bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fahr’s Disease: a case report of a patient with neuropsychiatric symptoms
Authors: Perez-Sagaseta I. , Yelmo-Cruz S. , Cardenes-Moreno C. , Torres-Tejera L. , Crisostomo-Siverio A. , Dorta-Gonzalez J. , Tascon-Cervera J. J. , Paniagua-Gonzalez M. , Canessa S. , Cejas-Mendez M. R. 
Published: August 2023

IntroductionFahr’s disease (FD) is a rare disorder consisting of bilateral and symmetrical calcium deposits in basal ganglia and cerebral cortex. These lesions are associated with neurological and psychiatric symptoms such as a rigid hypokinetic syndrome, mood disorders and memory and concentration abnormalities. It can be idiopathic or secondary to endocrine disorders, infectious diseases or mitochondrial myopathies.ObjectivesTo highlight the importance of considering organic causes when evaluating patients presenting atypical psychiatric symptoms and claim the role of neuroimaging.MethodsCase report and non-systematic review of literature: sources obtained from Pubmed database.ResultsA 69-year-old man, native of Syracuse (Italy), was admitted to the Psychiatry Unit in February 2022 presenting behavioural disturbances and irritability. In July 2021 he presented the same symptoms, being mistakenly diagnosed with Bipolar Disease type I. He has no previous psychiatric history. He started with changes in his personality, short-term memory loss, aggressiveness and disorganized behaviour at the age of 66. At admission he was talkative and hyperfamiliar, presenting delusions of grandiosity, exalted affectivity and insomnia. Neurological examination showed short-term memory problems, signs of frontal disinhibition and abnormal glabellar tap sign. Blood tests, CT brain and MRI were performed to rule out organic underlying causes. Neuro-imaging found bilateral and symmetric calcifications in globus pallidus, thalamus and corpus striatum, in favour of FD. Secondary causes (abnormalities in the PTH, vitamin disorders and infectious diseases such as HIV, brucellosis or neurosyphilis) where discarded, allowing us to conclude it was probably a primary case of FD. Valproate was started as a mood stabilizer and anticonvulsant. Genetic tests were indicated.ConclusionsFD should be considered as a differential diagnosis in the evaluation of psychiatric symptoms, especially when atypical and/or presented with neurological symptoms. The role of neuro-imaging is essential.Disclosure of InterestNone Declared
MALIGNANT CATATONIA IN MEDICAL WARDS: A BROAD DIFFERENTIAL DIAGNOSIS
Authors: Arbelo N. 
Published: August 2023

IntroductionCatatonia is an uncommon and heterogeneous psychomotor syndrome. It can be not only the manifestation of a psychiatric disorder but also a wide range of medical conditions. The malignant catatonia is a subtype of catatonia which includes dysautonomic signs such as hyperthermia or hemodynamic instability, and because most of the affected patients are taking antipsychotics or antidepressants previously, it can be confounded with medical conditions such as neuroleptic or serotonin syndrome.ObjectivesTo present a case of malignant catatonia admitted in a medical wardMethodsThe present study is a case report of a patient admitted with initial diagnosis of serotonin syndrome in a medical ward of our hospital and referred to the consultation and liaison psychiatry (CLP) unit. We also searched previously case reports, series and systematic reviews about catatonia secondary to medical conditions and hyperthermia catatonia.ResultsMs. TN is a 71-year-old woman, with prior history of major depressive disorder. One month ago she was admitted in a psychiatric ward of another hospital for a depressive episode with psychotics features, and was treated with escitalopram 10mg/day, vortioxetine 10mg/day, mirtazapine 15mg/day, trazodone 50mg/day, quetiapine 700mg/day and haloperidol 5mg/day. She had a worsening of depressive symptoms with suicidal thoughts, negativism and psychomotor retardation, and subsequently hyperthermia, rigidity, mydriasis, tachicardia and increased bowel sound. She was tranfered to our medical ward, and diagnosed of serotonin syndrome. She was stopped all the psychiatric drugs and was treated with dantrolene and support measures. After 10 days without antidepressants or antipsychotics she maintened the same symptomatology and was referred to our CLP unit. The psychopathological evaluation showed stupor, mutism, waxy flexibility and negativism, and she responded to a challenge test with intravenous clonazepam 0,5mg. She was diagnosed of malignant catatonia and was started oral clonazepam 2mg/day. Although there was a partial response, she did not tolerate higher doses because of sedation and finally was treated with electroconvulsive therapy (ECT). She dad a remission of catatonic symptoms after only two sessions of ECT.ConclusionsMalignant catatonia can be confounded with other medical conditions such as serotonin or neuroleptic syndromes. All of them can have catatonic signs, and it is important to recognize them (a challenge test with a benzodiacepine can be helpful). The key to distingish malignant catatonia from them is that some of the catatonic signs (negativism and psychomotor retardation) happened before the dysautonomic signs. Also, it is uncommon that a serotonin syndrome persisted more than 3-5 days after the suspension of antidepressants. Consultation and liaison psychiatrists can help for the differential diagnosis and management of patients with suspected catatonia in medical wards.Disclosure of InterestNone Declared
SEROTONIN SYNDROME AFTER HIGH DOSAGE QUETIAPINE INTAKE: CASE REPORT AND BRIEF LITERATURE REVIEW
Authors: Fountas P. , Kasimis D. , Goulas K. , Niamonitos N. , Basdekis A. , Thanasas E. , Charitakis G. , Koumpis M. 
Published: August 2023

IntroductionSerotonin syndrome is a potentially life-threatening condition due to increased serotonergic activity in the CNS. Its most well-known causes are the ingestion of large amounts of serotonergic drugs or the inappropriate combination of two or more serotonergic antidepressants. Rarer causes of serotonin syndrome have been reported in the literature.ObjectivesThe aim of this paper is to highlight, through case presentation, rarer causes of serotonin syndrome.MethodsCase presentation (woman, 39 years old) who was hospitalized with clinical presentation of Serotonin syndrome, after pharmaceutical self-poisoning with a large amount of quetiapine (>20g). The search of the case data (clinical and paraclinical examination findings) was performed from the medical records and files of the 3rd Internal Medicine Clinic and the Liaison Psychiatry Department of our hospital. A literature search of similar cases (through PubMed) was performed.ResultsA patient with a history of mood disorders, under treatment with venlafaxine, lamotrigine, quetiapine and aripiprazole, was admitted to the hospital ICU due to a decreased level of consciousness (GCS 11/15). Ingestion of approximately 100 tablets of Quetiapine 200mg was reported. The patient developed upper and lower limb myoclonus, supraventricular tachycardia (130bpm), nystagmus, bilateral mydriasis with normal photomotor reflexes, increased tendon reflexes, excessive sweating, upper limb muscle rigidity and abdominal flatulence with the presence of loud bowel sounds. Gastric lavage was performed and admission to the Internal Medicine department followed. Intravenous diazepam was administered, 30mg on the 1st 24 hour period and 20mg on the 2nd, with gradual tapering. From the very 2nd 24 hour period of hospitalization, her clinical condition showed significant improvement, with complete remission of symptoms and recovery of a satisfactory level of consciousness.ConclusionsSerotonin syndrome can be effectively treated if early recognition of symptoms is made. Clinicians should be particularly alert and suspect the possibility of serotonin syndrome in a patient with compatible symptoms by clinical examination, especially in case of overdose of a drug, with or without a serotonergic mechanism of action.Disclosure of InterestNone Declared
A Complicated Case: Presenting Neuropsychiatric Symptoms After COVID Infection
Authors: Evecen A. , Bülbül A. , Karaytuğ M. T. 
Published: August 2023

IntroductionThe COVID-19 pandemic has affected millions of people worldwide. Among a large number of deaths, COVID-19 has caused significant health-related sequelae involving many systems of the body. Some results include increased anxiety, depression, insomnia, and other distress symptoms. Additionally, there are reports of sudden onset of psychosis in patients with no psychiatric history following COVID-19.ObjectivesEmphasizing the importance of Covid 19 causing many psychiatric diseases, although its etiology is not yet known.MethodsReport of a clinical caseResultsWe report a 68-year-old previously healthy woman with no personal or family history of mental illness who was hospitalized due to COVID-19 and then started to have psychiatric complaints. She had complaints such as refusal to speak, eat and drink, fear of death which started after her discharge from the hospital due to COVID-19.On 14.07.2021, she applied to the psychiatry outpatient clinic of our hospital for the first time. In addition to the existing complaints, we have considered the preliminary diagnoses of dementia and psychotic depression due to the increasing fear of being alone, going out alone, confusion in the interim periods, and thoughts that someone will harm her and her family. We consulted the neurology clinic and she was admitted to the neurology service with a preliminary diagnosis of encephalitis. During her hospitalization, the patient’s EEG and MRI were taken, LP was performed, and no pathology was detected in the examinations. Her current psychiatric treatment (escitalopram 10mg/d, medazepam 2mg/d, and olanzapine 2,5mg/d) continued throughout her hospitalization in the neurology service, but her complaints did not change. She was fed formula with an NG tube, IV hydration was provided, and a urinary catheter was inserted.After ruling out neurological disease on 12.08.2021, the patient was admitted to our psychiatry service with a prediagnosis of catatonic-psychotic depression. Electroconvulsive therapy was planned because the visual hallucinations and persecutory delusions persisted. Total of 7 sessions of ECT were received. The patient’s oral intake started with the current treatment, and her fluent speech began. Olanzapine dose was increased to 7.5mg/d, and escitalopram dose was increased to 20mg/d due to persistent depressive and psychotic symptoms. The patient was discharged on 02.09.2021 with the current treatment. Her complaints had improved before she was discharged.Conclusions
COVID-19 remains an emerging disease with unknown psychological sequelae. Caution should be exercised regarding psychiatric symptoms and associated risks in patients with a recent diagnosis of COVID-19. Cytokine storm may also be involved in the etiology, in addition to many psychological factors such as fear of illness, uncertainty, and isolation. Potential risk factors and underlying biological mechanisms should be investigated.Disclosure of InterestNone Declared
COVID-19 vaccination rate in patients with mental illness in a psychiatric hospital: a cohort study
Authors: Areias D. , Portela C. , Dionísio R. , Sousa S. M. , Pereira E. G. 
Published: August 2023

IntroductionIndividuals with severe mental health problems are at greater risk of COVID-19 infection and increased risk of hospitalization and mortality. Vaccination against COVID-19 has demonstrated its importance in preventing and reducing these negative outcomes.ObjectivesThis study aims to assess the vaccination rate of people with mental illness in comparison with the general population.MethodsWe will conduct a retrospective evaluation of vaccine uptake in a sample of patients admitted to a psychiatric hospital between the 1st of July of 2021 and the 30th of June of 2022 in the Porto region. According to their vaccination plan, all patients were offered the possibility vaccination. Statistical analysis will be performed to analyse the data.ResultsWe expect to assess over 1500 patients. Regarding other studies on the same subject, although in different countries, we may predict that the vaccination rate in our sample will not, statistically, differ from the general population.ConclusionsSome studies have shown higher resistance and hesitancy towards the COVID-19 vaccination in mental health patients, however others did not find differences between these patients and the general population. Therefore, this study will allow us to better understand the impact of mental illness in the vaccination rate in our population.Disclosure of InterestNone Declared
First wave of psychological impact and associated factors in hospitalized COVID-19 patients; cross sectional study in supra tertiary hospital in Thailand
Authors: Na Bangxang J. , Wongkulab P. 
Published: August 2023

IntroductionThe Severe Acute Respiratory Syndrome Coronavirus (COVID-19) pandemic not only impacted on physical but also mental health of the patients. We investigated the prevalence and associated factors of depression, anxiety among hospitalized patients with COVID-19. Rajavithi hospital is a supra-tertiary hospital which was the frontline in the first wave and gets referral SARS CoV-2 cases from other parts of Thailand.Objectives
We investigated the prevalence and associated factors of depression, anxiety among hospitalized patients with COVID-19.MethodsA cross-sectional study was designed to evaluate prevalence of depression, anxiety and associated factors among 93 hospitalized COVID-19 patients between 1 July 2020 – 31March 2021. Depression and anxiety were measured with Thai Hospital Anxiety and Depression (Thai HADS).ResultsPrevalence of depression was 5.4 %, prevalence of anxiety was 2.2 % Depression was associated with age greater than or equal to 60 years old (p-value = 0.028) and requiring supplemental oxygen therapy (p-value = 0.021).ConclusionsThis study shows low prevalence of depression and anxiety in hospitalized patients with COVID-19. Depression was significantly related with elderly and supplemental oxygen therapy. Elderly is vulnerable to depression during treatment and patients who require supplemental oxygen therapy. Severity of the disease might affect neuroinflammatory responses which can relate to depression. Furthermore, severity of disease puts patients in more isolation or guilt that might lead to depression.Disclosure of InterestNone Declared
Burnout and its associated factors in healthcare workers during the COVID-19 pandemic
Authors: Halouani N. , Koukane M. , Elleuch O. , Turki M. , Samet A. , Jemil F. , Ellouze S. , Aloulou J. 
Published: August 2023

IntroductionDue to the COVID-19 pandemic, our health system had to face new challenges such as Burnout (BO), particularly among healthcare workers (HCWs).ObjectivesOur study aimed to examine the prevalence of burnout among HCWs, as well as to identify the sociodemographic and professional factors associated to it.MethodsThis was a cross-sectional descriptive and analytical survey, conducted during the fifth wave of COVID-19 between December 2021 and February 2022, among the healthcare workers of 3 hospitals in Djerba city. We used an online questionnaire to collect their sociodemographic and professional data. Maslach Burnout Inventory (MBI) was used to assess their burnout level.ResultsOur population consisted of 95 HCWs with a sex ratio of 0.46. Most of them (75%) had an age of less than 40 years. Among our participants, 56.8% were paramedics and 71.6% had a working experience of less than 10 years. A rate of 56.8% worked full-time with a minimum of 36 hours per week and more than 5 on-calls per month in 56.8%.In our study, 76% of the HCWs were affected by BO. The mean emotional exhaustion, depersonalization and professional accomplishment scores were 35.74 ±12.16, 11.84 ±8.08 and 27.32 ±6.95, respectively. A rate of 69% had a high level of emotional exhaustion, 42% had a high level of depersonalization and 41% had a low level of personal accomplishment.The subgroup analysis showed that BO was associated with: an age of less than 30 years (p=0.007); having no children (p=0.030); a work experience of less than 10 years (p=0.001); a number of working hours greater than 36 hours (p=0.030) and a number of on-call duties greater than 5 per month (p=0.007).ConclusionsOur study shows the burden of BO in the HCWs of Djerba, especially among the youngest ones, the least experienced and those with the highest workload. Thus, a special attention must be paid to this condition, and the implementation of a prevention strategy is essential.Disclosure of InterestNone Declared
Pandemic COVID 19 and healthcare professionals: Mental health impact and depression
Authors: Ben Soussia R. , Melki R. , Aoun M. H. , Bouali W. , Zarrouk L. 
Published: August 2023

IntroductionThe SARS-COV2 pandemic represents a problematic and disruption of global health. Repeated exposure to stressful situations leads to increased psychological distress.ObjectivesTo determine the psychoaffective impact of the Covid-19 pandemic on the mental health of health professionals in Tunisia, assess the intensity of depressive symptoms professionals and determine factors associated with the development of these symptoms.MethodsThis was a multicenter, cross-sectional, descriptive and analytical study conducted among health professionals, from May 2nd, 2020 to June 30th, 2020 in Tunisia. The health professionals included were physicians, nurses, dentists, and pharmacists. Using an electronic form << Google Form >>, a questionnaire was drawn up with 32 items. Assessment of depressive symptoms was performed using the PHQ-9 psychometric scale.Statistical analysis was performed using SPSS 21.0 statistical software. Regarding the analytical study, a professional with a PHQ-9 scale score between 10 and 27 was considered as having moderate to severe depressive symptoms while a score between 15-27 was in favor of severe depressive symptoms.ResultsCaregivers were predominantly female 69.5% with a mean age of 30.74 years. Anxiety-depressive psychiatric history was found in 11.8% of the subjects. The majority of the professionals were doctors (77.8%) and 9.4% of the participants were nurses. The majority of participants worked in university hospitals (84.2%). One third of the participants, (34.3%) worked in departments with Covid-19 patients with respective rates of 57% for nurses and 36% for physicians. Dentists and pharmacists did not work in Covid-19 circuits.The mean score on the PHQ-9 scale was equal to 8.62 ± 5.35. Depressive symptoms were noted in 37.4% of the professionals, with moderate to severe intensity in 35.5% of cases. Participants with a psychiatric history of depression or anxiety disorder had significantly higher depressive symptom scores (p<0.001) with 6 times higher the risk of developing moderate to severe depressive symptoms (p<0.0001, OR 6.25, CI [2.35-16.61] and almost 3 times higher the risk of experiencing severe depressive symptoms (p=0.05, OR=2.93, CI [1.09-7.88]). The nursing profession had high odds ratios for the occurrence of moderate to severe depressive symptoms (p=0.002, OR=4.41, CI [1.58-12.28]) and severe depressive symptoms (p=0.02, OR=3.82, CI [1.28-11.39]). A significant relationship was established, between the development of depressive symptoms of moderate to severe intensity with the history of depressive disorder or anxiety disorder (p=0.001) and the nursing profession (p=0.01).ConclusionsThe optimization of prevention, the creation of specific treatment, the promotion of health education and specific hygiene rules would participate in improving the mental health of health professionals.Disclosure of InterestNone Declared
First episode psychosis Post-COVID 19 infection : case report
Authors: Dhakouani S. , Kammoun R. , Hamrouni N. , Karoui M. , Ellouze F. 
Published: August 2023

IntroductionDuring the course of COVID-19 pandemic, the respiratory system is the most commonly affected while many neuropsychiatric manifestations of the disease have been observed.ObjectivesEmphasize the importance of detecting psychiatric symptoms in patients infected with Covid 19.MethodsPresentation of case reportResultsA 44-year-old woman with no personal history of chronic diseases and with no psychiatric family history. About her experience with covid 19, her mother died as a result of covid 19 infection and our patient had been hospitalized for 17 days for pulmonary infection covid 19, during her hospitalization in COVID 19 unit she presented insomnia and anxiety without behavioural disorders. She had a good evolution of the respiratory symptoms and she was discharged under corticotherapy and anticoagulants.She was admitted in our department after 45 days of her covid 19 infection for acute behavioural disorders.On physical examination: she was hemodynamically stable and well oriented. Neurological examination was with no abnormalities. Cerebral CT scan was normal and lumbar puncture was indicated and the analysis of the CSF did not reveal any anomalies. At the psychiatric interview she was extremely agitated, anxious and hallucinated, she had disorganised speech with derailment and neologisms, she was disinhibited and her mood was exalted. She presented also a delusion of grandeur and delusion of persecution.ConclusionsIn individuals presenting with COVID-19 infection, consideration should be made for psychiatric manifestations because COVID-19 diagnosis predispose vulnerable patients to psychosis.Disclosure of InterestNone Declared
Socio-professional stigmatization among healthcare workers with COVID-19
Authors: Fendri M. N. , Brahim D. , Mechergui N. , Youssef I. , Ernez S. , Ben Said H. , Ladhari N. 
Published: August 2023

IntroductionThe COVID-19 pandemic had deeply altered the social and professional lives of people with SARS-COV2. The anxiety of being contaminated by the virus during the first waves had created avoidance behaviors and established a climate of rejection towards healthcare workers (HW) with COVID.ObjectivesThe aim of this study was to assess stigmatization among healthcare workers with COVID-19MethodsThis is a retrospective cross-sectional study carried out on HWs in a university hospital in Tunis who were affected by COVID-19 and who consulted the occupational medicine department. The study was conducted between March 2021 and June 2021. Data collection was based on pre-established forms. The questionnaire assessing stigmatization was inspired by the questionnaire assessing stigma in AIDS patientsResultsThe study included 100 health personnel. The sex ratio (M/W) = 0.29. The average age was 39.22 ± 9.3 with extremes ranging from 24 to 58 years. The average professional seniority was 11.39±9.4. Nurses were the most represented professional category (26%). The psychiatric history was: Depressive disorder (14%) and anxiety disorder (10%). Eighty HW were infected with SARS-COV2 for the first time. Contamination was intra-hospital in 50% of cases. Eighteen HW had been rejected. Verbal abuse towards HW with COVID was noted in 8% and physical abuse in 11%. Twenty-six HW had lost their friends and 36 of them no longer had as much social activity as before. In the workplace, rejection was noted in 21% cases, 10 health personnel reported a discriminatory orientation for the care of patients with COVID and 19 HW felt useless at work.ConclusionsSocio-professional stigmatization should help us to understand the vulnerability and psychological impact of this health crisis on health workers. Control and prevention strategies need to be established.Disclosure of InterestNone Declared