bluuebunny/crossref_metadata_2025_split huggingface dataset:
Valproate-induced hypothyroidism in schizoaffective disorder
Authors: Facucho-Oliveira J. , Espada-Santos P. , Fraga A. , Moura N. , Laginhas C. 
Published: September 2022

IntroductionValproate is widely used in the treatment of maniac and mixed episodes and is well known to be safe with side effects being mostly related to hepatic disorders and psychomotor retardation.ObjectivesRaising attention to valproate-induced hypothyroidism that despite the increasing evidence tends to be neglected.MethodsHere, we report a case of a 55-year-old woman, with a previous diagnosis of schizophrenia, treated for many years with 200mg of zuclopenthixol triweekly and 2mg of risperidone daily. Patient developed a maniac episode characterized by elevated mood, sense of grandiosity, increased energy and psychomotor activity, disinhibition and insomnia. No laboratory abnormalities were detected and inpatient treatment was initiated with paliperidone up to 12mg/day and valproate 1000mg/day.ResultsPatient showed progressive clinical recovery attaining full remission within 2 weeks. Despite the absence of clinical side effects and the valproate serum levels of 74.9μg/mL (range 50–100μg/mL), laboratory testing found progressive reduction F-T4 down to 0.45ng/dL (range 0.8–1.5 ng/dL) and a concomitant upregulation of TSH to 73.99mUI/L (range 0.55–4.8mUI/L). Thyroid autoantibodies and thyroid echography were negative. Considering that patient was previously medicated with risperidone, it was suspected that her hypothyroidism was caused by valproate. Normalization of thyroid function was observed after 21 days valproate withdrawal. Patient is currently being treated with 150 mg paliperidone (monthly) with no recurrence of mood or psychotic episodes and maintain normal thyroid function.ConclusionsOur case emphasizes the need for extended laboratory testing upon prescription of new pharmacological medications as severe analytic alterations can take place in the absence of immediate clinical manifestation.DisclosureNo significant relationships.
Alternative starting regimen with aripiprazole long-acting treatments, a case report
Authors: Huete Naval M. , Serván B. , Expósito Durán M.E. , Albarracin P. , Herrero Pellón E. , Galerón R. 
Published: September 2022

IntroductionAripiprazole long-acting treatments can significantly control symptom, improve adherence and reduce the risk of relapse compared to oral drugs. An alternative start-up guideline has recently been approved in several countries that simplifies its administration.ObjectivesTo present a case report of a patient with schizophrenia treated with alternative starting regimen of aripiprazole long-acting treatment.MethodsPresentation of a clinical case supported by a non-systematic review of literature.ResultsWe present the case of a 22-year-old patient diagnosed with schizophrenia, whose symptoms started after the birth of her son, 2 years ago. She has presented a poor clinical evolution, requiring several admissions to our inpatient service after discontinuation of her medication. The patient has taken different antipsychotics, including olanzapine and paliperidone long-acting treatment, which were suspended due to side effects (weight gain and increased prolactin levels). A switch to oral aripiprazole 20mg was made, which showed good response and tolerance. Given the persistence of irregular intake, it was decided to switch to aripiprazole long-acting treatment, applying an alternative initial regime consisting of two doses of aripiprazole long-acting treatments 400mg and one oral aripiprazole 20mg. The patient has since had no delusions or hallucinations and is living independently at home.ConclusionsThe administration of a simplified initial regime with aripiprazole long-acting treatments could improve therapeutic adherence while maintaining the same effectiveness and similar side effects.DisclosureNo significant relationships.
“Setting up and Tailoring Early Intervention Teams in a Already Established Healthcare System: the Experience of the Greater Lyon”
Authors: Haesebaert F. , Franck N. , Haesebaert J. 
Published: September 2022

The implementation of early intervention services (EIS) dedicated to first episode psychosis (FEP) remains a challenge in France. In 2016, the London School of Economics published a report in which France appeared as a poorly developed country in terms of early intervention services. Since the 1980s, the French psychiatric “sectorization” system offers access to general psychiatric care with a graduated intensity (outpatient consultations, day hospitalization, full time hospitalization) targeting territories (“sectors”) of approximately 70,000 inhabitants. While this system has advantages in terms of universal access to care, it leaves little room for specialized services. The Greater Lyon agglomeration (2.4 million inhabitants) is composed of several psychiatric sectors administered by 3 psychiatric hospitals and a psychiatric emergency system administered by a University Hospital. Since 2018, various hospital and university stakeholders, patient associations and international partners, have been working together to tailor, set up and organize a care system for FEP patients. We present here how we have federated workforce resources initially working within 11 general psychiatric “sectors” and covering a population of 850,000 inhabitants. A 3-step process of (1) field analysis, (2) the creation of a community of practice composed of healthcare workers, researchers and service users, and (3) confrontation of the already existing healthcare with the logic of “principal components” for FEP care, allowed the creation of the outpatient “PEPS” service, which now offers continuous case management, a functional recovery program and new pathways to care to more than 200 patients with a diagnosis of first episode psychosis.DisclosureNo significant relationships.
Mydriasis caused by ESCITALOPRAM: Case report
Authors: Bouattour N. , Bouattour W. , Messedi N. , Charfeddine F. , Aribi L. , Aloulou J. 
Published: September 2022

IntroductionSerotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants thanks to the overall safety and tolerability spectrum. However, they can cause different side effects that not all of them are well identified.ObjectivesWe intend to clarify the clinical presentation of mydriasis caused by Escitalopram.MethodsReporting the case of a patient suffering a major depressive disorder, that presented a mydriasis after adjusting her antidepressant medication. Then, we conducted a literature review using “PubMed” database and keywords “Mydriasis”, “escitalopram”, “SSRI”,” side effects”.ResultsA 29-year-old female with no past clinical history, presented in May 2021 a severe depression requiring an antidepressant treatment. Under 10 mg per day of escitalopram there was a partial remission of the symptoms, leading to increase the dose by another 10 mg. One month after taking 20 mg/day, she consults before the appointment suffering from a blurry vision and photophobia. Ophthalmologic examination showed a bilateral reactive half-mydriasis, eye pressure was 14 mmHg and fundus examination was normal. Iatrogenic origin of mydriasis was suspected. A gradual interruption of the medication lead to disappearance of the latter. A pharmacological investigation concluded to the suspension of escitalopram and to be vigilant if antidepressant medication would be needed.ConclusionsMydriasis is an uncommon side effect caused by SSRI that needs to be kept in mind by clinicians. Therapeutic patient education can help to detect abnormal side effects and treat them if needed.DisclosureNo significant relationships.
Clinical experience with the new double aripiprazole depot regime in a psychiatric hospitalization unit
Authors: Moleón Ruiz Á. , Tenorio Villegas R. , Gómez Rebollo A. 
Published: September 2022

IntroductionNowadays, relapses are typical in patients with schizophrenia and may have serious implications due to most of them are caused by a lack of adherence to treatment.Therefore, numerous long-acting injectable antipsychotics (LAI) have been developed as aripiprazole depot who need a proper oral supplementation. Since November 2020, FDA approved a new treatment indication with a double injection start and a single dose of 20mg of oral aripiprazole, with the aim of avoiding oral supplementation during the next 14 days.ObjectivesThe purpose of our study is to expose our experience with the new double injection start with aripiprazole LAI, regarding the rehospitalization rate.MethodsA prospective study (n=17 patients) has been developed between November 2020 and October 2021 with the purpose of studying the rehospitalization and antipsychotic adherence after the new guideline of aripiprazoleResultsAfter an 11-month-follow-up, it is noticed a 65% non-rehospitalization rate and a 76% proper treatment persistence rate. The 94% did not present any kind of side effects, only one patient had a case report of bullous pemphigoid. Regarding the concomitant use of other antipsychotics, 82% of the patients remained in monotherapia. The average stay time was shortened (11 days) regarding the standard dose (14 days).ConclusionsThe new LAI regimen is well tolerated in our patients obtaining a high treatment persistence after several months of hospital discharge. It was already possible to shorten the time of rehospitalization, not having to add oral aripiprazole for 14 days. Most patients were discharged are on antipsychotic monotherapy and have not been rehospitalized in the short term.DisclosureNo significant relationships.
Drug-induced liver injury in association with antipsychotics
Authors: Zeiss R. , Gahr M. 
Published: September 2022

IntroductionDrug-induced liver injury is one of the leading causes for acute liver failure and drug withdrawal after marketing approval. One important risk factor is the extent of exposure of the hepatocytes to a substance, either by high doses or by long-term medication. In many psychiatric diseases, like schizophrenia long-term use of drugs is common. However, systematic data on the hepatotoxic potential of antipsychotics is scarce.ObjectivesTo perform an explorative analysis of pharmacovigilance data on the risk of hepatotoxicity related to the use of antipsychotics.MethodsWe conducted an explorative case/non-case study based on data from VigiBase for 30 antipsychotics marketed in the European Union. Reporting odds ratios were calculated for antipsychotics associated with the SMQ “Drug related hepatic disorders - comprehensive search” and the SMQ “Drug related hepatic disorders - severe events only”.ResultsWe found several associations of antipsychotics with drug-induced liver injury including associations with severe events. 17/30 antipsychotics were associated with “Drug related hepatic disorders - comprehensive search”, and for 10/30 substances were associated with severe hepatic events.ConclusionsSeveral antipsychotics are associated with the risk for hepatotoxic side effects, even severe ones. Further research is warranted on patient and substance-dependent risk factors.DisclosureNo significant relationships.
Neutropenia induced by Valproic Acid: A case report
Authors: Baldaquí N. , Anmella G. , Madero S. , Gutierrez F. , Pujal E. , Colomer L. , Giménez-Palomo A. 
Published: September 2022

IntroductionValproic acid (VPA) is considered a well-tolerated antiepileptic drug used in Bipolar Disorder as a mood stabilizer. Nevertheless, VPA has been related to several adverse effects. Neutropenia is included as a potential adverse effect, although in clinical practice it is not often measured with regularity.ObjectivesTo report a case of a patient with Bipolar Disorder type 2 and Personality Disorder Cluster B treated with VPA with a neutropenia caused by VPA.MethodsA 61-year-old woman assists to the outpatient psychiatric unit in order to a pharmacological treatment adjustment. A blood test is performed showing a decrease in the levels of neutrophiles in comparison with previous tests. Psychiatric history is revised finding and association between the prescription of VPA and the reduction of neutrophile levels. When this drug was removed, neutrophile levels had increased again up to normal levels.ResultsDue to the relationship between neutropenia and VPA treatment, we decided to discontinue this drug. At the beginning the patient doesn’t agree with the withdrawal of VPA treatment due to its effectiveness in her mood stabilization. Psychoeducation sessions are performed in order to explain risk and benefits of potentials treatment alternatives versus maintaining the same prescription. Finally the patient accepts the switch of the mood stabilizer treatment to oxcarbazepine with a good tolerability and effectiveness.ConclusionsPeriodical blood test monitoring is needed in order to study adverse effects as neutropenia in patients with VPA treatment.DisclosureThe author has received support from Janssen-Cilag, Otsuka-Lundbeck, Italfármaco, Angelini Pharma and Casen Recordati; and declares no support related to the subject of this article.
“Contemporary Treatment in Multi-Professional Team of Acute Psychosis- Pros and Cons”
Authors: Jaudzema J. 
Published: September 2022

The approach of a multi-professional team in the treatment of acute psychosis was started in 2018/2019 In Latvia, within the framework of the early intervention program. Until then, the patient was mostly examined and treated with medication in the inpatient phase of acute psychosis. After discharge, further treatment and rehabilitation in Latvia is still relatively limited and largely based on the initiative of the patient and relatives. Within the multi-professional team of the inpatient department of the Riga Psychiatry and Narcology Center, a psychiatrist, mental health nurses, nursing assistants, psychologists, occupational therapists, a physiotherapist, a visual arts and dance - movement therapist, as well as a social worker work together. The benefits of teamwork in the treatment of acute psychosis are undeniable, but during these few years, working in challenging conditions, various disadvantages have crystallized. Among the ’pros’ is a more successful, multifaceted outcome of recovery, better patient compliance and reduction of stigma among patients and their relatives (and thus in society as a whole). ’Cons’ are mainly due to limited availability of resources, from limited funding and infrastructure to a lack of professionals and time. It should also be noted that mental health literacy is still low in Latvian society, which means that patients often arrive late for help, which means that it is not possible to achieve good results in a limited time within the hospital. For these reasons, treatment is often discontinued after discharge, which increases the risk of rehospitalisation and adverse course of the disease.DisclosureNo significant relationships.
Levetirazetam: antiepileptic-induced psychosis
Authors: Vilella Martín C. , García Vázquez P. , Barrera García Y. , Fernández Perea P. , Serrano García A. , Alonso De La Torre López M.Á. , Gómez Martínez R. , Franch Pato C. 
Published: September 2022

IntroductionLevetirazetam is an antiepileptic drug with psychiatric adverse reactions. It includes psychosis, paranoia or hallucinations. The frequency is less than 1%.ObjectivesTo describe a case of Psychosis produced by LevetirazetamMethodsRetrospective review of clinical records and complementary test, including psychiatry, electrophysiology and neurology. Diagnosis schales such as Salamanca Questionnaire were used as suport.ResultsA 42-year-old woman diagnosed with tuberous sclerosis and undergoing treatment with levetirazetam acudes to the emergency department for behavioral disorders. She has presented an episode of aggression against a relative threatening him with a kitchen knife. The family reports that since the change in antiepilepticus 1 month ago, the patient has presented strange behaviors. Te Patient is conscious, uncooperative. Barely Approachable. Suspicious of her surroundings, with psychomotor restlessness, self-reference ideas and sparse speech. Auditory hallucinations seem to be present, as well as depressed and irritable mood. Psychic and somatic anxiety is found.Levetirazetam is discontinued, being replaced by valproic acid. Risperidone is started at a 3 mg dose. Treatment is well tolerated, and clinical stability is achived. Cluster A personality traits are found. Complementary test Blood and Urine simples, Imaging tests (CT and MRI), electroencephalogram and Electrocardiogram show no alterationsConclusionsLevetirazetam can cause psychiatric adverse effects. it is important to make a proper diagnosis before a first psychotic outbreak in later life. Drugs that can produce psychiatric side effects should be identified and patients should be inform.DisclosureNo significant relationships.
Perceived stress and physiological consistency during mental stress exercises and controlled breathing
Authors: Vasquez D. , Mejia-Mejia E. , Torres R. , Restrepo D. 
Published: September 2022

IntroductionThe measurement of the physiological coherence, the order and the quality of the connection of complex systems such as the cardiac and the respiratory system, varies in situations of stress and relaxation.ObjectivesWe aim to assess changes in physiological coherence and perception of stress during mental stress and directed breathing exercises.MethodsRepeated-measures study in healthy adults without prior training in breathing techniques, aged between 18 and 65 years of both sexes who were evaluated in three situations: baseline, mental stress (Stroop test and successive subtractions), and directed breathing, during which were captured heart rate and respiratory signals to estimate physiological coherence and the participants rated the perceived stress at each moment.Results34 participants were analyzed, 59% women, with a median age of 36 years (Rq = 13). During mental stress tasks, the median for physiological coherence was similar to baseline coherence but increased significantly with five minutes of directed breathing exercises (38% vs. 63% p <0.0001). The highest perception of stress was during successive subtractions (Me 7, Rq = 4) and the lowest during directed breathing exercises (Me 2 Rq = 3.0). The correlation was sought between physiological coherence and perception of stress during each of the four moments of the study. Basal (Rho Spearman -0.05, p 0.54); Stroop (Rho -0.17, p 0.03); successive subtractions (Rho 0.50, p 0.77); and directed breathing (Rho -0.28, p 0.09).ConclusionsA correlation was found between physiological coherence and perception of stress during the Stroop test; however, no association was found.DisclosureNo significant relationships.
Non-invasive vagus nerve stimulation attenuates the burnout
Authors: Tukaiev S. , Pravda O. , Vysokov N. , Tarasenko A. , Toleukhanov D. , Komarenko V. , Danylov S. , Kravchenko V. 
Published: September 2022

IntroductionVagus nerve stimulation produces therapeutic effects for the treatment of psychiatric disorders, heart failure, and others.ObjectivesThe aim of the current study was to evaluate the effects of the non-invasive vagus nerve stimulation on emotional burnout.Methods6 right-handed male volunteers aged 18-22 years participated in study. We used the combination of pleasant meditative classical music and a slow bi-polar wave (0.1-0.2 Hz) of electrical non-invasive transcutaneous auricular vagus nerve stimulation for 5 minutes. The set of 4 VNS was performed at intervals of 3 days. EEG was registered during the rest state (3 min, closed eyes condition). To measure the severity of emotional burnout in students, we used the 22-item Maslach Burnout Inventory (MBI).ResultsVNS significantly improve the depersonalization and reduction of personal achievements (components of the emotional burnout). Changes in the psychoemotional state of the respondents were accompanied by the increase in the theta-Fz/alpha-Pz ratio, that reflects an enhancement of the activation level. A set of non-invasive stimulation of the auricular branch of the vagus nerve leads to an increase in the level of activation (the ratio of beta / alpha rhythms). The changes in the power of the alpha rhythm may relate to improving of mental process, creativity, creative thinking. An increase in alpha rhythm may reflect internally oriented attention in creative activities.ConclusionsThe preliminary data suggests that the novel mastoid stimulation device may have a prolonged stimulating effect on the brain processes while attenuating the burnout at the same time.DisclosureNo significant relationships.
Estradiol and Progesterone as key modulators of central systems implicated in schizophrenia
Authors: Ruiz-Tristan A. , Rivera-Clemente C. , Gomez-De-Las-Heras V. , Ávila S. , Molina J. 
Published: September 2022

IntroductionIt has been suggested that dysregulation of sex hormones is associated with schizophrenia. However, obesity and metabolic syndrome are very common between schizophrenic patients, and it can also dysregulate sex hormones so they could act as confounders.ObjectivesTo determine if estradiol and progesterone are abnormally elevated regardless of obesity or metabolic syndrome in men with SCZ.MethodsWe measured serum levels of progesterone and estradiol in 56 schizophrenic male patients at treatment with a depot antipsychotic. Subsequently, we studied the association or independence of our results with obesity or metabolic syndrome by a Chi Square Test.Results66.07% of our patients elevated progesterone levels, 19.64% of our patients elevated estradiol levels, and 16.07% of our patients elevated both, progesterone and estradiol, simultaneously. We found no relationship between increased estradiol and / or progesterone with obesity and / or metabolic syndrome.ConclusionsEstradiol and progesterone are abnormally elevated regardless of obesity and / or metabolic syndrome in male schizophrenic patients on depot treatment.DisclosureNo significant relationships.
Suicidality during neuromodulation in the elderly depressed: study design
Authors: Van Daele A. , Zeeuws D. , Baeken C. 
Published: September 2022

IntroductionLate life depression is a major global health issue, with an estimated 7% of older adults suffering from this mental disorder. Depression is one of the most important predictors for suicide in the elderly. However, it is often difficult to recognize and manage, making treatment-resistance a common occurrence. Treatment-resistant depression itself is also a known risk factor for suicide. Recently, non-invasive neuromodulation techniques have been used as a new treatment for depression and suicidality with promising results.ObjectivesThis study aims to investigate the effect of adTMS (accelerated deep Transcranial Magnetic Stimulation) and tDCS (transcranial Direct Current Stimulation) on the suicidality of elderly, therapy-resistant depressed patients. The hypothesis is that suicidal ideation and risk of suicide will decrease after a treatment with adTMS and tDCS.MethodsIn this randomized double-blinded sham-controlled clinical trial, geriatric therapy-resistant depressive patients will receive adTMS treatment (See: Figure 1). Suicidality will be assessed before and after the active or sham treatment, through the Columbia Suicide Severity Rating Scale (C-SSRS) and Beck Scale for Suicide Ideation (BSI). After one week of rest, all patients will receive an at-home tDCS treatment for 3 weeks. Likewise, the suicide risk will be estimated before and after the tDCS. During the screening period, the severity of the patients’ depressive symptoms will be determined by using the 17-item Hamilton Depression Rating Scale (HDRS-17). In total, the trial will last for 5 weeks, and suicidality will be examined at five different time points (during screening, at T0, T1, T2 and T3).ResultsNot applicableConclusionsNot applicableDisclosureNo significant relationships.