bluuebunny/crossref_metadata_2025_split huggingface dataset:
Valproate-induced severe symptomatic hyponatremia in a patient with schizoaffective disorder: a case study and literature review
Authors: Heflin K. , ElSayed M. 
Published: August 2023

IntroductionThe syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a serious condition associated with persistently high ADH with water retention despite sufficient vascular volume. Sodium valproate (VPA), an antiepileptic indicated to treat bipolar disorder, blocks sodium (Na) and calcium ions. Few studies have examined the association between VPA and SIADH.ObjectivesThis abstract has two interrelated objectives: (1) to describe a VPA-associated SIADH case study we encountered in our clinical setting; and (2) to review literature for other VPA-associated SIADH cases to illuminate associations and possible risk factors.MethodsAfter recording a case from clinical experiences, we completed a literature review of other cases of hyponatremia associated with VPA.We reviewed resulting artticles from searches in PubMed and in the aggregate Dartmouth Biomedical Library indices with no date or language parameters. We then searched those articles’ bibliographies.ResultsMs. A is a 63-year-old woman with schizoaffective disorder, bipolar type, hospitalized for the resurgence of visual hallucinations (VH) of “monsters” asking her to hurt herself and others. She had been adherent to VPA (500mg twice daily) and non-adherent to prescribed Olanzapine (25mg). On Day 1 (D1), her labs were concerning for serum Na 119mEq/L (n=135-145), serum osmolality (SOsm) 264mEq/L (n=275-295), and inappropriately high urine osmolality 111mOsm/kg (n <100 mosmol/kg in hyponatremia) and urine Na 34mEq/L (n <20 mosmol/kg in hypovolemic hyponatremia). Her VPA level was 73.6 mcg/mL.She was restarted on her home psychiatric medications for VH, and her hyponatremia responded to water restriction, with serum osmolality at 292mEq/L by D4 (see Figure). She was admitted to the inpatient psychiatric unit for concerns of persistent VH. On D13, her SOsm worsened to 267mEq/L and VPA was discontinued at that time. On D19, SOsm improved to 283mEq/L. Her VH responded well to discontinuing VPA and adding Risperidone (titrated to 6mg) and on D22 she was discharged home. Given the chronological sequence of her newly developed VH, the patient’s hallucinations were likely multifactorial, with contribution from hyponatremic encephalopathy-related psychosis.Our literature review found ten articles reporting thirteen other cases of VPA-associated SIADH (see Table). Our patient shared demographics with most previously reported cases: being older in age and having polytherapy and a low baseline Na. None of the previous case reports showed specific drug interactions to be particularly likely causes of hyponatremia.Image:Image 2:ConclusionsAlthough VPA-associated SIADH is a rare phenomenon, caution is warranted when evaluating patients with VPA use presenting acutely with psychosis and hyponatremia. These symptoms could be the manifestation of hyponatremic encephalopathy-related psychosis.Disclosure of InterestNone Declared
Association between adverse childhood experiences and the number of suicide attempts in lifetime
Authors: Andreo-Jover J. , Fernandez-Jimenez E. , Curto-Ramos J. , Angarita-Osorio N. , Roberto N. , De la Torre-Luque A. , Cebria A. , Diaz-Marsa M. , Ruiz-Veguillla M. , Bobes Garcia J. B. , Fe Bravo Ortiz M. , Perez Solá V. 
Published: August 2023

IntroductionAdverse childhood experiences (ACEs), defined as abuse, neglect, or a dysfunctional household in childhood, have been associated with suicidality (Fjeldsted et al., 2020). Every type of ACE has a direct impact on suicide ideation, self-harm and/or suicide attempt (Angelakis et al., 2019).ObjectivesWe aim to quantify the association between types of ACEs (including emotional, physical, sexual abuse, and emotional and physical neglect) and the number of suicide attempts in lifetime.MethodsWe included 748 patients who attempted suicide at least once. They were asked to complete the Columbia-Suicide Severity Rating Scale (CSSRS), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Logistic regression models were run to assess the association between each ACE type and the number of suicide attempts.ResultsPoisson univariate regression analyses show a linear trend in the relationship between having a higher number of suicide attempts and having suffered every ACE type in childhood (p<0.05). Our results show a lower percentage of previous suicide attempts among participants without ACEs, and an increasing tendency among patients with various types of ACEs. The rate of ACEs types is significantly higher in the group with previous suicide attempts than in the first-attempt group (p=0.000).Image:Image 2:ConclusionsThis study contributes to clarify the role of childhood trauma in the number of suicide attempts in lifetime. This has important implications for reducing suicide rates, and preventing future re-attempts. Further studies analysing every construct of childhood trauma may contribute to the detection of suicidal behaviour.FundingsThis work was supported by the Instituto de Salud Carlos III (grant number: PI19/00941 SURVIVE) and co-funded by the European Union (grant numbers: COV20/00988, PI17/00768), the European Union’s Horizon 2020 research and innovation programme Societal Challenges (grant number: 101016127), and the Fundación Española de Psiquiatría y Salud MentalAcknowledgementsSURVIVE project (PI19/00941)KeywordsSuicide attempt, Adverse Childhood ExperiencesReferencesAngelakis, I., Gillespie, E. L., & Panagioti, M. (2019). Childhood maltreatment and adult suicidality: A comprehensive systematic review with meta-analysis. Psychological Medicine, 49(7), 1057-1078. https://doi.org/10.1017/S0033291718003823Fjeldsted, R., Teasdale, T. W., & Bach, B. (2020). Childhood trauma, stressful life events, and suicidality in Danish psychiatric outpatients. Nordic Journal of Psychiatry, 74(4), 280-286. https://doi.org/10.1080/08039488.2019.1702096Disclosure of InterestNone Declared
A healthy dietary pattern is associated with microbiome diversity in bipolar patients: the Bipolar Netherlands Cohort (BINCO) study
Authors: Riedinger M. A. , Mesbah R. , Koenders M. , Geleijnse M. , de Leeuw M. , van der Wee N. , Giltay E. 
Published: August 2023

IntroductionThe gut microbiome is one of our most prominent surfaces interacting with the outside world through the food we eat. It is influenced in terms of composition and diversity by our diets and life style habits and, in turn, affects us through the ‘gut-brain axis’. Cardiovascular risk, which is one of the main causes of death in Bipolar Disorder (BD), is affected by diet. The association between diet and microbiome in BD patients has not been studied.ObjectivesWe aimed to assess whether [1] dietary quality is associated with the microbiome’s diversity, and [2] what changes and interactions occur during in both the dietary quality and microbiome diversity during the subsequent year of onset BD.Methods39 recently diagnosed patients with BD of the ‘Bipolair Nederlands Cohort’ (BINCO) (mean age 36 years, 61.5% female) were included. Food Frequency Questionnaires (FFQ) and corresponding Dutch Healthy index (DHD-15) were analyzed at baseline and one year follow-up. Feces samples corresponding to the FFQ were analyzed using 16S rDNA gene amplicon sequencing to attain the Shannon Diversity index and the Chao1 diversity index. Multivariate regression analyses were performed.ResultsThe Shannon diversity index significantly correlated to the DHD-15 total score after adjusting for sex and age (beta = 0.451; P = 0.004). The Chao1 index showed the same trend, but did not reach significance (beta = 0.264; P = 0.11). These positive correlations seemed to be driven by the positive effect of fish, beans, coffee, fruits and nuts. There was neither a significant change in DHD-15 index nor in the diversity measures after one year.Image:Image 2:ConclusionsDiversity of the microbiome is positively associated with a healthy and varied diet in BD patients, which could have consequences on mood episodes and cardiovascular risk.Disclosure of InterestNone Declared
Thrombotic complications of treatment with antipsychotic drugs : risk factors
Authors: Abid W. , Chérif F. , Bouattour N. , Masmoudi R. , Guermazi F. , Feki I. , Sallemi R. , Masmoudi J. 
Published: August 2023

Introduction
Antipsychotic agents (AP) are widely used drugs to treat psychotic symptoms. For
decades, some studies suggested that there is a relationship between using (AP) and the risk
of venous thromboembolism (VTE) and pulmonary embolism (PE). The causality of this
association, its risk factors, and its implications for clinical practice have not been fully
elucidated.

Objectives
We undertook a systematic literature review to evaluate the evidence for an
association between antipsychotic medication and venous thromboembolic events (VTE) and to
identify risk factors for these adverse effects.

Methods
To identify relevant studies, we searched the PubMed, Science Direct databases up
using the following keywords « pulmonary embolism », « venous thromboembolism » «
antipsychotics agents ». We also searched the reference lists relevant articles for related
studies.

Results
Twelve articles are included in this analysis and indicate an elevated risk of VTE in
antipsychotic drug users. The results showed that compared with non-users, current AP users
have significantly increased risks of VTE. The risk of venous thrombosis in obese people was
higher than that in overweight people, patients not less than 65 years old had an increased
risk compared with younger patients . In addition, women taking antipsychotics had a higher
risk of pulmonary embolism than men. The other factors that increased risk were use of
second-generation antipsychotics and antipsychotic polytherapy. The highest risk was noted in
the first 3 months of treatment. Data also suggested a dose-dependent increase in the risk of
thrombotic complications. For individual drugs, increased risk of VTE and PE was observed in
taking clozapine , haloperidol, risperidone and olanzapine. Clozapine was associated with the
highest risk. However, careful interpretation is needed because of high heterogeneity among
studies and scarce data.

Conclusions
The use of antipsychotics will increase the risk of venous thromboembolism and
pulmonary embolism, which will be affected by AP and patient characteristics.

Disclosure of Interest
None Declared
COVID-19 pandemic and associated factors in pregnant women in urban Bangalore, South India: A qualitative analysis
Authors: Thomas S. , Srinivasan K. , Thomas T. , Ekstrand M. 
Published: August 2023

IntroductionThe World Health Organization declared COVID-19 as a pandemic in March 2020, and this was followed by a series of preventive measures that included social distancing, travel restrictions and lockdowns in India. Pregnancy is a vulnerable time, with several physical and psychological changes associated with it. The added burden of pandemic could lead to significant stress, and it would be helpful to understand the mitigating factors of stress in this population.ObjectivesThe objective of this study was to examine the mitigating factors associated with COVID-19 pandemic among pregnant women.MethodsThe study was conducted in an Urban Primary Health Center (UPHC) in Bangalore that provides maternity care to low-middle income population. Antenatal check-ups are conducted here daily. Pregnant women visiting the clinic for routine antenatal care were approached and informed consent was sought for an interview. 295 women consented to participate in the study. The qualitative interview was conducted in a quiet room. Open ended questions were used to understand the participants’ personal, familial, occupational, and social factors related to COVID-19. The transcripts of the interviews were manually coded for recurring themes by two research assistants. These were examined and similar or identical themes were grouped together. These were further analyzed, and themes were summarized.ResultsThe mean (SD) age of the participants was 24.9 (4.2) years, approximately half of the participants were in their first trimester and primiparous. The majority were high school educated and self-employed. 25% of the participants reported mild to moderate depressive symptoms assessed using PHQ-9. The most predominant theme among personal factors was negative emotions that included fear and anxiety. The uncertainty about the transmission and the lack of clarity about the causes during the pregnancy were the reasons for these fears. They reported that they found news and media more stressful. They reported that even though the lockdown restricted their movement, they enjoyed the time they spent with the family, especially their husbands. Most participants reported job loss, theirs and their husbands’ and had to encounter severe economic difficulties. However, the predominant theme was the social support that they received from family, friends, neighbors, and local governing bodies.ConclusionsSocial support was reported to be the most predominant factor that helped the pregnant women to cope with the problems presented during the pandemic. Social support, both instrumental and emotional were important mitigating factors for stress during the pandemic. Strengthening the social support system by support groups and community networking should be a crucial component in government- led initiatives as a factor that may promote resilience in difficult situations like the pandemic.Disclosure of InterestNone Declared
Association between Diffusion Tensor Imaging, inflammation and immunological alterations in unipolar and bipolar depression: a review
Authors: Aronica R. , Enrico P. , Brambilla P. , Delvecchio G. 
Published: August 2023

IntroductionMajor Depressive Disorder (MDD) and Bipolar Disorder Depression (BDD) are common psychiatric illnesses characterized by structural and functional brain alterations and signs of neuroinflammation. In line with the neuroinflammatory pathogenesis of depressive syndromes (Mechawar N, Savitz J. Neuropathology of mood disorders: do we see the stigmata of inflammation? Transl Psychiatry. 2016;6(11):e946), recent studies have demonstrated how white matter (WM) microstructural impairments detected by Diffusion Tensor Imaging (DTI) are correlated to peripheral immunomarkers in depressed patients.ObjectivesIn this context, the aim of our review is to report an updated overview of the evidence on the correlation between the blood immuno-markers changes and the brain WM disruptions in MDD and BDD patients.MethodsBased on PRISMA 2020 guidelines (Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372), we performed a systematic search on original DTI studies exploring the association between WM integrity, neuroimmune alterations and inflammation in patients affected by MDD or BDD.ResultsConcerning MDD, most of the reviewed studies provided evidence of a link between systemic immune dysregulation, detected through the elevation of peripheral markers (IL-1β and TNF-alfa) or an altered ratio between proinflammatory and counterregulatory cytokines (IL-8/IL-10), and DTI alterations in specific WM tracts, such as the genu of corpus callosum and the IFOF. As for the BDD, we detected an increase of pro-inflammatory molecules (such as TNF-alfa, IL-8, IFN-γ etc.) that correlated with DTI changes in different cerebral areas such as cingulum, forceps, corona radiata, corpus callosum, longitudinal fasciculus and internal capsule. Furthermore, other molecules seem to play a specific role in BDD pathogenesis, including counter-regulatory cytokines, kynurenine and specific lymphocyte classes, such as Th1 and Th17.ConclusionsTaken together, these pathogenetic insights could outline an integrated clinical perspective to affective disorders, helping psychiatrists to develop novel biotype-to-phenotype models of depression and opening the way to tailored approaches in treatments.Disclosure of InterestNone Declared
The silent waitress. A case report of mutism without catatonia
Authors: Fernández T. , Pujal E. , Salmeron S. , Bioque M. 
Published: August 2023

IntroductionMutism, defined as an inability or unwillingness to speak, resulting in an absence or reduction of speech, has a wide differential diagnosis. It rarely presents as an isolated disability and often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. Mutism is typically associated with catatonia, usually in schizophrenia, but also depression, bipolar disorder, intoxication, and neurological conditions.ObjectivesTo describe a case of mutism without catatonia.MethodsWe describe a clinical case of a patient admitted to our psychiatric inpatient unit with mutism as the presenting symptom. The literature on this subject is also selectively reviewed.ResultsA 49-year-old woman was found mute at home by her brother and brought to our emergency room. Not a word had come out of his mouth for the past month. She would show up at the restaurant where she worked as a waitress and do her job, but she didn’t talk. As a result, she had been fired. Her routine daily chores and her vegetative functions were maintained. She had no prior history of medical or psychiatric illness or substance abuse. In addition to the mutism, the patient showed an important psychomotor restlessness and performed repetitive hand movements suggestive of occupational delirium. There was no rigidity, stupor, negativism, catalepsy, echosymptoms or any other catatonic symptomatology.She was then admitted to our inpatient unit, where a complete blood test, EKG, brain CT, brain MRI, EEG and a lumbar puncture with biochemistry and neuroimmunology studies were performed, none of them showing any abnormalities.The clinical presentation suggested the diagnosis of either a psychotic disorder or a major depressive episode.The patient was then started on olanzapine up to 20 mg/d, fluoxetine up to 20 mg/d and lorazepam up to 6 mg/d. Due to persistence of symptomatology despite pharmacological treatment, she was started on Electroconvulsive Therapy (ECT). At the time of issuance of this report, 7 bilateral ECT courses have been carried out and absolute mutism persists. Although she has presented an improvement of the anxiety and the repetitive behaviors noted on admission have disappeared, she hasn´t resumed speaking.ConclusionsMutism occurs in a number of conditions, both functional and organic, and an accurated diagnosis is important for the management. One must perform a thorough physical and systemic examination to rule out organic causes for mutism. An observation for some time period may be warranted and should be done to reach final diagnosis in our case.Disclosure of InterestNone Declared
Relationship between CAINS negative symptoms and cognition, psychosocial functioning and quality of life in patients with a first psychotic episode of schizophrenia
Authors: Rodriguez-Jimenez R. , García-Fernández L. , Romero-Ferreiro V. , Valtueña García M. , Aparicio A. I. , Espejo-Saavedra J. M. , Sánchez-Pastor L. , Nuñez-Doyle A. , Dompablo M. , Jiménez-Rodríguez O. , Rentero D. , Fernández-Sotos P. , Martínez-Gras I. , Santos J. L. 
Published: August 2023

IntroductionNegative symptoms has been classically associated with cognition, psychosocial functioning and quality of life in patients with schizophrenia. But negative symptoms are not a unitary construct, encompassing two different factors: diminished expression, and motivation and pleasure. Few works have studied the relationship between these two different negative symptoms factors and cognition (neuro and social cognition), psychosocial functioning and quality of life, jointly, in patients with a first psychotic episode of schizophrenia.ObjectivesThe objective of the present work was to study, in a sample of patients with a first psychotic episode of schizophrenia, the relationship between the negative symptoms (diminished expression and motivation and pleasure) and neurocognition, social cognition, functioning and quality of life.MethodsThe study was carried out with 82 outpatients with a first psychotic episode of schizophrenia from two Spanish hospitals (“12 de Octubre” University Hospital, Madrid and “Virgen de la Luz” Hospital, Cuenca). The patients were assessed with the Clinical Assessment Interview for Negative Symptoms (CAINS) for evaluating diminished expression (EXP) and motivation and pleasure (MAP) symptoms, the MATRICS Consensus Cognitive Battery (MCCB) for evaluating neurocognition and social cognition, the Social and Occupational Functioning Assessment Scale (SOFAS), and the Quality of Life Scale (QLS).ResultsA negative correlation was found between neurocognition and the two negative symptoms subscales: CAINS-EXP (r=-0.458, p<0.001) and CAINS-MAP (r=-0.374, p<0.001); but with social cognition only CAINS-EXP was correlated (r=-0.236, p=0.033). Also, it was found a high negative correlation between SOFAS scores and CAINS-MAP (r=-0.717, p<0.001); and a medium negative correlation with CAINS-EXP (r=-0.394, p<0.001). Finally, QLS score was high correlated with both CAINS subscales: CAINS-EXP (r=-0.681, p<0.001) and CAINS-MAP (r=-0.770, p<0.001).ConclusionsThis study found a relationship between negative symptoms and neurocognition, social cognition, functioning and quality of life in a sample of patients with a first psychotic episode of schizophrenia. But the two different negative symptom factors, diminished expression, and motivation and pleasure, are associated differently with psychosocial functioning, but especially with social cognition where the relationship was only found with diminished expression symptoms.Disclosure of InterestNone Declared
Clinical characteristics of chemsex users attended in a ngo in madrid
Authors: Curto Ramos J. , Ibarguchi L. , Barrio P. , García A. , Morillas Romerosa M. A. , Herrero P. , Dolengevich Segal H. 
Published: August 2023

IntroductionThe intentional use of drugs before or during sexual intercourse (chemsex) is a phenomenon of special importance in the MSM (men who have sex with men) population due to its impact on mental, physical and sexual health.ObjectivesThe objective of this study was to describe the sociodemographic and medical characteristics, psychoactive substances use of a sample of users with sexualized drug use (chemsex) attended by the non-govenrmental organization Apoyo Positivo in the program “Sex, Drugs and You”.MethodsA cross-sectional descriptive analysis of a sample of users attended by the non-govenrmental organization Apoyo Positivo in the program “Sex, Drugs and You” was performed.Results230 participants were included. Most common drugs used during sexual intercourse were: mephedrone, cocaine, poppers, GHB and methamphetamine. The frequencies of substances consumed during sex were: mephedrone (95%), methamphetamine (80%), GHB (92.2%), ketamine (52%), poppers (alkyl nitrites) (95%), cocaine (89 .7%), speed (amphetamine sulfate) (49.6%) and drugs for erectile dysfunction (86%). 61.3% reported having practiced slamsex intravenous substance use at some time in their life, being a habitual practice at the time of collecting information for 50.7%. The most frequent genitally transmitted infections were: syphilis, chlamydia and gonorrhea. Users reported having been diagnosed with the following genitally transmitted infections: hepatitis B virus (7.4%), hepatitis A virus (18.6%), syphilis (69.6%), human papillomavirus (16 %), herpes (9.4%), chlamydia (43%), gonorrhea (60.5%) and candidiasis (9.7%).ConclusionsSlamsex and STIs are usually reported in our sample. Interventions for chemsex users must include a colaborative model which includes professionals from different areas, including internists and emergency physicians, psychiatrists, psychologists, nurses, social workers and sexologists.Disclosure of InterestNone Declared