5 results
Capgras and Fregoli syndromes revisited through six different psychiatric clinical cases
- L. Santa Marinha, P. Felgueiras, A. Miguel, O. Nombora, A. Horta
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S447-S448
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Capgras and Fregoli syndromes are delusional misidentification syndromes, characterized by a belief in duplicates and replacements. Capgras delusion was first described by Capgras in 1923, reporting a belief that a person (usually a close relative) has been replaced by an exact double (imposter). On the other hand, Fregoli Syndrome was first described by Courbon and Fail in 1927, and holds a delusion that a familiar person is disguised as a strange person. Several explanatory models have been hypothesized, through myths, psychoanalytical and psychological interpretations, as well as neurobiological explanations.
ObjectivesThrough six different clinical cases and a narrative review, we aim to revisit the concepts of Capgras and Fregoli syndromes, emphasizing their complexity and heterogenicity.
MethodsWe conducted a non-systematic review of recent evidence on Capgras and Fregoli syndromes and expose exemplary clinical cases.
ResultsCapgras and Fregoli syndromes are complex psychotic experiences involving a great number of brain areas, with many heterogeneous clinical manifestations and comorbidities. Even though they were initially encompassed in pure psychotic disorders, today they are mainly understood as neurological disorders, in which the delusion primarily results from organic brain lesions or degeneration. Nevertheless, we present several distinct clinical cases with psychiatric diagnoses that include these curious phenomena: a 39-year-old man with schizophrenia; a 67-year-old woman with late-onset schizophrenia; a 24-year-old woman with schizoaffective disorder; a 48-year-old woman with first episode of acute and transient psychotic disorder; a 76-year-old woman with psychotic depression; and a 25-year-old woman with psychosis and intellectual development disorder.
ConclusionsOur review highlights the complexity of the delusional misidentification syndromes. We expose different patients with different psychiatric diagnosis, showing the diversity of pathologies in which these syndromes can fit. Although they seem to be very common in non-psychiatric disorders, little is known about the prognosis and response to treatment or whether there are systematic differences between delusional misidentification syndromes associated with “functional” and “organic” disorders, which should encourage further studies in order to address this gap and provide appropriate care.
Disclosure of InterestNone Declared
Electroconvulsive therapy vs Esketamine among patients with Major Depressive Episode
- M. D. R. D. R. F. D. A. Basto, O. Nombora, L. Santa Marinha, J. L. Simães, A. Horta
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S836-S837
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Major depressive disorder is one of the most common and disabling mental disorders. More than 30% of individuals do not achieve remission after several trials of antidepressants and treatment-resistant depression (TRD) is associated with premature mortality. Electroconvulsive therapy (ECT) is considered the gold-standard for TRD treatment,unfortunately it´s underused due to health care barriers and association with adverse cognitive impairment. So, scientists have sought to identify alternative treatments that approach ECT-equivalent efficacy. Trials with Ketamine and more recently with its S-enantiomer (Esketamine) has been made, revealing a rapid and robust antidepressant effect, emerging as an option for TRD treatment.
ObjectivesWe we aim to conduct a qualitative review, comparing clinical efficacy, tolerability and acceptability between the use of Esketamine and ECT as a TRD treatment.
MethodsWe conduct a non-systematic review of recent evidence between the use of Esketamine and ECT as a TRD treatment, using PubMed/Medline database.
ResultsTo compare clinical efficacy, tolerability and acceptability between the use of Esketamine and ECT as a TRD treatment we analyzed outcomes of interest. First,ECT was superior to Esketamine improving depressive symptoms. Comparing suicidal ideation and suicide attempts, most results were not statistically different. About cognition impairment, Esketamine performed better than ECT, particularizing attention, verbal memory, and executive functions; no differences were found for immediate memory or visual memory.About adverse effects Esketamine has less risk of headache and muscle pain, but higher reports of transient, dissociative or depersonalization symptoms, blurred vision, diplopia and nystagmus. An important consideration for clinicians is the comparative tolerability and safety of Esketamine vs ECT; as ECT involves a full dose of anesthesia,it is expected that Esketamine would be better tolerated and safer than ECT. But no study assessed the relative tolerability or acceptability of these different adverse effect profiles.The best strategy for relapse prevention appears to be continuing ECT, continuing pharmacotherapy, or using some combination of both; but Esketamine continuing treatment is effective too.
ConclusionsECT may be superior to Esketamine for improving depression severity in the acute phase, but long-term outcomes of these treatments are important to be considered. There are just two studies with long-term follow-up after the trial completed:one found no difference in depression severity during the 3-month follow-up, and the other reported that the remission rates were not different between groups by the 12-month follow-up period.Therefore,future research is needed to further optimize long-term treatment outcomes for both Esketamine and ECT to prevent relapse. Until then,treatment options should be individualized and patient-centered.
Disclosure of InterestNone Declared
A reflection on the use of Antidepressants to manage agitation in dementia
- M.D.R.D.R.F.D. Basto, L. Santa Marinha, O. Nombora, A. Horta
-
- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S656
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Agitated behaviors is a common neuropsychiatric symptom (NPS) in dementia, defined as inappropriate verbal, vocal, or motor activity that is not thought to be caused by an unmet need. It is frequently reported as a major problem, that impairs the quality of life for the elderly themselves and for caregivers. There has been increasing interest in the use of sedative antidepressants to treat NPS due to concerns over the safety and efficacy of antipsychotics in this setting.
ObjectivesWe aim to review clinical evidence of alternatives to antipsychoticst to manage agitation in dementia.
MethodsWe conduct a non-systematic review of recent evidence on dementia and agitation, using PubMed/Medline database.
ResultsAlthough non-pharmacological interventions are the first-line treatment for agitation, it is a legitimate target for therapeutic intervention and according to previous guidelines, antipsychotic are among the most used drugs, albeit restricted because of side-effects. A substitution strategy to avoid antipsychotic prescription was highly considered, however there is limited evidence to support the use of antidepressants as a safe and effective alternative for agitation in dementia. Studies compare Mirtazapine, Selective serotonin reuptake inhibitors (SSRIs) and Trazodone and a reduced benefit in mortality is observed. However, citalopram was more effective were more likely outpatients for moderately agitation and Mirtazapine reveals being potentially harmful, in different studies.
ConclusionsMoving forward, a greater understanding of NPS neurobiology, will help to clarify the efficacy of Antedepressants for the treatment of agitation in dementia. Benefits an also the patient and caregiver preference should be kept in mind.
DisclosureNo significant relationships.
Sexuality among elderly patients with dementia: Are we aware of their needs?
- L. Santa Marinha, O. Nombora, M. Basto, P. Felgueiras, A. Horta
-
- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S806-S807
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Sexuality is one of the basic needs in human life and its positive effects for the wellbeing are undeniable. People with dementia, despite cognition and functioning impairments, still pursue intimacy as part of their expression of basic human instincts.
ObjectivesWe aim to address the subject of sexuality among patients with dementia, emphasizing the physiological, environmental and legal barriers.
MethodsWe conduct a non-systematic review of recent evidence on dementia and sexuality, using PubMed/Medline database.
ResultsPeople with dementia face several difficulties expressing their sexuality. First, they struggle with physiological barriers to enjoyment of sexuality, such as ageism, apathy and limited free mobility. Secondly, either at home or in long-term care facilities, privacy is usually abolished. For care facilities, the Sexuality Assessment Tool supports the normalization of sexuality and self-audit policies that promote resident rights for privacy and assistance. Moreover, expression of sexuality in elderly can be misinterpreted as disinhibition, leading to unnecessary use of psychotropics to cease these behaviors. Additionally, legal barriers regarding consent arise when a partner loses the ability to consent sexual activity, questioning agreement and mutual desire. The Lichtenberg and Strzepek Decision Tree for Capacity to Participate in Intimate Relationships can be helpful to address this issue.
ConclusionsSexuality in older people remains neglected in clinical intervention. Besides the urgent need to deconstruct stereotypes, families and staff must be sensitized to understand the changes in expression and perception of sexuality among people with dementia, rather than being indifferent or medicate what can be perceived as disinhibited/distorted expressions of normal needs.
DisclosureNo significant relationships.
An Overview Of The Mental Health Problems Among Elite Athletes – Is It A Dream Or A Nightmare?
- O. Nombora, L. Lopes, L. Santa Marinha
-
- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S354-S355
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Mental health problems (MHP) are common among elite athletes (EA) and have received increased attention recently, revealing the need to assess them properly. Although EA are increasingly speaking out on their own MHP in public, research-informed approaches for practitioners are still lacking.
ObjectivesWe aim to perform an overview of the MPH among EA, emphasizing the potential risk factors and interventions.
MethodsWe conduct a non-systematic review of the recent evidence on the topic using PubMed/Medline database.
ResultsAlthough EA have comparable prevalence rates of MHP to the general population, they are exposed to various sports-related stressors. Studies reveal that 50% of EA face MHP during their career, with onset peak around 19 years. Therefore, there is a need for early detection and intervention. Burnout, alcohol abuse, anxiety, depression, insomnia and eating disorders are some MHP reported. Their management should address psychosocial and environmental aspects. Psychoeducation and psychotherapy are considered the first line treatment. Moreover, EA may encounter barriers to seeking mental healthcare. Therefore, it is important to promote positive attitudes about MHP, create an environment that supports mental well-being, resilience, psychological flexibility, self-compassion and coping skills. Screening tools may facilitate the process, so there is a need for validated athlete-specific questionnaires for MHP screening and measuring.
ConclusionsMental health is an integral dimension of EA wellbeing and performance and should be assessed. Specific programs to support EA mental health are recommended and research targeting common MHP for athletes are needed to better understand how to minimize their distress.
DisclosureNo significant relationships.