bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic Overshadowing of Post-ictal Psychosis in the ED– A Case Series
Authors: Keenan K. , Moran A. 
Published: August 2023

IntroductionDiagnostic overshadowing is established as a mechanism by which physical symptoms are misattributed to mental disorder, hence under-diagnosing and under-treating medical pathology. We report a case series of adult males with established neurological disorders who presented to the ED with visual hallucinations in the postictal period. The phenomena of postictal psychosis is long established in neuropsychiatric literature, with reported rates of postictal psychosis in epilepsy of 2%. Patients vsual hallucinations resolve with anticonvulsant stabilisation and rarely require antipsychotic augmentation.ObjectivesTo illustrate diagnostic overshadowing in a case series of postictal psychosisMethodsRetrospective case seriesResultsCase 1:A 36year old man self-presented to the ED 24hrs post tonic-clonic seizure of 15minutes duration. Medical history was significant for hydrocephalus as an infant with 29 surgical revisions of in-situ ventriculoperitoneal shunt since initial placement. Secondary epilepsy was reported to be poorly controlled with an estimated 50 ED attendances in the past year for management of seizure activity. On assessment new symptomatology of non-threatening visual hallucinations with associated low mood was elicited. A diagnosis of postictal psychosis was advised following psychiatric assessment and medical admission with anticonvulsant titration recommended. Despite this characteristic presentation there were repeated requests to admit this patient to the psychiatric unit and a perceived lack of understanding of his acute medical needs.Case 2:A 45year old man self-presented to the ED <24hours post discharge following medical admission for management of seizure. Medical history was significant for a right parieto-temporal infarct one year prior, with acceptable return to functioning following rehabilitation. The man had recently been diagnosed with secondary epilepsy and titration of sodium valproate commenced. The patient presented as distressed in the context of new onset visual hallucinations and palinopsia. Medical admission with urgent neurology input and anticonvulsant titration was advised following psychiatric assessment. ED physician repeatedly stated this patients presentation was stress related and requested psychiatric admission. Following medical admission the patient was managed by neurology. Sodium valproate was augmented with clobazam and the patients psychopathology resolved in full.ConclusionsDiagnostic overshadowing is prevalent in the ED. Despite established medical diagnoses there may be a reluctance for medical teams to acknowledge or treat organic psychopathology. Psychiatrists must keep abreast of medical comorbidities and physical treatment guidelines of neuropsychiatric disorders in order to advocate appropriately for due medical input. Postictal psychosis is effectively managed by neurological input for effective seizure control with collaborative neuropsychiatry input.Disclosure of InterestNone Declared
A Case of Severe Somatized Depression in a Young Adult: Diagnostic Challenges
Authors: Pityk O. M. , Kuzhda I. M. , Pityk M. I. 
Published: August 2023

IntroductionDepressive disorders in adolescence and young adulthood have always been and remain an urgent problem due to their fairly high prevalence among the population, serious difficulties in diagnosis and untimely treatment. Timely diagnosis and adequate treatment can have a powerful impact on the future life of a person in a positive context. This process requires both standardized mechanisms, and an individual detailed study of each case, as the future of the individual depends on it.ObjectivesA young adult M., 20 years old, a university student, from a socially prosperous family, approached us.Main complaints: headaches that have been going on for almost 4 years. Pains did not depend on loads, both physical and mental, were of various characteristic and different localization. Non-steroidal anti-inflammatory drugs, as well as anti-migraine drugs, have little effect on the pathological experiences.MethodsOur main method of examination was clinical interview. In the complex assessment detailed neurological and ophtalmological examination included.ResultsThe parents referred patient for a medical examination about a year ago, because they noticed persistent mydriasis in him. During the year, the patient underwent a detailed examination (consultations of a therapist, endocrinologist, neurologist, ophthalmologist, MRI, EEG, dopplerography). Doctors expressed various assumptions about the diagnosis, because all the studies did not reveal any pathology that could explain the indicated complaints and mydriasis.During the initial interview, a high level of intelligence and knowledge was revealed, as well as a sufficient ability to learn. Examining the emotional-volitional sphere, a slight level of emotional instability, mild irritability, anhedonia and a slight degree of hypobulia (which can be explained by long-lasting and persistent pathological somatic experiences in the form of headaches) were found. Incomplete Protopopov’s triad was revealed.The patient was referred for repeated neurological and ophthalmological examination. Specialists with a high qualification level discovered the A. Athanassio symptom in him.He was diagnosed with recurrent depressive disorder, a current episode of severe depression with somatic symptoms, and appropriate treatment was prescribed.Conclusions1. Depressive disorders in adolescence and young adulthood require special attention from specialists of all medical specialties.2. The need for a detailed medical examination and modern neuroimaging methods is beyond doubt.3. Psychiatric examination cannot be limited to assessment of mental status only, and assessment of Protopopov’s triad should be part of psychiatric examination.4. Neurological and ophthalmological examination must necessarily include an assessment of neuro-ophthalmological symptoms.5. Individual selection of treatment should be carried out by a psychiatrist.Sorry to say, Professor Mykola Pityk died 27.12.2020Disclosure of InterestNone Declared
Psychoemotional distress on patients with cutaneous manifestations and SARS-CoV-2 infection
Authors: Sapaniuc C. , Rascanu M. , Bran D. , Lacatusu G. A. , Rosu F. M. , Pulbere M. , Gheuca-Solovastru L. , Manciuc D. C. 
Published: August 2023

IntroductionThe new coronavirus had a huge impact on individuals from a social, economical and psychological point of view. In march 2020 The World Health Organization declared the coronavirus diseases 2019 (COVID-19) a pandemic and highlighted its psychoemotional implications.ObjectivesThe aim of this study was to investigate the psychological distress during the COVID-19 pandemic in patients with cutaneous manifestations and SARS-CoV-2 infection.Methods
Data was collected from one first-line infectious diseases hospital from northeastern Romania. All patients with cutaneous manifestations and SARS-CoV-2 infection who accepted to answer the quality of life questionnaire (QLQ) were included in the study. The descriptive data analysis was conducted with the SPSS.Results
A total of 191 patients with cutaneous manifestations and COVID-19 completed a questionnaire concerning their psychological distress and financial burden during the pandemic. Patients with chronic dermatological diseases (psoriasis) – 31% reported the highest level of psychological distress and financial burden compared to patients with acute cutaneous manifestations (chickenpox, dermatitis, infectious mononucleosis, steven-johnson syndrome, etc.). Furthermore, this patients showed generalized anxiety disorder, depressive symptoms, post-traumatic stress disorder (PTSD), sleep disturbances and they attributed their individual psychological distress to the COVID-19 pandemic. This patients received psychological/psychotherapeutic treatment due to the COVID-19 crisis, during hospitalization and after discharge.Conclusions
During the pandemic, patients with dermatological diseases needs not only medical support but also psychological and psychosocial support. This study results emphasize the importance of monitoring the psychological impact of the COVID-19 pandemic on patients with cutaneous manifestations.Disclosure of InterestNone Declared
Psychological distress in Portuguese university students during COVID-19 pandemic: relationship with stress, sleeping and emotion regulation strategies
Authors: Sousa J. , Soares M. J. , Pereira D. , Macedo A. 
Published: August 2023

IntroductionDuring the COVID-19 pandemic outbreak, psychological distress, anxiety and depression reached new highs associated with a number of variables such as pandemic related-stress and sleep difficulties. These later two are known to be the precipitant and risk factors for psychological distress/mental disorders, respectively, and negative cognitive emotion regulation strategies can also have a key role on psychological/mental health problems generation and maintenance.ObjectivesTo study stress, sleep difficulties and the use of cognitive emotion regulation strategies by groups of students with different levels of psychological distress during the COVID-19 pandemic.Methods496 university students (mean age ± SD=20.99 years ± 2.27; 78.6% women) completed an online questionnaire between January and April, 2021, which included the Mental Health Inventory, the Perceived Stress Scale (PSS) and the Cognitive Emotion Regulation Questionnaire, as well as three questions from the Insomnia Scale to evaluate Difficulties in Initiating Sleep (DIS), Maintaining Sleep (DMS) and Early Morning Awakening (EMA). A Sleep Difficulties Index (SDI) was calculated by summing the scores of these three items.Results18.3% of the students showed high levels of psychological distress (group 1; scores 1 SD =/< Mean), 62.7% average levels (group 2), and 19% low levels (group 3; Scores 1SD =/>Mean). The group 1, compared with group 3, showed higher levels of sleeping difficulties (DIS, DMS, EMA and SDI), greater stress levels and an increased use of negative emotion regulation strategies, as well as a lesser use of positive emotion regulation strategies. Furthermore, the group 2, with average levels of psychological distress is significantly distinct from the group with better mental health when comparing these same variables.ConclusionsAlmost one fifth of the Portuguese university students report elevated levels of psychological distress during the COVID-19 pandemic. Clinical interventions to promote psychological/mental health in this population should focus on reducing stress, promoting adequate sleep habits, reducing the use of negative cognitive emotion regulation strategies and increasing the use of positive ones.Disclosure of InterestNone Declared
Acute psychosis following corticosteroid administration for COVID-19 and Respiratory Syncytial Virus infection: A case study
Authors: Miranda Ruiz E. , Marimon Muñoz E. , Ramirez Gonzalez J. , Fariña M. , Troyano R. G. , Arroyo Ucar M. I. , Ferreiro S. , Fernandez Marquez I. , Hidalgo C. , Quispe A. , Delgado L. 
Published: August 2023

IntroductionSteroids are a necessary treatment for hypoxic respiratory failure; however there are many side effects that should be taken into account. A 44- year-old-woman with asthma and no past psychiatric history was admitted due to COVID-19 pneumonia and Respiratory syncytial virus (RSV) infection, presenting hypoxic respiratory failure. After two days of intravenous methylprednisolone administration, the patient presented acute psychosis and agitation.It has been previously described that steroid use can cause effects such as mania, anxiety, agitation, delirium and psychosis amongst other. However they are a necessary treatment in respiratory illnesses and are sometimes unavoidable.Objectives
The aim was to examine the appropriate medical response to steroid induced psychosis in patients with acute hypoxic failure.MethodsA bibliographical review was done in PubMed database searching recent cases of steroid induced psychosis using the words (“Steroid”, “Psychosis” and “COVID-19”).Results
According to literature, it has been shown that partial or complete reduction of steroid use and/or use of psychotropic has been successfully used to treat steroid induced psychosis. Following the research it was decided to reduce intravenous methylprednisolone dose from 20mg/ 8h to 20mg/12h and start oral haloperidol 5mg/8h the first 24h and reducing the dose progressively as the patient recovered. After the first 24 hours the patient presented adequate response to steroids as well as partial response to antipsychotic treatment; presenting no further agitation, absence of hallucinations and partial persistence of the persecutory delusion. A couple of days later there was complete remission of the psychotic symptoms and the patient was on the way to recovery from COVID-19 and RSV.ConclusionsThere is evidence that suggests that medications such as steroids used to treat COVID-19 and other respiratory illnesses can lead to psychotic episodes. It is very important to pay attention to possible side effects when treating with steroids and evaluate the patient history as well as suggest having a follow up visit after the hospital discharge.Disclosure of InterestNone Declared
Mental Health and Psychosocial Support in Response to Onset of the COVID-19 Pandemic: Findings from Action Against Hunger’s Emotional and Stress Management Intervention in Ivory Coast, Liberia, and Sierra Leone
Authors: Le Roch K. , Garriott A. , Phan X. , Bintu F. M. , Darciba S. P. , Koleti P. B. , Murray S. M. 
Published: August 2023

IntroductionIn 2020, as in the rest of the world, the COVID-19 pandemic spread in Africa and transformed people’s lives. Adding to the already existing burden of fragile health care systems, especially in low-resource settings, the pandemic response highlighted the need to address the health and well-being of populations in innovative ways. While research findings reported critical impacts on populations’ mental health, few studies assessed this progression within African countries. At the onset of the COVID-19 pandemic, Action Against Hunger (ACF), developed and delivered a brief Emotional and Stress Management Intervention (ESMI) to reduce symptoms of emotional distress and increase perceived social support through problem solving techniques and relaxation exercises among adults and youth living in vulnerable communities experiencing a relatively high prevalence of COVID-19 in urban and rural areas in Sierra Leone, Liberia and Ivory Coast.ObjectivesThe primary aim of this study is to evaluate whether individuals who received ESMI experienced changes in psychological distress and social support following the intervention and the association between change in psychological distress and change in social support for each country.MethodsThis study consisted of secondary analysis of data collected via routine monitoring of activities by ACF for their ESMI programs implemented in community-based centers and health facilities from May to December 2020. Service delivery mechanisms were adapted to each context and setting (i.e., face to face vs. remote, health facilities vs. home visits, etc.). The main outcomes were psychological distress and social support measured with culturally relevant visual analogue scales. All analyses were performed separately for each country.ResultsIn total, 1,412 adults and youth (11-17 years old) benefitted from the intervention across all countries and 1,350 were assessed at follow-up. As a result, changes for psychological support and social support with mean scores difference at baseline and follow up were significantly different in all countries. Correlations between changes in distress and changes in social support varied by country, and ranged from negative in Liberia, (r = -.88, p = 0.001), to positive in Ivory Coast (r = .55, p = 0.001), and null in Sierra Leone (r = -.07, p = 0.11). Across countries, the most commonly reported presenting problems were fear of infection, stigma, and socio-economic difficulties, with coping strategies differing by country.ConclusionsAt the onset of a pandemic crisis, low-intensity psychosocial support activities hold potential for reducing psychological distress and improving social support among adults and youth from vulnerable communities in the context of the COVID-19 pandemic.Disclosure of InterestNone Declared
COVID-19 related Delusional Beliefs: A Case Report
Authors: Akyildirim Cor S. , Akcay B. D. 
Published: August 2023

IntroductionA delusion is a fixed false belief based on an inaccurate interpretation of an external reality despite evidence to the contrary. The diagnosis of a delusional disorder is made when a person has one or more non-bizarre (situations that are not real but also not impossible) delusional thoughts for one month or more that cannot be explained by any other condition. In patients with delusional disorder, delusions(s) do not impact the functionality and the patient’s behavior is not overtly bizarre. Although delusional core themes tend to be the same throughout different epochs (i.e., persecution, grandiosity, guilt, religion, hypochondria, love, or jealous), clinicians commonly notice how delusions tend to rapidly incorporate popular hot topical issues. Hence, delusions are dynamic and often represent a combination of psychopathology and external events.ObjectivesThe COVID-19 outbreak has affected millions of people globally and it also has a huge psychological impact. The objective of this case report is to outline the possible effect of the COVID-19 pandemic to delusional disorder in patients with healthy person.MethodsThe 40-year-old gentleman, a drum major (field commander), married, living with his wife and daughter (4,5 years old). He’s current complaints started when he did not want to have the Covid vaccine in April 2021 and therefore was exposed to mobbing at work. It is understood that the patient had irrevocable ideas about vaccine and PCR testing (radioactive lights were coming out from the PCR rod in a video he watched). For this reason, it is understood during the clinical interview that the patient was exposed to social restrictions at work and in his social life (he could not travel by public transport, plane, bus, and enter social facilities because he did not have a vaccination card or did not have a PCR test).He was admitted to our ward for the purpose of arranging his diagnosis and treatment.ResultsOn our ward, the patient showed poor insight with persistence of delusions. The impression was delusinal disorder. He was treated with olanzapine up to 5 mg/day and sertraline up to 100 mg/day, with a progressive resolution of symptoms.ConclusionsThere are other case reports on COVID-19 delusional themes in patients with schizophrenia and patients with no history of mental illness, which means that this phenomenon is not exclusive to affective disorders. In this case, different from the literature, the patient has never had covid. An area of clinical concern is the potential of the pandemic’s psychological context to trigger psychotic disorders and influence their symptomatology. A review of contemporary epidemics and pandemics psychosis research found no evidence of changes in the form and content of psychotic symptoms. Further research should examine those biopsychosocial COVID-related factors that predispose to, precipitate, and perpetuate psychosis.Disclosure of InterestNone Declared
Levels of anxiety, depression and stress among health care workers during the COVID19 pandemic: Study conducted at the University Hospital Farhat Hached of Sousse-Tunisia
Authors: Belhadj Chabbah N. , Chatti S. , Athimni Z. , Bouhoula M. , Chouchane A. , Aloui A. , Kacem I. , Maoua M. , Brahem A. , Kalboussi H. , Elmaalel O. , Mrizek N. 
Published: August 2023

Introduction
During the COVID-19 pandemic, health care workers found themselves threatened by developing psychological effects.ObjectivesThe objective of this study is to evaluate the impact of exposure to COVID-19 on the mental health of medical and paramedical staff at Farhat Hached Hospital in Sousse and to identify potential risk factors.MethodsThis is a descriptive cross-sectional study that included 166 health care workers of Farhat Hached Hospital of Sousse throughout 3 months. The patient health questionnaire (PHQ-9), the generalized anxiety disorder (GAD-7), and the revised event impact scale (IES- R) were used to assess depression, anxiety, and stress respectively.ResultsThe mean age of the participants was 37.06 ±11.07 years with a female predominance (80.1%). The median professional seniority was 7.5 years with extremes ranging from 1 to 39 years. Nurses were the most represented (34.3%) followed by medical residents (24.7%). PHQ-9, GAD-7, and IES- R scores revealed that 51.8%, 40.4%, and 28.3% of participants had moderate or severe levels of depression, anxiety, and stress, respectively. Personal history of psychiatric disorders was significantly associated with depression (p<10-3) and anxiety (p=0.004). On the other hand, paramedical staff had a significantly higher risk of experiencing symptoms of depression (OR = 2.40 ; 95% CI [1.28-4.48] ; p= 0.006) and stress (OR = 2.03 ; 95% CI [1.01-4.11] ; p= 0.04) than medical personnel.ConclusionsThis study reported a high prevalence of symptoms of anxiety, depression and stress among health care workers. Improving mental well-being and providing psychological support to health care workers is recommended.Disclosure of InterestNone Declared
Efficacy of brexanolone in postpartum depression
Authors: Rodríguez Mercado C. M. 
Published: August 2023

Introduction
Depression whose onset in the peripartum period is commonly referred to as Postpartum Depression.Postpartum Depression affects 11.5% of women during pregnancy or postpartum.Brexanolone has been developed for the treatment of Postpartum Depression, it is a formulation of Allopregnanolone, which is administered parenterally. Several studies have found that a single Brexanolone infusion had rapid antidepressant effects for severe Postpartum Depression, with good safety.ObjectivesThe objective of this review is to evaluate the effectiveness of treatment with Brexanolone in Postpartum Depression.MethodsA systematic search was performed through Pubmed, including randomized controlled trials (RCTs).Results2 articles were selected that included three RCTs, in which participated 156 women diagnosed with Postpartum Depression who received an infusion of Brexanolone and 111 women with Postpartum Depression who received placebo .Compared to placebo, women who received Brexanolone had a significant clinical response, starting 24 hours after administration (RR: 1.34; 95% CI: 1.03–1.73). ), reaching its maximum action peak at 36 hours ( RR: 1.50; 95% CI 1.06–2.13; P = 0.02 ), and with a duration of effect up to the seventh day ( RR = 1.32, 95% CI: 1.01–1.73). Likewise, women with Postpartum Depression, treated with Brexanolone, had a significantly greater remission, starting at 24 hours of treatment (RR: 1.86; 95% CI: 1.03–3.34), reaching its peak maximum action at 60 hours ( RR: 2.20; 95% CI 1.31–3.70 ), and with a duration of effect up to 72 hours ( RR = 1.96; 95% CI: 1 .41–2.72).ConclusionsThe administration of a dose of Brexanolone seems to have an ultra-rapid antidepressant effect for the treatment of Postpartum Depression. The short-term and long-term therapeutic effect of brexanolone needs to be examined with large-scale randomized controlled studies.Disclosure of InterestNone Declared