12 results
Delirious Mania in an elderly person?: a case report.
- P. Setién Preciados, E. Arroyo Sánchez
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S940
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Introduction
Delirious mania is a potentially fatal neuropsychiatric syndrome of unknown etiology often characterized by the acute onset of delirium, symptoms of mania, and psychosis. The presentation is often punctuated by catatonia.
Delirious mania may constitute up to 15% of all acute mania cases. When delirious mania is unrecognized or improperly treated, it can progress rapidly in severity and can become life-threatening.
Despite being relatively prevalent, literature on delirious mania is sparse, and there are no formal diagnostic criteria or treatment guidelines.
ObjectivesReview delirious mania as an entity, its symptoms, type of patient and treatment.
MethodsPresentation of a patient’s case and review of existing literature regarding delirious mania and its characteristics.
ResultsIn delirious mania symptoms present abruptly, within hours. Symptomatology varies from psychotic (hallucinations, delusions…), maniac (agitation, dysphoria…) and altered sensorium (desorientation, fluctuation of symptoms…). A differential diagnosis has to be done, as well as discarding an organic origin, which in the end, as illustrated in this case, was the etiology of the symptomatology in this patient.
ConclusionsDelirious mania is a clinical entity very underdiagnosed given that patients exhibit an array of different symptoms, making diagnosis very challenging for professionals. It should always be considered in differential diagnosis when these symptoms are present, especially in elderly people, given that early treatment is key. However, discarding an orgnanic origin should always be the first thing to do in clinical practice.
Disclosure of InterestNone Declared
How cultural factors along with mental health diagnoses influence the treatment of a stroke patient with no previous mental health history: a case report
- P. Setién Preciados, E. Arroyo Sánchez, A. Sanz Giancola, I. Romero Gerechter, M. Martín Velasco
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S822-S823
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Introduction
Mental health awareness campaigns in the past few years have vastly improved how medical professionals treat mental health patients. However, prejudices and ignorance still interfere in medical practice. In this context, with the case presented we can see that even in presumed mental health diagnoses along with cultural factors (race, language…), the best medical assistance is not ensured.
ObjectivesReview how different intersectional factors can determine the treatment patients receive at hospitals.
MethodsPresentation of a patient’s case and review of existing literature, in regards to the influence of race, language barriers and mental health diagnoses when attending patients.
ResultsThe patient is presumed to suffer from a mental health condition after a battery of initial tests with inconclusive results do not demonstrate an organic origin. Instead of continuing with the medical study, the patient is disregarded as psychiatric even though his profile doesn´t fit beforehand of a fictitious or conversion disorder. The fact that there are also cultural factors in play (race and language) probably unconsciously influence how the medical team treats this patient’s case. Cultural social factors persistently present as barriers in clinical practice.
ConclusionsRace, language barriers and mental health diagnoses as well as other intersectional factors do have a great impact in the treatment patients receive. There is yet a lot to do when it comes to educating health professionals if we want to offer the best medical assistance.
Disclosure of InterestNone Declared
Weight gain as a secondary effect of Olanzapine, and its interference in treatment adherence: a case report.
- P. Setién Preciados, E. Arroyo Sánchez
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1014
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Introduction
Olanzapine is a second generation antipsychotic that is approved for the treatment of schizophrenia, bipolar disorder type 1 as monotherapy, or as an add-on to lithium or valproate (manic or mixed episodes), and it is also used off label for acute anxiety, insomnia… It is one of the most effective antipsychotics but concerns remain due to its significant metabolic adverse effects. Olanzapine has one of the highest rates of weight gain among all antipsychotic drugs, which challenges patient’s adherence to treatment.
ObjectivesReview how much influence Olanzapine has on weight gain, its influence in treatment adherence and alternatives in clinical practice.
MethodsPresentation of a patient’s case and review of existing literature, in regards to Olanzapine and its repercussions on weight gain and the old and new alternatives available right now.
ResultsOlanzapine is an effective antipsychotic, however, it causes secondary effects that complicate treatment, especially weight gain. In the case presented, the patient does gain weight with Olanzapine and adherence is compromised. In these cases, professionals try to look for alternatives, either to try another drug or use adjunct treatment. In this patient, a change to lithium was made. In the last few years, adjunct treatment has gained traction, like for example: metformin and topiramate. The latest discovery in this matter are opioid antagonists: single dose oral tablet Olanzapine/samidorphan.
ConclusionsEven though Olanzapine is one of the most effective antipsychotics and medications in mental health, its impact on patients’ weight hinders treatment continuity. The use of other already known medications and the appearance of new ones, that reduce weight gain probability, are the possible ways forward.
Disclosure of InterestNone Declared
Suicide behaviour after hospitalisation and related factors: a case report.
- P. Setién Preciados, A. Sanz Giancola, E. Arroyo Sánchez, M. Martín Velasco, I. Romero Gerechter
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1115
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Introduction
Suicide is a global epidemic, with the World Health Organization (WHO) estimating that there are roughly 800,000 suicides annually, accounting for 1.4% of all deaths, and making suicide the 18th leading cause of death in 2016 (World Health Organization. There is a pressing need to better understand factors that contribute to suicide risk. One important domain for suicide prevention is inpatient psychiatric treatment, as many patients are admitted precisely in order to reduce their risk of suicide. Although inpatient psychiatric treatment is often used for suicide risk prevention the risk of suicide after inpatient treatment remains high. Patients who have been recently discharged have a greater risk of suicide than non-hospitalised mentally ill people.
ObjectivesReview suicidal risk after hospitalisations and the factors that may have an influence on it.
MethodsPresentation of a patient’s case and review of existing literature, in regards to the rate of suicide after a patient is released from psychiatric hospitalisation and the factors that surround it.
ResultsThe patient in question is admitted into a psychiatric ward with a diagnosis of severe psychotic depression, after a suicide attempt trying to dissect his arms’ blood vessels. Health professionals at the hospital attend to his needs and the patient sees improvement. Not long after his release, there is a second hospital admission, which doesn’t have the same result and after his release he successfully ends his life. What comes to mind with these sorts of patients is: what kind of help would they have needed? Why hospital admission was not enough? And which factors and profile of patient is more prone to develop suicide behaviour?
ConclusionsAdmissions at psychiatric wards always have to be thought of as a beneficial resource for patients. There are some cases in which patients do not get the help they need by being hospitalised, increasing the risk of comitting suicide. A lot more studies will have to be carried out to understand what variables play a part in this. Meanwhile an improvement in outpatient care to support patients after hospital release is crucial.
Disclosure of InterestNone Declared
New-Onset Bipolar Disorder in Late Life: a case report and review of literature
- A. Sanz Giancola, E. Arroyo Sánchez, P. Setién Preciados, M. Martín Velasco, I. Romero Gerechter, C. Díaz Mayoral
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S691
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Introduction
The elderly represents the fastest growing group of the population. It is fair to assume that the portion of old age patients suffering from bipolar disorder will grow in a similar manner. Elderly patients represent approximately 25% of the bipolar population. Summarizing, 5–10% of patients were 50 years of age when they experienced their first manic episode, constituting the subgroup of late onset bipolar disorder (LOBD).
ObjectivesThe purpose of this case report and literature review is to emphasise the importance of LOBD in old population and to highlight its still sparse-knowledge.
MethodsDescriptive case study and review of literature (Arnold,I. et al. Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment. Medicina 2021,57,587; Baldessarini et al. Onset-age of bipolar disorders at six international sites. J Affect Disord 2010;121(1-2):143-6).
ResultsA 60-year-old woman is brought to the emergency department for evaluation by her family. Over the past 7 days, the patient has become increasingly irritable and argumentative, is sleeping less, is talking faster than usual and has begun to express paranoid concerns about her students “stealing my exam”. The patient is a university professor.
In the assessment interview she is hyperverbal, expansive, and grandiose. The family has also just recently discovered that she has spent a large sum of money on the Internet.
She has no history of psychiatric contact or substance use disorders; however, she has a family history of severe depression.
In the absence of any plausible non-psychiatric condition that could mimic or induce mania, the working diagnosis is bipolar I disorder, most recent episode (MRE) manic with psychotic features.
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ConclusionsThe share of older age bipolar disorder will grow constantly in the next decades and further research on this neglected patient group is urgently required.
Disclosure of InterestNone Declared
Lithium management in pregnant patients with bipolar disorder
- I. Romero Gerechter, M. Martín Velasco, A. Sanz Giancola, E. Arroyo Sánchez, C. Díaz Mayoral, P. Setien Preciados
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S198
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Introduction
Women with bipolar disorder often ask their treating clinician for information about family planning, as they are concerned about the impact of their illness on offspring. Pregnancy places additional stress on patients, and physiological changes are particularly acute during postpartum. On the other hand, the risk of abnormalities and teratogenicity from psychotropic drugs is significant. The decision wether resuming or discontinuating lithium is discussed.
ObjectivesWe present a theoretical review on the topic.
MethodsA bibliographic review is presented.
ResultsThe choice to continue medication during pregnancy balances the risks of an untreated illness with the risks of medication exposure. Abrupt discontinuation of psychotropic medications is associated with an increased risk for illness recurrence. Women with BD who discontinue their medications before or during pregnancy have a 71% risk of recurrence with new episodes occurring most frequently in the first trimester. Recurrent illness during pregnancy is associated with a 66% increase in the risk of postpartum episodes. Untreated or under-treated BD during pregnancy is associated with poor birth outcomes independent of pharmacotherapy exposure, including preterm birth, low birth-weight, intrauterine growth retardation, small for gestational age, fetal distress, and adverse neurodeve- lopmental outcomes. Women with untreated BD also have behavioral risk factors such as decreased compliance with prenatal care, poor nutrition, and high-risk behaviors. Impaired capacity to function may result in loss of employment, health care benefits, and social support. The biological and psychosocial risks of a BD episode are the justification for the risk of medication exposure.
Fetal exposure to lithium has been associated with an increased risk for cardiac abnormalities. The risk for Ebstein’s anomaly with first trimester exposure is 1 (0.1%) to 2 in 1000 (0.2%), but the absolute risk remains low. Folate supplementation with 5 mg reduces the risk and severity of congenital heart disease. Lithium toxicity causes lethargy, hypotonia, tachycardia, coma, cyanosis, and chronic twitching in the newborn.
Strategies to minimize fetal exposure and maintain efficacy include using the lowest effective dose, prescribing lithium twice daily to avoid high peak serum concentrations, and regular monitoring of lithium serum concentrations. The effective serum concentration must be established before pregnancy. If a therapeutic concentration has not been established, the lithium dose is titrated to a concentration within the therapeutic range. Breast feeding is discouraged in women taking lithium because of the high rate of transmission to the infant.
ConclusionsTreatment decisions for pregnant women with mood disorders must weigh the potential for increased risks of lithium during pregnancy, especially during the first trimester, against its effectiveness at reducing relapse.
Disclosure of InterestNone Declared
Clozapine use in drug induced psychosis in Parkinson´s disease: a case report and review of literature.
- A. Sanz Giancola, P. Setién Preciados, E. Arroyo Sánchez, I. Romero Gerecther, M. Martín Velasco, C. Díaz Mayoral
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1041
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Introduction
The occurrence of psychotic symptoms induced by dopaminergic drugs marks a new phase in the course of Parkinson’s disease (PD). The term drug induced psychosis may be used when other significant psychiatric diseases are excluded in patients with no history of psychosis. The prevalence of dopaminomimetic psychosis varies from 5% to 20%. Therefore, knowledge of the psychopharmacological management of this condition is essential.
ObjectivesThe purpose of this case report and literature review is to to learn the psychopharmacological management of this not uncommon medical complication.
MethodsDescriptive case study and review of literature
ResultsWe present the case of a 71-year-old man with a medical history of Parkinson’s disease with partial response to treatment with high doses of levodopa and carbidopa.
He was brought to the emergency department by his family due to the presence of behavioural alterations at home.
The patient reported seeing men in foam trying to harm his family. In a disjointed way in his speech, he links this idea with the delusional belief that he is being watched by electronic devices placed throughout the house. In a variegated manner he links this with a coelotypical type of discourse, however the delusional ideation remains unstructured throughout.
With no previous personal or family history of mental health and ruling out underlying organic conditions, a diagnosis of psychosis secondary to pharmacological treatment for Parkinson’s disease is presumed.
Considering the risks and benefits, it was decided to maintain the anti-Parkinson’s dose in order to avoid worsening the patient’s motor function. Therefore, after reviewing the literature, the best option was to introduce clozapine at low doses, up to 50 mg at night, with the respective analytical control. After a week’s admission, the patient began to improve psychopathologically, achieving an ad integrum resolution of the psychotic symptoms.
ConclusionsDespite the availability of other antipsychotic treatments such as quetiapine or the more recent pimavanserin, clozapine remains the treatment of choice for drug-induced psychosis in Parkinson’s disease.
Disclosure of InterestNone Declared
Differential diagnosis of psychosis and dissociative disorder: a case report
- E. Arroyo Sánchez, P. Setién Preciados
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S750
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Introduction
Psychosis and dissociative disorders are both described in the DSM-5 as different diagnostic categories. However, a high comorbidity of these diagnoses has been observed in different studies, perhaps due to the overlapping of symptoms between them.
ObjectivesA systematic review about overlapping symptoms in psychotic spectrum and dissociative disorders
MethodsPresentation of the case of a patient and review of the existing literature on the differential diagnosis between dissociative disorder and other psychotic spectrum disorders.
ResultsBoth similarities and differences have been found between both diagnoses. Patients with dissociative disorder experienced more dissociative and positive symptoms while those on the psychotic spectrum experienced more negative symptoms. The literature reflects that the two entities overlap on many of their diagnostic symptoms. On some occasions, more dissociation has been detected in patients diagnosed with the psychotic spectrum than those with a diagnosis of dissociative disorder.
ConclusionsDespite the fact of being different diagnostic entities, the literature does not reflect clear boundaries between psychosis spectrum symptoms and dissociative disorder.
Disclosure of InterestNone Declared
Psychotic denial of pregnancy: case report and narrative literature review.
- M. Martín Velasco, I. Romero Gerechter, C. Díaz Mayoral, E. Arroyo Sánchez, A. Sanz Giancola, P. Setién Preciados
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1129
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Introduction
Denial of pregnancy is the phenomenon where a woman fails to recognize or accept her pregnancy at >20 weeks gestational age. It associates with increased morbidity and mortality of mother and child, and can be classified as non-psychotic or psychotic. There is fewer medical literature regarding the latter, making it difficult to recognize, let alone to treat, since we do not have robust data regarding incidence nor approved interventions or treatment.
ObjectivesTo describe this unfamiliar entity in order to be able to perform a proper diagnosis and thus prevent possible negative outcomes.
MethodsWe present a case report alongside a narrative literature review on the topic.
ResultsWe report the case of a 39-year-old caucasian woman, foreign, undomiciled, with an advanced pregnancy, who was admitted to a Psychiatry in-patient unit due to psychotic symptoms such as mistrust and delusions. She showed scarce collaboration during assessment and did not give any plausible information about her identity. Her birthplace and prior medical records were therefore unknown. Apparently, she had no family nor social support network. Despite the obvious signs, she did not recognize being pregnant and showed great irritability when asked; her responses ranged from claiming she was suffering from a gastric tumor and making delusional attributions of symptoms clearly related to the pregnancy to partially acknowledging her state but refusing to answer any questions on the matter. Blood work showed no significant abnormalities and obstetric ultrasound revealed a low risk 35 weeks pregnancy.
With an estimated prevalence of 1:475 in general population, denial of pregnancy is not as rare as it may seem. The psychotic variant, however, is rather uncommon. Typically, women with psychotic pregnancy denial have prior history of major mental illness, most frequently schizophrenia, and suffer from extreme psychosocial vulnerability. They usually present previous or anticipated child custody loss, which hampers the process of developing antenatal attachment behaviours. Psychotic denial does not associate with concealing, since these women are mentally detached from the gestation and tend to create delusional explanations to their pregnancy symptoms. Not all of them show complete denial, some being able to acknowledge it, though mostly in an inconsistent way. These patients often fail to seek prenatal care or are noncompliant, they are at greater risk of drug exposure, and some are unable to recognize symptoms of labour, all of which increases the rate of negative outcomes for mother and baby, including neonaticide.
ConclusionsPsychotic denial is a rare diagnosis which should be properly assessed due to its clinical implications and the need to prevent potential negative outcomes for mother and baby.
Disclosure of InterestNone Declared
Mania induced after corticosteroid treatment: a case report
- E. Arroyo Sánchez, A. Sanz- Giancola, P. Setién Preciados, I. Romero Gerechter, M. Martín Velasco, C. Díaz Mayoral
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S697
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Introduction
Corticosteroids are drugs widely used in clinical practice for their anti-inflammatory and immunosuppressive properties. Despite their beneficial effects, a high association of these drugs with neuropsychiatric adverse effects such as psychosis, mania, depression, delirium or increased risk of suicide, among others, has been observed. We present the case of 54-year-old man who started treatment with hydroaltesone 20 mg/8h after undergoing surgery for a pituitary macroadenoma who began with maniform clinic.
ObjectivesTo know the prevalence, risk factors and treatment of mania as a side effect of corticosteroid drugs.
MethodsPresentation of the case and review of the available literature on the risk of developing mania after corticosteroid treatment.
ResultsSeveral studies confirm that the incidence of psychiatric adverse effects after the use of corticosteroids is around 6% if we refer to severe reactions; 28% moderate reactions; and 72% if we consider milder reactions. The direct relationship between these drugs and affective symptoms ranges in rates between 1-50% of cases, the most frequent being depression and mania. The risk of mania after treatment with corticosteroids is 4-5 times higher than if we compare it with a group of population not exposed to these drugs. There is a dose-response relationship, increasing the risk from a daily dose of 40 mg/day, with an average duration of symptoms of around 21 days. Female sex seems to be a risk factor in relation to the fact that diseases requiring this type of treatment are more common in this gender. As first-line treatment for mania secondary to corticosteroids, a decrease in treatment dose or its interruption, whenever possible, is proposed. Adjuvant treatment may be required, with atypical antipsychotics being the first choice.
ConclusionsCorticosteroid therapy has a direct dose-response relationship with the presence of psychiatric adverse effects such as mania. Dose and sex have been studied as possible adverse effects. Therefore, the pharmacological treatment of choice consists of a reduction in the dose of corticosteroids administered or withdrawal, if possible, and may be combined with an atypical antipsychotic such as olanzapine, quetiapine or risperidone. Re-evaluation is recommended until complete resolution of the clinical picture and then antipsychotic treatment can be progressively withdrawn.
Disclosure of InterestNone Declared
When nausea invades your life (Psychosomatic): a case report
- E. Arroyo Sánchez, P. Setién Preciados
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S768
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Introduction
Nausea is a very common symptom related to multiple physical illnesses. In the same way, nausea and other gastrointestinal symptoms are frequently associated with the symptomatology presented at the onset of anxiety or depression. These symptoms can significantly affect the patient’s functionality, reduce school or work attendance and lead to consultation with multiple medical specialties. Therefore, it is important that in addition to a good organic screening, psychiatric pathology should be considered in the differential diagnosis. We will present the case of a 22-year-old male with nausea as the main symptom referred to Psychiatry after having seen several specialists and having undergone multiple diagnostic tests without significant findings.
ObjectivesTo review the association of psychosomatic symptoms with anxiety disorders and/or depression, as well as their management.
MethodsPresentation of a case and review of the available literature on the presence of psychosomatic symptoms, specifically nausea, in patients with anxiety and/or depression.
ResultsIn patients in whom anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS), 48% reported gastrointestinal symptomatology during the previous year, of whom 12% reported nausea. It has been observed that anxiety had a higher risk for the presence of nausea (OR 3.42) than depression, although the latter also increased the risk of nausea (OR 1.47). The literature shows that interventions such as cognitive-behavioral therapy or pharmacological treatment with selective serotonin reuptake inhibitor (SSRI) drugs independently or in combination are strategies that have demonstrated therapeutic success.
ConclusionsThe multidimensional nature of symptomatology such as nausea and other types of psychosomatic symptoms forces us to take a broad view of the symptom. The association of gastrointestinal symptoms and pathologies such as anxiety and/or depression has been demonstrated, so that, after a correct organic screening, mental health professionals should be considered to evaluate the possible management of symptoms that can become so disabling in the life of these patients.
Disclosure of InterestNone Declared
Psychotic symptoms in eating disorders: a case report
- E. Arroyo Sánchez, P. Setién Preciados, A. Sanz- Giancola
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S848-S849
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Introduction
Psychotic symptoms and eating disorders can occur in the same person, sometimes at the same time. This comorbidity is not well studied despite the difficulties of management at both clinical and pharmacological levels that it may entail. We present the case of a 35-year.old female patient with anorexia nervosa with years of evolution, currently admitted to a center specializing in Eating Disorders, who comes to the emergency department with psychotic symptoms.
ObjectivesTo know the prevalence of comorbidity of psychotic symptoms in people with eating disorders, as well as possible risk factors, severity and management of them.
MethodsPresentation of a case and review of the available literature on the presence of symptoms of the psychotic sphere in persons diagnosed with eating disorders.
ResultsThe literature reflects data of a prevalence of 10-15% of patients with eating disorders presenting psychotic symptoms. The presence of psychotic symptoms is not directly related to a greater severity of the eating disorder. Some genetic associations have been found, as well as alterations at the physiological, cognitive and brain structure level that coincide in both pathologies. In some cases, an improvement in eating behavior has been observed when the psychotic symptomatology is resolved. In the case of patients with bulimia nervosa, a higher number of psychotic symptomatology has been observed, such as paranoid ideations, which some studies relate to a greater emotional capacity and histrionic expressiveness of this patient profile.
ConclusionsThe comorbidity of psychotic symptoms and eating disorders is relatively frequent and makes us face challenges in the diagnosis, as well as in the management of these patients. This comorbidity is especially important in patients with bulimia nervosa. Future research is necessary to know a more exact management of these pathologies.
Disclosure of InterestNone Declared