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22 Cordoba Naming Test Performance and Acculturation in a Geriatric Population
- Isabel C.D. Muñoz, Krissy E. Smith, Santiago I. Espinoza, Diana M. R. Maqueda, Adriana C. Cuello, Ana Paula Pena, Carolina Garza, Raymundo Cervantes, Jill Razani, Tara L. Victor, David J. Hardy, Alberto L. Fernandez, Natalia Lozano Acosta, Daniel W. Lopez-Hernandez
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 335-336
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Objective:
A commonly used confrontation naming task used in the United States is The Boston Naming Test (BNT). Performance differences has been found in Caucasian and ethnic minorities on the BNT. The Cordoba Naming Test (CNT) is a 30-item confrontation naming task developed in Argentina. Past research has shown acculturation levels can influence cognitive performance. Furthermore, one study evaluated geriatric gender differences on CNT performance in Spanish. Researchers reported that older male participants outperformed female participants on the CNT. To our knowledge, researchers have not evaluated ethnic differences on the CNT using a geriatric sample. The purpose of the present study was to examined CNT performance and acculturation in a Latinx and Caucasian geriatric sample. It was predicted the Caucasian group would outperform the Latinx group on the CNT. Moreover, the Caucasian group would report higher acculturation levels on the Abbreviated Multidimensional Acculturation Scale (AMAS) compared to the Latinx group.
Participants and Methods:The sample consisted of 9 Latinx and 11 Caucasian participants with a mean age of 66.80 (SD =6.10), with an average of 14.30 (SD = 2.00) years of education. All participants were neurologically and psychologically healthy and completed the CNT and the AMAS in English. Acculturation was measured via the AMAS English subscales (i.e., English Language, United States. Identity, United States, Competency). A series of ANCOVAs, controlling for years of education completed and gender, was used to evaluate CNT performance and acculturation.
Results:The ethnic groups were not well demographically matched (i.e., years of education and gender).We found that the Caucasian group outperformed the Latinx group on CNT performance p = .012, ηp 2 = .34. Furthermore, the Caucasian group reported higher acculturation levels (i.e., English Language, United States, Identity, United States, Competency) compared to the Latinx group p’s < .05, ηps2 = .42-.64.
Conclusions:To our knowledge, this is the first study to evaluate CNT performance between ethnic groups with a geriatric sample. As expected the Caucasian group outperformed the Latinx group on the CNT. Also, as expected the Caucasian group reported higher English acculturation levels compared to the Latinx group. Our findings are consistent with past studies showing ethnic differences on confrontational naming performance (i.e., The Boston Naming Test), favoring Caucasians. A possible explanation for group differences could have been linguistic factors (e.g., speaking multiple languages) in our Latinx group. Therefore, since our Latinx group reported lower levels of English Language, United States identity, and United States competency the Latinx group assimilation towards United States culture might of influence their CNT performance. Future studies with different ethnic groups (e.g., African-Americans) and a larger sample size should examine if ethnic differences continue to cross-validate in a geriatric sample.
30 Analyzing Spanish Speakers Cordoba Naming Test Performance
- Raymundo Cervantes, Isabel D.C. Munoz, Estefania J. Aguirre, Natalia Lozano Acosta, Mariam Gomez, Adriana C. Cuello, Krissy E. Smith, Diana I. Palacios Mata, Krithika Sivaramakrishnan, Yvette De Jesus, Santiago I. Espinoza, Diana M. R. Maqueda, David J. Hardy, Tara L. Victor, Alberto L. Fernandez, Daniel W. Lopez-Hernandez
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 443-444
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Objective:
A 30-item confrontation naming test was developed in Argentina for Spanish speakers, The Cordoba Naming Test (CNT). The Boston Naming Test is an established confrontation naming task in the United States. Researchers have used the Boston Naming Test to identify individuals with different clinical pathologies (e.g., Alzheimer’s disease). The current literature on how Spanish speakers across various countries perform on confrontational naming tasks is limited. To our knowledge, one study investigated CNT performance across three Spanish-speaking countries (i.e., Argentina, Mexico, and Guatemala). Investigators found that the Guatemalan group underperformed on the CNT compared to the Argentine and Mexican groups. The purpose of this study was to extend the current literature and investigate CNT performance across five Spanish-speaking countries (i.e., Argentina, Mexico, Guatemala, Colombia, United States). We predicted that the Argentine group would outperform the other Spanish-speaking countries.
Participants and Methods:The present study sample consisted of 502 neurologically and psychologically healthy participants with a mean age of 29.06 (SD = 13.41) with 14.75 years of education completed (SD = 3.01). Participants were divided into five different groups based on their country of birth and current country residency (i.e., United States, Mexico, Guatemala, Argentina, & Colombia). All participants consented to voluntary participation and completed the CNT and a comprehensive background questionnaire in Spanish. The CNT consisted of 30 black and white line drawings, ranging from easy to hard in difficulty. An ANCOVA, controlling for gender, education, and age, was used to evaluate CNT performance between the five Spanish-speaking country groups. Meanwhile, a Bonferroni post-hoc test was utilized to evaluate the significant differences between Spanish-speaking groups. We used a threshold of p < .05 for statistical significance.
Results:Results revealed significant group differences between the five Spanish speaking groups on the CNT, p = .000, np2 = .48. Bonferroni post-hoc test revealed that the United States group significantly underperformed on the CNT compared to all the Spanish-speaking groups. Next, we found the Guatemalan group underperformed on the CNT compared to the Argentinian, Mexican, and Colombian groups. Additionally, we found the Argentinian group outperformed the Mexican, Guatemalan, and United States groups on the CNT. No significant differences were found between the Argentinian group and Colombian group or the Mexican group and Colombian group on the CNT.
Conclusions:As predicted, the Argentinian group outperformed all the Spanish-speaking groups on the CNT except the Colombian group. Additionally, we found that the United States group underperformed on the CNT compared to all the Spanish-speaking groups. A possible explanation is that Spanish is not the official language in the United States compared to the rest of the Spanish-speaking groups. Meanwhile, a possible reason why the Argentinian and Colombian groups demonstrated better CNT performances might have been that it was less culturally sensitive than the United States, Mexican, and Guatemalan groups. Further analysis is needed with bigger sample sizes across other Spanish-speaking countries (e.g., Costa Rica, Chile) to evaluate what variables, if any, are influencing CNT performance.
Using rational surfaces to improve pellet fuelling in stellarators
- N. Panadero, K. J. McCarthy, B. Pégourié, R. Carrasco, I. García-Cortés, R. García, J. Hernández-Sánchez, F. Köchl, J. Martínez-Fernández, R. Sakamoto, the TJ-II team
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- Journal:
- Journal of Plasma Physics / Volume 89 / Issue 6 / December 2023
- Published online by Cambridge University Press:
- 16 November 2023, 955890601
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Pellet injection is currently the primary candidate for achieving efficient plasma fuelling, one of the key issues for steady-state operation in large fusion devices. In this paper, pellet injection experiments are performed for several magnetic configurations of the TJ-II stellarator. The aim of this study is to increase the understanding of the role played by rational surfaces in plasmoid drift and deposition profiles in stellarators. The analysis of experimentally observed plasmoid drifts is supported by simulations of such cases made with the HPI2 code. Plasmoid drift is found to be significantly reduced, as in tokamaks, in the vicinity of rational surfaces. This is attributed to the fact that plasmoid external charge reconnection lengths are shorter near rational surfaces, resulting in a more effective damping of the plasmoid drift. Although the effect of plasmoid external currents on the drift is expected to be negligible in stellarators, compared with those caused by plasmoid internal currents, the effect observed in TJ-II is clearly measurable. In addition, simulations show that enhanced drift reductions near rational surfaces lead to significantly different deposition profiles for the magnetic configurations included in this study. This implies that it should be possible to select the magnetic configurations to obtain more efficient pellet fuelling.
Brief psychotic episode in an adult without medical antecedents after suffering the indirect consequences of the Russian-Ukrainian war
- R. G. Troyano, M. Fariña Francia, E. Marimon Muñoz, I. Fernandez Marquez, E. Miranda Ruiz, M. Arroyo Ucar, J. Ramirez Gonzalez, S. Ferreiro Gonzalez, C. Hidalgo, A. Quispe
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S911
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Introduction
Almost nine months after the start of the war between Russia and Ukraine, millions of people have been affected physically, economically and mainly mentally. Those who have stayed in their homeland, and the ones that have chosen to emigrate to a safer place.
ObjectivesThe objective of this article is to assess the importance of social stressors in the onset of a brief psychotic episode, even in the absence of substance abuse or previous illnesses.
MethodsThe case of a 45-year-old woman is described, known by the Pediatric Emergency Service, for being the tutor of a patient who suffered from anxiety attacks, having emigrated without her parents from Ukraine together with her 5 brothers. The psychotic episode begins when our patient gets notified that she must abandon the custody of the girl, because she will have to go to Turkey with her legal guardians. The family explains the behavioral changes that the patient made and how the clinical picture worsened.
ResultsShe was admitted at the Hospital’s Psychiatry Service and antipsychotics treatment started. After 5 days, the episode had completely been solved.
ConclusionsIn conclusion, we highlight the importance of social problems in the development of a psychiatric pathology and the necessary elements to prevent it: family support network, fast and efficient care services and availability of hospital and pharmaceutical resources.
Disclosure of InterestNone Declared
Acute psychosis following corticosteroid administration for COVID-19 and Respiratory Syncytial Virus infection: A case study
- E. Miranda Ruiz, E. Marimon Muñoz, J. Ramirez Gonzalez, M. Fariña, R. G. Troyano, M. I. Arroyo Ucar, S. Ferreiro, I. Fernandez Marquez, C. Hidalgo, A. Quispe, L. Delgado
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S790
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Introduction
Steroids are a necessary treatment for hypoxic respiratory failure; however there are many side effects that should be taken into account. A 44- year-old-woman with asthma and no past psychiatric history was admitted due to COVID-19 pneumonia and Respiratory syncytial virus (RSV) infection, presenting hypoxic respiratory failure. After two days of intravenous methylprednisolone administration, the patient presented acute psychosis and agitation.
It has been previously described that steroid use can cause effects such as mania, anxiety, agitation, delirium and psychosis amongst other. However they are a necessary treatment in respiratory illnesses and are sometimes unavoidable.
ObjectivesThe aim was to examine the appropriate medical response to steroid induced psychosis in patients with acute hypoxic failure.
MethodsA bibliographical review was done in PubMed database searching recent cases of steroid induced psychosis using the words (“Steroid”, “Psychosis” and “COVID-19”).
ResultsAccording to literature, it has been shown that partial or complete reduction of steroid use and/or use of psychotropic has been successfully used to treat steroid induced psychosis. Following the research it was decided to reduce intravenous methylprednisolone dose from 20mg/ 8h to 20mg/12h and start oral haloperidol 5mg/8h the first 24h and reducing the dose progressively as the patient recovered. After the first 24 hours the patient presented adequate response to steroids as well as partial response to antipsychotic treatment; presenting no further agitation, absence of hallucinations and partial persistence of the persecutory delusion. A couple of days later there was complete remission of the psychotic symptoms and the patient was on the way to recovery from COVID-19 and RSV.
ConclusionsThere is evidence that suggests that medications such as steroids used to treat COVID-19 and other respiratory illnesses can lead to psychotic episodes. It is very important to pay attention to possible side effects when treating with steroids and evaluate the patient history as well as suggest having a follow up visit after the hospital discharge.
Disclosure of InterestNone Declared
Acute mutism in a young female. A case report of a 20-year-old female who presents a 3-month mutism
- A. Gonzalez-Mota, A. Gonzalez-Gil, C. Martin-Gomez, J. A. Benito-Sanchez, I. M. Peso-Navarro, L. Fernandez-Alonso
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S177-S178
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Introduction
A 20-year-old female presents with a progressive 3-month mutism, hyporexia (20kg weight loss), abulia, anhedonia, apathy, social isolation,seeking company of her parents even at night, bradypsychia, sialorrhea, psychomotor slowdown and hypomimia. She is hospitalized in the Psychiatric Brief Hospitalization Unit (PBHU).Her parents relate the beginning of this symptomatology to a breakup and gender violence,which the patient confirms during the interview by eye/cephalic movements and single words jotted down.
ObjectivesThe objective of this study is to describe the evolution of the patient during her hospitalization in the PBHU of Salamanca and to look into the available bibliography about mutism related to stress and sialorrhea.
MethodsWe carried out a follow-up of the hospitalization of the patient and a structured search in PubMed with the keywords “mutism”,“sialorrhea” and “stress” in the last 10 years in English,Spanish and French.
ResultsFew or no articles where found.Therefore, the articles about mutism and stress were analyzed, which focused mostly in selective mutism. Regarding fear,the response to cope with the threat(fight, flight, freeze) is mediated by the autonomic system. The “Polyvagal Theory” speaks about the vagus nerve participating in emotion regulation (social communication and mobilization). Dissociation, in this context,has adaptive and defensive purposes and its threshold can be reduced by repeated stress situations.Long-term alteration of the autonomic nervous system has been described in selective mutism.This malfunction can be related to an elevated production of saliva due to the activation of the parasympathetic in the salivary glands, causing sialorrhea in our patient.
The patient began treatment with sertraline 100mg and risperidone 2mg with the aim of its antidepressive and major tranquilizer effects, she also began individual and family psychotherapy, we assured her sleep and intakes and she began to progressively recover her speech and mobility,identifying a possible trigger for the symptomatology: a physical beating of gender violence after her breakup.
ConclusionsDissociation and “freeze” response can be a maladaptative mechanism to fear.The malfunction of the autonomic nervous system can explain the disconnection,poor gaze,low facial and body expression and inability to speak.
Disclosure of InterestNone Declared
Joint treatment of an acute manic episode and a multiple sclerosis debut: A case study
- M. Fariña Francia, E. Marimon Muñoz, E. Miranda Ruiz, I. Fernandez Marquez, R. G. Troyano, J. Ramirez Gonzalez, S. Ferreiro Gonzalez, C. Hidalgo Vazquez, A. Quispe Sulca, M. I. Arroyo Ucar
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S570-S571
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Introduction
Multiple Sclerosis (MS) is an autoimmune inflammatory disease that affects 1 in 1000 people. Given the association of MS to many affective disorders and specifically with Bipolar Disorder (BD), it is possible that a manic episode and an acute episode of MS may appear together. In these cases, it is difficult to decide whether it is necessary to start a corticosteroid regimen as treatment for the acute episode of MS, since it may worsen manic symptoms.
ObjectivesThe aim is to carry out a review of the existing information in relation to the comorbidity prevalence of MS and TB as well as the joint treatment of both illnesses, and to expose the details of a clinical case, regarding the treatment that was used in the acute psychiatry unit.
MethodsFirst, a search was done in PubMed database reviewing recent cases of steroid induced psychosis using the words (Multiple Sclerosis) AND (Bipolar Disorder). Subsequently, we describe the case of a 41-year-old patient who was admitted to the acute care unit from the emergency department presenting manic symptoms (megalomania, sensation of increased capacities and ideas of mystical content) associated to episodes of muscle weakness and gait disturbances. A screening Magnetic Resonance was performed in which lesions with inflammatory-demyelinating characteristics were detected, and was therefore catalogued as MS debut.
ResultsAfter carrying out a bibliographical review, we can conclude that studies recommend the inclusion of MS within the differential diagnosis of a first manic episode (1), performing neurological examinations, complete anamnesis and imaging tests, given that there is a high prevalence ratio of the comorbidity (2.95%) (2). It has been described that the use of lithium has a calming and neuroprotective agent that may be useful (3).
ConclusionsWe consider it of interest to describe the therapeutic approach to the case. After the introduction of Aripiprazole and Lithium, a short regimen of methylprednisolone in high doses was administered to treat the MS episode. When the treatment started, the patient presented a progressive improvement of the manic episode and motor symptoms. We observed that corticosteroid therapy did not worsen the manic symptoms or the patient’s evolution in this case. We intend to contribute by providing information on the joint management of these pathologies and we consider that it is necessary to continue studying this matter to be able to manage these cases in the most appropriate way.
Disclosure of InterestNone Declared
Psychiatric comorbidity profiles among suicidal attempters: A cohort study
- Y. Sanchez-Carro, M. Diaz-Marsa, V. Fernandez-Rodrigues, W. Ayad-Ahmed, A. Pemau, I. Perez-Diaz, A. Galvez-Merlin, P. de la Higuera-Gonzalez, V. Perez-Sola, P. Saiz, I. Grande, A. Cebria, J. Andreo-Jover, P. Lopez-Peña, M. Ruiz-Veguilla, A. de la Torre-Luque
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S318-S319
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Introduction
More than 700,000 people die by suicide in 2019 globally (World Health Organitation 2021). Mental health problems constitute a risk factor for suicidal behavior and death by suicide (Hoertel et al. Mol Psychiatry 2015; 20 718–726). Different mental disorders have been related to different forms of suicidal ideation and behavior (Conejero et al. Curr Psychiatry Rep 2018; 20, 33) (Quevedo et al. Compr Psychiatry 2020; 102 152194). However, little is known on comorbidity profiles among suicide attempters.
ObjectivesThe aim of our work was to identify the psychiatric comorbidity profiles of individuals who were admitted a hospital emergency department due to a suicide attempt. Moreover, it intended to know their clinical characteristics according to comorbidity profile.
MethodsA sample of 683 attempters (71.30% female; M age= 40.85, SD= 15.48) from the SURVIVE study was used. Patients were assessed within the 15 days after emergency department admission. Sociodemographic (i.e., sex, age, marital status and employment status) and clinical data were collected. The International Neuropsychiatric Interview (MINI) was used to assess DSM-V Axis 1 mental health diagnoses and the Columbia Suicide Rating Scale (C-SSRS) to assess suicidal ideation and behavior. The Acquired Capacity for Suicide-Fear of Death Scale (ACSS-FAD), the Patient Health Questionnaire (PHQ-9) to assess the frequency of depressive symptoms during the past 2 weeks, and the General Anxiety Disorder-7 (GAD-7) scale to assess symptoms of worry and anxiety were also conducted. For the identification of comorbidity profiles, latent class analysis framework was followed considering diagnosis to each individual disorder as clustering variables. On the other hand, binary logistic regression was used to study the relationship between comorbidity profile membership and clinical factors.
ResultsTwo classes were found (Class I= mild symptomatology class, mainly featured by emotional disorder endorsement; and Class II= high comorbidity class, featured by a wide amount of endorsed diagnoses) (see figure 1). Individuals from the High comorbidity class were more likely to be female (OR= 0.98, p<.05), younger in age (OR= 0.52, p< .01), with more depressive symptoms (OR=1.09, p<.001) and have greater impulsivity (OR= 1.01, p<.05).
Image:
ConclusionsWe found two profiles of people with suicidal behavior based on the presence of mental disorders. Each of the suicidal subtypes had different associated risk factors. They also had a different profile of suicidal behavior.
Disclosure of InterestNone Declared
The therapeutic potential of psilocybin in depression resistant to psychotropic drugs
- J. Ramírez González, I. Fernández Márquez, S. Ferreiro González, E. M. Ruíz
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S834
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Introduction
The use of hallucinogens has accompanied the human being throughout history. In the 1970s, studies focused on the therapeutic potential of hallucinogens were blocked due to their misuse in the young population. At present, psilocybin is re-emerging as the center of attention due to its possible therapeutic potential in different psychiatric pathologies such as depression, anxiety or substance use.
ObjectivesThe main objective of this work has been to review recent studies on the therapeutic potential of psilocybin in drug-resistant depressive disorder.
MethodsFor the search for articles, the search strategy “psilocybin AND depression” was established in PUBMED. Regarding the inclusion criteria, it was established that they were recent articles, in Spanish or English and that the full text was freely accessible. On the other hand, those articles whose studies did not focus on humans and resistant depressive disorder were excluded. A total of 19 articles were obtained to review.
ResultsFocusing on Drug-Resistant Depressive Disorder, multiple studies have agreed that the administration of one or two microdoses (10-25mg) of psilocybin accompanied by psychotherapy improves the clinical picture for at least 6 months. These results make us feel optimistic in the search for new treatments in the field of mental health.
ConclusionsPsilocybin microdoses associated with psychotherapy improves depressive symptoms in a patient resistant to common antidepressants.
The psilocybin response in terms of improvement of the depressive symptoms persists after 6 months of evolution.
One or, in some two cases, two microdoses of psilocybin (10-25mg) are enough to obtain statistically significant results in the improvement of the depressive symptoms.
Disclosure of InterestNone Declared
I don’t know where I’m going or where I come from. Self-disorders in schizophrenia.
- M. D. C. Vallecillo Adame, L. Rodríguez Andrés, C. de Andrés Lobo, T. Jimenez Aparicio, M. Queipo de Llano de la Viuda, G. Guerra Valera, A. A. Gonzaga Ramirez, M. Fernández Lozano, M. J. Mateos Sexmero, N. Navarro Barriga, B. Rodríguez Rodríguez, M. P. Pando Fernández, M. Calvo Valcárcel, P. Martínez Gimeno, M. A. Andreo Vidal, I. D. L. M. Santos Carrasco
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1069-S1070
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Introduction
In the early stages of schizophrenia the person experiences feelings of strangeness about themselves, difficulty in making sense of things and difficulty in interacting with their environment. Based on this, self-disorder assessment instruments have been developed and empirical studies have been conducted to assess people at risk of developing a schizophrenia spectrum disorder. These studies show that self-disorders are found in pre-psychotic stages and that their manifestation can predict the transition to schizophrenia spectrum disorders.
ObjectivesWe present the case of a patient with multiple diagnoses and mainly dissociative symptoms who, after years of evolution, was diagnosed with schizophrenia.
MethodsBibliographic review including the latest articles in Pubmed about self-disorders and schizophrenia.
ResultsWe present the clinical case of a 51-year-old woman with a long history of follow-up in mental health consultations and with multiple hospital admissions to the psychiatric unit, with several diagnoses including: dissociative disorder, histrionic personality disorder, adaptive disorder unspecified psychotic disorder and, finally, schizophrenia. The patient during the first hospital admissions showed a clinical picture of intense anxiety, disorientation and claiming to be a different person. The patient related these episodes to stressors she had experienced, and they improved markedly after a short period of hospital admission. Later, psychotic symptoms appeared in the form of auditory and visual hallucinations and delusional ideation, mainly of harm, so that after several years of follow-up and study in mental health consultations and in the psychiatric day hospital, she was diagnosed with schizophrenia and treatment with antipsychotics was introduced, with a marked clinical improvement being observed.
ConclusionsIt is important to take into account this type of symptoms (self-disorders), as they allow the identification of individuals in the early stages of the disorder and create the opportunity for early therapeutic interventions.
Disclosure of InterestNone Declared
Impact of COVID-19 pandemic on psychiatric emergency care in a general hospital
- J. M. Rodríguez Capilla, A. Rubio Carramiñana, S. Vega Castellote, S. López Fernández, I. Arilla Herrera, J. M. Almenara Galdeano, A. Mora Prat, M. Campillo Benito, J. Albero Garcia, A. Valderrey Ratia, A. Grau Peñas, C. Pastor Fernández, M. Moreno Monzó, J. Guitart Gil, J. Martínez Raga, C. Knecht
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S405-S406
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Introduction
The SARS-CoV-2 pandemic has produced an unprecedented clinical situation, causing a direct and indirect impact on the physical and mental health of the population. In Spain, between March 15 and June 21 of 2020, it was decreed a home confinement that caused the interruption of the daily life of millions of people. However, there are few studies that analyze the changes produced in psychiatric care in the Emergency Department (ED).
ObjectivesTo analyze the changes produced in psychiatric emergencies, subanalysing paediatric population, during the first year of the pandemic (COV1/Y-COV1) compared to the previous year (NOCOV/Y-NOCOV1). To analyze the clinical features of patients attended during the lockdown period of the pandemic (LOCK) and compare it to the period of the pandemic after the lockdown (NOLOCK).
MethodsThrough the registry of computerized medical records, patients who attended the psychiatric hospital emergency department between 03/01/2019 and 02/28/2021 were identified. We also identified all attendances from 15/03 to 21/06 in 2019 and in 2020 to obtain variables from the lockdown period.
ResultsDuring period of this study, 2694 psychiatric visits made in the ED (1744 patients - 54.3% women, and 69.5% were between 25 and 64 years-), 1537 in NOCOV and 1157 in COV1. Significant differences were found between COV1 and NOCOV in sociodemographic variables, such as employment status and number of offspring. At a clinical level, in COV1, we observed an increase in attendance due to heteroaggressive behaviors, mania, insomnia and problems due to substance use. An increase in the prescription and/or modification of treatment was observed (59.3% vs 54.3%). During COV1, in terms of discharge follow-up in the month following the ED visit, telematic assistance increased (11.4% vs. 5.3%). During the period of study, 282 ED attendances were performed, 153 in Y-NOCOV and 129 in Y-COV1. At a clinical level, during Y-COV1, a decrease in attendances related to substance use was found significant. The sub-analysis carried out for LOCK and NOLOCK yields similar data to those obtained in the COV1 vs. NOCOV1 comparison. During lockdown, the face-to-face follow-up in the month following the ED was significantly lower (39,5% vs 57,1%) regarding telematic follow-up (24,4% vs 5,8%) In this period, an increase of adolescents without previous mental health follow-up was observed (44% LOCK vs. 22% NOLOCK).
ConclusionsOur work supports the hypothesis that the COVID-19 pandemic caused a change in psychiatric care in the ED. It also shows how lockdown changed the attendance in psychiatric emergencies, and also in the later community care attendance. Changes are detected in emergency care for adolescents during the pandemic compared to the previous year. Strikingly, our study does not reflect a quantitative increase in the demand. It would be of interest to continue collecting data after the time of the present project.
Disclosure of InterestNone Declared
Relationship between CAINS negative symptoms and cognition, psychosocial functioning and quality of life in patients with a first psychotic episode of schizophrenia
- R. Rodriguez-Jimenez, L. García-Fernández, V. Romero-Ferreiro, M. Valtueña García, A. I. Aparicio, J. M. Espejo-Saavedra, L. Sánchez-Pastor, A. Nuñez-Doyle, M. Dompablo, O. Jiménez-Rodríguez, D. Rentero, P. Fernández-Sotos, I. Martínez-Gras, J. L. Santos
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S641-S642
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Introduction
Negative symptoms has been classically associated with cognition, psychosocial functioning and quality of life in patients with schizophrenia. But negative symptoms are not a unitary construct, encompassing two different factors: diminished expression, and motivation and pleasure. Few works have studied the relationship between these two different negative symptoms factors and cognition (neuro and social cognition), psychosocial functioning and quality of life, jointly, in patients with a first psychotic episode of schizophrenia.
ObjectivesThe objective of the present work was to study, in a sample of patients with a first psychotic episode of schizophrenia, the relationship between the negative symptoms (diminished expression and motivation and pleasure) and neurocognition, social cognition, functioning and quality of life.
MethodsThe study was carried out with 82 outpatients with a first psychotic episode of schizophrenia from two Spanish hospitals (“12 de Octubre” University Hospital, Madrid and “Virgen de la Luz” Hospital, Cuenca). The patients were assessed with the Clinical Assessment Interview for Negative Symptoms (CAINS) for evaluating diminished expression (EXP) and motivation and pleasure (MAP) symptoms, the MATRICS Consensus Cognitive Battery (MCCB) for evaluating neurocognition and social cognition, the Social and Occupational Functioning Assessment Scale (SOFAS), and the Quality of Life Scale (QLS).
ResultsA negative correlation was found between neurocognition and the two negative symptoms subscales: CAINS-EXP (r=-0.458, p<0.001) and CAINS-MAP (r=-0.374, p<0.001); but with social cognition only CAINS-EXP was correlated (r=-0.236, p=0.033). Also, it was found a high negative correlation between SOFAS scores and CAINS-MAP (r=-0.717, p<0.001); and a medium negative correlation with CAINS-EXP (r=-0.394, p<0.001). Finally, QLS score was high correlated with both CAINS subscales: CAINS-EXP (r=-0.681, p<0.001) and CAINS-MAP (r=-0.770, p<0.001).
ConclusionsThis study found a relationship between negative symptoms and neurocognition, social cognition, functioning and quality of life in a sample of patients with a first psychotic episode of schizophrenia. But the two different negative symptom factors, diminished expression, and motivation and pleasure, are associated differently with psychosocial functioning, but especially with social cognition where the relationship was only found with diminished expression symptoms.
Disclosure of InterestNone Declared
Late diagnosis of attention deficit hyperactivity disorder and cocaine abuse
- C. De Andrés Lobo, C. Vallecillo Adame, T. Jiménez Aparicio, M. Queipo de Llano de la Viuda, G. Guerra Valera, A. A. Gonzaga Ramírez, M. Fernández Lozano, N. Navarro Barriga, M. J. Mateos Sexmero, B. Rodríguez Rodríguez, M. Calvo Valcárcel, M. Andreo Vidal, M. P. Pando Fernández, P. Martínez Gimeno, I. D. L. M. Santos Carrasco, J. I. Gonçalves Cerejeira, A. Rodríguez Campos
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S335-S336
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Introduction
Adult ADHD diagnosis sometimes represents a challenge for the clinician, due to the comorbid psychiatric diseases that are often associated and which complicate de recognition of the primary symptoms of ADHD. The prevalence of ADHD in adult populations is 2’5% and it is a relevant cause of functional impairment.
ObjectivesPresentation of a clinical case of a male cocaine user diagnosed with adult ADHD.
MethodsLiterature review on adult ADHD and comorbid substance abuse.
ResultsA 43-year-old male who consulted in the Emergency Department due to auditory hallucinosis in the context of an increase in his daily cocaine use. There were not delusional symptoms associated and judgment of reality was preserved. Treatment with olanzapine was started and the patient was referred for consultation. In psychiatry consultations, he did not refer sensory-perceptual alterations anymore, nor appeared any signals to suspect so, and he was willing to abandon cocaine use after a few appointments. He expressed some work concerns, highlighting that in recent months, in the context of a greater workload, he had been given several traffic tickets for “distractions.” His wife explained that he had always been a inattentive person (he forgets important dates or appointments) and impulsive, sometimes interrupting conversations. In the Barkley Adult ADHD Rating Scale he scored 32 points.
He was diagnosed with adult ADHD and treatment with extended-release methylphenidate was started with good tolerance and evolution, with improvement in adaptation to his job and social environment. Since then, the patient has moderately reduced the consumption of drugs, although he continues to use cocaine very sporadically.
ConclusionsEarly detection of ADHD and its comorbidities has the potential to change the course of the disorder and the morbidity that will occur later in adults. Comorbidity in adult ADHD is rather the norm than the exception, and it renders diagnosis more difficult. The most frequent comorbidities are usually mood disorders, substance use disorders, and personality disorders. Treatment of adult ADHD consists mainly of pharmacotherapy supported by behavioral interventions. When ADHD coexists with another disorder, the one that most compromises functionality will be treated first and they can be treated simultaneously. The individual characteristics of each patient must be taken into account to choose the optimal treatment.
Disclosure of InterestNone Declared
“The cat and the calcium”. A case of delirium secondary to hypercalcaemia.
- T. Jiménez Aparicio, C. Vallecillo Adame, C. de Andrés Lobo, G. Medina Ojeda, M. Queipo de Llano de la Viuda, A. A. Gonzaga Ramírez, G. Guerra Valera, M. Fernández Lozano, M. J. Mateos Sexmero, B. Rodríguez Rodríguez, N. Navarro Barriga, M. A. Andreo Vidal, M. Calvo Valcárcel, P. Martínez Gimeno, M. P. Pando Fernández, I. D. L. M. Santos Carrasco, J. I. Gonçalves Cerejeira
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S946-S947
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Introduction
Interconsultation with the psychiatry service is frequently requested from other specialties for the assessment and treatment of patients who present neuropsychiatric symptoms secondary to organic alterations. On the other hand (and in relation to this case), within the possible causes for the elevation of calcaemia figures, the most frequent are hyperparathyroidism and neoplasms, representing between these two entities 90% of cases (1).
Among the organic mental disorders, Delirium stands out, with an approximate prevalence between 1 and 2% (general population), which increases in hospitalized and elderly patients (2).
ObjectivesPresentation of a clinical case about a patient with delirium secondary to hypercalcemia, with hallucinations and behavioral disturbance.
MethodsBibliographic review including the latest articles in Pubmed about delirium (causes and treatment) and hypercalcaemia secondary to neoplasms.
ResultsWe present a 52-year-old male patient, who went to the emergency room accompanied by his wife, due to behavioral alteration. Two days before, he had been evaluated by Neurology, after a first epileptic crisis (with no previous history) that resolved spontaneously. At that time, it was decided not to start antiepileptic treatment.
The patient reported that he had left his house at midnight, looking for a cat. As he explained, this cat had appeared in his house and had left his entire bed full of insects. His wife denied that this had really happened, and when she told the patient to go to the emergency room, he had become very upset.
As background, the patient used to consume alcohol regularly, so the first hypothesis was that this was a withdrawal syndrome. However, although the consumption was daily, in recent months it was not very high, and at that time no other symptoms compatible with alcohol withdrawal were observed (tremor, tachycardia, sweating, hypertension…).
We requested a general blood test and a brain scan. The only relevant finding was hypercalcaemia 12.9mg/dL (which could also be the origin of the previous seizure). It was decided to start treatment with Diazepam and Tiapride in the emergency room, with serum perfusion, and keep under observation. After several hours, the patient felt better, the hallucinations disappeared, and calcium had dropped to 10.2mg/dL. A preferential consultation was scheduled, due to suspicion that the hypercalcaemia could be secondary to a tumor process.
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ConclusionsIt is important to rule out an organic alteration in those patients who present acute psychiatric symptoms. Hypercalcaemia is frequently associated with tumor processes (1) due to secretion of PTH-like peptide (4), so a complete study should be carried out in these cases.
Delirium has a prevalence between 1 and 2% in the general population (2).
Psychopharmacological treatment is used symptomatically, with antipsychotics (3). For the episode to fully resolve, the underlying cause must be treated.
Disclosure of InterestNone Declared
COVID-19 after two years: trajectories of different components of mental health in the Spanish population
- I. Bayes-Marin, M. Cabello-Toscano, G. Cattaneo, J. Solana-Sánchez, D. Fernández, C. Portellano-Ortiz, J. M. Tormos, A. Pascual-Leone, D. Bartrés-Faz
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 32 / 2023
- Published online by Cambridge University Press:
- 17 April 2023, e19
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Aims
Our study aimed to (1) identify trajectories on different mental health components during a two-year follow-up of the COVID-19 pandemic and contextualise them according to pandemic periods; (2) investigate the associations between mental health trajectories and several exposures, and determine whether there were differences among the different mental health outcomes regarding these associations.
MethodsWe included 5535 healthy individuals, aged 40–65 years old, from the Barcelona Brain Health Initiative (BBHI). Growth mixture models (GMM) were fitted to classify individuals into different trajectories for three mental health-related outcomes (psychological distress, personal growth and loneliness). Moreover, we fitted a multinomial regression model for each outcome considering class membership as the independent variable to assess the association with the predictors.
ResultsFor the outcomes studied we identified three latent trajectories, differentiating two major trends, a large proportion of participants was classified into ‘resilient’ trajectories, and a smaller proportion into ‘chronic-worsening’ trajectories. For the former, we observed a lower susceptibility to the changes, whereas, for the latter, we noticed greater heterogeneity and susceptibility to different periods of the pandemic. From the multinomial regression models, we found global and cognitive health, and coping strategies as common protective factors among the studied mental health components. Nevertheless, some differences were found regarding the risk factors. Living alone was only significant for those classified into ‘chronic’ trajectories of loneliness, but not for the other outcomes. Similarly, secondary or higher education was only a risk factor for the ‘worsening’ trajectory of personal growth. Finally, smoking and sleeping problems were risk factors which were associated with the ‘chronic’ trajectory of psychological distress.
ConclusionsOur results support heterogeneity in reactions to the pandemic and the need to study different mental health-related components over a longer follow-up period, as each one evolves differently depending on the pandemic period. In addition, the understanding of modifiable protective and risk factors associated with these trajectories would allow the characterisation of these segments of the population to create targeted interventions.
My stomach is full
- M. Queipo De Llano De La Viuda, A. Gonzaga Ramírez, N. De Uribe Viloria, G. Guerra Valera, T. Jiménez Aparicio, C. Vallecillo Adame, C. De Andrés Lobo, I. Santos Carrasco, J. Gonçalves Cerejeira, N. Navarro Barriga, M.J. Mateos Sexmero, B. Rodríguez Rodríguez, M. Fernández Lozano
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S583
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Introduction
Anorexia nervosa is an eating behavior disorder that is often related to various personality factors. The relationship between obsessive compulsive disorder and eating Disorders has been highlighted.
ObjectivesTo present a clinical case of a patient with eating disorder and gastric bezoar, secondary to compulsive hair ingestion.
MethodsBibliographic review of articles published in relation to the comorbidity of these disorders, based on articles published in the last 5 years in Pubmed.
Results26-year-old female. Diagnosis of restrictive anorexia nervosa. She was admitted to the hospital on two occasions for nutritional disorders. In the last admission, she reported greater anxiety and significant weight loss. She reports that she has limited her food intake, but she does feel thin and is unable to eat for fear of gaining weight. Ruminative thoughts about her body image. During admission, the patient expressed a sensation of fullness, nausea and vomiting, later observing in abdominal X-ray and gastroscopy, the presence of a gastric trichobezoar, which was finally resolved conservatively.
ConclusionsTrichotillomania is observerd in 1 in 2000 people, trichophagia is even less frequent. According to DSM- V, these disorders are grouped within obsessive-compulsive spectrum disorders. A Trichobezoar is a conglomerate that can be found in the stomach or intestine, composed mainly of hair, previously ingested. Trichotillomania can be associated with anorexia nervosa, especially in patients with obsessive personality traits, which occurs frequently. The gastric slowing that patients with anorexia often present is a factor that favors the formation of the bezoar
DisclosureNo significant relationships.
Something inside my head
- T. Jiménez Aparicio, G. Medina Ojeda, C. De Andrés Lobo, C. Vallecillo Adame, J. Gonçalves Cerejeira, I. Santos Carrasco, G. Guerra Valera, A. Gonzaga Ramírez, M. Queipo De Llano De La Viuda, N. Navarro Barriga, M. Fernández Lozano, B. Rodríguez Rodríguez, M.J. Mateos Sexmero, N. De Uribe Viloria
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S740
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Introduction
Electroconvulsive therapy (ECT) is a medical treatment for those patients with high suicide risk or refractory psychiatric disorders. It is currently a safe technique, and its effectiveness has been widely demonstrated.
ObjectivesPresentation of a clinical case about a patient with drug-resistant delusional disorder and high suicide risk, who eventually received ECT treatment.
MethodsBibliographic review including the latest articles in Pubmed about ECT procedure, effects and use.
ResultsWe present a 45-year-old man, who visited different doctors several times by reporting he had the feeling of “having a brain tumor or a vascular disorder”, so he requested imaging tests (computed tomography and magnetic resonance). These tests were absolutely normal, but he kept thinking something was wrong, and eventually attempted suicide by hanging (his family founded him before it was too late). The patient was admitted to hospital, and started psychopharmacological treatment, with minimal response. He desperately insisted that he had “something inside his head”. At this point, it was proposed to start ECT, and the patient accepted. After 6 bilateral ECT sessions, he was visibly more relaxed and less worried, and he no longer presented autolytic ideation. He was still a little bit suspicious about the feeling of having a neurological disease. Currently, the patient runs a follow-up consultation.
ConclusionsElectroconvulsive therapy is a safe and effective technique for those patients with high suicide risk. It may be useful to perform imaging tests in certain cases, for detecting intracranial pressure, acute hemorrhage, tumors… A follow-up of these patients must be performed
DisclosureNo significant relationships.
Mutism. What to expect?
- I. Santos Carrasco, J. Gonçalves Cerejeira, M. Fernández Lozano, A. Gonzaga Ramírez, M. Queipo De Llano De La Viuda, G. Guerra Valera, C. Vallecillo Adame, C. De Andrés Lobo, T. Jiménez Aparicio, B. Rodríguez Rodríguez, N. Navarro Barriga, M.J. Mateos Sexmero, E. Pérez, L. Gallardo Borge
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S588
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Introduction
Mutism is the inability or unwillingness to speak, resulting in an absence or marked paucity of verbal output. Mutism is a common manifestation of psychiatric, neurological, and drug-related illnesses. Psychiatric disorders associated with mutism include schizophrenia, affective disorders, conversion reactions, dissociative states, and dementias. Neurological disorders causing mutism affect the basal ganglia, frontal lobes, or the limbic system.
ObjectivesOutline the importance of setting a differential diagnosis of mutism in the Emergency Room.
MethodsReview of scientific literature based on a relevant clinical case.
ResultsMale, 58 years old. He has lived in a residence for 3 months due to voluntary refusal to ingest. Diagnosed with paranoid personality disorder. He is refered to the Emergency Service due to sudden mutism. During this day, he has been stable and suitable with a good functionality. For 3 hours he is mutist, oppositional attitude and stiff limbs, refusing to obey simple orders. Hyperalert and hyperproxia. Not staring. After ruling out organic pathology: normal blood tests, negative urine toxins and cranial CT without alterations, he was admitted to Psychiatry for observation and, finally, he was diagnosed with Psychotic Disorder NOS.
ConclusionsMutism most often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. The most common disorder of behavior occurring with mutism is catatonia. The differential diagnosis of mutism is complex. In some cases the diagnosis will be clarified only by careful observation and after a neurological evaluation. Published studies show neurological disorders presenting with mutism can be misdiagnosed as psychiatric.
DisclosureNo significant relationships.
Altered Executive Function in Suicide Attempts
- J. Fernández, S. Alberich, I. Zorrilla, I. González-Ortega, M.P. López, V. Pérez-Solà, E. Vieta, A.M. González-Pinto, P.A. Saiz
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S124
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Introduction
Executive function organizes and directs behaviour but alterations in this cognitive domain can lead to inaccurate perception, interpretation and response to environmental information, which could be a risk factor for suicide.
ObjectivesTo explore executive function performance of depressed recent suicide attempters in comparison to depressed past suicide attempters, depressed non-attempters and healthy controls.
Methods96 participants from the Psychiatry Department of the Araba University Hospital-Santiago were recruited as follows: 20 patients with a recent suicide attempt (<30days) diagnosed with a Major Depressive Disorder (MDD), 33 MDD patients with history of attempted suicide, 23 non-attempter MDD patients and 20 healthy controls. All participants underwent a clinical interview and neuropsychological assessment on executive function with the Wisconsin Sorting Card Test. Backward multiple regressions were performed adjusting for significant confounding variables. For group comparisons ANOVA test and Bonferroni post hoc test were performed with p<0.05 significance level.
ResultsPatient groups did not differ regarding severity of depression. All patient groups performed significantly worse than healthy controls on executive function. Adjusted comparisons between patient groups indicated that recent suicide attempters had a poorer performance in this cognitive domain in comparison to both depressed lifetime attempters and depressed non-attempters (B=0.296, p=0.019 and B=0.301, p=0.028 respectively).
ConclusionsExecutive function performance is altered in recent suicide attempts. As impaired executive function can be a risk factor for suicide, preventive interventions on suicide should focus on its assessment and rehabilitation.
DisclosureNo significant relationships.
Personality disorders and Juvenil Myoclonic Epilepsy
- I. Santos Carrasco, J. Gonçalves Cerejeira, M. Queipo De Llano De La Viuda, A. Gonzaga Ramírez, G. Guerra Valera, T. Jiménez Aparicio, C. De Andrés Lobo, C. Vallecillo Adame, M. Fernández Lozano, B. Rodríguez Rodríguez, N. Navarro Barriga, M.J. Mateos Sexmero, L. Gallardo Borge
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S668
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Introduction
There is a high comorbidity between psychiatric disorders and juvenile myoclonic epilepsy (JME), observed in up to 58% of these patients; specifically, mood disorders, anxiety and personality disorders (PD). In some patients with PD there are nonspecific alterations in the EEG, which nevertheless sometimes involve pathology. The presence of personality disorders along with JME has been repeatedly described. Previous studies have emphasized the difficulties in treating patients with JME, which have been attributed to some specific psychiatric, psychological and psychosocial characteristics.
ObjectivesDescribing distinctive personality traits in JME
MethodsReview of scientific literature based on a relevant clinical case.
Results19-year-old woman, single. Psychiatric history since she was 12 due to anxiety-depressive symptoms, after being diagnosed with JME. 4 admissions in Psychiatry, with a variety of diagnoses: eating disorder, attention deficit hyperactivity disorder and borderline personality disorder. The evolution of both disorders has been parallel, presenting epileptic seizures due to irregular therapeutic adherence together with pseudo-seizures, which made difficult their differential diagnosis. In addition, he has had frequent visits to the emergency room for suicide attempts and impulsive behaviors.
ConclusionsIn 1957, for the first time, distinctive personality traits were described in patients with JME: lack of control and perseverance, emotional instability, variable self-concept and reactive mood, which have been confirmed in subsequent studies. It is believed as epilepsy progresses, patients tend to develop symptoms of depression, anxiety, social problems, and attention deficit. Therefore, these patients have difficulty in following medical recommendations, especially precautions regarding precipitating factors for seizures.
DisclosureNo significant relationships.