During the COVID19 pandemic numerous cases of neuropsychiatric complications were reported as a result of COVID19.

Presentation of a clinical case and literature review of new cases of neuropsychiatric complications after SARS-CoV2.

We present the case of a 43-year-old woman in follow-up for 15 years borderline personality disorder who was diagnosed with SARS-CoV2 pneumonia without signs of severity. Throughout the admission the patient, who had no history of epilepsy or other neurological affections, presented up to 5 generalized tonic-clonic seizures during 15 days.

In the ECG was evidenced intercritical epileptiform activity predominantly right frontotemporal. No analytical alterations were observed, neither in the imaging tests (cranial MRI and CT). Lumbar puncture was normal. During the admission, he presents an affective deterioration, with generalized impoverishment, decreased functional autonomy and hearing voices without structured delusional ideation. No previous psychotic history. Her previous treatment with Sertraline 100mg was suspended and valproic acid was added (1300 mg/day) which, being insufficient in the control of seizures, was necessary to boost with Levetiracetam (1000 mg/12h). Risperidone 3 mg and Diazepam 5 mg/8h were added to control psychotic symptoms. In the subsequent follow-up, previous antipsychotic treatment was gradually discontinued. The patient evolved favorably without new psychotic symptoms and clinical stability was observed with euthymia.

Taking care of these complications it is necessary to avoid misdiagnosing. It is essential to expand the study of this entities in the context of COVID19 in order to increase knowledge and to be able to carry out an adequate approach and follow-up.

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Space occupying lesions compromising frontal lobes usually may produce in the first place psychiatric symptoms such as progressive change of personality and/or symptoms suggestive of depressive episodes. Thus they can be misdiagnosed and mistreated.

A case report is presented as well as an updated review of frontal lobe tumor diagnosis and treatment literature.

We present the case of a 45 years-old male patient with no relevant medical history who arrives at the mental health center due to behavioral disorders, depressive mood, workplace absenteeism and personal hygiene neglect in the last 3 months.

Since the clinical picture was compatible with depressive disorder the patient was treated with psychotherapy and antidepressant drugs with no remission. Due to the treatment absence of response he attends emergency services where he is performed a craneal tomograpy (CT) where a right frontal lobe tumor (FLT) is observed.

In early stages FLT are sometimes presented as psychological mood or anxiety disorders without accompanying neurologic deficits. Thus, mental health professionals should be aware that psychological symptoms might be a presentation of organic disease of the brain and in some cases (e.g. middle-aged patients with affective symptoms with no previous mental health history) organic screening and hence brain imaging should be considered.

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Type 1 diabetes (T1D) incidence is increasing around the world, being the third chronic medical condition in childhood. It is characterized by pancreatic β-cell loss which leads to insulin deficiency. Treatment includes insulin medication and lifestyle changes. Youngsters with T1D are at a high risk of psychological comorbidity (depression, anxiety, eating disorders), and especially anxiety symptoms have been correlated with worse diabetes control.

Our purpose is to examine the impact of T1D in adolescence regarding a case report and literature review.

We present the case of a 14-year-old female with T1D onset and no psychiatric history. She is referred to our service three months after the T1D onset. Both her parents and the patient were anxious about the diagnostic implications and the treatment. The patient sometimes refused to follow insulin treatment and was angry and labile. Both family and individual assessment interviews were accomplished.

Regarding our assessment and after coordination with endocrine service (doctor and nurse) we diagnosed an [F43.23] Adjustment Disorder (acute, with mixed anxiety and depressed mood). Following recent evidence Acceptance and Commitment Therapy and Family Therapy were the election treatment with good outcomes. The patient was released after 3 months of follow-up.

T1D treatment entails lifestyle changes and self-control, which may be stressful and challenging for adolescents and their families, causing mental health problems. Since learning self-care and emotional coping strategies can improve both psychological well-being and glucose management, an interdisciplinary approach including psychological care, especially on the onset, can be crucial.

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Hyperammonemic encephalopathy is an unusual side-effect of the treatment with valproic acid. According to several sources, this side effect could be underdiagnosed and underreported.

We present the case of a 54-year-old patient institutionalized in a psychiatric hospital who was referred to a general hospital after an episode of delirium of unknown etiology. The patient had been diagnosed with Schizoaffective disorder 26 years prior to his admittance and had started treatment with valproic acid the previous month.

A case report is presented alongside a review of the relevant literature regarding valproate-induced hyperammonemic encephalopathy, its differential diagnosis and treatment.

During his hospital stay, the patient underwent a complete panel of tests including CT Scan, EEG, toxic panel and complete blood tests. In them the only altered parameter was hyperammonemia, therefore valproic acid was removed and was treated with lactulose and rifaximin to reduce ammonium levels.

Hyperammonemic encephalopathy in the context of the treatment with valproic acid is a side-effect which is more prevalent than what was thought in the past. Valproate could reduce ammonium elimination therefore increasing the levels of the molecule. It should be administered carefully in cases where the patient may be presenting with other causes of increased ammonium metabolism or decreased elimination. It is important to bear in mind this possible side-effect to increase patient’s safety.

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Resident physician’s working conditions are linked to poor health outcomes of professionals and patient’s safety. Previous studies suggest that residents in Spain have difficulties enjoying mandatory rest after on-call shifts.

This study aims at describing the working conditions: working hours and the absence of mandatory rest periods after a 24h on-call shift in residents of psychiatry in the region of Madrid.

A descriptive observational cross-sectional study was carried out through an anonymous survey adapted from the available literature.

Up to 24,1% of the surveyed residents could not enjoy mandatory resting periods after a 24 hour on-call shift and the mandatory weekly rest of at least 36 hours was not done in up to 17% of the cases with statistical significance (p <0.05). The average number of 24 hours on call shifts residents had to work per month was 5, which exceeds the maximum weekly hours allowed by law.

The findings reveal a violation of resident physician labor rights in relation to resting times after on-call shifts, weekly breaks and working hours. These phenomena pose a significant threat to resident physician’s health and patient safety.

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Lymphocytic colitis is an unusual side-effect of the treatment with SSRIs particularly sertraline. According to several sources, this side effect could be underdiagnosed and underreported.

We present the case of a 31-year-old female patient who presented watery non-bloody diarrhea for a month. The patient had been diagnosed with Persistent Depressive Disorder six years prior to the episode and was being treated with sertraline.

A case report is presented alongside a review of the relevant literature regarding Lymphocytic colitis, its differential diagnosis and treatment.

The case was coordinated between the out-patient psychiatry department and the patient’s Family Medicine specialist. The patient underwent a complete panel of tests including blood and stool test, and colonoscopy. The biopsy showed results compatible with the aforementioned diagnosis. Since the only pharmacological treatment which could cause or trigger lymphocytic colitis was sertraline, it was removed and treatment with oral budesonide was started with good results.

Lymphocytic colitis in the context of the treatment with SSRIs, particularly sertraline, is a side-effect which is more prevalent than what was thought in the past. A close coordination between psychiatrists and GP is of vital importance for the adequate treatment of mental health problems and treatment’s side-effects. It is important to bear in mind this possible side-effect to increase patient’s safety.

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Oxcarbazepine (OXC) is an antiepileptic drug used as a mood stabilizer in patients diagnosed with bipolar disorder (BD). OXC has been reported as a source of hyponatremia in its use in both epilepsy and BD.

We present the case of a 53 year-old male patient diagnosed with Schizoaffective disorder, bipolar type who developed hyponatremia during his treatment with OXC.

The patient’s treatment was desvelafaxine 100 mg, Paliperidone depot 150 mg, Oxcarbazepine 600 mg which he had maintained for at least one year. He began to manifest headache, asthenia and mild confusion gradually, with morning predominance, without being clearly suggestive of an acute worsening.

In control analysis, the existence of sodium leveles of 127 and low osmolarity was observed. Therefore it was decided to suspend furosemide, close monitoring of water intake in order to rule out primary polydipsia and extra salt was introduced into the diet. Given the persistence of the symptoms, laboratory abnormalities and ruled out the existence of primary polydipsia, it was decided to suspend treatment with oxcarbazepine. After the discontinuation of the aforementioned drug the analytical findings went back to normal ranges and the symptoms disappeared.

Carrying out control tests in patients with psychiatric pathology and multiple psychiatric treatments is essential to be able to rule out analytical alterations which could be asymptomatic or with nonspecific symptoms that could be attributed to the underlying pathology. The easy reversal of symptoms encourages us to emphasize the study and differential diagnosis of each case.

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Othello syndrome (OS) is a psychiatric condition consisting of delusional jealousy, and irritability. It is often associated with psychiatric or neurological disorders. The most common are delusional disorder and dementia.

The purpose of this poster is to examine the phenomenon of OS and its etiopathogenesis throughout a case report.

We present the case of a 78-year-old male patient who was treated in our department due to delusional jealousy and depressive symptoms. The patient has a medical history of cardiac events in the past, being stable at the current moment. We performed a detailed psychiatric and physical history paying special attention to personality traits in the past. The patient was administered Mini Mental State Examination and CamCog (subscale of Camdex).

According to him and his family our patient had neither episodes of jealousy nor affective disorders. His results were: 18 in MMSE and 57 in CamCog. Both compatible with a dementia course.

Attending our results we inferred that the OS belongs to a dementia clinical picture instead of a psychotic disorder. Therefore we decided to treat the patient with neuroleptics, with partial improvement, and to start cognitive stimulation treatment in a day centre and a short term psychological family intervention to help the family to understand and cope with the course of dementia. Thus, clinicians should keep in mind the possible organic origin of OS, especially in elderly persons, to develop an appropriate individual and familiar case approach.

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Bilateral cingulotomy and anterior capsulotomy are two neurosurgical procedures which are reserved as a last resort for cases of severe OCD in Spain; these procedures are not approved in cases of AN.

We present the case of a 29-year-old female patient who was diagnosed with anorexia nervosa (AN) when she was 15 (2006). Due to the severity of the case the patient needed to be hospitalized for many months due to excessive weight loss. She was also treated in an out-patient department and started several intensive psychotherapeutic procedures. In 2015 the patient’s family took her to a private clinic where she was diagnosed with Obsessive-compulsive disorder (OCD) and had a bilateral cingulotomy and anterior capsulotomy.

A case report where the ethical implications of the case are weighed alongside a review of the relevant literature regarding neurosurgical treatments of AN.

There were no significant short or long term improvements in terms of Body Mass Index or reduction of symptoms, the patient’s cognitive functions showed a decline in neuropsychological tests. Contrary to that the patient has needed hospitalizations for at least 9 months per year since the surgery and has needed admission in the Intensive Care Unit at least 3 times because of extreme malnutrition. Due to her need for chronic hospitalization was institutionalized in a long-stay psychiatric hospital.

Psychosurgery is a controversial therapy which has limited evidence in cases of AN. Our case shows the way in which neurosurgical procedures can do more harm than good and worsen the prognosis of patients.

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Early stages of autoimmune encefalitis (AE) often present cognitive and neuropsychiatric symptoms such as personality change, irritability, axiety, depression, behavioral disorders, hallucinations, disorientation, sleep-wake cycle reversals, …). Thus often these cases are first treated as psychiatric disorders.

A literature review throughout a case report presentation.

We present the case of a 25-year old female with a medical history of iron-deficiency anemia who arrives at the emergency service. She presents the following one week of evolution clinical picture: complex auditive hallucinations, behavioral disturbances, sleep disorder and short term memory impairment. Neurological examination, LP and craneal CT are all normal. CSF analysis has no abnormalities. Thus she entered the psychiatric ward. There she was treated with neuroleptics with no improvement of symptoms presenting a severe psychomotor agitation and language impairment. After neurology interconsultation AE is suspected.

She was performed an EEG (left temporal epileptiform activity), CSF (inflammatory pattern), MRI (bilateral temporal lobe hyperintensity). Suspecting limbic encephalitis the presence of anti-NMDAR antibodies was tested , which turned out to be positive. First she was treated with corticotherapy with mild results. Then she was treated with intravenous immunoglobulin improving significantly.

Anti-NMDAR encephalitis is usually a multistage illness. Early in the course of disease psychiatric manifestations are not rare. Therefore the proper diagnosis and approach of AE may requiere a highly organized assessment, starting with detailed history and physical examination and an appropriate testing to exclude other possible relevant pathologies.

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Published evidence describes the appearance of manic episodes in patients who suffer localized brain lesions with no prior psychiatric history.

A case report is presented alongside a review of the relevant literature regarding the relationship between Bipolar disorder and strokes.

We present the case of a 54-year-old man who, after suffering a pontine hemorrhage, developed a depressive mood for which he was treated with Sertraline 50 mg. The following month the patient developed hypomanic mood, disinhibition, insomnia and megalomaniac ideation. He was treated with Risperidone 2 mg and the antidepressant was withdrawn. The symptomology disappeared shortly after but a few months later he developed a major depressive disorder (inhibition, ideas of ruin and guilt, low mood, decreased intake and daily activities…). He was treated again with antidepressants (Citalopram 30mg) and lithium was introduced in the absence of a total response.

Mania secondary to brain lesions has been observed in multiple studies, where an association is made mainly with lesions at the frontal, temporal, subcortical limbic brain areas and in lesions causing hypofunctionality on the right side. Most of the cases described occurred in male patients with no prior psychiatric record and with associated vascular risk.

It is important to carry out an exhaustive medical history to be able to identify the cases of secondary mania so as not to ignore the underlying neurological condition in the approach.

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We present the case of an 82-year-old patient who was treated by our liaison psychiatry unit after a suicide attempt through prescription-drug overdose. The patient had been diagnosed with Parkinson’s disease (PD) ten years prior to his admittance and was being treated with carbidopa/levodopa and non-ergot dopamine agonists.

Impulse control disorders and depression are the most prevalent neuropsychiatric manifestation of PD. According to several sources, this symptomatology is underdiagnosed and undertreated, causing helplessness and distress to patients and their caregivers. Likewise, the accumulated evidence suggests that certain drugs can contribute to the appearance of the aforementioned symptoms.

A case report is presented alongside a review of the relevant literature regarding the neuropsychiatric manifestations in the context of PD and the diagnosis and treatment of these symptoms.

During his treatment, ropinirole was removed while quetiapine was progressively administered (up to 150mg/day). Carbidopa/levodopa regime was increased causing visual hallucinations and delusional jealousy. A careful balance between antiparkinsonian and antipsychotic medication needed to be achieved before discharge.

Neuropsychiatric manifestations in the context of PD are more prevalent than what was thought in the past. Certain medications, particularly non-ergot dopamine agonists could potentially contribute to the onset of these symptoms. Moreover, these manifestations can be underdiagnosed due to the stigma or social burden imposed upon family and / or caregivers. It is important that recent advances in the understanding of non-motor symptomatology of PD could permeate clinical practice to achieve an adequate identification and treatment of these symptoms.

Multiple neuroendocrine disorders can present themselves through diverse psychiatric symptoms. In the case of hypothyroidism it can manifest itself through mood disorders that will require a comprehensive differential diagnosis.

We present a case report and a review of the relevant literature about the relation between mood disorders and hypothyroidism.

We present the case of a 56-year-old man with no prior psychiatric record who concurring with a grieving process, developed a depressed mood, fatigue, decreased daily activity, and home isolation for months of evolution. He was diagnosed of hypothyroidism and treated with levotiroxine. It was necessary to boost hormonal treatment with antidepressant drugs due to the persistence of the symptoms after the resolution of the hormonal deficit.

The relationship of depression in patients with overt hypothyroidism is widely recognized. Common alterations to both disorders that could make their diagnosis difficult have been observed: existence of psychomotor slowing, attentional and executive disturbance, anxiety, asthenia, weight gain, depressed mood or bradypsychia among others. In the case of subclinical hypothyroidism, certain neuropsychiatric disorders have been linked without having conclusive evidence.

An early screening of thyroid function at the onset of psychiatric symptoms in individuals without prior psychiatric record is essential in the provision of adequate treatment. Clinical improvement has been seen with hormone replacement therapy alone. However, in up to 10% of patients it becomes insufficient, being necessary to complete it with antidepressant drugs for the complete resolution of the condition.

We present the case of a 34-year-old female patient with no prior psychiatric record who was treated in our outpatient department due to persecutory delusions of recent onset. The patient had a history of refractory temporal epilepsy since adolescence and underwent a temporal lobe resection 4 month prior to the appearance of her symptoms.

Temporal lobe resection is a well-established technique to treat refractory temporal lobe epilepsy in which psychotic symptoms are an infrequent complication; the most frequent being cognitive sequelae, visual field defects and depression. According to several sources, this symptomatology may be underdiagnosed and undereportend and there have been a number of case reports and series of cases which describe the aforementioned entity.

A case report is presented alongside a review of the relevant literature regarding cases of secondary psychosis after brain surgery.

During her treatment we administered olanzapine up to doses of 7.5mg per day because of the risk of reducing the convulsive threshold. We observed a marked improvement and the disappearance of the delusions. The dose of olanzapine has been maintained for a year with no important side-effects and without a relapse in symptoms.

Psychotic symptoms as a complication of temporal lobe resection may be more frequent than what was thought in the past. It is important to study this phenomenon more in-depth because the symptoms may remain undetected and present worse outcomes given that there are effective treatments which could ameliorate the condition.

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The diagnosis of psychotic depression has its origin in the millennial term of Melancholia.

A case of psychotic depression is presented to highlight its psychopathological characteristics and to make a historical overview of its origins.

We present the case of a 40-year-old male patient with a history of dysthymic mood who developed a major depressive mood, loss of self-care, decreased apetite, insomnia and repetitive speech with ideas of guilt and ruin of psychotic characteristics.

Melancholy is a term used since the time of Hippocrates, who spoke of it as the state that appears after the prolongation of an intense period of sadness. It was extolled and self-attributed by authors such as Montaigne and branded as selfish by authors such as Cicero in the days when reason and madness formed a whole and distinguishing their limits was a complex task. Esquirol changed his name to Lypemania to get rid of its poetic nuances and framed it within partial insanity. Both he and the rest of the psychopathologists of the XIX century and early XX considered the melancholic as the great tormented, the one who despises himself and blames all ills, who suffers from apathy and above all presents a strong pain of the soul.

Later it was Falret and Baillarger who unified melancholy with mania in what they nominate as circular and dual-form insanity. This gave way to the Krapelinian entity of manic-depressive insanity, the direct predecessor of the current Bipolar Disorder, which includes the diagnosis of our clinical case.

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We present the case of a 19-year-old female patient treated in our hospital due to an outburst of persistent vomiting. The patient had a diagnosis of Cyclic Vomiting Syndrome (CVS), a year before the diagnosis the patient had been labeled as a somatizer and admitted into the department of psychiatry. Given her psychiatric record and the fact that CVS is a rare diagnosis we were consulted on arrival.

CVS is an infrequent disorder of unknown etiology which shares similarities with migraine headaches. It is characterized by episodes of vomiting followed by periods of remission without active symptomatology with no organic pathology to account for the symptoms. Epistemic injustice (EI) is defined by Miranda Fricker as “a damage done to someone in their capacity as a knower”. She defined two forms of EI: testimonial and hermeneutical injustice.

A case report is presented alongside a review of the relevant literature regarding CVS and epistemic injustice.

On arrival at the emergency department she tried explaining her condition, but her testimony was disregarded on the basis of her psychiatric record. It was only after the on-call psychiatrist explained the condition when she received the appropriate abortive treatment, after which she was admitted to the internal medicine department where she was followed by the liaison psychiatrist.

CVS is a disabling disease still unknown to most clinicians in spite of the increasing quality evidence about its identification and treatment. The case highlight how cases of newly identified disease can suffer from testimonial and hermeneutical injustice.