bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychiatric comorbidity in epilepsy and difficulties in treatment: A case report
Authors: Fernández Fariña M. , Mayor Sanabria F. , Regueiro Martín-Albo C. , Expósito Durán M.E. , Francos Ajona A. 
Published: September 2022

IntroductionWe present the case of a 36-year-old male with depressive states, impulsive traits and fits of anger (including episodes of self and heteroagressiveness) since early childhood, in the context of traumatic family history and the beginning of an epileptic disease. These symptoms have been maintained over the years, in addition to other variable and recurrent symptoms, such as severe anxiety, somatizations or serious depressive symptoms.ObjectivesTo highlight the possible influence of epilepsy in the course of mental illnesses, especially depression, as well as the increased difficulty in management.MethodsWe collected the complete medical history of a patient with an important history of mental health in addition to epileptic disease since childhood and we carried out a review of the comorbidity between these diseases and their treatment.Results
The epileptic disease of our patient may have influenced the behavioural alterations and the depressive symptoms since childhood, as well as the personality traits with aggressiveness and impulsiveness. There is an added difficulty in treating this case given the possible interactions between antiepileptic and antidepressant medications.ConclusionsThis case highlights the importance of taking into account the influence of this comorbidity on the prognosis of patients. Knowing the interactions and side effects of drugs is essential for good clinical management.DisclosureNo significant relationships.
Eating problems in ADHD: self-regulatory or inattentive/impulsive
Authors: Araújo A. , Batista M. , Pascoal M.D. , Pereira A.T. , Ventura F. , Madeira N. , Macedo A. 
Published: September 2022

IntroductionADHD is a risk factor for impulsive/compulsive eating problems (EP). In, bulimia nervosa and compulsive eating disorder, EP are frequently preceded by negative affect and experienced as loss of control. Clarifying the underlying causes (eg., ADHD symptoms and/or psychological distress) of EP in ADHD would allow the development of targeted interventions.ObjectivesTo a) compare levels of EP between ADHD patients and a community sample, and b) test if ADHD symptoms and psychological distress predict EP, in ADHD patients.MethodsAdults with ADHD (n=32; age=23.78+/-6.12; 69% males) from the Neurodevelopmental Outpatient Unit of Coimbra and healthy participants (n=30; age=36.90+/-13.23; 57% males) answered an online survey including the Portuguese versions of the Adult ADHD Self-Report Scale Symptom Checklist, the Parkinson’s Disease Impulsive-Compulsive Disorders Questionnaire-Current Short and the Depression, Anxiety and Stress Scale.ResultsThe ADHD group reported experiencing more EP than healthy individuals (18/32 vs. 4/30; χ2=12.458, p<.001). ADHD patients with EP suffered from severer ADHD inattentive, hyperactive, and global symptoms and higher levels of psychological distress (p<.001 to p=.027). Logistic regression model testing if ADHD and psychological distress symptoms predicted EP, in ADHD, explained 38.8% of the variance and showed that the only significant predictor was ADHD symptoms (B=.121, SE=.051, p=.017).ConclusionsOur results indicate that EP are associated with severer ADHD clinical pictures. EP arose secondarily to ADHD symptoms, instead of serving as means to alleviate psychological distress. Clinicians should be mindful that, in ADHD patients, EP follow specific motivations, i.e., impulsivity and inattention, and may respond to combined cognitive-behavioural/executive training strategy.DisclosureNo significant relationships.
Comorbid Opioid Use Disorder in Body Dysmorphic Disorder
Authors: Kim J. , Alli-Balogun O. , Gill G. , Korenis P. , Mitra S. 
Published: September 2022

IntroductionBody Dysmorphic Disorder (BDD) is a severe and common disorder that consists of distressing or impairing preoccupation with nonexistent or slight flaws in one’s physical appearance. People with BDD typically describe themselves as looking ugly, unattractive, deformed, or abnormal, whereas in reality they look normal or even very attractive.ObjectivesCase StudyMethodsCase StudyResultsMr. X is a 31 year-old male with history of Opiate (heroin, oxycodone) use disorder currently on maintenance (Buprenorphine-Naloxone) treatment. On admission, urine toxicology was positive for opiates and other drugs.CIWA score was 11. He was started on Lorazepam taper, Mirtazapine, Fluoxetine, and was started on Suboxone soon after. His cravings decreased and he was admitted for Rehab. He reports that anxiety associated with his “body image” related to ears, shape of head, eyebrows since he was in high school which made him “feel uncomfortable” going to school and concentrating in his classes. His coping mechanism was covering his head with hats, shaving eyebrows, substance use, and receiving an otoplasty.ConclusionsAccording to Houchins et al (2019), alcohol is the predominant substance used in BDD. It is interesting to note that only 6% of BDD patients had Opioid Use Disorder, but as this case demonstrates, can be a debilitating comorbidity that raises the risk for suicidality or hospitalization. However, little research has been done on the treatment of OUDs in patients with BDD or on the treatment of BDD in patients with an SUD, and this is an area of research that could benefit the modern population greatly.DisclosureNo significant relationships.
Management of Parkinson’s disease challenged by co-morbid drug abuse
Authors: Simas J. , Delgado A. , Guedes R. , Silveira C. , Soares C. 
Published: September 2022

IntroductionParkinson’s disease (PD) is a neurologic degenerative condition with complex neuropsychiatric manifestations which can be challenging to manage and greatly impact quality of life and prognosis.ObjectivesThe description of this case aims to highlight the complex interaction between PD, drug-abuse and impulse control disorder (ICD).MethodsClinical information was obtained through patient interviewing and medical records consulting. A literature review on the topic was conducted.ResultsWe report the case of a 52-years-old male with PD diagnosed at the age of 45, presenting with rigidity of right limbs and freezing of gait. He had a history of multiple substance-abuse: hashish, heroin and cocaine, with cessation of all substances by the age of 40. The patient responded well to antiparkinsonian medication initially, but needed frequent adjustments and developed ICD secondary to dopamine agonists, presenting pathological gambling and hypersexuality. At 47 he restarted using cocaine stating that it diminished the motor symptoms. Motor symptoms worsened and became partially responsive to medication. Pharmacologic options were limited due to ICD. He developed dopamine dysregulation syndrome, abusing dopaminergic drugs and requesting multiple prescriptions. Deep brain stimulation surgery was proposed, but the patient was deemed unfit for the procedure after two separate psychiatric evaluations, mainly because of behaviour and social problems in relation to sustained cocaine abuse and personality disorder. Attempts to stop drug abuse were unsuccessful despite several interventions by addiction psychiatry.ConclusionsCo-occurrence of PD, substance-abuse and personality disorder poses as a therapeutic challenge conditioned by pharmacological iatrogenesis and behavioural disturbances, requiring a multidisciplinary and individualized approach.DisclosureNo significant relationships.
A Case of Adult Attention Deficit Hyperactivity Disorder with Non-Organic Psychosis Comorbidity
Authors: Akyıldırım Çor S. , Duman M. , Uzun Ö. 
Published: September 2022

IntroductionAlthough ADHD is the most frequently diagnosed psychiatric disorder in childhood, the majority of adults with ADHD are not diagnosed and 90% of the cases remain untreated. One of the main reasons that may lead to the missed diagnosis of ADHD in adults may be the high rate of comorbid psychiatric conditions masking the main symptoms.ObjectivesIn this study, it was aimed to present a case who was followed up with the diagnosis of ADHD since childhood and developed psychosis after a recent traumatic life event.MethodsA 19-year-old male patient was consulted because of his complaints of persecution delusions, and disorganized speech that started 2 years ago. IIt was learned that the first psychiatry application of the patient was 10 years ago with complaints of impulsivity, aggression, increased psychomotor movements, and methylphenidate treatment was started during this period. The patient, whose current clinical picture was evaluated as psychosis, was discharged after the symptoms subsided with paliperidone depot 100mg/month treatment after hospitalization. It is understood that his psychotic complaints completely regressed in the follow-ups.ResultsIt is stated that approximately 80% of adult ADHD cases have at least one accompanying psychiatric disorder. However, there are limited studies in the literature on the relationship between psychotic disorders and ADHD.ConclusionsRecent studies indicate that beyond the fact that ADHD is a feature of the schizophrenia prodrome, ADHD diagnosis may be associated with an increased risk of psychosis in the future. Therefore, this association can be better clarified in further studies on comorbidities.DisclosureNo significant relationships.
QT Prolongation-induced Seizures Masquerading as Depression with Mixed Features
Authors: Capilla Crespillo A. , Salvat Pujol N. , Palao Vidal D. , Pinzón-Espinosa J. 
Published: September 2022

IntroductionSevere mental disorders experience premature mortality mostly from physical causes. When a patient with a history of bipolar disorder is admitted to the emergency room (ER) for psychiatric symptoms, these are routinely interpreted as a psychiatric disturbance. However, a careful history should be performed to correctly interpret key clinical information to rule out somatic etiology and establish adequate diagnosis.ObjectivesTo describe a patient whose presenting symptoms were misdiagnosed as psychiatric relapse, rather than serious somatic comorbidity debut.MethodsA 70-year-old man, with a history of type I bipolar disorder and multiple cardiovascular conditions, was admitted to the ER for self-referred nervousness, depressed mood, insomnia, and suicidal thoughts. Symptoms had greatly worsened the previous week to his consultation with paroxysmal episodes of severe anxiety, feelings of strangeness, and sensations of unpleasant odors.ResultsDuring observation, the patient was found lying down with loss of consciousness, urinary incontinence, and amnesia of the event. Generalized tonic-clonic seizures were observed by neurologists while mental status examination was being performed. After symptoms were oriented as having a neurological etiology, the patient suffered cardiac arrest and defibrillation was required. After admittance to the intensive care unit and inpatient cardiology care, the patient was discharged from the hospital with the diagnosis of ventricular fibrillation due to drug-induced QT prolongation. There was no evidence of mixed depression or seizures once the cardiac dysfunction was identified and treated.ConclusionsThe psychiatric symptoms were the clinical manifestation of a generalized seizure-like activities that were attributed to transient cerebral hypoperfusion secondary to ventricular fibrillation.DisclosureNo significant relationships.
Functional Neurologic Symptom Disorders: Bridging the Chasm between the Psychoanalytic and Neuroscientific Understandings
Authors: Deka A. , Banayan D. 
Published: September 2022

Introduction

Since before the time of “Anna O”, the functional neurologic symptom disorder (FNSD) has captivated psychiatry. While the definitive psychopathological mechanism for this phenomenon remains elusive, it is nevertheless of great value for patients and clinicians alike to develop a more nuanced understanding of FNSD. It is necessary to make an enquiry into the mechanism by bridging the psychoanalytic and neurobiological theories.Objectives1.Elucidate psychoanalytic concepts to FNSD 2.Elucidate neuroscientific aspects of FNSD 3.Reconcile the chasm between the two conceptsMethodsComprehensive review of literature at the interface of psychoanalytic and neuroscientific theories of FNSDResultsEmerging evidence have found putative explanations to account for FNSD. Orbitofrontal cortex, anterior cingulate gyrus, dorsolateral prefrontal cortex and striatothalamocortical circuits have been implicated. Number of total studies remain small with each study having few participants. This necessitates a degree of caution in interpreting results. Thus far, mechanisms such as signal rerouting or hypoactivation of specific frontal regions appears to play a material role in FNSD. Neuroscience may be approaching to providing evidence that psychological defenses may have neurobiological correlates that can be measured in certain conditions. However, a definitive answer remains elusive.ConclusionsThe expanding narrative of a relatively nascent dialogue between neuroscience and psychoanalysis remains not only clinically relevant, but also promotes a holistic view of patients with psychiatric illnesses. Through our discussion, psychoanalytic theory is woven into the current neurobiological framework for FNSD, which we believe will assist clinicians provide empathic care and help patients develop a more adaptive and meaningful explanatory paradigm of their lived experience.DisclosureNo significant relationships.
Somatic comorbidity and physical frailty in elderly with medically unexplained symptoms
Authors: Arts M. 
Published: September 2022

IntroductionReported prevalence rates of medically unexplained symptoms (MUS) in people aged ≥65 years range between 1.5 and 18%. People with MUS often describe a low quality of life and frequently suffer from co-morbid anxiety and depressive disorders. In our pilot study on older patients with MUS, the level of somatic comorbidity as well as frailty parameters were significantly higher among patients with MUS which was partially explained by a somatic origin compared to patients with MUS for which no explanation at all was found.ObjectivesThe objective of this study was to examine the level of frailty and somatic comorbidity in older patients with medically unexplained symptoms (MUS) and compare this to patients with medically explained symptoms (MES).MethodsFrailty was assessed according to Fried’s criteria (gait speed, handgrip strength, unintentional weight loss, exhaustion, and low physical activity), somatic comorbidity according to the self-report Charlson Comorbidity Index and the number of prescribed medications.ResultsAlthough MUS-patients had less physical comorbidity compared to MES-patients, they were prescribed the same number of medications. Moreover, MUS-patients were more often frail compared to MES-patients. Among MUS-patients, physical frailty was associated with the severity of unexplained symptoms, the level of hypochondriacal beliefs, and the level of somatisation.ConclusionsDespite a lower prevalence of overt somatic diseases, MUS-patients are more frail compared to older MES-patients. These results suggest that at least in some patients age-related phenomena might be erroneously classified as MUS, which may affect treatment strategy.DisclosureNo significant relationships.
Secondary Gerstmann syndrome, a case report
Authors: Orozco Aguirre A.L. , Marín Valdovino M. , Ruíz Santos M.A. , González Meléndez A.M. 
Published: September 2022

IntroductionGerstmann syndrome is a rare neurological disorder that consist primarily of 4 neuropsychological signs that include acalculia (impairment in performing calcultaions), digital agnosia (dificulty discriminating their own fingers), agraphia (impairment or dificulty to write by hand); and left-right disorientation (impairment of distinguishing left from right.ObjectivesPresentation of a case report of a patient with Gertsmann syndrome secondary to breast cancer metastasis.MethodsWe analyze the case of a 79 years-old female with a history of breast cancer in remission, with a severe depressive episode of 8 months of evolution, dysphoria, apathy, decrease in the ability to carry out basic activities of daily life, acute personality changes and sleep disruption. 15 days previous to the first examination the patient suffers gait disturbances, falling from her own height, memory impairment, suicide ideation and nomination aphasia.ResultsAt the examination we encounter digital agnosia, acalculia, agraphia, right-left disorientation, right hemiparesis. MRI are taken founding 3 tumor lesions in the left and right frontal lobe, 2 solid lesions with a necrotic appearance in the right parietal lobe, one of them in the angular gyrus of the parietal cortex. CT scan found a solid tumor-like lesion in the left pulmonary apex. CA-125 antigen 429.5 U/mL. She was sent to continue her treatment with oncology, receiving radiotherapy.ConclusionsThe psychiatric abnormalities secondary to Gerstmann syndrome make the relatives of this patient seek psychiatric care, requiring multidisciplinary work to reach an accurate diagnosis. Gerstmann syndrome is a rare neurological condition that can mimic lots of other clinical pictures.DisclosureNo significant relationships.
A Complicated Case of Catatonia
Authors: Makela A. 
Published: September 2022

IntroductionMany different causes of catatonia are well-documented in medicine. Modern understanding of catatonia has evolved in the last 100 years with the suggestion that there is a root cause in neuroinflammation. This is a case report of a young woman who presented to the emergency department with altered mental status, found to have catatonia responsive to lorazepam, with the underlying etiology being a diagnosis of multiple sclerosis.ObjectivesA case-based approach is used to support the following learning objectives: - Review the diagnostic criteria for catatonia - Distinguish between simple and malignant catatonia - Review the Bush-Francis Scale - Review available treatmentMethodsMother brings 24-year-old woman into the hospital for altered mental status and changes in behavior including staring spells, periods of withdrawal, refusal to eat, lack of purposeful movement, apraxia, and mutism that worsened 24 hours prior to presentation.ResultsThe patient was afebile with negative covid-19 test. Recent diagnosis of Bell’s palsy treated with antivirals and oral steroird, which terminated just prior to presentation. Additionally, patient had outpatient treatment for vertigo. Lumbar puncture was negative for an infectious process. MRI revealed multiple stable white matter lesions in the periventricular, pontine, and subcortical regions, some oriented perpendicular to the corpus callosum.ConclusionsThis case of a 24-year-old woman with catatonia brought an opportunity to retrospectively review a case in detail in order to feature learning objectives that review very important considerations in the evaluation, differential diagnosis, symptom tracking, and treatment of catatonia. The future of research in catatonia is bright and diverse.DisclosureNo significant relationships.
Irritable Bowel Syndrome: The role of the Psychiatry
Authors: Fraga A. , Mesquita B. , Esteves-Sousa D. , Albuquerque M. , Facucho-Oliveira J. , Espada-Santos P. , Cintra P. , Moutinho A. 
Published: September 2022

IntroductionIrritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder, affecting about 20% of people worldwide. This complex and multifaceted disorder has been proposed as a system disease involving not only individual systems including the nervous, endocrine, imune, digestive, microbiota and the environment but also the interactions of these systems. The aetiology of IBS is complex and incompletely understood and this disease are frequently associated with a comorbid psychiatric disease. Current treatment is symptom-directed, rather than based on underlying pathophysiological mechanisms.ObjectivesThe authors elaborate a narrative literature review to identify the pathophysiology and therapeutic approach of IBS.MethodsPubmed databased searched using the therms “psychiatry”, “irritable bowel syndrome” and “treatment”.ResultsThe IBS is the most common and best described of the functional bowel disorders, which represents a considerable therapeutic challenge. Studies looked at the efficacy of fibre, antispasmodics and peppermint oil in the treatment of IBS found moderately effectiveness in the treatment of global symptoms. Elimination diets are helpful in improving IBS. There is evidence that a low-FODMAP diet can have a favorable impact on IBS symptoms, especially abdominal pain, bloating and diarrhea with improved irritable bowel syndrome symptoms and quality of life. Among the currently available classes of drugs for the treatment of IBS, antidepressants such as selective serotonin releasing inhibitors and tricyclic antidepressants are useful because of their analgesic properties, independent of their mood-improving effects.ConclusionsEvidence suggest that antidepressants might be useful for treatment symptom of IBS however further investigation is required.DisclosureNo significant relationships.
Acute Confusional Syndrome and Covid-19 disease. Clinical and Sociodemographic differences with other comorbid diseases
Authors: García Hernández D. , Calls Samora M. , Llimona González A. , Dinamarca F. , Casanovas F. , Pérez Oms A. , Llimona Sánchez C. , Oller Canet S. 
Published: September 2022

IntroductionCoronavirus Disease 19 (COVID-19) was declared a pandemic by the World Health Organization (WHO) in March 2020. Since the outbreak, neuropsychiatric presentations such as delirium have been developing.ObjectivesOur aim is to describe sociodemographic and clinical differences between inpatients cursing with Acute Confusional Syndrome (ACS) with and without COVID-19 pneumonia.MethodsThis is an observational-descriptive study. All patients attended by the liaison psychiatry service of Hospital del Mar, between February and April 2020, with ACS diagnosis were included. The sample was divided in 2 groups (with and without COVID-19 pneumonia). Sociodemographic and clinical variables including sex, age, previous somatic or psychiatric history, ACS risk factors, ACS subtype and pharmacological treatment were compared. Chi-square and U Mann Whitney tests were used.ResultsThe total sample was 62 patients. 43.5% were women with a mean age of 71,7 (SD 11,3). Covid pneumonia group included 26 patients. There was a higher percentage of Hypoxemia in Covid pneumonia patients (p<0,001). There were significant differences between Covid pneumonia group and ACS in relation to: a previous diagnosis of Ischemic Heart Disease (p=0,007), Heart Failure (p=0,029) and Nephropathy (p=0,022). Dexmedetomidine (p=0,001) was highly used for ACS treatment in Covid pneumonia patients.ConclusionsIn this sample, patients with ACS and Covid pneumonia had a bigger rate of hypoxemia and previous history of Ischemic Heart Disease, Heart Failure and Nephropathy compared to the rest of ACS patients. Dexmedetomidine was more commonly used for the treatment of ACS in Covid pneumonia group. More studies would be necessary to assess the significance.DisclosureNo significant relationships.