bluuebunny/crossref_metadata_2025_split huggingface dataset:
How to Manage Suicidal Risk at Digital Distance
Authors: Courtet P. 
Published: September 2022

Suicide prevention remains very difficult to achieve for many reasons, notably because we do not have any indicator of risk prediction, short-term risk factors being little explored, and evaluations being retrospective they are biased. Furthermore, patients at risk are not followed up, because of their lack of confidence in care, stigma, shame. On the other hand, the gap observed during the covid19 pandemic between distress and less occurrence of suicides could be linked to more virtual contacts. Then, the smartphone might be a good tool to stay connected to a protective network. We will discuss the opportunity offered by the smartphone to monitor patients with ecological momentary assessment, allowing to better characterize their acute states and detect an increased risk in real time, and thanks to the ecological momentary intervention 24/7 availability, improve access to care and better coordinate resources, and encourage self-care. These tools while offering new solutions for an efficient real time suicide prevention, may also raise some ethical issues that should be addressed.DisclosureFondamental Foundation supported the developement of the application EMMA
Misdiagnosis and therapeutic impasse in psychiatry
Authors: Zrelli M. , Bergaoui E. , Staali N. , Moalla M. , Melki W. 
Published: September 2022

IntroductionWe frequently receive patients with atypical psychiatric symptoms admitted in our department after consulting other psychiatrists and triying several treatments.ObjectivesTo highlight the factors of misdiagnosis in patients of our department.MethodsWe recruited 70 patients during their appointment or during their hospital admission in our department between March and April 2021. We collected the patients’ socio-demographic and clinical data using a pre-designed questionnaire.ResultsPatients were aged between 17 and 68 years with a sex ratio (M/F) of 1. Mood disorders accounted for 24.6% of disorders (N=17) whereas schizophrenia 66.7% (N=46). Patients resided in urban areas in 88.6% of cases (N=69). The average number of hospitalizations was 2.7 with extremes ranging from 0 to 14. The average time between the onset of the symptoms and the first consultation was 1 year. The mean time from onset to hospitalization was 4.37 years. The rate of consulting a psychiatrist prior to admission was 42.8%. The diagnosis was corrected during the follow-up of the patients in 24.3% of cases. Conventional neuroleptics were prescribed as first-line treatment in 42.85% of cases. Due to poor tolerance or ineffectiveness of the treatment, 31.42% of patients had to change treatment.ConclusionsPatients, who were desperate to find an adequate treatment for their disorders, put a lot of hope in the Razi psychiatric hospital. But after several years of evolution of their disease, we are faced with a therapeutic impasse. Raising awareness of mental illnesses is necessary for an early and adequate treatment.DisclosureNo significant relationships.
How to deal with Substance Abuse in a Telepsychiatric Setting
Authors: Dom G. 
Published: September 2022

Abstract BodyAlcohol and (illicit) substance abuse are among the most common psychiatric disorders within the general population and their impact can not be underestimated. Reputedly for these disorders, there is a large treatment gap and treatment delay, i.e. large numbers of afflicted individuals never receive appropriate treatment and if they do so often many years after the onset of the disorder. The Covid19 pandemic has only aggravated these gaps. In many countries, due to the Covid 19 pandemic and its associated restriction measures telepsychiatric tools have become increasingly implemented (and funded) as regular parts in the possibilities in delivering interventions. With respect to substance abuse treatment, a vast body of research already showed promises both in the field of telepsychiatry as broader the use of digitalization (e.g. the use of virtual reality designed treatment interventions, digital monitoring). In the current presentation, an overview will be presented of both telemental health interventions and digital tools/interventions in the field of substance abuse treatment.DisclosureNo significant relationships.
Lymphocytic colitis in the course of a treatment with sertraline. A case report
Authors: Cerame A. , Cotillas A. , Coucheiro P. , Franco Soler A. 
Published: September 2022

IntroductionLymphocytic colitis is an unusual side-effect of the treatment with SSRIs particularly sertraline. According to several sources, this side effect could be underdiagnosed and underreported.ObjectivesWe present the case of a 31-year-old female patient who presented watery non-bloody diarrhea for a month. The patient had been diagnosed with Persistent Depressive Disorder six years prior to the episode and was being treated with sertraline.MethodsA case report is presented alongside a review of the relevant literature regarding Lymphocytic colitis, its differential diagnosis and treatment.ResultsThe case was coordinated between the out-patient psychiatry department and the patient’s Family Medicine specialist. The patient underwent a complete panel of tests including blood and stool test, and colonoscopy. The biopsy showed results compatible with the aforementioned diagnosis. Since the only pharmacological treatment which could cause or trigger lymphocytic colitis was sertraline, it was removed and treatment with oral budesonide was started with good results.ConclusionsLymphocytic colitis in the context of the treatment with SSRIs, particularly sertraline, is a side-effect which is more prevalent than what was thought in the past. A close coordination between psychiatrists and GP is of vital importance for the adequate treatment of mental health problems and treatment’s side-effects. It is important to bear in mind this possible side-effect to increase patient’s safety.DisclosureNo significant relationships.
Legal and Forensic Issues in Telepsychiatry
Authors: Goethals K. 
Published: September 2022

Covid-19 has induced many changes to society, including some in the practice of medicine and psychiatry. Among them is increasing use of telecommunications. A previous editorial outlined the possible uses and dangers of telemedicine with prisoners (Gunn et al 2020). Forensic psychiatry is also concerned with providing expert evidence to courts and other arbitration bodies and, increasingly, these bodies too are relying on such technology. Further in addition to traditional paper-style records (many now held electronically rather than literally on paper) there is increasing use of video recording of interviews, of day to day behaviour on secure hospital units and by bodycams when intervening in a tense, potentially violent situation. To what extent are these being used in court? Is there a European framework for guiding us on how to proceed? How has this been interpreted to date in countries across Europe? In this paper these issues will be addressed.DisclosureNo significant relationships.
Olanzapine and its use for methamphetamine-induced psychosis
Authors: Nazir S. , Talpur A. , Hassan N. , Sharif U. 
Published: September 2022

IntroductionOver time the prevalence of methamphetamine associated psychosis (MAP) has increased globally including Asia and Europe. Shoptaw et al looked at an RCT and concluded that olanzapine is superior to haloperidol in terms of tolerability and the side effect profile as it causes fewer extrapyramidal symptoms. Another study by Xue et al compared the efficacy of olanzapine and haloperidol and found that they had comparable effects but the onset time in the olanzapine group was significantly earlier than the haloperidol group. Srisurapanont et al analyzed 6 RCTs and concluded that quetiapine and olanzapine are probably superior than aripiprazole and risperidone.ObjectivesThe purpose of this review is to find out if olanzapine is better than other antipsychotics in treating methamphetamine-induced psychosis.MethodsPubMed, SCOPUS, and Web of Science literature databases were screened and filtered by using specific search terms, inclusion/exclusion criteria. Texts of the selected articles and trials were reviewed and the search terms generated a total of 248 results from the databases. After applying the criteria 200 citations were left and 15 papers were reviewed.ResultsThe literature review concluded that olanzapine can be used as an effective treatment for methamphetamine-induced psychosis. Olanzapine can help to reduce the psychotic symptoms in MAP with a quicker onset and lesser side effects.ConclusionsOlanzapine can help in the treatment of methamphetamine-associated psychosis and can be considered as the first-line therapy. Research is further needed with a higher pool of candidates in the future to compare the efficacy and tolerability of different typical and atypical antipsychotics.DisclosureNo significant relationships.
Co-occurrence of clozapine-related DRESS syndrome core clinical manifestations: results of a systematic review
Authors: De Filippis R. , De Fazio P. , Kane J. , Schoretsanitis G. 
Published: September 2022

IntroductionDrug reaction with eosinophilia and systemic symptoms (DRESS) syndrome refers to a cluster of clinical symptoms/signs related to drug hypersensitivity. The main clinical features include fever, skin rash, eosinophilia, enlarged lymph nodes, atypical lymphocytosis, and involvement of at least one internal organ. Clozapine-related DRESS syndrome has been rarely reported, but this may be due to a different clinical presentation pattern compared to DRESS for other culprit drugs.ObjectivesWe aimed to assess clusters of main clinical features of clozapine-related DRESS.MethodsWe ran a network analysis for clinical manifestations in the pooled sample of all previous published cases of clozapine-related DRESS.ResultsWe observed a triad of core symptoms (i.e., organ implication, fever, and eosinophilia) among DRESS criteria co-occurring in 59.3% (n=16) of 27 patients. The organs most likely to be involved in clozapine-related DRESS included lungs, liver, heart, and kidneys. Fever was also present in almost all cases (n=25 patients), while eosinophilia was observed in two thirds of the sample (n=18 patients).ConclusionsRegarding clinical manifestations clozapine-related DRESS may differ from DRESS for other culprit drugs as skin reaction is not very typical; thus, clinicians need to consider DRESS as a potential diagnosis even in absence of a skin reaction. When managing clozapine-treated patients with the core triad of organ implication, fever, and eosinophilia clinicians should consider guidelines for DRESS treatment.DisclosureNo significant relationships.
What if Cannabis has a medical relevance in psychiatric disorders?
Authors: Abassi B. , Khelifa E. , Nourchene K. , Maatouk O. , Mnif L. 
Published: September 2022

IntroductionCannabis was used as a medicinal plant in Asia before the Christian era. Nowadays, after 40years of a “war on drugs” with an illegal status, there is a big interest on the use of cannabis in some medical conditions. With more and more users revealing having used this substance to cope with certain psychiatric manifestations, researchers have tried to explore this substance in the psychiatric field where the actual pharmacological treatments and psychotherapy remain ineffective in some cases.ObjectivesTo Explore the medical use of cannabis in psychiatric disorders.MethodsA literature review was based on the PubMed interface and adapted for 2 databases: Science Direct and Google Scholar over the last 10 years.ResultsGiving the interactions between cannabinoids and specific neurotransmitters, it has been suggested that cannabis may have medical effect on some psychiatric illnesses. In this direction, a significant overlap has been demonstrated between PTSD and cannabis use. CBD a non-psychotomimetic cannabinoid, seemed to show promising results as an enhancer of fear extinction and therapeutic consolidation of emotional memories. Military veterans are increasingly using it for reducing induced nightmares although this residual symptom remains difficult to treat. No benefit for improving depression was proved. One isolated study indicated a potential efficacy for cannabinoid combined with terpene in ADHD.ConclusionsStudies exploring the possibility of using cannabis in the treatment of psychiatric illnesses are promising but it is premature to recommend this drug for the moment especially since it requires gradual titration, regular assessment and precaution in certain diseases.DisclosureNo significant relationships.
Antipsychotics and mood stabilizers on risk for hepatic failure in people with schizophrenia and bipolar disorder
Authors: Tascón Guerra M.F. , Pérez Fominaya M. , López Rodrigo M.V. , Osca Oliver A. , Palomo Monge M. , Costoso López A. , Ros Font V. 
Published: September 2022

IntroductionPatients with severe mental disease have a considerably shorter lifespan than the general population. The majority of psychiatric drugs are metabolized by the liver. Cytochromes play a central role, interactions between drugs are expected. Neuroleptics are frequently associated with weight gain, steatosis development, elevation of liver enzymes and rare acute cytolytic hepatitis, particularly with clozapine and olanzapine. Mood stabilizers, like Valproate classically gives mitochondrial steatosis with potentially important damages, and also possible acute liver failure.ObjectivesThis case presents a 56-year-old patient, previously diagnosed of schizoaffective disorder, with chronic psychotic symptoms that showed high drug resistance. She had been treated in the past with most common antipsychotic drugs with no clinical response. While being in treatment with valproate and olanzapine, she was started on clozapine while olanzapine removed. Two weeks later she developed Acute Pharmacologic Hepatitis with mild liver failure.MethodsPhysical examination was normal. Mental exam revealed presence of delusion. Blood tests showed: hyperbilirubinemia and mil coagulopathy. Clozapine dose was reduced and valproate was suspended.ResultsThe patient showed a substantial improvement of hepatic damage. Delusions are active after 12 weeks of treatment with clozapine.ConclusionsPsychiatric disorders and liver illnesses are entangled in multiple ways. Screening for liver diseases is essential in order to prevent liver complications in patients receiving psychotropic medications. Further investigation of combinations of agents such as mood stabilizers and atypical antipsychotics may yield valuable insights into the potential of combination therapies to enhance clinical outcomes in patients with Severe Mental Disease.DisclosureNo significant relationships.
A new day, a new treatment. A case report
Authors: Galerón R. , Serván B. , Huete Naval M. , Herrero Pellón E. , Albarracin P. 
Published: September 2022

IntroductionWe present the case of a 21 year-old male, with history of a psychotic episode, currently with monthly follow-up in an outpatient facility, with a favorable clinical evolution after one year of intensive follow-up. In the context of abandonment of his medication and a problematic family situation, the patient starts to show suspicious, with insomnia and a progressive social isolation. Despite an attempt of ambulatory treatment with oral aripiprazole, showing good tolerance, the patient refuses such treatment, showing active clinical psychotic with great distress and behavioral repercussion, finally requiring hospital admission.ObjectivesTo perform a literature review about the treatment initiation with two vials of aripiprazole long-acting injection.MethodsLiterature review of scientific articles using Pubmed as search engine. We considered articles published both in English and Spanish.ResultsDuring hospital stay, treatment with 2 intramuscular injections of 400mg of aripiprazole is started, combined with a single dose of oral aripiprazole 20mg on day 1, assuring correct dosing, with good tolerance and favoring therapeutic adherence. Progressively, the patient starts to feel calmer, adequate, collaborative and emotionally stable, recuperating chronobiological rhythms, with remission of the hallucinations and appearing more distant from delusions.ConclusionsAccording to the currently available studies, the use of this posology could avoid the potential impact that lack of adherence to oral treatment could have in the therapeutic outcome, assuring a correct dosing and favoring adherence from day 1. Furthermore, this would help simplify the medication regiment for patients, physicians and caregivers.DisclosureNo significant relationships.
The combination of long-acting injectable antipsychotics, a new key in resistant schizophrenia
Authors: Tascón Guerra M.F. , Osca Oliver A. , López Rodrigo M.V. , Palomo Monge M. , Pérez Fominaya M. 
Published: September 2022

IntroductionSchizophrenia is a chronic disease that requires lifelong medical care and supervision. There is a high rate of relapse, mostly caused by poor adherence to oral antipsychotics. Long-acting injectable (LAI) antipsychotics have proved effective in schizophrenia and other severe psychotic disorders due to the stable blood levels, leading to a reduction of the risk of relapse. LAIs are associated with better functioning, quality of life, and patient satisfaction. In Treatment-resistant schizophrenia the combination of antipsychotics is a common practice. Nevertheless, the combination of two different long-acting injectable antipsychotics is not frequent.ObjectivesA case of a 34-year-old man is presented, previously diagnosed of Schizophrenia, with highly disabling chronic positive symptoms. With no in-sight and no will in receiving treatment. Has been stable for a year while being in treatment with paliperidone 525mg LAI/ 10 weeks, and aripiprazole 400mg LAI/28 days.MethodsThe patient was closely observed and given oral paliperidone, after 5 days long-acting paliperidone was introduced. He was discharged with mild improvement of his psychiatric symptoms. While being in treatment with Paliperidone 525mg, he kept vivid delusions and hallucinations. The patient still refused to take any oral medications. Long-acting aripiprazole 300mg was added to the treatment.ResultsHe showed clinical improvement after a month. He has been stabilized for one year.ConclusionsTreating resistant schizophrenia is among the most challenging clinical endeavors. A very helpful approach to improve adherence in schizophrenia is the use of long-acting injectable (LAI) antipsychotics. A major effort on scientific research of combination of LAI is needed.DisclosureNo significant relationships.
Time of onset of hematological side effects with Clozapine
Authors: Ktari H. , Ouertani A. , Madouri S. , Aissa A. , Zgueb Y. , Ouali U. , Jomli R. 
Published: September 2022

IntroductionClozapine use is not deprived of serious complications that can condition treatment strategies, particularly hematological. Recognizing the time it takes for these effects to set, can therefore help to better screen their appearance, improving healthcare.ObjectivesTo study the time of onset of hematological adverse reactions in patients treated with Clozapine.MethodsA longitudinal, retrospective and descriptive study on a period of 20 years starting from the first of January 2000, at the psychiatry department A of the Razi hospital in Tunisia. This study was conducted on patients treated by Clozapine. The data was collected from patients’ medical files using a pre-established sheet.ResultsThe studied sample included 64 patient. Hematological disorders were found in 21 patients (32.8%). The mean time of onset of hematological adverse reactions was 119.71±126.56 days. Indeed, some patients had presented more than one hematological disorder and this at different times. Mild to moderate neutropenia had a mean time of onset of 502.57±908.32 days. The time of onset of eosinophilia was 937.75±1725.87 days, 297.67 ± 444.93 days for thrombocytopenia, 741±1268.85 days for leukopenia, 69.25 ± 48.19 days for hyperleukocytosis and 183. 33±231.80 days for anemia. Two cases of agranulocytosis were noted: one case occurred 10 years and three months from treatment beginning and the second case occurred after 7 months of treatment onset.ConclusionsThe time of onset of hematological side effects with clozapine varies widely and cannot be predicted with precision. Early, more frequent and regular surveillance is therefore necessary in this population.DisclosureNo significant relationships.
Hypertriglyceridemia induced by aripiprazol: about a clinical case
Authors: Jordán G. , San Miguel A. , García Jimenez J. 
Published: September 2022

Introduction41 years-old man diagnosed of schizophrenia and peripheral spondyloarthropathy HLA-B27 (-) in treatment with methotrexate. Psychiatric background: First psychotic episode at 18, with no further medical monitoring. In 2018 he underwent a new episode consisting in auditory hallucinations, delusional ideas and clinophilia of months of evolution. He was sent to a Psychiatric Rehabilitation Unit and prescribed aripiprazole 20mg. The routine blood analysis revealed triglycerides level of 414mg/dL, with previous normal levels (123 mg/dL), without no other cause to justify it.ObjectivesTo study the relationship between aripiprazole treatment and acute hypertriglyceridemia.MethodsA clinical case is presented and available bibliography about the relation between aripiprazole and acute hypertriglyceridemia is reviewed.ResultsHypertriglyceridemia was confirmed in the second analysis, so we concluded it was due to the start of aripiprazole, after rejecting other potential causes. Aripiprazole was replaced by cariprazine 3mg because of its similar profile. The analysis was repeated after a month and the normalization of the triglyceridemia (159mg/dL) was verified, while cholesterol levels remain stable. Moreover, the patient experienced an improvement in akathisia and sedation.ConclusionsAlthough metabolic impact is not expected with aripiprazole, after reviewing the bibliography we have found a clinical trial and a case series that described this adverse effect. Our case highlights the importance of closely monitoring of patients in whom an antipsychotic treatment is started due to the high mortality and morbidity related to cardiovascular diseases.DisclosureNo significant relationships.
“Flexible Assertive Community Mental Health Teams for the Treatment of Psychosis in Extraordinary Circumstances during Pandemics and Earthquakes 2020/2021: are we Flexible Enough?”
Authors: Rojnic Kuzman M. , Medved S. , Bjedov S. , Kovac M. , Mihaljevic-Peles A. 
Published: September 2022

During the ongoing COVID-19 pandemic, two regions in Croatia, Zagreb and Petrinja in the Sisak-Moslavina County experienced strong earthquakes, on the March 22nd 2020 and on the 29th of December 2020. Both earthquakes, but especially the later one resulted on severe damage of the regions and caused severe disruptions in (mental) health service delivery. In these circumstances, the RECOVER-E project (LaRge-scalE implementation of COmmunity based mental health care for people with seVere and Enduring mental ill health in EuRopE), which was ongoing in Croatia from 2018-2022 aimed to implement flexible assertive community treatment as the new health care service for persons with severe mental illness (SMI). Since the pandemic and earthquakes have significantly influenced the life circumstances of all RECOVER-E project participants with SMI, we wanted further to examine the impact of health care delivery on mental health and the response to stress caused by a pandemic and earthquake in the patients with SMI involved in the project, in the first and second wave of the COVID-19 pandemics. Additionally, using case series, we will demonstrate the community mental health teams’ contributions in managing SMI after a double disaster in providing feasible, comprehensive, and accessible mental health services.1DisclosureNo significant relationships.