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First psychotic episode due to inmunosupresor medication
- A. Corrales, L. Unzue, L. Llovera, N. Cancelo
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1047
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- Article
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Introduction
48-year-old man from Spain who lived with his wife until he got divorced 4 months before starting the follow up in Mental Health. The debut was in September 2021 with a hospitalization in the Brief-acute hospitalization unit due to florid psychotic clinic-
He consumed several drugs in his twenties (cocaine, marihuana and heroin IV) and was diagnosed of HIV at the age of 29. He abandoned the use of drugs after the diagnoses and keep good adherence to the antiretroviral treatment (Abacavir + Lamivudine +Efavirenz).
At the age of 46 (January 2020), he was successfully transplanted a kidney. Afterwards, he started taking inmunosupresor medication to avoid transplant rejection
At the few months of the transplant and the beginning of the inmusosupresor medication, the patient became more irascible with moments of remarkable disinhibition and progressive abandon of the work obligations.
In January of 2021, he got divorced after months of difficulties with his wife, married 28 years before, due to the mentioned problems as well as moments of bizarre and disorganized conducts and suspicion towards his wife with probable delusional jealousy. He, therefore, lost his job, hose and marriage and started taking drugs again after 17 years of abstinence.
He was hospitalized in e Brief Acute Inpatient Unit in September 2021 with distrustful and hypervigilant attitude- He was suffering from delusional ideation of harm and persecution with high distress and emotional repercussion. He also presented disorganized conduct and probable auditory hallucinations. He was positive to amphetamines and cocaine After 3 days without consuming; there was no remission of the clinic.
ObjectivesDiscussing the association between the initiation of inmunsupresor medication and the beggining of psychotic clinic
MethodsFirst psychotic episode (FEP) has a likely consequence of the initiation and maintenance of Tacrolimus -due to a kidney transplant- with the concomitant abuse of amphetamines and cocaine as a trigger factor.
The psychotic clinic progressively remitted in one week after the administration of 3 mg/day of risperidone.
The antiretroviral treatment was changed due to the poor adherence during the disorganization period. The tacrolimus was not removed because of the good response to the neuroleptic and the risk of transplant rejection
ResultsThe patient started with prodromic symptoms of psychosis at the time he began with the inmunosupresor medication. Progresively, the psychotic clinic worsen wit the consequence of a biographical break with the consequence of a divorce, therlost of work and home and a drug relapse.
ConclusionsThere is evidence of the association between psychotic episodes in people with no psychiatric history and the inmunosupresor medication for the kidney transplant (Above all, tracolimus). This case remarks the need of an exhaustive medical anamnesis in the diagnosis of psychiatric pathologies.
Disclosure of InterestNone Declared
Cycloid psychosis
- R. Hernandez Anton, L. Aranguren Conde, M. Basteguieta Gardeazábal, P. Antía Ozcariz, N. Cancelo Zariquiey, N. De Sousa Figueiredo, V. Fronda Salinas
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S641
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Introduction
When we talk about cycloid psychosis we have doubts about their nosological enclave; whether they should be considered as a subform of schizophrenia or as independent psychoses.Some solutions were proposed, such as the thesis of mixed psychoses (Kretschmer) or that of intermediate forms (Bleuler, Schneider). Cycloid psychoses and bouffée delirante are recognized in ICD-10 under the name of acute polymorphic disorder without symptoms of schizophrenia (F23.0) and with symptoms of schizophrenia (F23.1).
ObjectivesClinical case
MethodsWe present the case of a 16-year-old patient with no psychiatric history, with medical background of epilepsy; she was in fllow-up by Neurology and in treatment with valproate.Neurology indicates to stop treatment; it is then whwn the patient begins to appear disoriented, confused, with significant anguish and lability and regressive behaviors.She has sudden mood swings (from laughing to crying); sudden changes in emotional reaction (from distress to anger) and sudden changes in behavior (from agitation to prostration); verbiage with pressure of speech and dysprosodia; delusional ideation and incongruous affect; visual, auditive and kinesthetic hallucinations with important repercussion. We request blood and urine tests, drug test, EEG, cranial MRI.
ResultsShe presents fluctuating, polymorphic and unstable affective and psychotic symptoms. What is the most appropriate diagnosis? We treat the patient with antipsychotic, mood stabilizer and anxiolytic treatment.
ConclusionsPsychopathology in early ages is not so clearly defined and it can take very different forms. The diagnosis of cycloid psychosis can be useful as well as necessary to describe certain patients with similar characteristics and different from other groups.
DisclosureNo significant relationships.