8 results
Delirium and dementia retrospective cohort study
- O. Martin-Santiago, C. Alario-Ruiz, G. Guerra-Valera
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S399
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Introduction
Delirium is common and is associated with many adverse short-term consequences as increased hospital costs, health care complications, and increased mortality. Long-term cognition consequences on delirium have not been well synthesized and quantified.
ObjectivesOur study aims to determine the relationship between an episode of delirium and subsequent dementia and death over five years.
MethodsPostoperative delirium, previous psychiatric disorders, mental health service use, and death data collected from a cohort of inpatients diagnosed with delirium that requires psychiatric attendance in a general hospital were analyzed. Between 2009 and 2011, we started a follow-up of 91 patients aged 65 years or older at baseline for 60 months.
ResultsFive patients (5.4%) were diagnosed with dementia previously. During the first year, 35 patients without previous dementia (40.6%) died. More than half of the one-year survivors (27; 52.9%) were diagnosed with dementia at the follow-up. Differences in age (79,5 vs 80.3; Z=-0.07; p=0.93), survival time (54.8 vs 48.8;Z=1.30;p=0.19), postoperative delirium rates (74%vs66.6%; χ2=0.33, DF=1, p=0.56) and mental disorder antecedents were not found. Patients with dementia after delirium were more likely to be attentive in mental health services (48.1vs16.6%; χ2=5.666, DF=1, p=0.017).
ConclusionsIn our study, delirium is an important risk marker for dementia and death and is significantly associated with the long-term cognitive decline in surgical and non-surgical patients. Subsequent follow-up in mental health service could help detect dementia after episodes of delirium and lead to fewer potentially harmful interventions such as hospitalization or antipsychotic medication. An important question to determine is whether delirium is simply a risk marker for dementia or whether the delirium could cause neuronal damage leading to dementia.
Disclosure of InterestNone Declared
Efficacy of maintenance electroconvulsive therapy in recurrent depression: a case series
- G. Guerra Valera, Ó. Martín Santiago, M. Esperesate Pajares, Q. D. L. de la Viuda, A. A. Gonzaga Ramírez, C. Vallecillo Adame, C. de Andrés Lobo, T. Jiménez Aparicio, N. Navarro Barriga, B. Rodríguez Rodríguez, M. Fernández Lozano, M. J. Mateos Sexmero, A. Aparicio Parras, M. Calvo Valcárcel, M. A. Andreo Vidal, P. Martínez Gimeno, M. P. Pando Fernández, M. D. L. Á. Guillén Soto
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S832
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Introduction
Maintenance electroconvulsive therapy (mECT) is an option in the treatment of affective disorders which progress is not satisfactory. It is certainly neglected and underused during the clinical practice.
ObjectivesTo evaluate the efficacy of mECT in reducing recurrence and relapse in recurrent depression within a sample of three patients.
MethodsWe followed up these patients among two years since they received the first set of electroconvulsive sessions. We applied the Beck Depression Inventory (BDI) in the succesives consultations for evaluating the progress.
ResultsThe three patients were diagnosed with Recurrent Depressive Disorder (RDD). One of them is a 60 year old man that received initially a cycle of 12 sessions; since then he received 10 maintenance sessions. Other one is a 70 year old woman that received initially a cycle of 10 sessions; since then she received 6 maintenance sessions. The last one is a 55 year old woman that received initially a cycle of 14 sessions; since then she received 20 maintenance sessions.
All of them showed a significant reduction in depressive symptoms evaluated through BDI and clinical examination. In the first case, we found a reduction in the BDI from the first consultation to the last that goes from 60 to 12 points; in the second case, from 58 to 8 points; and in the last case, from 55 to 10 points. The main sections that improved were emotional, physical and delusional.
As side-effects of the treatment, we found anterograde amnesia, lack of concentration and loss of focus at all of them.
ConclusionsWe find mECT as a very useful treatment for resistant cases of affective disorders like RDD.
It should be considered as a real therapeutic option when the first option drugs have been proved without success.
Disclosure of InterestNone Declared
Psychiatric admission decrease during COVID-19 lockdown in older patients
- O. Martin-Santiago, M. C. Vallecillo-Adame, T. Jimenez-Aparicio, A. Perez-Escudero
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S233-S234
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Introduction
Coronavirus disease 2019 (COVID-19) modify voluntary admission rates to psychiatric wards in the early phases following pandemic onset. Older patients have higher COVID-19 distress scores because elderly people are at risk for COVID-19 infection.
ObjectivesThe present investigation aimed at admission rates of elderly patients to a General Hospital Psychiatric Ward during the lockdown due to the COVID-19, compared to similar periods of 2018 and 2019.
MethodsAnonymized data on psychiatric admissions (n=55) from one general hospital psychiatric ward have been obtained and analysed. We compared admission characteristics between April and June of 2018 and 2019 with the same period of 2020 (lockdown).
ResultsDuring the COVID-19 lockdown, a significant reduction in psychiatric hospitalizations of older patients (aged >65 years) was observed in the lockdown (69.2%; χ2=4.823,df=1,p=0.028) in contrast with young patients (26.7% reduction). There was a reduction of 14% in admission due to suicidal behaviour (IRR = 0.57; 95% CI: 0.11-2.75; p=0.48), 25% in depression (IRR = 0.28; 95% CI: 0.64-1.25; p=0.09) and 50% in psychotic disorders (IRR = 0.33; 95% CI: 0.07-1.48; p=0.15). There was none admission by dementia during the lockdown.
ConclusionsChanges in the number of psychiatric admissions, particularly for older patients, were observed during the COVID-19 lockdown. During this period, their fear levels could modify their psychiatric admission rates. We suggest that the decrease of psychiatric admissions in the elderly was due to fear of contagion in hospitals.
Disclosure of InterestNone Declared
Specific treatment for alcohol use disorder reduces relapse after psichiatric hospitalization
- O. Martin-Santiago, J. I. Goncalves-Cerejeira, G. Guerra-Valera, M. Calvo-Valcarcel, P. Martinez-Gimeno
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S565
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Introduction
Patients with an alcohol use disorder frequently relapse after various efforts to quit. Admission to hospital units is a possible start to stop drinking alcohol and reach abstinence. Among the pharmacological strategies to quit this addiction are specific drugs, such as disulfiram or namelfen, which are widely studied. Hospitalized patients frequently initiate these medications to control addiction, but little is known about their efficacy after discharge in this group.
ObjectivesThe aim is to determine whether the initiation of treatment with specific drugs for alcohol use disorder could help to maintain alcohol abstinence after admission to a General Hospital Psychiatric Ward. In addition, we want to check those factors associated with a higher rate of relapse in consumption.
MethodsWe conducted a retrospective cross-sectional study of a group of patients admitted in 2018 to a psychiatric hospitalization ward due to alcohol use disorder and who expressed their desire to stop drinking. At the time of admission, we recorded sociodemographic data, consumption of other substances and alcohol family history. Patients initialized specific treatments to reduce and control alcohol consumption if they wanted. Twenty-four months after discharge, we acquired the number of relapses through new admissions, emergency room visits or outpatient follow-up data.
ResultsA sample of 36 patients (28 men) admitted to a psychiatric hospitalization ward was analyzed. At discharge, 17 accepted specific pharmacological treatments to reduce alcohol consumption. After a follow-up period of 24 months, 70.8% relapsed compared to 94.7% who did not accept treatment (χ2=4.001, DF=1, p=0.045, OR=0.13). There were no differences between the two groups in age, gender, amount of alcohol consumed, follow-up modality at discharge or if it was their first detoxification attempt. However, those who did not accept the specific pharmacological treatment consumed other drugs (41.1% vs 5.8%, χ2= 5.888, DF=1, p=0.015), had other history of mental disorder (64.7% vs 23.5%, χ2= 5.845, FD=1, p=0.015) and a higher proportion of relatives with alcohol consumption (81.8% vs 42.8%, χ2= 3.896, FD=1, p=0.048) more frequently. The time (in days) to relapse was faster in this group of patients (200.8 vs 402.7 , Z=-2.5413, p=0.005).
ConclusionsAccepting drug-specific treatment for alcohol use can be helpful for many patients who want to achieve alcohol abstinence. Among the factors that prevent the acceptance of this treatment is the consumption of other substances, comorbidity with another mental pathology and family history, which may involve genetic factors that favour addiction. This group of patients could benefit from a specific pharmacological treatment, although other psychosocial factors may also help.
Disclosure of InterestNone Declared
Chronic psychosis associated with new hallucinogenic drug 25I-NBOMe
- O. Martin-Santiago, G. Guerra-Valera, C. Alario-Ruiz, N. Navarro-Barriga
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S634
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Introduction
The presence of perceptual disturbances and psychotic symptoms associated with substance abuse are widely known. While the abuse of substances is becoming more widespread, there is a general perception that their use entails fewer risks. 25I-NBOMe is a recently introduced hallucinogenic drug producing visual hallucinations and euphoria. Although people consume it like LSD, its chemical structure is different to LSD. 25I-NBOMe is related to other phenylethylamine derivatives (amphetamines and mescaline).
ObjectivesPresent a clinical case of psychosis triggered after the consumption of new emerging drugs and highlight that the extension of their consumption in the general population, especially in the most vulnerable, can trigger prolonged psychotic symptoms.
MethodsWe present a clinical case report of a subject who developed perceptual disturbances and paranoid symptoms. These lasted for months.
ResultsWe describe the case of a 30-year-old man who required psychiatric admission after a single NBOMe intake five months earlier. He began with self-referential experiences and delusional ideas of prejudice, persecution and control in social networks. For months, intrusive images appeared in the form of flashbacks. He remains isolated, hardly sleeps and is easily irritated. He previously worked and had a well social network. Since adolescence, he had occasionally used alcohol, cannabis and cocaine. An uncle was diagnosed with schizophrenia. Treatment with long-term injectable aripiprazole started, reducing the symptoms and managing to recover work activity in a year.
Conclusions25I-NBOMe has its main activity as 5HT2 receptor agonism, which is associated with increased dopaminergic activity in the brain. Hallucinations, delusions, anxiety symptoms and depersonalization appear during acute consumption. However, some patients have developed a persistent hallucinatory chronic syndrome after consumption. As its use is expanding, it probably could increase the number of patients with induced chronic psychoses, especially those with greater susceptibility. One of the possible causes would be its analogous structure to other derivatives of phenylethylamine, which increase the risk of psychosis, and another would be the erroneous perception of being a less dangerous drug.
Disclosure of InterestNone Declared
Changes in psychiatric admissions to psychiatric wards due to COVID-19
- O. Martin-Santiago, M. C. Vallecillo-Adame, T. Jimenez-Aparicio, A. Perez-Escudero
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S595-S596
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Introduction
Functioning in acute inpatient psychiatric units has been challenged by the Coronavirus disease 2019 (COVID-19). Patients with more severe mental health symptoms changed their rates of voluntary admission to psychiatric wards during the onset of the pandemic. Peritraumatic distress scores and increased likelihood of being psychologically affected by the COVID-19 pandemic can lead to a psychiatric admission. However, other factors could prevent hospitalization.
ObjectivesThe present investigation aimed at admission rates of patients by depression, adjustment disorder or suicidal behaviour to a General Hospital Psychiatric Ward. We compared the lockdown due to COVID-19 in 2020 to similar periods of 2018 and 2019.
MethodsThe data of one general hospital psychiatric ward admissions have been obtained and analysed. We compared admission characteristics of 237 patients between April and June of 2018 and 2019 with 79 patients in the same period of 2020 (lockdown).
ResultsDuring the COVID-19 lockdown, there was a 35.8% reduction in psychiatric admissions and a significant reduction in psychiatric admission was observed due to suicidal behaviour (IRR = 0.49; 95% CI: 0.26-0.89; p=0.002) and depression (IRR = 0.24; 95% CI: 0.08-0.68; p=0.007), but similar rates of adjustment disorders (IRR = 1.12; 95% CI: 0.58-2.15; p=0.73).
ConclusionsWe suggest that patients with depression or suicidal behaviour avoided admission, for fear of contagion in hospitals. Also, greater family support could prevent self-injurious behaviours. By contrast, other disorders continued to require the same admission rate, since the social consequences derived from confinement could lead to the genesis or worsening of symptoms, such as adjustment disorders.
Disclosure of InterestNone Declared
Psicosis and suicide risk: who, when and why
- J. Gonçalves Cerejeira, I. Santos Carrasco, C. De Andrés Lobo, C. Vallecillo Adame, T. Jiménez Aparicio, G. Guerra Valera, M. Queipo De Llano De La Viuda, A. Gonzaga Ramírez, O. Martin-Santiago
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S842-S843
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Introduction
Suicide rates in people diagnosed with a psychotic disorder can be up to 50 times higher than in the general population, with the lethality of attempts being significantly higher in this group, compared to people diagnosed with other psychiatric disorders. Furthermore, it is known that being male is associated with more serious suicide attempts and higher rates of completed suicides.
ObjectivesTo reflect on the increased risk of suicide associated with psychotic disorders.
MethodsCase report and literature review.
ResultsCase report 40-year-old male, recently diagnosed with Schizophreniform Disorder and currently with persistent positive symptoms. He was admitted to our psychiatric hospitalization unit due to a voluntary overdose of almost 100 tablets (antihypertensives, antiarrhythmics, and benzodiazepines) and alcohol. He admits taking the pills with the aim of committing suicide. Literature review: - Around 10% of people diagnosed with schizophrenia commit suicide. - In young patients diagnosed with schizophrenia, suicide is the leading cause of death. - Between 15 and 65% of patients diagnosed with schizophrenia have depressive symptoms such as hopelessness. - Depressive symptoms in these patients seem to be directly proportionally with awareness of the disease (stigma, awareness of its severity and a sudden decrease in quality of life and social integration). - The risk of suicide increases especially in the first 10 years of the disease.
ConclusionsPsychosis is an important risk factor of suicide and active preventive measures should be carried out in these patients.
DisclosureNo significant relationships.
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- By J. William Allwood, Eleni T. Bairaktari, Jean-Pierre Bellocq, Malika A. Benahmed, Hanne Christine Bertram, Zaver M. Bhujwalla, Ulrich Braumann, Juan Casado-Vela, Marta Cascante, Arancha Cebrián, Albert Chen, Man Ho Choi, Bong Chul Chung, Yuen-Li Chung, Morten Rahr Clausen, Patrick J. Cozzone, Ralph J. DeBerardinis, Julien Detour, Santiago Díaz-Moralli, Warwick B. Dunn, Karim Elbayed, Udo Engelke, Teresa W.-M. Fan, Ana M. Gil, Kristine Glunde, Markus Godejohann, Teresa Gómez del Pulgar, Royston Goodacre, Angelina Goudswaard, Gonçalo Graça, Richard W. Gross, Herbert H. Hill, Ralph E. Hurd, Alessio Imperiale, Kimberly A. Kaplan, Neil L. Kelleher, Michael A. Kiebish, Ann M. Knolhoff, Christina E. Kostara, Juan Carlos Lacal, Andrew N. Lane, Martin O. Leach, Norbert W. Lutz, Elizabeth Maher, Craig R. Malloy, Isaac Marin-Valencia, Laura Menchén, Bruce Mickey, Fanny Mochel, Éva Morava, François-Marie Moussallieh, Izzie J. Namer, Peter Nemes, Ioanna Ntai, Geoffrey S. Payne, Marie-France Penet, Martial Piotto, Stanislav S. Rubakhin, Elsa Sánchez-López, A. Dean Sherry, Bindesh Shrestha, Jonathan V. Sweedler, Akos Vertes, Mark R. Viant, Ralf J. M. Weber, Ron Wehrens, Ron A. Wevers, Catherine L. Winder, David S. Wishart, Kui Yang, Yi-Fen Yen
- Edited by Norbert W. Lutz, Jonathan V. Sweedler, University of Illinois, Urbana-Champaign, Ron A. Wevers
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- Book:
- Methodologies for Metabolomics
- Published online:
- 05 January 2013
- Print publication:
- 21 January 2013, pp viii-xii
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