17 results
Off-label use of atypical antipsychotics- Where are we?
- R. P. Vaz, J. Martins, A. L. Costa, J. Brás, R. Sousa, E. Almeida, J. Abreu, N. Castro, R. Andrade, N. Gil
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S305
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Introduction
Nowadays, In the exercise of psychiatric clinical activity, the prescription of atypical antipsychotics is a widespread practice.
However, despite the approval in the treatment of psychoses and bipolar affective disorder, where its effectiveness is clearly demonstrated, these drugs are off-label prescribed in most of the clinical situations.
ObjectivesThis work aims to clarify which atypical antipsychotics are most frequent prescribed and the clinical conditions where their off-label prescription is more common.
MethodsBibliographic research in the Pubmed® database using the terms “atypical antipsychotics and off-label use”
ResultsAccording to the scientific literature consulted, the off-label prescription of atypical antipsychotics may represent about 70% of the total prescription of these psychotropic drugs.
Risperidone, olanzapine, quetiapine and aripiprazole are the most off-label prescribed among the atypical antipsychotics.
The psychiatric conditions where atypical antipsychotics are most often off-label prescribed are addictive disorders, anxiety disorders, post-traumatic stress disorder, personality disorders, eating disorders, insomnia and dementia, where therapeutic benefits are demonstrated when carefully selected.
ConclusionsThe off-label prescription can be interpreted from two points of view. On the one hand, it can guide innovation in clinical practice and improve symptoms in patients who do not respond to standard treatments. On the other hand, it may be associated with negative consequences due to the lack of data on safety and efficacy in these situations.
Despite widespread prescribing of atypical antipsychotics, there is no evidence-based recommendation beyond psychoses and bipolar affective disorder.
Thus, when prescribed, we must proceed with careful monitoring and consider the risks and benefits in relation to off-label prescription.
Disclosure of InterestNone Declared
Knocking on the Doors of Perception: the role of psilocybin in substance use disorder treatment
- R. Sousa, L. Costa, J. Brás, R. Vaz, J. Martins, J. Abreu, E. Almeida, N. Castro, R. Andrade, N. Cunha
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S270
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Introduction
Substance use disorders(SUDs) are a major health concern and current treatment interventions have proven only limited success. Despite increasing effectiveness, still about 50–60% relapse within 6–12 months after treatment [Cornelius et al., Addict Behav. 2003;28 381-386]. SUDs are defined as chronic disorders of brain reward system, motivation, and memory processes that have gone awry. Medication reducing craving and substance use is mainly available for alcohol dependence and to a lesser extent for other substances.
Hallucinogens may represent a group of agents with potential anti-craving properties subsequently reducing substance use in SUD patients. For instance, lysergic acid diethylamide(LSD) and psilocybin have previously been shown to effectively alleviate symptoms of alcohol and nicotine dependence.
ObjectivesNew treatments preferably focusing on reducing craving and subsequent substance use are therefore urgently needed. The hallucinogen psilocybin may provide a new treatment option for SUD patients, given the beneficial results observed in recent studies
MethodsSystematic revision of literature.
ResultsIn the 1950s, a group of drugs with potential to alter consciousness were discovered (hallucinogens). Several studies suggested their anti-SUD potential, improving self-acceptance and interpersonal relationships, reducing craving and alcohol use. As a result of its recreational popularity during the 1960s, they were banned in 1967, greatly hampering scientific research in this field. Recently, psilocybin, an hallucinogenic substance in psilocybin-containing mushrooms has gained popularity in neuropsychological research, showing to increase trait openness, cognitive and behavioral flexibility, and ratings of positive attitude, mood, social effects, and behavior and even reported persistent positive changes in attitude and behavior. These findings might suggest a valuable compound for the treatment of psychiatric conditions with several additional studies providing supportive evidence for the therapeutic potential of psilocybin for SUD treatment and relapse prevention.
ConclusionsWith the reported limited amount of side effects and potential beneficial effects of psilocybin in SUD, there are valid reasons to further investigate the therapeutic efficacy and safety of psilocybin as a potential SUD treatment. On the one hand, psilocybin may exert its anti-addictive properties by beneficial effects on negative emotional states and stress. On the other hand, psilocybin may improve cognitive inflexibility and compulsivity. Research on the efficacy of psilocybin on SUD is still limited to a handful of published studies to date. As a result, many important questions related to the use of psilocybin as a complement to current treatment of SUD and its working mechanisms remain unanswered. Before psilocybin can be implemented as a treatment option for SUD, more extensive research is needed.
Disclosure of InterestNone Declared
Suicide among physicians: what do we know about it?
- R. P. Vaz, J. Martins, A. L. Costa, J. Brás, R. Sousa, E. Almeida, J. Abreu, N. Castro, R. Andrade, N. Gil
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1115-S1116
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Introduction
The prevalence of mental illness has increased worldwide over the past few years. At the same time, and even in the sense, there is also an increase in suicide rates with special incidence in certain risk groups, among which health professionals stand out.
In this particular group, physicians seem to represent a class particularly vulnerable by the stress and demand associated with it, but also by access and knowledge about potentially lethal means.
For this very part, they have a higher risk of suicide than the general population.
ObjectivesThis paper aims to better understand the phenomenon of suicide among physicians and identify which medical specialties are most vulnerable.
MethodsBibliographic research in the Pubmed® database using the terms “suicide and physicians”.
ResultsThe data obtained from the scientific literature consulted indicate that physicians have a higher risk of suicide than the general population, with greater emphasis on females who have higher rates compared to males.
Work factors that translate into higher levels of demand and stress combined with easy access and knowledge about the use of potentially lethal means seem to contribute very significantly to this phenomenon. Perfectionist personality traits with a high sense of responsibility and duty are also important characteristics that place these professionals in a position of greater vulnerability.
With regard to the different medical specialties, anesthesiology, psychiatry and general and family medicine are the ones with higher suicide rates among the medical class.
ConclusionsThe risk of suicide, although admittedly high in the medical class, is not homogeneous among different countries, being naturally influenced by the satisfaction/gratification obtained in the performance of their profession. In this sense, countries such as Switzerland and Canada show higher levels of professional satisfaction. In the opposite direction, dissatisfaction in the exercise of clinical activity is associated with higher levels of fatigue and burnout.
Medical women, due to the need to combine the responsibility of family tasks with professional responsibility, are at greater risk.
In this sense, it is necessary to develop strategies that are more appropriate for the prevention and early identification of suicide risk situations that can be experienced not only by improving working conditions but also by better addressing professionals suffering from mental disorders.
Disclosure of InterestNone Declared
Psychosis in Parkinson’s Disease: a Case Report of Diagnosis and Management
- R. P. L. Andrade, N. P. Gil, A. L. Costa, J. Brás, N. Castro, R. Sousa, R. P. Vaz, J. Martins, E. Almeida, J. Abreu, H. Afonso
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1085
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Introduction
Psychosis is a frequent complication in patients diagnosed with Parkinson’s Disease (PD). Characterized mainly by visual hallucinations and paranoid delusions, it occurs most frequently, but not exclusively, as an adverse effect of antiparkinson medications. Nevertheless, cognitive impairment and dementia, as a frequent feature of PD, needs to be considered for differential diagnosis.
ObjectivesOur main objective is to report a case of PD Psychosis, its diagnosis and management and complement it with a non-systematic review of literature.
MethodsPatient file consultation and an additional research, based on the key words “Psychosis” and “Parkinson’s Disease”, using Pubmed as database.
ResultsA 53-year-old female, diagnosed with Juvenile Parkinson’s Disease since age 45 and, as expected, polimedicated with antiparkinson medication. Without any relevant psychiatric background, she was admitted to the emergency department for disorganized behaviour, with 2 weeks of evolution. There, it was also possible to determine the presence of auditive hallucinations and persecutory delusions, associated with marked anguish.
After exclusion of any underlying cause for this symptomatology, inpatient treatment was proposed and accepted by the patient. In collaboration with the Neurology Department, a gradual reduction and optimization of antiparkinson drugs was conducted, associated with introduction of low doses of antipsychotic drugs, in this case Olanzapine. With this medication adjustments, clinical improvement was accomplished, with eventual fading and cessation of psychotic symptoms. Additionally, an irregularly intake of antiparkinson drugs was considered the most probably cause of this clinical decompensation.
ConclusionsAs present in literature, due to the chronicity and complexity of PD, stopping all antiparkinson drugs is not an option, even when psychotic symptoms, that could be a consequence of these drugs, are present. Therefore, a rigorous evaluation and management are mandatory, including the exclusion of other underlying causes and a careful therapeutic adjustment, with gradual reduction of antiparkinson drugs, addressing an eventual temporal relationship between the beginning of a specific drug and the onset of symptoms, and verification of therapeutic compliance, including an involuntary overdose. In cases of refractory symptoms, and after a risk-benefit assessment, pharmacologic treatment directed at these symptoms, low doses of anti-psychotics, may be necessary.
Disclosure of InterestNone Declared
A Challenging Sexsomnia Seen as a Deceptive Case of Depression
- J. Brás, M. Meira e Cruz, C. Teixeira, R. Andrade, A. P. Costa
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1103
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Introduction
Sleep related sexual behaviors or sexsomnias are unconscious behavioral activities that occur during sleep (e.g. parasomnias). Behaviors could range from sexual vocalizations, orgasms, sexualized movements, masturbation, or full sexual intercourse with a subsequent amnesia. Early epidemiological studies showed a prevalence of 7.1%, with a male predominance. While intended as a rare condition, leads to important physical and psychological consequences for both the patient and their bed partner. For our knowledge this is the first case of sexsomnia reported in Portugal.
ObjectivesTo report the clinical and psychosocial impact of a Sexsomnia case in a young woman which was misdiagnosed with depression.
MethodsPatient´s clinical files consultation and literature review using Pubmedâ and the keywords: sexsomnia.
ResultsA 18-year-old female referred to a psychiatric consultation to be assessed and treated from a diagnostic of depressive disorder. This was a young woman with a previous history of sleepwalking during childhood, with no recurrent episodes since adolescence. A familiar positive history for sleepwalking was confirmed (mother). She reported the beginning of her sleep related sexual behavior six months before the consultation, conflicting with the moment in which she started pharmacological therapy for Chron Disease, diagnosed at that time.
After she slept with her boyfriend, she was told by him about the recurrence of masturbatory activity during sleep. These episodes were told to occur as often as 1 to 2 times a night, shortly after falling asleep, with posterior amnesia for the event.
As for medical or psychiatric history, only Chron’s disease is highlighted, being under control with azathioprine. Likewise, he took 1mg of melatonin/night.
Pittsburgh Sleep Quality Index at presentation was 7/21 and the STOP-Bang questionnaire revealed a low risk of Obstructive Sleep Apnea.
A Type I Polysomnographic study was performed revealing decreased sleep efficiency and fragmented sleep presenting an alternating cyclic pattern. The existence of significant respiratory events during sleep, as well as periodic movements, was excluded.
Cognitive behavioral therapy by means of highlighting the need of improvement on sleep hygiene measures was prescribed and the dose of melatonin was increased up to 3mg. Despite the good clinical response, the patient discontinued the melatonin treatment mainly due to familiar and personal reasons and failed to comply with the prescribed hygienic measures, with a further worsening of the clinical condition.
ConclusionsThis particularly challenging case representing the emerging medicolegal issues and psychosocial aspects related with the still poorly understood sleep disorders like sexomnia, shows up how much awareness is required from psychiatric team members to better assist and refer patients, promoting both an assertive diagnostic and an effective management.
Disclosure of InterestNone Declared
Sleep Quality in Medical Students of a Portuguese University: a cross-sectional Study
- R. Gonzaga, J. Brás, A. P. Costa, C. Peixoto, J. Fialho
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S266
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Introduction
Sleep is a complex physiological process present in all living beings, performing essential functions for various biological functions. The prevalence of sleep disorders has increased exponentially, as well as studies relating to sleep patterns of the general population.
University students are especially vulnerable to a decrease in sleep quality, particularly medical students. Even so, the literature on sleep quality in medical students is scarce, especially when referring to Portugal, where studies are almost non-existent.
ObjectivesTo evaluate sleep quality in medical students and to analyze the differences in sleep quality according to age, sex, cohabitation and physical activity. It is also intended to compare the sleep quality of medical students throughout the various phases of the medical course.
MethodsThis is a cross-sectional study involving medical students at the University of Beira Interior, Covilhã, Portugal. All medical students were invited to complete the Pittsburgh Sleep Quality Index (PSQI), which has been validated for the portuguese population. First, the scores obtained in each of the components of the PSQI and the global PSQI score were analyzed for the global population. Lastly, the global PSQI score was correlated with each of the sociodemographic variables to verify the existence of a statistically significant relationship.
Results296 students completed the instrument. Of these, 62.2% classify their sleep quality as good; 42.4% scored 2 in the sleep latency component; 50% reported sleeping 6 to 7 hours; 73.9% stated an adequate sleep efficiency; 85.5% mentioned few or no sleep disturbances; 83,8% said they never used sleep medication; and 60.8% had low or no sleepiness or daytime dysfunction.
As for the overall PSQI score, 72.6% of the students had a score greater than 5, indicating a poor quality of sleep. 74.7% of female respondents have a low quality of sleep, as well as 67.7% of male respondents. Likewise, 91.3% of students who live alone have poor sleep quality, as well as 76.8% of those living with family members and 69.8% of those living with colleagues.
Regarding the course year, 82.4% of the first-year students report a poor quality of sleep, as well as 77.5% of the second-year students, 72.1% of the third-year students, 77.8% of the fourth-year, 65.8% of the fifth-year students and 71.4% of the sixth-year students.
ConclusionsMedical students seem to be more likely to have poor sleep quality, especially when compared to other university students. Thus, further studies are needed to prove this susceptibility as well as therapeutic interventions aimed at improving sleep parameters.
Disclosure of InterestNone Declared
Postpartum Delirium: A Psychosis Born in the 18th Century
- J. R. Martins, R. Vaz, A. L. Costa, J. Brás, R. Sousa, J. Abreu, E. Almeida, R. Andrade, N. Castro, T. Casanova
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1128
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Introduction
Pregnancy and childbirth are moments of great vulnerability in a woman’s life, which can predispose her to the development of psychopathology, ranging from transient depressive symptoms (“baby blues”) to psychotic symptoms. Postpartum delirium is the psychiatric syndrome that some authors refer to as puerperal psychosis par excellence. It was first described in the 18th century and were thought to be associated with painful delivery, then became rare after the introduction of effective analgesia.
ObjectivesThe objective of this work is to contribute to a better understanding of this condition, through a literature review.
MethodsBibliographic research using Pubmed® and the keywords: postpartum delirium.
ResultsClinical presentation of postpartum delirium includes: constantly varying degrees of consciousness; perplexity; hallucinations or pseudo-hallucinations of one or more organs of sense; delusions or delusive-type thoughts; great motoric unrest and considerable motoric and verbal abandon; and acute aggressive discharges can also occur. It is thought to be due to organic complications, such as infectious disease, abnormal loss of blood, thrombosis, neurological disease, obstetric disease, vitamin deficiencies, hormonal changes. An article from 1975 mentions how difficult was to treat postpartum delirium despite the development of psychopharmaceutical therapy. The patients remained psychotic for long periods and had many relapses. They mention a comparative study that found that the symptomatic treatment of this syndrome with a combination of perfenazine and lithium carbonate produced relatively favorable results. For that reason, at that time, it was the medication of choice. Nowadays the psychopharmacological treatment of puerperal psychosis, in general, still consists of the combination of lithium and an antipsychotic, such as haloperidol, and possibly a benzodiazepine, such as lorazepam.
ConclusionsPostpartum delirium is rarely mentioned in the literature and just a few cases have been described. It is considered a rare postpartum psychotic condition but would perhaps be less rare if its existence were recognized. On this note, it is important for clinical practice to research on the psychoses of pregnancy and not just the most common.
Disclosure of InterestNone Declared
Role of migration in the development of a first episode of psychosis
- R. Vaz, J. Martins, A. Costa, J. Brás, R. Sousa, E. Almeida, J. Abreu, D. Teixeira, A. Marques, N. Gil
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S633
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Introduction
Currently, there is scientific evidence supporting the relationship between socio-environmental factors and the onset of a first episode of psychosis (FEP). In this context, the phenomenon of migration, seen as a negative life experience, may become an important risk factor in developing a psychotic disorder (PD). In Europe, the impact of this phenomenon is growing and, therefore, it’s necessary to provide a proper answer to these individual’s mental health problems.
ObjectivesIdentify which phases of this migration process are most important in the development of a FEP and what are the more significant socio-environmental factors in each phase.
MethodsBibliographic research in Pubmed database using the terms “Migration” and “First Episode Psychosis”.
ResultsResearch confirms that migrants have a 2 to 3-fold increased risk of developing a PD. This risk will be even higher in the refugee population. Pre- and post-migration factors demonstrated to be more important than factors related with the migration process itself. In the pre-migration phase highlight factors like the lower parental social class and a previous trauma. In the post-migration phase highlight factors like discrimination, social disadvantage and a mismatch between expectations and reality.
ConclusionsLiterature is unanimous in considering migrant status as an independent risk factor for the development of FEP, possibly due to the outsider’s role in society. Thus, despite the growing interest in Biological Psychiatry, this work demonstrates that socio-environmental factors are very preponderant in the development of these disorders and because of that further investigation is still necessary.
DisclosureNo significant relationships.
Dissociation and emotional dysregulation in pathological personalities related to the fear of SARS-COV-2: a case report
- R. Sousa, J. Brás, A. Costa, R. Vaz, J. Martins, D. Teixeira, A. Marques, J. Abreu, E. Almeida, N. Cunha
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S528
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Introduction
The COVID-19 pandemic represented a serious strain on the mental health resilience worldwide. Implementation of restrictive rules implied the disruption of social networks, eliciting emotional exhaustion and intense response to fear. This was amplified by media spread of panic and fake news, representing risk factors for post traumatic stress disorder (PTSD). Fear can be dangerous, especially accounting premorbid psychopathological vulnerability, such as pathological personality traits. Emotional dysregulation increases fear levels, mediated by the relationship between emotional dysregulation and lack of tolerance.
ObjectivesClinical case presentation of patient who developed dissociative and behavioral symptoms following COVID-19 infection. Bibliographic research.
MethodsBibliographic research using Pubmed®. Clinical file consultation and patient interviews.
ResultsHeightened psychophysiological reactivity can result from the persistent fear experienced during a traumatic event and repeated memories related to it, leading to a sensitization of the response to fear. We present 57 year-old female patient, admitted to the COVID ward after trying to escape from home isolation due to positivity to COVID-19. In the hospital setting she developed dissociative symptoms, trying to escape from the ward and infect other people.
ConclusionsIntense fear responses to COVID-19 are likely explained by poor emotion regulation capacities as well as dissociative mechanisms. Studies have shown that this pandemic was experienced as a real traumatic event and some studies have found that it may lead to the development of PTSD. Pathological personality is positively related to PTSD symptoms, attributable to higher levels of mood instability, cognitive/perceptual disorders, interpersonal dysfunctions and negative affection.
DisclosureNo significant relationships.
Catatonia and dementia: a case report
- E. Almeida, J. Abreu, J. Martins, R. Vaz, R. Sousa, J. Brás, A. Costa, D. Teixeira, A. Marques, E. Monteiro
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S652-S653
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Introduction
Catatonia is a neuropsychiatric disorder characterized by motor, behavioral and autonomic changes. It is associated with several psychiatric disorders, including dementia. Catatonia is an underdiagnosed syndrome, so it is important to draw attention to it. Here, we review a case of a patient admitted to our psychiatric department with a clinical presentation compatible with catatonia. After proper treatment, further assessment revealed dementia.
ObjectivesThis work aims to describe a case of catatonia in a patient with dementia.
MethodsBibliographic research using Pubmed®. Clinical file consultation and patient interviews.
ResultsCatatonia is a disorder that was already been described as part of several types of dementia. We present a 69-year-old female patient, admitted to our psychiatric department with clinical presentation compatible with catatonia. To admission, she presented some typical complications resulting from long immobility such as pressure ulcers and nutritional deficiencies. During the hospitalization, she developed a urinary infection and there was the need to tube feeding. She was treated with benzodiazepines and improved. Further assessment revealed dementia.
ConclusionsCatatonia in dementia is not uncommon, although it is an underdiagnosed syndrome, and when treated early and properly it has a good prognosis.
DisclosureNo significant relationships.
Anorexia Nervosa and Gender Dysphoria: A Clinical Case
- J. Martins, R. Vaz, A. Costa, J. Brás, R. Sousa, J. Abreu, E. Almeida, T. Casanova
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S584
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Introduction
Eating disorders (ED) and gender dysphoria (GD) are associated with a change in body perception. Therefore, body dissatisfaction plays a common and central role in these disorders. In GD, body image concerns are related to the features of the biological sex. In ED, body dissatisfaction comes from a distorted perception of weight and body shape and plays an important role in the development and maintenance of the psychopathology.
ObjectivesTo present and discuss the clinical case of a patient with a previous diagnosis of GD who presented with a clinical condition suggesting a restrictive anorexia nervosa (AN).
MethodsPatient´s clinical files consultation and literature review using Pubmed and the keywords: eating disorders and gender dysphoria.
ResultsWe present the case of a 25-year-old patient who was living in a shelter for victims of domestic violence and was admitted for severe restrictive AN. The patient was discharged after 40 days and medicated with sertraline, diazepam and olanzapine, as well as her previous medication (hormonal therapy): cyproterone, finasteride, estradiol, oxybutynin.
ConclusionsAlthough studies on this subject are still scarce, there has been some progress and the literature recognizes the coexistence of these conditions. However ED symptoms in patients with GD could have a different meaning: they may represent a dysfunctional coping strategy adopted to block features of the biological sex. Therefore health professionals may take a more holistic approach to body image. Additional studies will be necessary, allowing the establishment of cause-consequence interactions between weight loss and psychopathology related to GD.
DisclosureNo significant relationships.
“Walking with myself by my side” - non-medical use of Ketamine
- R. Vaz, J. Martins, A. Costa, J. Brás, R. Sousa, E. Almeida, J. Abreu, D. Teixeira, A. Marques, N. Gil, P. Carriço
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S829-S830
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Introduction
Ketamine, synthesized in 1962 as phencyclidine derivate, is denominated a “dissociative anesthetic” because of its side-effects, such as dissociative episodes and psychotic-like symptoms, which have limited its applicability on clinical practice. Otherwise, in the last decades the non-medical use of ketamine has been growing and today is one of the most popular illicit substances consumed between adolescents and young adults.
ObjectivesIncreasing the knowledge and understanding of the factors related to crescent use of ketamine and the experiences and consequences associated to its consumption.
MethodsClinical interview with patients diagnosed with ketamine use disorder and bibliographic research in Pubmed database using the terms “Ketamine use” and “Ketamine addiction”.
ResultsPat et al. (2002) describes a clinical case of a young male, diagnosed with substance use disorders, specifically alcohol and cocaine use disorders, that started a treatment with ketamine. After the treatment, pleasant depersonalization experiences contributed to the development of patient’s ketamine dependence. Other patient’s reports confirm the association of ketamine use with psychedelic effects and dissociative episodes and pointed these effects as main reason for its consumption.
ConclusionsThe adverse effects that limited the medical use of ketamine are the same that promote its utilization with recreational purposes by adolescents and young adults in parties and nightclubs. About the ketamine dependence, the literature is scarce and doesn´t clearly identify a physical withdrawal syndrome, pointing only to a serious psychological dependence. Thus, with the crescent non-medical use of ketamine, it’s urgent to develop an intervention plan directed to this problem.
DisclosureNo significant relationships.
ONLY IN DREAMS: a case report of sleep deprivation psychosis
- J. Brás, A. Costa, R. Sousa, R. Vaz, J. Martins, E. Almeida, J. Abreu, A. Costa
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S773
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Introduction
Sleep is essential for an adequate neurobiological functioning, being implicated in several cognitive functions. Even in healthy individuals, sleep deprivation can lead to a number of psychopathological changes, including perceptual distortions, hallucinations and delusions. Thus, the resulting clinical picture may be similar to a psychotic disorder.
ObjectivesTo present a clinical case of psychotic symptomatology induced by sleep deprivation.
MethodsPatient’s clinical file consultation and literature review using the search engine Pubmed® and the keywords: “sleep deprivation”, “sleep loss” and “psychosis”.
ResultsWe present the case of a 41-year-old woman with a history of an episode of mood changes with psychotic symptoms that was preceded by a period of total insomnia. No psychotropic drugs since then and no relapses. In May 2020, she was admitted in psychiatry department due to clinical picture composed by significant psychomotor slowing, drowsiness, slowed speech, verbal visual, tactile and auditory hallucinations accompanied by grandiose delusions. These symptoms were preceded by total insomnia with one week of duration. In the hospital was administered quetiapine 100mg and lorazepam 2.5mg to aid in the recovery of sleep deprivation and concomitantly aripiprazole 15mg was prescribed. The patient presented a rapid and significant clinical improvement. Currently, it is without any type of medication and without psychopathological changes.
ConclusionsThe clinical picture present in this case report was triggered after a significant period of sleep deprivation. Thus, it illustrates the role that sleep has in the development of psychiatric symptomatology, sometimes difficult to differentiate from psychiatric disorders.
DisclosureNo significant relationships.
Sociocultural and economic determinants of stunting and thinness among adolescent boys and girls in Nepal
- Charlotte J. W. van Tuijl, Dónya S. Madjdian, Hilde Bras, Binaya Chalise
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- Journal of Biosocial Science / Volume 53 / Issue 4 / July 2021
- Published online by Cambridge University Press:
- 08 July 2020, pp. 531-556
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Despite the increasing interest in the determinants of adolescent undernutrition in low- and middle-income countries, a comprehensive multi-level overview at the country level is missing. Using the nationally representative 2014 Nepal Adolescent Nutrition Survey, this study aimed to provide a comprehensive overview of the sociocultural and economic determinants of stunting and thinness of adolescent boys and girls in Nepal. Multivariate logistic regression models were used to estimate the associations between multiple individual, household and community determinants and stunting and thinness among 3773 adolescents aged 10–19 years (1888 boys and 1885 girls). The prevalence rates of stunting and thinness indicated suboptimal nutritional status and an inadequate growth environment in Nepali adolescents. The results highlighted an association of paternal occupation and education, household income, number of earning household members, geographical place of residence, caste/ethnicity and nutritional knowledge with stunting, with higher odds for males and older adolescents. Paternal occupation, education, household income, geographical region, caste/ethnicity and nutrition knowledge were associated with thinness, with higher odds for males and younger adolescents. The findings underscore the importance of involving adolescents, their parents and their communities in interventions. Such interventions should not only be aimed at improving adolescent nutrition but also at optimizing adolescents’ growth environment for better health and development. Future research should focus on context-specific causal pathways and mechanisms through which sociocultural and economic determinants influence nutritional outcomes within broader societal, cultural and political settings. A longitudinal approach, including a range of dietary and nutrition indicators would allow understanding how and when the relative importance of these factors change during adolescence.
Attitudes of nurses towards schizophrenia
- M. Bras, J. Topic, M. Andelic
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- European Psychiatry / Volume 22 / Issue S1 / March 2007
- Published online by Cambridge University Press:
- 16 April 2020, pp. S83-S84
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Objectives
According to the recent literature, stigma connected to schizophrenia has a negative impact on the commencement, process and the outcome of the treatment. The aim of this study was to investigate the attitude of nurses from our local community towards schizophrenia.
MethodsThis study engaged 166 nurses (8 male, 158 female) employed at the Clinical Hospital in Osijek and the Primary Medical Care in Osjecko-baranjska County. The subjects have filled out the Canadian Community Antistigma Questionnaire during 3 mental health lectures for nurses.
ResultsOut of total of 166 nurses, 74.7% (124) of them has heard something about schizophrenia in the last couple of months. 45.8% (76) of nurses was employed at the institution that treated patients with mental illness. 34.3% (57) of nurses personally knew someone who was diagnosed with schizophrenia or were treated for schizophrenia themselves. The results have shown an extensive knowledge of the facts related to schizophrenia among the nurses in our local community. It has also emerged that the attitude to the person with schizophrenia is more negative, and the level of stigma is higher as the higher emotional involvement is required.
ConclusionMedical staff has a good level of knowledge about schizophrenia. Emotional acceptance of the person with schizophrenia is lower as the closer contact is required. Because the results show a certain degree of stigma to schizophrenia in the population of nurses in our local community, it would be necessary to develop specific anti-stigma programs for medical staff.
Phenotypical characteristics, biochemical pathways, molecular targets and putative role of nitric oxide-mediated programmed cell death in Leishmania
- P. HOLZMULLER, R. BRAS-GONÇALVES, J.-L. LEMESRE
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- Journal:
- Parasitology / Volume 132 / Issue S1 / March 2006
- Published online by Cambridge University Press:
- 03 October 2006, pp. S19-S32
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Nitric oxide (NO) has been demonstrated to be the principal effector molecule mediating intracellular killing of Leishmania, both in vitro and in vivo. We investigated the type of cell death process induced by NO for the intracellular amastigote stage of the protozoa Leishmania. Specific detection methods revealed a rapid and extensive cell death with morphological features of apoptosis in axenic amastigotes exposed to NO donors, in intracellular amastigotes inside in vitro – activated mouse macrophages and also in activated macrophages of regressive lesions in a leishmaniasis-resistant mouse model. We extended our investigations to the dog, a natural host-reservoir of Leishmania parasites, by demonstrating that co-incubation of infected macrophages with autologous lymphocytes derived from dogs immunised with purified excreted-secreted antigens of Leishmania resulted in a significant NO-mediated apoptotic cell death of intracellular amastigotes. From the biochemical point of view, NO-mediated Leishmania amastigotes apoptosis did not seem to be controlled by caspase activity as indicated by the lack of effect of cell permeable inhibitors of caspases and cysteine proteases, in contrast to specific proteasome inhibitors, such as lactacystin or calpain inhibitor I. Moreover, addition of the products of two NO molecular targets, cis-aconitase and glyceraldehyde-3-phosphate dehydrogenase, also had an inhibitory effect on the cell death induced by NO. Interestingly, activities of these two enzymes plus 6-phosphogluconate dehydrogenase, parasitic enzymes involved in both glycolysis and respiration processes, are overexpressed in amastigotes selected for their NO resistance. This review focuses on cell death of the intracellular stage of the pathogen Leishmania induced by nitrogen oxides and gives particular attention to the biochemical pathways and the molecular targets potentially involved. Questions about the role of Leishmania amastigotes NO-mediated apoptosis in the overall infection process are raised and discussed.
Simultaneous, Time-Resolved, Saxs/Waxs Studies on Block Copoly(Ether-Urethane) Phase Behaviour
- W. Bras, G. E. Derbyshire, G. N. Greavest, G. R. Mantt, S. Naylor, A. J. Ryan
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- Journal:
- MRS Online Proceedings Library Archive / Volume 307 / 1993
- Published online by Cambridge University Press:
- 15 February 2011, 333
- Print publication:
- 1993
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A new experimental technique for the characterisation of the thermal-morphological properties of materials has been developed at Daresbury. Many thermal events, for example melting endotherms, are signals of changes in morphology covering size scales from the atomic to the microscopic, that is Å to μm. There are obvious advantages in collecting both the wide angle (1-20Å) and small angle (20-1000Å) patterns simultaneously to unambiguously characterise such thermal events. The new apparatus comprises a Linkam hot-stage capable of controlled heating and cooling mounted in a combined SAXS/WAXS camera. The camera is equipped with a multiwire quadrant detector (SAXS) located 3.5 m from the sample position and a curved knifeedge detector (WAXS) that covers 120° of arc at a radius of 0.4 m. SAXSIWAXS is possible with a time resolution of 0.1 seconds and heating/cooling rates up to 120 °C min-1.