bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can pleiomorphic psychotic symptoms with movement disorders mask wilson’s disease?
Authors: Marques J. , Bajouco M. 
Published: September 2022

IntroductionWilson’s disease is a rare (1:30,000) autosomal recessive disorder of copper metabolism that is caused by mutations in the adenosine triphosphatase copper transporting beta (ATP7B) gene, located on chromosome 13. The reported percentage of patients with psychiatric symptoms as the presenting clinical feature is 10%-20%.ObjectivesTo present and discuss a rare case admitted in the First Psychotic Episode Inpatient Unit (UIPEP) with pleiomorphic psychotic symptoms and low serum copper and ceruloplasmin and high 24h urine copper.MethodsThe data was collected through patient and family interviews, as well as from his medical record. We searched Pubmed using MeSH terms: psychotic disorders AND Hepatolenticular Degeneration.ResultsA twenty-two years old male, without known psychiatric history presented in the Emergency Department with a myriad of psychotic symptoms: motor stereotypes/mannerisms, paranoid delusions and auditory hallucinations. He was admitted in UIPEP, started low-dose antipsychotic medication with good response. As part of the implemented protocol, he did a battery of exams, including Brain CT-scan, EEG, ECG and blood and urine analysis, in which low serum copper and ceruloplasmin stood out, leveraging the suspicion of Wilson´s disease. Therefore, 24h urine copper was done, with 140 mcg/d (reference range < 40 mcg/d). Brain MRI was normal and no Kayser–Fleisher rings were seen by a consulting ophthalmologist.ConclusionsWithout proper treatment, Wilson’s disease is a progressive and fatal disease. Therefore, it’s of upmost importance to recognize the clinical signs that raise suspicion of this disorder, especially recent onset in young adult of miscellaneous psychotic symptoms with movement disorders.DisclosureNo significant relationships.
Is it psychosis? Heads or tails. A case report
Authors: Rodado León B. , Huete Naval M. , García Carpintero A. , Jiménez Cabañas M. , Bermejo Pastor A. , Pérez Lombardo M. 
Published: September 2022

IntroductionPsychotic disorders usually come with diagnosis difficulties, especially when the clinical presentation is recent or if there are organic factor associated. Regarding this, we propose the clinical case of a man 47 years old without psychiatric history, who is brought to the hospital after being run over by the subway. At his arrival, he verbalizes delirious thoughts of persecution and harm.ObjectivesThe objective is to emphasize the importance of making an appropriate somatic study in psychosis cases, especially when we don’t know the time of setting or we can’t make a psychiatric interview in optimal conditions.MethodsThe study included a blood test including methemoglobine, cranial tomography, serologies and a heavy metals test. We reviewed the scientific literature in Pubmed and Web of Science about the possible association between the psychiatric and the dermatological symptoms.ResultsDuring his admission, the patient recognizes delusional thoughts of harm since he was young and he was so frightened because of this that he tried to commit suicide in the subway. Moreover, he also thinks that silver can heal any disease, so he has licked silver coins for years. The final diagnosis was schizophrenia, and argyria due to a chronic silver intoxication.ConclusionsHeavy metals intoxications can be associated to acute psychotic disorders, so we must take them into account. As well, schizophrenia can cause bizarre believes which can lead to the intoxication.DisclosureNo significant relationships.
Correlates of late-onset antipsychotic treatment resistance
Authors: Fonseca De Freitas D. , Agbedjro D. , Kadra-Scalzo G. , Francis E. , Ridler I. , Pritchard M. , Shetty H. , Segev A. , Casetta C. , Smart S. , Morris A. , Downs J. , Christensen S. , Bak N. , Kinon B. , Stahl D. , Hayes R. , Maccabe J. 
Published: September 2022

IntroductionThere is emerging evidence of heterogeneity within treatment-resistance schizophrenia (TRS), with some people not responding to antipsychotic treatment from illness onset and a smaller group becoming treatment-resistant after an initial response period. It has been suggested that these groups have different aetiologies. Few studies have investigated socio-demographic and clinical differences between early and late onset of TRS.ObjectivesThis study aims to investigate socio-demographic and clinical correlates of late-onset of TRS.MethodsUsing data from the electronic health records of the South London and Maudsley, we identified a cohort of people with TRS. Regression analyses were conducted to identify correlates of the length of treatment to TRS. Analysed predictors include gender, age, ethnicity, positive symptoms severity, problems with activities of daily living, psychiatric comorbidities, involuntary hospitalisation and treatment with long-acting injectable antipsychotics.ResultsWe observed a continuum of the length of treatment until TRS presentation. Having severe hallucinations and delusions at treatment start was associated shorter duration of treatment until the presentation of TRS.ConclusionsOur findings do not support a clear cut categorisation between early and late TRS, based on length of treatment until treatment resistance onset. More severe positive symptoms predict earlier onset of treatment resistance.DisclosureDFdF, GKS, EF and IR have received research funding from Janssen and H. Lundbeck A/S. RDH and HS have received research funding from Roche, Pfizer, Janssen and Lundbeck. SES is employed on a grant held by Cardiff University from Takeda Pharmaceutical Comp
Electroconvulsive therapy in treatment resistant schizophrenia: Old beacon of hope when nothing else works
Authors: Adão C. , Quintão A.A. , Velosa A. , Trindade P. , Almeida C. 
Published: September 2022

IntroductionElectroconvulsive therapy (ECT) is one of the oldest psychiatric treatments used to this day. It is particularly useful in cases of schizophrenia resistant to treatment with antipsychotics. 49% of patients with schizophrenia experience little or no response with one trial of antipsychotics, 71% do not achieve remission and up to 20% of patients are also resistant to clozapine.ObjectivesDescription of a clinical case where ECT is used in the treatment of resistant schizophrenia and review of the literature.MethodsDescription of a clinical case. Non systematic review of the literature, searching the terms “treatment resistant”; “schizophrenia”; “ect” in the databases Pubmed, Medline, Cochrane and Uptodate.ResultsMale, 38-year-old patient, diagnosed with schizophrenia for 20 years, with history of multiple hospitalizations, institutionalized for 9 years. Treated with risperidone 50 mg intramuscular fortnightly, clozapine 750 mg daily, aripiprazol 30 mg daily and diazepam 10 mg daily. He presented with increased delusional intensity for a year. Hospitalized for treatment with ECT, submitted to 12 sessions with bitemporal stimuli, with effective convulsions. MoCA, PANSS and BPRS were applied before and after treatment, with an increase of 25% in MoCA and a decrease of 47.3% and 57.9% respectively, in the psychotic symptoms scales.ConclusionsWe present a case of schizophrenia resistant to treatment with multiple antipsychotics, including clozapine. ECT was used, with clinically demonstrated efficacy. In the future, it might be interesting to study in detail the mechanism of action of this treatment with the goal of deepening the knowledge of the neurobiology of schizophrenia.DisclosureNo significant relationships.
Schizophrenia And Polycystic Ovary Syndrome: A Case Report
Authors: Turki M. , Abidi O. , Ellouze S. , Ben Abdallah F. , Youzbechi F. , Halouani N. , Aloulou J. 
Published: September 2022

IntroductionPatients with Polycystic ovary syndrome (PCOS) have increased vulnerability to psychiatric disorders, particularly a tendency to depression and anxiety, as well as schizophrenia. The association between PCOS and psychiatric disorders is a topic of research given the possibility of common potential mechanisms as well as the clinical similarity between the adverse effects of atypical antipsychotics and the symptoms of PCOS.ObjectivesWe proposed to investigate the etiopathogenic relationship between schizophrenia and PCOS as well as the therapeutic particularities.MethodsWe report a case of schizophrenia occurring in a patient with PCOS. Then, we conducted a literature review using “PubMed” database and keywords “psychosis”, “schizophrenia”, “Polycystic ovary syndrome” and “antipsychotic drugs”.ResultsShe was an 18-year-old patient, diagnosed with PCOS since 2018. She has been followed in the psychiatry outpatient department since 8 months for psychotic symptoms (hallucinatory syndrome with thoughts of self-aggressiveness, delusional syndrome with mental automatism…). She was prescribed olanzapine (5 then 10 mg/day). However, after a weight gain (4 kg per month), this drug was switched by Risperidone (2 then 4 mg/day). The evolution was marked by the appearance of galactorrhea. Thus, the Risperidone was switched to Aripiprazole. Then, we noted a significant improvement on the psychiatric features and a better clinical tolerance.ConclusionsFor women with PCOS and psychosis, treatment with antipsychotic drugs can worsen PCOS symptomatology and lead to negative consequences for a woman’s reproductive potential and her quality of life. Therefore, the psychosis management must take these particularities into account, in order to improve the prognosis of both diseases.DisclosureNo significant relationships.
Smoking in patients with schizophrenia : “No smoking without fire”
Authors: Abassi B. , Khelifa E. , Nourchene K. , Bouguerra I. , Mnif L. 
Published: September 2022

IntroductionMore than half patients with schizophrenia are smokers. Heavy smoking has been correlated to more severe positive symptoms, a higher number of hospitalizations and a less efficiency of antipsychotics. Unfortunately, abstinence is difficult to achieve in these patients, therefore it is importance of understanding the link between smoking and psychosis.ObjectivesAnalyzing the complex relationship between schizophrenia and nicotine’s effects on the human brain.MethodsThe study was a review of literature over the past 10 years based on the pubmed database.ResultsSmoking might be a precipitating factor in the development of schizophrenia since it preceded the onset of this illness for several years.Shared genetic background was also emphasized establishing a complex biological link between nicotine and schizophrenia.In another approach, the “self-medication hypothesis” has been proposed suggesting a beneficial effect of nicotine on both cognitive impairment and negative symptoms in schizophrenia, related to the regulation of the dopamine and nicotinic receptor systems. But this conclusion is controversial since other studies concluded to a more neurocognitive impairment in smokers compared to controlled population.ConclusionsSmoking in schizophrenia is a complex “phenomenon” that remains, so far, misunderstood. Greater differences might exist between heavy and light smokers making it more difficult to point out the exact effect of nicotine on the brain. Smoking cessation therapies taking into account the specificity of patients with schizophrenia should be more developed.DisclosureNo significant relationships.
A case report of inhibition and severe desnutrition: negative symptoms in resistant schizophrenia
Authors: Coucheiro Limeres P. , Díez Valle B. , Cerame A. , Lozano Serrano C. , Navas Collado E. 
Published: September 2022

IntroductionThe appearance of inhibitory symptoms encompassed in what are known as negative symptoms is part of the usual symptoms of schizophrenia. Sometimes this inhibition reaches a significant severity, so it is essential to know its approach.ObjectivesCase report and literature review regarding the treatment of resistant schizophrenia with a predominance of negative symptomsMethodsWe present the clinical case of a 28-year-old man diagnosed with schizophrenia at 23 years old, whose onset was characterized by delusional ideas of harm (poisoning) and delusions with a mystic-religious theme that lead him to reduce his intake until requiring a first admission for severe desnutrition. Subsequently, after two more admissions, the patient presents selective reduction in food intake, decrease in daily activity and apathy without positive symptoms.ResultsThroughout the treatment, several lines of antipsychotic treatments have been tried at the maximum tolerated dose (haloperidol, oral paliperidone and depot, aripiprazole and clozapine up to a dose of 600 mg). Clozapine resistance required testing various augmentation strategies (Venlafaxine, Lamotrigine and Electroconvulsive therapy) with low results. Finally, to complement the treatment, the patient was transferred to a mid-stay unit where psychosocial treatment with a multidisciplinary approach was started. This has allowed more continuous follow-up and thus a partial improvement of the clinic.ConclusionsNumerous studies describe numerous augmentation strategies for clozapine-resistant schizophrenia with negative symptoms. However, the results are still inconclusive, needing more research. Meanwhile, we want to highlight the importance of complementing the treatment with psychosocial approaches.DisclosureNo significant relationships.
Early Career Psychiatrists in Education and Academia in Europe – Challenges and Ways Forward
Authors: Baessler F. 
Published: September 2022

Academic research and publications can serve as important drivers of career development for early-career psychiatrists. However, the current focus on clinical teaching during the postgraduate program leaves much less room for scholastic training for young professionals. Combined with a lack of standardized European curricula despite automatically recognized qualifications in European Union countries, early-career psychiatrists encounter challenging job prospects across Europe, often faced with the hard choice of pursuing careers in clinical practice or opt for academia. In recent years, academia has attracted more and more young psychiatrists eager to contribute as researchers, teachers and/or administrators within academic and higher education institutions. What are the challenges they face and how they can overcome them to combine clinical work, teaching and research? The component of teaching and research varies widely in European psychiatry training and mostly early-career psychiatrists are unaware about the importance of publications, formal qualifications, stipends, international experiences, participating in studies, writing grant applications, etc, for their academic career. Often, they are not clearly informed about the advantages/disadvantages of pursuing an academic career and learn at a later stage about the important steps towards a successful career combining clinical work, research and teaching. In this session, we will share a brief insight into the challenges of academia and the possible ways forward with some real-life experiences of the speaker, who is leading several interdisciplinary research projects at the Heidelberg University Hospital along with handling patients and family at the same time. An interactive discussion and exchange of knowledge is desired.DisclosureNo significant relationships.
Effect of Semaglutide versus placebo on psychotic symptoms and quality of life - a pre-specified secondary analysis of HISTORI: A randomized clinical trial in people with pre-diabetes and schizophrenia
Authors: Uhrenholt N. , Ganeshalingam A. , Arnfred S. , Frystyk J. , Gæde P. , Bilenberg N. 
Published: September 2022

IntroductionLife expectancy of people with schizophrenia is reduced by 10-20 years compared to the general population. The excess mortality is part due to an increased prevalence of cardiovascular disease, prediabetes and obesity, which are in part due to antipsychotic treatment. Gaining weight is associated with reduced quality of life and also among the most frequently reported reasons for the discontinuation of treatment. Lifestyle changes have a time limited effect, and therefore, interest has focused on Glucagon-Like Peptide 1 receptor agonist treatment. Semaglutide, currently used to treat type 2-diabetes in doses up to 1.0 mg once-weekly, has shown promising results regarding weight loss in doses up to 2.4 mg once-weekly. It may also be able to reduce the risk of developing diabetes and cardiovascular disease.ObjectivesThe HISTORI Trial aims to reduce risk of developing diabetes and cardiovascular disease in people with schizophrenia, prediabetes and overweight and to investigate for an indirect effect of Semaglutide on psychotic symptoms and quality of life through a weight loss.MethodsA 30 weeks randomized, placebo-controlled, double-blinded study with once-weekly injections of Semaglutide 1.0 mg. Primary inclusion criteria are age 18-40 years, schizophrenia, prediabetes, overweight and treatment with antipsychotics. Questionnaires and interviews regarding psychotic symptoms, quality of life, medication adherence and physical activity will be applied either monthly or every third month.Resultswill not be ready for the congress. A poster outlining the feasibility challenges will be presented.ConclusionsPerspective: Through weight loss, Semaglutide may indirectly be able to improve quality of life, medication adherence and psychotic symptoms.DisclosureNo significant relationships.
Pharmacogenetic testing in schizophrenia in real clinical practice: before or after antipsychotic -induced adverse drug reactions development?
Authors: Abdyrakhmanova A. , Shnayder N. , Nasyrova R. 
Published: September 2022

IntroductionSchizophrenia is socially significant mental disorder characterized by early onset and high time and financial expenditure on treatment. Antipsychotics (APs) are highly effective against positive and negative symptoms, but at same time have a wide range of adverse drug reactions (ADRs). APs efficiency and safety are variable and depend on characteristics of genetically determined mechanisms (transportation, biotransformation, and elimination).ObjectivesInvestigation role of pharmacogenetic testing (PhGT) on example of clinical case of severe ADRs in 47-year-old woman with schizophrenia.MethodsPatient’s medical history analysis; clinical observation; biochemical serum analysis; therapeutic drug monitoring; PhGT.ResultsThe clinical case of a woman with schizophrenia who has been noted to be unresponsive to APs for some years after schizophrenia onset. She was found to be homozygous for nonfunctional SNVs CYP2D6*4 and CYP2C9*2, heterozygous for CYP1A1*2A, which was reason for complete shutdown of isoenzymes 2D6, 2C9 and 1A1 activity and development of ADRs in use of initial doses of several APs, as well as for an increase in severity of ADRs with schizophrenia positive symptoms aggravation with an even slower titration of APs daily dose not only with polytherapy, but also with monotherapy. So, not recommented APs for patient: aripiprazole, haloperidol, zuclopenthixol, cariprazine, quetiapine, paliperidone, risperidone, thioridazine, sertindole, asenapine, alimemazine, chlorpromazine, etc. (CYP2D6); haloperidol, clozapine, olanzapine, perphenazine, promazine (CYP2C9); carefully: haloperidol, olanzapine, perospirone (СYP1A1).ConclusionsThis rare case demonstrates PhGT importance before APs therapy, because the patient had very high risk AP – induced ADRs. She needed PhGt before APs use, but not after severe ADRs during 12 years.DisclosureNo significant relationships.
A case report of Acute and transient psychotic disorder precipitated by Reiki practise
Authors: Danacı S. , Asdemir A. 
Published: September 2022

IntroductionATPD is defined in the ICD‐10 as a polymorphic, predominantly delusional, or schizophreniform psychotic condition characterized by an acute onset (≤2 weeks) and rapid remission (expected within 1–3 months), which is often associated with acute stressful life events. A woman in her 30s was brought to the emergency department in an acute psychotic state. Her mental health had deteriorated rapidly following her attendance to Reiki training two weeks ago (Reiki is a form of alternative medicine called energy healing). She presented as agitated, confused and had disorganised thoughts. She had paranoid, referential, misidentification and bizarre delusions.ObjectivesThis paper reports the case of a 37-year-old woman with stress-induced new-onset psychosis instigated by Reiki practise.MethodsA female patient is described who developed an acute and transient psychosis with polymorphic symptomatology after meditating. Physical examinations, paraclinical testing, and neuroimaging excluded an organic cause of symptoms.ResultsIn this case, we wanted to present an example of acute and transient psychosis episodes in which individuals with low psychosis threshold experienced recipient factors such as insomnia, dopaminergic agent (modafinil), practising reiki and meditation.While the family history of the patient, fragile personality structure suggest that the threshold of psychosis may be low; physical fatigue, insomnia, which is common in all 3 episodes, may have triggered acute psychosis.ConclusionsOur patient recovered completely within 1week after a brief admission and treatment with haloperidol. The real question here is whether the patient needs psychotropic medication for life.DisclosureNo significant relationships.
Voices change my name
Authors: Vallecillo Adame C. , Jiménez Aparicio T. , De Andrés Lobo C. , Gonzaga Ramírez A. , Queipo De Llano De La Viuda M. , Guerra Valera G. , Santos Carrasco I. , Gonçalves Cerejeira J. , Rodríguez Rodríguez B. , Fernández Lozano M. , Mateos Sexmero M.J. , Navarro Barriga N. , De Uribe Viloria N. , Medina Ojeda G. , Rodriguez Andrés L. 
Published: September 2022

IntroductionWe present the clinical case of a patient where the psychotic clinic coexists with gender dysphoria. This scenario can be the result of a change in gender identity derived from the psychotic process or appear independently of it.ObjectivesWe want to explain the importance of knowing how to act with a patient in whom these two processes coexist.Methods20-year-old woman, with no history of mental health. She comes to the emergency department for behavioral alteration. The family observes strange behaviors, unmotivated laughter, soliloquies and aggressive episodes. Abandonment of studies, hobbies and radical physical change. Delusions of prejudice and self-referential delusions. Possible phenomena of echo and diffusion of the thought. Auditory hallucinations talking to her in male gender, since then she presents doubts about her sexual identity and manifests her desire to change sex. Altered judgment of reality.Results
During admission, we started treatment with an antipsychotic with good tolerance and she was referred to mental health team, where psychopharmacological treatment was adjusted with good response. In the following medical appointments the psychotic clinic disappeared at the same time that sexual identification was completely restored and made a critique of the behavior and experiences.ConclusionsThis case highlights the importance of assessing the chronology of symptoms, the patient’s criticality, the response to antipsychotic treatment and the need to exclude the psychotic background of the desire for gender reassignment before making a therapeutic decision.DisclosureNo significant relationships.