3 results
Catatonia in depressive disorder, more usual than it is supposed to be
- R. J. Carrillo Molina, F. Vilchez Español, I. Caparros del Moral
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S842
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Introduction
Catatonia is a psychomotor syndrome characterized by various motor, affective and behavioral symptoms. It can occur as a cause of various underlying organic and psychiatric disorders. In Psychiatric nosology is used to specify a subtype of the disorder underlying.Unlike what was assumed in the past, today it is accepted that catatonia is more frequent in affective disorders than in schizophrenia. But despite this, diagnosis and treatment are still late in affective cases on many occasions.
Objectives-A case of catatonia is presented to review the diagnostic difficulties that can sometimes entail.-Review treatment algorithm.
MethodsWe present the case of a 62-year-old woman, initially diagnosed of major depressive symptoms with psychotic symptoms, showing no response to different treatments, evolving to catatonia, which is diagnosed after screening for neurological and medical diseases.
ResultsThe patient had an adequate evolution after the withdrawal of antipsychotics and the application of ECT (Electroconvulsive therapy).
Conclusions- It is important to carry out an adequate screening, because many times the symptoms are caused by medical or neurological diseases.
-Catatonia has a good prognosis with an early treatment, but it may increase the risk of mortality after 5 days from the onset of symptoms.
-It is important to avoid the use of antipsychotics or other dopamine blockers. The use of benzodiazepines and ECT is indicated.
Disclosure of InterestNone Declared
Early-onset schizophrenia: an adolescent case report
- C. Alcalde-Diosdado Crespi, E. K. Alvarado Altuve, S. Cruz Bailén, I. Caparrós del Moral
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1049
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Introduction
This is the case of a girl, aged 13, starting on 2021 with a first psychotic episode. Before this episode, her psychiatric history was an adjustment disorder because of scholar bullying, fully recovered before the onset of the current symptoms.
ObjectivesTo describe an interesting case of early-onset psychosis.
MethodsWe have used the interviews with the patient and her profile in Diraya (the medical database software in Andalucía).
ResultsThe first symptoms started 6 months before the first hospitalization, and consisted in mild behavioural disorders, with disobedience and rudenesses, which represented a significant change compared with the previous personality of the patient. 3 weeks before the first admission she abruptly started to experience disconnection, unmotivated laughs, decreaded academic performance and incoherent speech. Also, she showed motor symptoms, consisting in oral and right-hand stereotypies. Then, she was hospitalized in a Pediatric unit, in order to rule out organicity. The nuclear magnetic resonance showed an image suggestive of venous development anomaly, with no acute injuries. Her cerebral spinal fluid was widely studied, and all the results were negative, including: the technique of PCR for many virus and bacteria that can cause meningitis or encephalitis; a bacterial culture; a biochemical study; antineuronal antibodies; and a limbic encephalitis antibodies study. Besides, the blood count, the biochemistry, the gasometry and serology were also negative. No drugs were detected in the urinalysis. Once the organicity was ruled out, she was treated with Olanzapine and Diazepam, and destinated to my child and adolescent psychiatry unit. During the first hospitalization we observed that she looked very often to the mirror, showed soliloquies and took leaps. During the interviews she was desinhibited. She initiated a delusional speech, focused in sexual topics. She said that she’s had a baby in the future with his father, and talked a lot about things she had already made in the future. During this admission, we changed the treatment to Quetiapine and Valproate.
The second hospitalization was was done due to a lack of efficacy with the previous treatment and the presence of autolytic thoughts. We switched from Quetiapine to Aripiprazole. After a few days, she showed again a desinhibited behaviour, and kept the delusional speech, that now was more complex, refering that she had more than 20 babies, with many different men. After this we tried Lurasidone and suspended Aripiprazole, she showed a clinical improvement, at the cost of many side effects, though. So we finally changed to Clozapine, in combination with Gabapentin. Since she got clinical levels of clozapine, the delusions have been encapsulated.
ConclusionsThe differential diagnosis is set with an early-onset schizophrenia and a schizoaffective disorder. Obviously, the evolution of the sypmptoms in the following months and years will have the last word.
Disclosure of InterestNone Declared
New Approaches to Psychotic Agitation: Staccato Loxapine
- A. Fontalba-Navas, I. Caparros-del-Moral
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- Journal:
- European Psychiatry / Volume 30 / Issue S1 / March 2015
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction
Psychomotor agitation is characterized by a significant increase in or inappropriate motor activity, from minimal anxiety to uncoordinated movement without purpose, accompanied by alterations in the emotional sphere.
Psychiatric causes includes schizophrenia, schizoaffective disorder and bipolar disorder
Case47-year-old patient with a diagnosis of paranoid schizophrenia with 25 years of evolution. Compensated during the last 5 years. She comes to the hospital with her husband.
She presents psychomotor agitation characterized by a megalomaniac delusion ('I'm a virgin', 'this is not my husband, my husband is someone else and he is dead, this is a double') delusional interpretations of the environment ('I won´t sit down, because you´re going to steal my movement'), irritability, dysphoria, vocal and behavioral disturbances such as insults or increased motor gestures like bumps against the furniture.
T 0 (00 min) PEC score scale: 18
Inhaled administration of Adasuve (Staccato loxapine)
T1 (08 min) The psychomotor agitation stopped. PEC score scale: 7
T2 (60 min) No adverse effects. She continued to be stable. PEC score scale: 6
DiscussionTaken to the extreme, agitation in psychosis can be a serious risk to the patient, family members, health workers and the environment.
It requires immediate action to ensure patient safety, to achieve an appropriate and effective approach to agitation, aggressive or violent behavior.
An effective treatment of an episode can facilitate future interventions.