reactions of children after acute brain injury (interdisciplinary rehabilitation)
Authors: Martyshevskaya D. , Zakrepina A. , Sidneva Y. 
Published: August 2024

IntroductionThe process of recovery of mental reactions in children after acute traumatic brain injury is determined by complex methods with an interdisciplinary approach. Studies of emotional, communicative and behavioral reactions are based on an assessment by a psychiatrist and a teacher-defectologist.Objectivesto study mental reactions and identify predictors of positive recovery of consciousness after acute brain injury in children in early rehabilitation.Methodspsychiatric and pedagogical examinations; also - neuroimaging data and others.Results
Three groups of children were identified, depending on the different severity of emotional, communicative and behavioral indicators:Group 1 (11%): The level of consciousness is minimal positive. Reactions: stable gaze fixation; emotional reaction to sound (smile) and the face of an adult; short-term tracking of the gaze of the object; the ability to touch an object and hold it; sits himself.Group 2 (33%): The level of consciousness is minimal positive / negative, with an advantage of positive. Reactions: unstable gaze fixation; emotional reaction and involuntary movements to sound; reflex seizure of an object; sits with support.Group 3 (56%): The level of consciousness is minimal negative. Reactions: no emotional reactions, low motor and sensorimotor activity.Conclusions
predictors of emotional-communicative and behavioral indicators of recovery of the level of consciousness were identified: sensory and motor, cognitive and socially-oriented (orienting reactions to the voice and face of an adult, tracking the gaze of an object, sensory and motor activity, etc.). These predictors are the basis for choosing a rehabilitation program with interdisciplinary support and a treatment strategy.Disclosure of InterestNone Declared