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Thyroid Stimulating Hormone circadian variations in paranoid schizophrenic psychosis between acute and stable phases. A comparative study.
- A. Marcos-Rodrigo, A. L. Morera-Fumero, P. Abreu-Gonzalez, E. Diaz-Mesa, L. Fernandez-Lopez, J. J. Tascon-Cervera
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S186
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Introduction
Day-night changes in several molecules are studied as biomarkers of circadian rhytms (Morera-Fumero, A. L. et al. Progress in Neuro-Psychopharmacology and Biological Psychiatry 2017; 75 207-212). Circadian rhythmicity of the pituitary-thyroid axis has been proven in healthy individuals, with a Thyroid Stimulating Hormone (TSH) peak in serum around midnight and peaks during day hours (Bellastella, G. et al. Life 2021; 11(5), 426). A recent meta-analysis has reported differences in serum TSH levels between first-episode psychosis and multiple-episode schizophrenia (Misiak, B. et al. Progress in Neuro-Psychopharmacology and Biological Psychiatry 2021; 111, 110402). However, studies assessing quantitative circadian variations on TSH serum in schizophrenic patients are scant.
ObjectivesComparing serum TSH levels at two different times of the day (12:00 and 24:00 hours) and the differences between the acute (hospital admission) and recovered phase (hospital discharge) of the disease.
MethodsFourteen male patients (age 26,8±9,3 years) with the diagnosis of paranoid schizophrenia psychosis according to the DSM-IV partake in the study. Patients were admitted to the University Hospital of the Canary Islands psychiatric room because of acute relapse. Blood samples were taken in the first 24 h of admission and at 24 h. before discharge. All patients gave written consent to participate in the research study. Serum TSH was determined by ELISA methods. Paired sample t-tests were performed between TSH serum levels at admission and discharge at 12:00 and 24:00 hours. Statistical analyses were performed using IBM® SPSS® Statistics 25 software for MAC (IBM Corporation 1989, 2017).
ResultsThere were statistical differences between the 12:00 h and the 24:00 h of the TSH serum levels at admission (12:00: 145,856±156,961vs. 00:00: 192,006± 122,757, p = 0.04); TSH discharge, (12:00: 134,483±72,882vs 00:00: 244,214±148,697, p = 0.002). There were no statistical differences between the 12:00 TSH levels at admission and discharge (145,856±156,961 vs. 134,483± 72,882, p = 0.66). The 24:00 h comparison of TSH levels neither elicited significant results (admission: 192,006±122,757 vs. discharge: 244,214± 148,697, p = 0.15).
ConclusionsSchizophrenic patients undergo TSH serum changes in a circadian pattern during the acute and stable phases of the disease; nevertheless, they experience smaller deviations during the acute phase. Higher levels of TSH were observed around midnight, as it happens in healthy individuals, with higher peaks during the stable phase compared to the acute one.
Disclosure of InterestNone Declared
Syndrome of inappropiate antidiuretic hormone secretion (SIADH) secondary to sertraline: case report and literature review
- C. Cardenes-Moreno, S. Yelmo-Cruz, I. Perez-Sagaseta, J. J. Tascon-Cervera, J. Dorta-Gonzalez, A. Crisostomo-Siverio, L. Torres-Tejera, M. Paniagua-Gonzalez, S. Canessa, M. R. Cejas-Mendez
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S556
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Introduction
Currently, in addition to their frequent use in community medicine, the use of antidepressants is a fundamental pillar of pharmacological treatments used in psychiatry. Due to this frequent use, we must be aware of the possible side effects, in particular the SIADH produced in this clinical case by SSRIs. There are already described cases of this association including other antidepressants and many different types of drugs.
ObjectivesTo review the current literature on the management of this pathology when it is secondary to the use of frequently used drugs such as SSRIs.
MethodsWe report the case of a 64-year-old woman hospitalised in the psychiatric department for malnutrition secondary to unspecified eating disorder (ED). During admission, treatment with sertraline was started with ascending doses up to 100mg, subsequently producing slight edema with the following analytical results: plasma Na: 123 mEq/L (135-145), plasma osmolarity: 250 mOsm/kg (275-300), urinary Na: 174 mEq/L (>40), fulfilling diagnostic criteria for SIADH.
Afterwards, we reduced sertraline until discontinuation and started treatment with water restriction and urea (30 grams/24 hours) during admission and after discharge. During admission, we observed disappearance of the edema and partial improvement of the analytical values (Na:131 mEq/L), which were normalised with home treatment of daily urea.
ResultsThe precise prevalence of SIADH from the use of SSRIs is unknown, it is known that patients older than 65 are at higher risk of developing severe hyponatraemia in the first 5 weeks after initiation. Similarly, treatment with water and urea restriction, together with discontinuation of SSRIs, appears to be sufficient.
ConclusionsSSRIs can cause SIADH a reversible but potentially life-threatening pathology, and we need to be aware of this possibility especially in the older population and being able to handle it
Disclosure of InterestNone Declared
Fahr’s Disease: a case report of a patient with neuropsychiatric symptoms
- I. Perez-Sagaseta, S. Yelmo-Cruz, C. Cardenes-Moreno, L. Torres-Tejera, A. Crisostomo-Siverio, J. Dorta-Gonzalez, J. J. Tascon-Cervera, M. Paniagua-Gonzalez, S. Canessa, M. R. Cejas-Mendez
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S769-S770
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Introduction
Fahr’s disease (FD) is a rare disorder consisting of bilateral and symmetrical calcium deposits in basal ganglia and cerebral cortex. These lesions are associated with neurological and psychiatric symptoms such as a rigid hypokinetic syndrome, mood disorders and memory and concentration abnormalities. It can be idiopathic or secondary to endocrine disorders, infectious diseases or mitochondrial myopathies.
ObjectivesTo highlight the importance of considering organic causes when evaluating patients presenting atypical psychiatric symptoms and claim the role of neuroimaging.
MethodsCase report and non-systematic review of literature: sources obtained from Pubmed database.
ResultsA 69-year-old man, native of Syracuse (Italy), was admitted to the Psychiatry Unit in February 2022 presenting behavioural disturbances and irritability. In July 2021 he presented the same symptoms, being mistakenly diagnosed with Bipolar Disease type I. He has no previous psychiatric history. He started with changes in his personality, short-term memory loss, aggressiveness and disorganized behaviour at the age of 66. At admission he was talkative and hyperfamiliar, presenting delusions of grandiosity, exalted affectivity and insomnia. Neurological examination showed short-term memory problems, signs of frontal disinhibition and abnormal glabellar tap sign. Blood tests, CT brain and MRI were performed to rule out organic underlying causes. Neuro-imaging found bilateral and symmetric calcifications in globus pallidus, thalamus and corpus striatum, in favour of FD. Secondary causes (abnormalities in the PTH, vitamin disorders and infectious diseases such as HIV, brucellosis or neurosyphilis) where discarded, allowing us to conclude it was probably a primary case of FD. Valproate was started as a mood stabilizer and anticonvulsant. Genetic tests were indicated.
ConclusionsFD should be considered as a differential diagnosis in the evaluation of psychiatric symptoms, especially when atypical and/or presented with neurological symptoms. The role of neuro-imaging is essential.
Disclosure of InterestNone Declared
Daytime/nighttime levels of serum IL-33 in schizophrenia at hospital admission and before discharge
- J. J. Tascon-Cervera, A. Morera-Fumero, P. Abreu-Gonzalez, E. Diaz-Mesa, M. R. Cejas-Mendez, S. Yelmo-Cruz, L. Fernandez-Lopez, A. Marcos-Rodrigo
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1062-S1063
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Introduction
It has been reported an inflammatory state in schizophrenia, with altered levels of some cytokines (Zhou et al. Cytokine 2021; 141:155441). Recent publications have shown the importance of IL- 33, a member of the IL-1 cytokine family which acts as an alarmin (Han et al. Neurosci Bull 2011; 27, 351-357). The role of this cytokine as a biomarker has been investigated in schizophrenia (Koricanac et al. Front Psychiatry 2022; 13, 925757). However, results are controversial. Some studies have not found significant associations between IL-33 and chronic schizophrenia (Campos-Carli et al. Compr Psychiatry 2017; 74 96-101), while other papers have reported increased levels (Kozlowska et. al. J Psychiatr Res. 2021; 138 380-387). In all these studies, levels of IL-33 were measured in a single daily measure, so that it has not been studied if IL-33 has changes during hospitalization.
ObjectivesTo study the serum level of IL-33 at 12:00 and 00:00 hours in schizophrenia patients at admission and before hospital discharge.
MethodsFifteen inpatients with diagnosis of paranoid schizophrenia according to ICD-10 criteria were studied. Patients were hospitalized at the University Hospital of the Canary Islands psychiatric ward because of an acute relapse. A total of four blood samples were taken from each patient: at 12:00 and 00:00 hours the day after admission and at 12:00 and 00:00 hours the day before discharge. Serum IL-33 levels were measured by ELISA techniques. Daytime and nighttime IL-33 serum levels at admission and discharge were compared using a non-parametric Wilcoxon signed-rank test.
ResultsIn table 1 the results of the comparison of IL-33 at admission and discharge are presented. There is a significant reduction of IL-33 levels at 00:00 h. at discharge in comparison with the IL-33 levels at 00:00 h. at admission (p=0.028). No other statistically significant differences were observed.
Serum IL-33 Admission Mean±sd Discharge Mean±sd Z P value 12:00 h. 191.0±348.7 247.0±378.2 -0.166 0.868 00:00 h. 218.8±370.3 153.6±275.7 -2.203 0.028 ConclusionsThe decrease of serum IL-33 at 00:00 at discharge compared to the 00:00 IL-33 serum level at admission points to the utility of this biomarker as a surrogate of brain inflammation.
Disclosure of InterestNone Declared
Anorexia nervosa and Wernicke-Korsakoff syndrome: case report an literature review
- S. Yelmo-Cruz, J. J. Tascon-Cervera, I. Perez-Sagaseta, C. Cardenes-Moreno, L. Torres-Tejera, A. Crisostomo-Siverio, E. Diaz-Mesa, J. Dorta-Gonzalez, M. Paniagua-Gonzalez, S. Canessa, A. L. Morera-Fumero, M. R. Cejas-Mendez
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S424
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Introduction
Wenicke-Korsakoff syndrome (WKS) is a neurological disorder caused by thiamine deficiency. Wernicke Encephalopathy (WE) is the acute phase and the chronic phase is called Korsakoff-syndrome (KS).
ObjectivesTo review the current literature on the management of WKS in a patient with anorexia nervosa.
MethodsWe report the case of a 63-year-old woman admitted to the Psychiatry Unit after weight loss in the last 3 months (from 39 kg to 33,500 kg). She only made one meal a day. By exploration and analysis, neoplastic disease is ruled out (thoraco-abdomino-pelvic CT without pathological findings). She has maintained restrictive intakes for more than 30 years. A long-term anorexia nervosa (AN) is suspected, with a worsening of restrictive behavior in recent months. Upon admission, she has a weight of 33,500 kg and a BMI of 14,10. She has a left palpebral ptosis and an alteration of the anterograde memory as well as affectation of executive functions. Progressive oral diet is started, and due to the suspicion of a WKS, thiamine ev is started for a week and then continued with oral thiamine. Thiamine levels are extracted once the ev treatment has begun, so we do not have previous levels to know if they were decreased. Brain MRI shows bilateral hyperintensities in white matter and at supratentorial level in T2 and FLAIR. After a month and a half of admission, the patient has progressively regained weight, has managed to make adequate intakes and has improvement in memory.
ResultsAn adverse consequence of severe malnutrition in AN due to severe food restriction and purging behavior is thiamine deficiency, and also global cerebral atrophy and concomitant cognitive deficits can be found. Thiamine deficiency occurs in 38% of individuals with AN and is often unrecognized. WKS is caused by thiamine deficiency, and WE is the acute phase of this syndrome (presentation of triad can vary). The chronic phase is KS and consists in amnesia with confabulations. WKS typically develops after malnourishment in alcoholic patients but can be associated in nonalcoholic such as prolonged intravenous feeding, hyperemesis, anorexia nervosa, refeeding after starvation, thyrotoxicosis, malabsorption syndromes; hemodialysis; peritoneal dialysis; AIDS; malignancy. WKS is a clinical diagnosis, and no specific abnormalities have been found in cerebrospinal fluid, brain imaging or electroencephalograms. MRI has a sensitivity of 53%, but high specificity of 93%, and shows an increased signal in T2 and FLAIR sequences, bilaterally symmetrical in the paraventricular regions of the thalamus, the hypothalamus, mamillary bodies, the periaquedutal region, the floor of the fourth ventricle and midline cerebellum.
ConclusionsIf the disorder is suspected, thiamine should be initiated immediately in order to prevent irreversible brain damage, with an estimated mortality rate of about 20%, or to the chronic form of the WE in up to 85% of survivors
Disclosure of InterestNone Declared