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“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
Monitoring sertraline and clozapine levels
- A. Rodriguez Campos, L. Rodriguez Andrés, G. Medina Ojeda, I. Santos Carrasco, J. Gonçalves Cerejeira, A. Gonzaga
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S718
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Introduction
One of the most frequent side effects seen when prescribing sertraline and clozapine together is the appearance of a seizure crisis. This event is usually related to an increase of plasmatic concentration due to interactions of these drugs with blood components.
ObjectivesTo investigate the effects of clozapine when combined with other drugs, especially its effects increasing plasmatic concentration.
MethodsA patient was treated sith 300 mg/day of clozapine followed by a treatment with sertraline 50 mg/day, which increases plasmatic concentration. The combination of these treatments produced seizures. Other works published about interactions are reviewed.
ResultsIt is important to monitor clozapine dosages to avoid increasing plasmatic concentration, especially if other drugs that have this effect are also administered.
ConclusionsIt is important to monitor clozapine dosages to avoid increasing plasmatic concentration, especially if other drugs that have this effect are also administered.
DisclosureNo significant relationships.
Testosterona and suicide
- L. Gallardo Borge, I.D.L.M. Santos Carrasco, P. Marqués Cabezas, A.I. Segura Rodríguez, G. Medina Ojeda
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S842
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Introduction
Testosterone is an anabolic androgenic steroid hormone involved in brain development, reproduction, and social behavior. Several studies have shown that testosterone can cause impulsivity in humans. This impulsivity could modify the mood and increase the risk of suicidal behaviour.
ObjectivesTestosterone is an anabolic androgenic steroid hormone involved in brain development, reproduction, and social behavior. Several studies have shown that testosterone can cause impulsivity in humans. This impulsivity could modify the mood and increase the risk of suicidal behaviour.
MethodsClinical case and literature review.
ResultsA 33-years male (biological female), single, gypsy ethnicity, with an 11-years daughter. Psychiatric history of one admission in a hospitalization unit. Diagnosed of depressive disorder and personality disorder NOS. Intermittent follow-up in Mental Health consultations. 8 years later, he consulted due to gender dysphoria. He refered not to be feeling identified with his body for a long time. He rejected his sexual characteristics. After his mental evaluation, he was refered to Endocrinology Service. He had been prescribed with testosterone. Three days after starting the treatment, he maked anattempt of suicide with medication. The patient had not presented previous suicide attempts or ideation. With the withdrawal of the testosterone, the suicidal behaviour dissapeared.
ConclusionsDue to the association of testosterone and suicidal behavoiur, we consider that is important to pay attention to people who have just started the androgenic treatment in order to avoid a high risk of suicide. In the same way, we should focus on evaluating the hostility, impulsivity and irritability in patients strongly related to suicidal behaviour.
DisclosureNo significant relationships.
Voices change my name
- C. Vallecillo Adame, T. Jiménez Aparicio, C. De Andrés Lobo, A. Gonzaga Ramírez, M. Queipo De Llano De La Viuda, G. Guerra Valera, I. Santos Carrasco, J. Gonçalves Cerejeira, B. Rodríguez Rodríguez, M. Fernández Lozano, M.J. Mateos Sexmero, N. Navarro Barriga, N. De Uribe Viloria, G. Medina Ojeda, L. Rodriguez Andrés
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S801
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Introduction
We present the clinical case of a patient where the psychotic clinic coexists with gender dysphoria. This scenario can be the result of a change in gender identity derived from the psychotic process or appear independently of it.
ObjectivesWe want to explain the importance of knowing how to act with a patient in whom these two processes coexist.
Methods20-year-old woman, with no history of mental health. She comes to the emergency department for behavioral alteration. The family observes strange behaviors, unmotivated laughter, soliloquies and aggressive episodes. Abandonment of studies, hobbies and radical physical change. Delusions of prejudice and self-referential delusions. Possible phenomena of echo and diffusion of the thought. Auditory hallucinations talking to her in male gender, since then she presents doubts about her sexual identity and manifests her desire to change sex. Altered judgment of reality.
ResultsDuring admission, we started treatment with an antipsychotic with good tolerance and she was referred to mental health team, where psychopharmacological treatment was adjusted with good response. In the following medical appointments the psychotic clinic disappeared at the same time that sexual identification was completely restored and made a critique of the behavior and experiences.
ConclusionsThis case highlights the importance of assessing the chronology of symptoms, the patient’s criticality, the response to antipsychotic treatment and the need to exclude the psychotic background of the desire for gender reassignment before making a therapeutic decision.
DisclosureNo significant relationships.
Microstructural Characterization of Dissimilar Joint: SAE1008-2340 Welded by GMAW Process
- L. L. Rodríguez López, G.Y. Perez-Medina, L.A. Carrasco González, R.J. Praga Alejo, F.A. Reyes-Valdés
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- Journal:
- MRS Online Proceedings Library Archive / Volume 1616 / 2014
- Published online by Cambridge University Press:
- 24 February 2014, imrc2013-s5c-o016
- Print publication:
- 2014
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Gas metal arc welding (GMAW) of a sub-frame automotive industry was studied, applying a design of experiment (DOE) in Minitab and Matlab software. Voltages, welding speed and wire feed speed was defined as input variables; legs and throats of welding were output variables in millimeters dimension. The requirement for GMAW process was to achieve complete penetration, minimum values acceptable of legs and throat indicated in AWS D8.8M:2007 “Specification for automotive weld quality-arc welding” without any discontinuity, like undercutting or porosity. The required of quality were difficult to achieve due to the materials have microstructural and mechanical properties different, the SAE 1008 has 279MPa for ultimate tensile strength (UTS) and the microstructure consist of ferrite matrix with some small areas of cementite, while SAE 2340 has 456MPa of UTS with a combination of perlite and ferrite. It was possible obtain good quality welds with proper geometry and defect free with help to design of experiment. The conditions needed were a combination of parameters to not obtained significant change microestructural characterized by optical microscopy, stereoscopy and scanning electron microscopy.
Mannheimia haemolytica and bovine respiratory disease
- J. A. Rice, L. Carrasco-Medina, D. C. Hodgins, P. E. Shewen
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- Journal:
- Animal Health Research Reviews / Volume 8 / Issue 2 / December 2007
- Published online by Cambridge University Press:
- 24 January 2008, pp. 117-128
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Mannheimia haemolytica is the principal bacterium isolated from respiratory disease in feedlot cattle and is a significant component of enzootic pneumonia in all neonatal calves. A commensal of the nasopharynx, M. haemolytica is an opportunist, gaining access to the lungs when host defenses are compromised by stress or infection with respiratory viruses or mycoplasma. Although several serotypes act as commensals, A1 and A6 are the most frequent isolates from pneumonic lungs. Potential virulence factors include adhesin, capsular polysaccharide, fimbriae, iron-regulated outer membrane proteins, leukotoxin (Lkt), lipopolysaccharide (LPS), lipoproteins, neuraminidase, sialoglycoprotease and transferrin-binding proteins. Of these, Lkt is pivotal in induction of pneumonia. Lkt-mediated infiltration and destruction of neutrophils and other leukocytes impairs bacterial clearance and contributes to development of fibrinous pneumonia. LPS may act synergistically with Lkt, enhancing its effects and contributing endotoxic activity. Antibiotics are employed extensively in the feedlot industry, both prophylactically and therapeutically, but their efficacy varies because of inconsistencies in diagnosis and treatment regimes and development of antibiotic resistance. Vaccines have been used for many decades, even though traditional bacterins failed to demonstrate protection and their use often enhanced disease in vaccinated animals. Modern vaccines use culture supernatants containing Lkt and other soluble antigens, or bacterial extracts, alone or combined with bacterins. These vaccines have 50–70% efficacy in prevention of M. haemolytica pneumonia. Effective control of M. haemolytica pneumonia is likely to require a combination of more definitive diagnosis, efficacious vaccines, therapeutic intervention and improved management practices.