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AIDS dementia complex and neuropsychiatric symptoms : a case report
- R. Fernández Fernández, P. del Sol Calderón, Á. Izquierdo de la Puente, A. Rodríguez Rodríguez
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S960
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Introduction
HIV infection presents complications that may include neuropsychiatric symptoms and whose management is important to avoid misdiagnosis and mistreatment.
ObjectivesThis case aims to highlight the importance of assessing HIV comorbidity in patients with psychiatric onset pathology.
MethodsCase report and literature review.
ResultsWe present the case of a patient diagnosed with HIV in 1985, who after 20 years of disease with irregular adherence begins to present delusional ideation of harm and self-referential, control experiences, thought diffusion phenomena, and possible auditory hallucinations, with poor evolution despite the establishment of numerous antipsychotic treatments, which evolves over the years towards a confabulatory character and with progressive neuropsychological deterioration. After numerous admissions, and despite several treatments, the patient developed over time memory failures, bradypsychia, gait disturbances, and difficulties in self-care, which further aggravated his condition by hindering therapeutic adherence, which ended with the patient’s chronic institutionalization. Diagnosis was AIDS dementia complex.
ConclusionsHIV hardly replicates in the central nervous system but generates antigenemia which, in turn, generates an inflammatory infiltrate that can cause diffuse involvement, predominantly subcortical and limbic system. Usually, the dementia-AIDS picture is insidious and develops in patients with poor control of the primary disease. It is recommended to optimize antiretroviral therapy and neuroprotective agents, as well as symptomatic treatment by psychiatry.
Disclosure of InterestNone Declared
Psychiatric Comorbidity and Length of Stay in a general hospital
- R. Fernández Fernández, P. del Sol Calderón, Á. Izquierdo de la Puente, R. Blanco Fernández, M. Martín García
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S588-S589
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Introduction
Psychiatric comorbidity has a significant impact on the patient’s overall health, with an increased risk of death for those patients with mental-physical comorbidity (Tan et al., 2021). This impacts, among other things, the average hospital stay of a patient with psychiatric comorbidity. For example, an American study shows that psychiatric comorbidity was associated with greater inpatient utilization, including the risk of additional hospitalizations, days of stay, and hospitalization charges (Sayers et al., 2007). Our study aims to confirm these results in patients admitted to a general hospital for any cause and presenting psychiatric comorbidity.
ObjectivesTo compare the mean length of stay of patients admitted to a general hospital for any cause according to whether they have psychiatric comorbidity or not.
MethodsWe made a descriptive retrospective study through the use of electronic medical records. The drug use history and average day of hospitalization were obtained for all patients admitted to the inpatient service of a general hospital during a 3-year period.
ResultsThe mean length of stay was longer in patients with psychiatric comorbidity (mean = 9.87 days, SD = 15.45) than in patients without psychiatric comorbidity (mean = 5.23 days, SD = 7.16), the difference being statistically significant for the analysis of variance with a small effect size (F = 18.2; p < 0.001, η²=0.038). The assumption of the equality of variances of the two groups is not fulfilled (Levene F = 29.0; p < 0.01) so Welch’s nonparametric test was applied, whose results do not modify those obtained.
N Mean SD SE No psychiatric comorbidity 296 5.23 7.16 0.416 Psychiatric comorbidity 238 9.87 15.45 1.002 ConclusionsOur results are in line with other studies, showing a longer mean length of stay in those patients admitted for any cause and with associated psychiatric comorbidity. This highlights the importance of having an integrated psychiatry service in a general hospital, as Bronson points out, where they find a shorter mean length of stay in units that have integrated, proactive psychiatric care (Bronson et al., 2019).
ReferencesBronson, B. D., Alam, A., & Schwartz, J. E. (2019). The Impact of Integrated Psychiatric Care on Hospital Medicine Length of Stay: A Pre-Post Intervention Design With a Simultaneous Usual Care Comparison. Psychosomatics.
Sayers, S. L., Hanrahan, N., Kutney, A., Clarke, S. P., Reis, B. F., & Riegel, B. (2007). Psychiatric comorbidity and greater hospitalization risk, longer length of stay, and higher hospitalization costs in older adults with heart failure. Journal of the American Geriatrics Society.
Tan, X. W., Lee, E. S., Toh, M., Lum, A., Seah, D., Leong, K. P., Chan, C., Fung, D., & Tor, P. C. (2021). Comparison of mental-physical comorbidity, risk of death and mortality among patients with mental disorders - A retrospective cohort study. Journal of psychiatric research.
Disclosure of InterestNone Declared
Cannabis use in different mental disorders: a descriptive study in a psychiatric hospital
- B. Samso, A. López Fariña, C. González Navarro, L. Morado San Segundo, A. Bilbao Idarraga, U. López Puentes, R. F. Lopez Brokate, T. Ruiz de Azua Aspizua, U. Ortega Pozas, C. Arán Cisneros, E. Garnica de Cos, I. Alonso Salas
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S334-S335
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Introduction
In the last decade, the prevalence of THC use is increasing among adolescents and adults. There is also strong evidence to suggest that cannabis use is associated with psychiatric comorbidities. The strongest evidence is found between cannabis use and psychotic disorder. However, the literature shows that those who have used cannabis in the past or for a large part of their lives are at higher risk of mood disorders, anxiety, personality disorder or other drug use than those who do not use cannabis in a harmful way.
ObjectivesTo provide an overview of the association between cannabis use and the different mental pathologies presented by the patients admitted during the study period. To describe the prevalence of THC use in the study according to the mental pathology presented by the patient.
MethodsA retrospective observational descriptive study was developed for 3 months, of all patients admitted to the acute unit of the psychiatric hospital. No exclusion criteria were included.
ResultsDuring the period of study 172 patients were admitted to the hospital, classified according to the main diagnosis we have: 49 patients suffer from schizophrenia, 26 bipolar affective disorder, 20 with depressive disorder, 20 with personality disorder, 19 with substance use disorder, 18 with other unspecified disorders and 20 patients with no known previous diagnosis. The prevalence of THC use in the study sample according to diagnosis, would be schizophrenia 16%, Bipolar affective disorder 19%, Depressive disorder 5%, Personality disorder 45%, Substance use disorder 21%, Unspecified disorders 11% and patients with no known previous diagnosis 10%.
ConclusionsThe results obtained in the study in terms of THC use are in agreement with those obtained in the literature. In our study, we observed that cannabis use is associated with psychotic disorders as well as with mood, personality and substance abuse disorders. Given that the frequency of use has increased and there is a strong association with different comorbid psychiatric diagnoses, guidance on modifications in medication strategies might be necessary.
Disclosure of InterestNone Declared
Associations between polysubstance use and psychiatric comorbidities
- R. Fernández Fernández, P. del Sol Calderón, Á. Izquierdo de la Puente, M. Vizcaíno da Silva
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S763
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Introduction
Polydrug use studies mention demographic and socioeconomic factors that may influence this problem. One of them is the existence of psychiatric comorbidity; Rentrop’s study (Rentrop et al., 2014) finds in a sample of 50 patients that all patients had at least one axis I disorder, 90% at least one axis II disorder, which may compromise the outcome of detoxification and dehabituation treatments (Rentrop et al., 2014). Another study found that 44.9% of patients admitted to a psychiatric unit are polydrug users (Karam et al., 2002).
ObjectivesTo study the possible association of polydrug use with psychiatric comorbidity in patients admitted to a general hospital and presenting drug use.
MethodsWe made a descriptive retrospective study through the use of electronic medical records. The drug use history was obtained for all patients admitted to the inpatient service of a general hospital during a 3-year period.
ResultsMore cases of poly-consumption together with psychiatric comorbidity are found than expected in the χ² Test, with significant results (χ² = 27.2; p<0.001). The mean age of the patient with poly-consumption and psychiatric comorbidity is 34.9 years.
Psychiatric comorbidity Polydrug use No Yes Total No Observed 296 0 296 Expected 284 11.64 296 Yes Observed 217 21 238 Expected 229 9.36 238 Total Observed 513 21 534 513 21 534 ConclusionsPsychiatric comorbidity in patients with polydrug use may be overlooked (Kruckow et al. 2016). Identifying patients with dual diagnosis is important given that these patients suffer decreased treatment compliance and life expectancy compared with single-diagnosis patients (Kruckow et al., 2016).
ReferencesRentrop, M., Zilker, T., Lederle, A., Birkhofer, A., & Hörz, S. (2014). Psychiatric comorbidity and personality structure in patients with polyvalent addiction. Psychopathology, 47(2), 133–140. https://doi.org/10.1159/000351784
Kruckow, L., Linnet, K., & Banner, J. (2016). Psychiatric disorders are overlooked in patients with drug abuse. Danish medical journal, 63(3), A5207.
Disclosure of InterestNone Declared
Adherence to psychiatric medications and diagnosis
- C. González Navarro, A. Bilbao Idarraga, I. Alonso Salas, L. Morado San segundo, A. López Fariña, U. López Puentes, B. Samsó Martínez, R. F. Lopez Brokate, T. Ruiz de Azua Aspizua, E. M. Garnica de Cos, U. Ortega Pozas
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S240-S241
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Introduction
Patients with mental disorders frequently become non-adherent during their long term prescribed treatment. This situation frequently triggers clinical worsening and hospital admission. Therefore, non-adherence may result in poorer long term clinical outcomes and has economic implications for health-care providers (Carlos De las Cuevas et al. Neuropsychopharmacol Hung 2021; 23(4):347-362).
Objectives- To describe the adherence to oral and long acting injectable treatment in the sample of patients that were admitted to the short stay hospital unit during the period of study.
- To describe the adherence to treatment amongst psychiatric diagnosis in the sample of study.
MethodsIt was a retrospective observational study with a duration of three months. Data was collected from all patients admitted to the short stay hospital unit during the period of study and there were no specific exclusion criteria. Descriptive statistics were performed. To assess the adherence to pharmachological treatment the patient report, the family report and the pharmacy dispensation according to the existent informatic prescription platform was considered. Regarding the long acting injectable treatment the formulary of administration in the clinical history was checked.
ResultsDuring the period of study 172 patients were admitted to the short stay hospital unit. Of those, 146 patients had a previous pharmacologic prescription. Data of treatment was not possible to obtain in 7 patients. In the sample of study, 83.5% were on oral and 16.5% on long acting injectable treatment. The general adherence to treatment in the sample was 61.87%. In the oral treatment group the adherence was 58.4% and in the long acting injectable treatment group was 65.2%.
Amongst the different psychiatric diagnoses the outcomes of adherence to treatment were: 60.4% in schizophrenia and related psychosis, 62.5% in bipolar disorder, 78.6% in depression, 58.3% in personality disorders and 62% in addictive disorders.
ConclusionsIn our descriptive study adherence to treatment was higher in the long acting injectable treatment group, agreeing with the existent scientific literature.
The results of adherence for schizophrenia and bipolar disorder are similar to the ones found in scientific literature but differ from the ones for depression, being higher in our sample (Judit Lazary et al. Neuropsychopharmacol Hung 2021;23(4): 347-362). Moreover, in scientific literature it is found a similar prevalence of adherence across diagnosis (for schizophrenia, bipolar disorder and depression) whereas in our sample patients with depression showed a different and higher adherence to treatment (Judit Lazary et al. Neuropsychopharmacol Hung 2021;23(4): 347-362). In our sample, patients with personality disorders had the lowest adherence to treatment.
Disclosure of InterestNone Declared
Lisdexamfetamine in combination with guanfacine as an effective treatment in the management of behavioral disturbances in patients with Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). Case report
- P. Del Sol Calderon, A. Izquierdo de la Puente, M. García Moreno, R. Fernández Fernandez
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S739-S740
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Introduction
We often find it challenging to manage hyperactivity, low frustration tolerance and angry outbursts in patients with ASD and comorbid ADHD. Fewer drugs are approved for these disorders and these patients are more likely to develop adverse effects.
ObjectivesThe aim of this case is to show how the combination of lisdexamfetamine together with guanfacine has very positive effects on anger outbursts and boundary heteroaggressiveness in patients with ASD and ADHD.
MethodsCase report and literature review
ResultsThis is a 14-year-old minor admitted to the psychiatric unit after physical aggression against his family due to anger after removal of video games, requiring police intervention. He has been diagnosed since he was 11 years old with ADHD and Autism Spectrum Disorder. He was being treated with methylphenidate 54 mg and aripiprazole 10 mg. Since the beginning of the admission, the following pharmacological adjustment has been made: Methylphenidate is substituted by lisdexamfetamine up to 50 mg per day. Guanfacine has been started up to 4 mg per day and the dose of aripiprazole has been maintained. The patient had no adverse effects with adequate tolerance without sedation, hyporexia or hypotension. With this adjustment, improvement was found in the levels of restlessness and hyperactivity. The patient expressed a subjective improvement in the levels of restlessness and with a notable improvement in attention in the hospital classroom. An improvement in emotional regulation was also observed, with more tolerance to the imposition of limits, without an explosion of anger in the face of any rule during admission
ConclusionsThe management of hyperactivity and episodes of low frustration tolerance in patients with ASD and ADHD is complex. Many studies point out the time-limited use of some antipsychotics such as risperidone or aripiprazole. This work aims to show guanfacine in combination with lisdexamfetamine as an excellent combination for the management of agitation and rage explosion in these patients. In addition, the profile of adverse effects at metabolic level is much better than that of atypical antipsychotics.
Reference- Extended-Release Guanfacine for Hyperactivity in Children With Autism Spectrum Disorder. Lawrence Scahill et al. Am J Psychiatry. 2015 Dec.
Disclosure of InterestNone Declared
Relationship between dementia and depression: a case series
- A. Izquierdo De La Puente, P. del Sol Calderón, R. Fernández Fernádez, A. Rodríguez Rodriguez, M. Vizcaíno Da Silva, M. Martín García, O. Médez Gonzalez
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S825
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Introduction
Four cases are presented who debut with depressive episodes and after close follow-up, are diagnosed and treated for Alzheimer’s disease
ObjectivesThe aim of this case series is to give a brief review of the depressive prodrome of dementia.
MethodsFour women, aged 67-77 years, treated on an outpatient basis, consulted for depressive symptoms. In addition to affective symptoms such as apathy, lack of interest, sadness, increased emotional lability and anhedonia, all three reported cognitive impairment. In their follow-up after two years, they became progressively more dependent on their partners, with more memory lapses, forgetfulness and progressive loss of higher cognitive functions. With the progression of cognitive impairment, anxious symptoms have become increasingly present.
ResultsThe mean age of the patients is 70 years. Two of them had an insidious onset of depressive symptoms, while the other two had a psychotic onset of depression. None of the patients had no previous history of depression. All four were started on antidepressant treatment with little response. Following the diagnosis of cognitive impairment, treatment was started with rivastigmine, with an adequate response.
ConclusionsDementia and depression are very common in the elderly. It appears that up to 40% of patients with dementia have depressive symptoms. It appears that depression in old age may actually be a prodromal symptom of dementia.
Disclosure of InterestNone Declared
Alcohol consumption and cardiovascular risk: a descriptive study in a psychiatric short stay unit
- C. González Navarro, I. Alonso Salas, L. Morado San segundo, A. López Fariña, A. Bilbao Idarraga, U. López Puentes, B. Samsó Martínez, R. F. Lopez Brokate, T. Ruiz de Azua Aspizua, E. M. Garnica de Cos, U. Ortega Pozas
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S754
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Introduction
Patients with mental disorders have a decreased life expectancy, being the main reason the cardiovascular disease. An important proportion of patients present a comorbid drug consumption. Amongst drugs, alcohol is the most frequent, and it is associated with a higher cardiovascular risk. The metabolic syndrome is one of the most employed tools to assess cardiovascular risk.
Objectives- To describe the demographic characteristics of the patients with an active alcohol consumption that were admitted to the hospital during the period of study.
- To describe the prevalence of metabolic syndrome in the sample, according to the Adult Treatment Panel III (ATP-III) criteria.
MethodsRetrospective observational study of three months duration. Data was collected from all patients admitted to the hospital during the period of study, with no specific exclusion criteria. Descriptive statistics were performed.
ResultsDuring the period of study 172 patients were admitted to the hospital (56.4% women and 43.6% men). A 44.8% presented alcohol consumption (25% sporadically, 6.4% weekly and 13.4% daily). Amongst women, 1% presented daily and 1% weekly consumption. Amongst men, 21.3% presented daily and 5.3% weekly consumption.
The prevalence of metabolic syndrome in the study sample was 29.11%. In the alcohol consumption group, the prevalence was 24.7% and differed according to the pattern of consumption: 43.5% in the daily consumption group, 27.3% in the weekly and 14% in the sporadically consumption group.
ConclusionsOn the one hand, in the sample of study a higher percentage of men present an active alcohol consumption, compared to women. It is remarkable the high percentage of daily alcohol consumption amongst men in our sample.
On the other hand, the prevalence of metabolic syndrome in our sample is similar to the one found in scientific literature regarding patients with mental disorders. It is noteworthy in our sample the increased prevalence of metabolic syndrome found in patients with a daily alcohol consumption, and a decreased prevalence in those with a sporadic pattern.
Disclosure of InterestNone Declared
Alcohol use in adult patients with autism spectrum disorder (ASD). Case report
- P. Del Sol Calderon, A. Izquierdo de la Puente, A. Alvarez Astorga, M. García Moreno, R. Fernandez Fernandez
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S762
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Introduction
Patients with autism spectrum disorder are characterized by high anxiety when facing social situations and dealing with interpersonal relationships on a daily basis. Although initially because of their rigid personality with the norm, and their tendency to social distancing, we do not have in mind this pathology as the most likely to develop a substance use disorder. However, it is observed in the literature a remarkable percentage of patients who resort to consumption, mainly alcohol, as an anxiolytic to be able to interact in society.
ObjectivesTo show the case of a 19-year-old adult with a diagnosis of ASD who resorts to alcohol consumption in her daily life as a strategy to manage anxiety in social situations.
MethodsCase report and literatura review
ResultsThis is a 19-year-old woman with a recent diagnosis of ASD. She is studying biotechnology and lives with her parents and 3 siblings. The patient reports difficulty in social relationships since early childhood, with experiences of school bullying. She expresses desire to relate with others, although she does it in an inadequate way, with difficulty in detecting nonverbal language, irony and anger when she does not understand a joke. The patient confesses that since she was 16 years old she has consumed alcohol to mitigate the anxiety caused by facing a group of people. She says that she feels that it relaxes her and facilitates interaction, making it more fluid and less tense. However, she recognizes that initially she used to drink 1 or 2 beers, but now she needs to drink up to 2 glasses of gin, recognizing this as something problematic.
ConclusionsThe literature shows how patients with ASD can also present substance use disorder. It has been shown that about 10% of these patients have an abusive use of alcohol. Other samples show wider ranges (7-71%) of prevalence of alcohol consumption in patients with autism. In relation to cannabis, it is seen that around 3% of these patients consume it. These patients seek its anxiolytic effect and to reduce mental health symptoms. In addition, the purchase of alcohol does not involve high social interaction to obtain it, since it is a substance that can be purchased legally. It is important to explore alcohol consumption in consultation with patients with ASD to help them develop more functional anxiety management strategies.
ReferencePrevalence of psychiatric disorders in adults with autism spectrum disorder: A systematic review and meta-analysis. Lugo-Marín.J et al. 2019. Research in Autism Spectrum Disorders Volume 59, March 2019, Pages 22-33
Disclosure of InterestNone Declared
How is depression in the elderly patient diagnosed?
- R. Fernández Fernández, Á. Izquierdo de la Puente, P. del Sol Calderón, O. Méndez González
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S942
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Introduction
The diagnosis of depression in the elderly patient presents peculiarities that should be taken into account. Studies point out the importance of an adequate screening of suspected cases of depression in older adults by physical therapists and other non-mental health professionals (Ramos Vieira et al., 2014). In this study, we intend to find out which are the most used diagnostic methods in Mental Health research on geriatric patient.
ObjectivesTo analyze the diagnostic methods most used in research on the geriatric patient, specifically in articles that analyze the patient with cognitive impairment.
MethodsA bibliographic search of all articles analyzing depression in patients with cognitive impairment between 2000 and 2020 was carried out. The diagnostic method of depression in each of them has been collected.
ResultsA total of 38 studies were analyzed. The most common diagnostic method continues to be the use of diagnostic criteria (ICD or DSM), which is used in 34.2% of the studies, while the Center for Epidemiologic Studies Depression Scale (CES-D) is the most commonly used test, appearing in 23.7% of the studies. The remaining tests (CIDI, GDS, HAM17, PHQ, SCID, SCL-90, SGDS) do not reach 10% each.
Counts % of Total Cumulative % GDS 2 5.3 % 5.3 % CES-D 9 23.7 % 28.9 % CIDI 2 5.3 % 34.2 % Diagnostic criteria 13 34.2 % 68.4 % EURO-D 1 2.6 % 71.1 % PHQ 2 5.3 % 76.3 % GMS-AGECTA 2 5.3 % 81.6 % HAM-17 1 2.6 % 84.2 % Others 6 15.8 % 100 % ConclusionsThe diagnosis of depression continues to be made primarily using diagnostic criteria. It is striking that the most commonly used test is the CES-D, given that the Geriatric Depression Scale (GDS) is usually the most popular scale for screening for late-life depression (Gana et al., 2017), which may be due to the fact that the studies analyzed have a more research than clinical purpose.
ReferencesGana, K., Bailly, N., Broc, G., Cazauvieilh, C., & Boudouda, N. E. (2017). The Geriatric Depression Scale: does it measure depressive mood, depressive affect, or both?. International journal of geriatric psychiatry, 32(10), 1150–1157.
Vieira, E. R., Brown, E., & Raue, P. (2014). Depression in older adults: screening and referral. Journal of geriatric physical therapy (2001), 37(1), 24–30.
Disclosure of InterestNone Declared
Use of cariprazine as an impulsivity regulator in an adolescent with non suicidal self-injury and suicidal attempts. Case report
- P. Del Sol Calderon, A. Izquierdo de la Puente, R. Fernández Fernández, M. García Moreno
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S739
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Introduction
Adolescents with emotional dysregulation are at risk for self-injury. Antipsychotics are often used to manage these symptoms.
ObjectivesThe aim of the present case is to show the use of cariprazine as an effective drug for emotional dysregulation and impulsivity in a 17-year-old adolescent girl
MethodsCase report
ResultsThe patient was a 17-year-old female admitted to in patient psychiatric unit for a self-harm attempt due to sertraline overdose. She was being followed up for self-injury, anxiety and eating disorder symptoms. Her treatment was sertraline 200 mg, diazepam 20 mg per day and olanzapine 15 mg per day. With this medication she had gained up to 7 kgs in 4 months. A progressive change was made with cariprazine up to 3 mg and olanzapine was reduced to 2.5 mg at night. With this adjustment the patient did not present worsening in anxiety levels, with adequate impulse control and being able to perform emotional regulation strategies.
ConclusionsAlthough it has no indication in patients under 18 years of age, it shows a case of good tolerance and efficacy for the management of impulsivity by improving emotional regulation. Cariprazine is an atypical antipsychotic that works through partial agonism on dopaminergic receptors, serotonin 5-HT1A receptors and an antagonist at the 5-HT2B receptors, with moderate affinity for adrenergic, histaminergic, and cholinergic receptors reducing the likelihood of side effects
Disclosure of InterestNone Declared
Tobacco and hypertension: a descriptive study in a psychiatric short care unit
- I. Alonso Salas, A. Lopez Fariña, C. Gonzalez Navarro, A. Bilbao Idarraga, L. Morado San Segundo, U. Lopez Puentes, R. Lopez Brokate, T. Ruiz de Azua Aspizua, E. M. Garnica de Cos, U. Ortega Pozas, B. Samsó Martinez
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S954-S955
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Introduction
Patients affected by mental disorders are known to have a decreased life expectancy.
One of the main reasons are cardiovascular diseases. It is known that tobacco and hypertension are risk factors to develop them. WHO estimates that hypertension is diagnosed and treated in less than half of adults with hypertension, and even less in patients with severe mental illness.
ObjectivesTo describe the demographic characteristics of patients with tobacco comsumption and hypertension admitted to a short-term hospitalization unit.
MethodsA three-month retrospective observational study. Data were collected by interviewing incoming patients and performing a blood pressure measurement, with no exclusion criteria.
ResultsOf 172 patients admitted, 100 were smokers of whom 49 were men and 51 were women. Among the smokers, a total of 18 patients were diagnosed with hypertension and 79 were not diagnosed. Within the group of patients not diagnosed with hypertension, elevated blood pressure was recorded in 5 of them. A total of 67 patients were non-smokers, 23 of whom were male and 44 female. Among the non-smokers, 19 were diagnosed with hypertension and 48 were not, despite which elevated blood pressure levels were recorded in 4 of them. No data were collected from 5 patients.
ConclusionsThe prevalence of smokers in our sample was 58%. The prevalence of patients diagnosed with hypertension was 21,51% which is coherent with the existent literature. We did not find a higher percentage of hypertensive patients among the smokers admitted. There were patients who suffered from hypertension and were not diagnosed or treated previously.
Disclosure of InterestNone Declared
Under-diagnosis of alcohol abuse: a descriptive study in a psychiatric hospital
- A. Lopez Fariña, U. López Puentes, I. Alonso Salas, C. Gonzalez Navarro, A. Bilbao Idarraga, L. Morado Sansegundo, U. Ortega Pozas, C. Aran Cisneros, B. Samso Martinez, R. F. Lopez Brokate, T. Ruiz de Azua Aspizua, E. M. Garnica De Cos
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S333
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Introduction
Incidence of alcohol abuse in our country is high, although it is still under-diagnosed and under-treated. The WHO estimates that a total of 3.3 million deaths worldwide per year are related to alcohol consumption.
ObjectivesThe main objective is to describe the pattern of alcohol consumption in a sample of patients who are admitted to our psychiatric hospital for different reasons, relating with previous diagnoses.
MethodsA retrospective observational descriptive study was carried out in the acute care unit of the psychiatric hospital, after approval of the corresponding protocol by the ethics committee. All patients admitted to this unit during a three-month period were taken as a sample. During admission, sociodemographic data, drug use, treatment type and time and previous diagnoses were collected.
ResultsOut of 172 patients, 81 reported being abstemious, 45 declared occasional consumption, 11 weekly and 22 daily consumption. There is no data about 13 patients. Among those who reported daily alcohol consumption, 59% had a previous diagnosis of Substance Use Disorder (SUD), 23% a previous diagnosis of Schizophrenia, 13.5% of Bipolar Disorder and finally 4.5% of Depressive Disorder. All the patients with a previous diagnosis of SUD reported consumption of more than 10 SDUs/day, the group with Schizophrenia stated less than 5 SDUs/day, of the group with T. Bipolar between 7-10 SDUs/day and with T. Depressive 5 SDUs/day.
ConclusionsThe results obtained are consistent with the literature in relation to the under-diagnosis of alcohol use disorder, taking into account that 40% of patients in the sample with daily alcohol consumption previously had not such a diagnosis and it was not recorded in their medical history. For this reason, and for the sake of being able to treat them, it is essential to question all patients about alcohol consumption, whatever the reason for their admission.
Disclosure of InterestNone Declared
Neuropsychiatric symptoms related to agenesis of the corpus callosum. A case report
- A. Izquierdo De La Puente, P. del Sol Calderón, M. García Moreno, R. Blanco Fernandez, M. Vizcaino Da Silva
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S892
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Introduction
We present the case of a 41-year-old male patient with multiple psychiatric diagnoses, he was diagnosed with agenesis of the corpus callosum, which explains his clinical presentation.
ObjectivesThe objective is to carry out a brief review of the symptoms associated with the agenesis of the corpus callosum.
MethodsThe patient has been diagnosed with ADHD, cyclothymia, depressive anxiety disorder and social phobia. He has been treated with a multitude of drugs such as antidepressants, anxiolytics, stimulants and even low-dose antipsychotics. Despite the pharmacological treatments received, as well as the therapies, the patient’s functionality has progressively worsened, to the point of restricting going out of the home or maintaining a stable job.
Biographical data were collected, including psychomotor retardation and inappropriate laughter. He showed mannerisms such as fluttering and low frustration tolerance. He was slow to respond to his name and showed little affective resonance with his sister and parents. Restrictive interests, especially with English culture, for which he later studied English philology. On the other hand, his mother explains that he had no symbolic play and that, from early childhood, he had difficulties in relationships with peers.
Due to the aforementioned clinical manifestations, the functional worsening and the examination carried out in the consultation room, it was decided to extend the study with a brain MRI, where an agenesis of the corpus callosum was observed.
ResultsAgenesis of the corpus callosum is a malformation of the central nervous system, which affects one in every 4000 births. It can be partial or complete, and occurs between the 7th-20th week of gestation.
Agenesis of the corpus callosum presents with a triad of symptoms:
- Reduced interhemispheric communication of sensory-motor information.
- Increased information processing time
- Difficulty in abstract thinking.
This triad causes difficulties not only cognitively, but also socially. There is difficulty in integrating and learning new verbal and visual information. Tendency to literalism, with difficulty in understanding double meanings. They also have difficulty understanding non-verbal language and reading emotions, which makes interaction with peers difficult. All these symptoms can sometimes be confused with symptoms compatible with Autism Spectrum Disorder.
ConclusionsAfter the diagnosis and after focusing the patient’s treatment on the most limiting symptoms of his daily life, an integrated approach was initiated, not only at a pharmacological level, with the use of antidepressants and anxiolytics, but also from a psychotherapeutic point of view, working on those areas in which the patient is most dysfunctional. He was accompanied in the disability application process, as well as helped in the search for associations for adults with ASD, finding there the answer to his symptoms and difficulties.
Disclosure of InterestNone Declared
Length of stay and reason for admission in an adolescents inpatient unit
- M. Taracena Cuerda, M. Esperesate Pajares, M. Feito Garcia, C. Arranz Martin, E. Sánchez Sampedro, A.M. Jiménez Bidón, R. Puente García, C. Pastor Jordá
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S445
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Introduction
Psychiatric Inpatient units are important resources of the mental health network. These units have elevated costs, so it is important to get to know some factos that might mediate the lengh of stay in these units.
ObjectivesPsychiatric Inpatient units are important resources of the mental health network. These units have elevated costs, so it is important to get to know some factos that might mediate the lengh of stay in these units.
MethodsAn observational and descriptive analysis of the sample of patients between 12 and 17 years-old, that were admitted to the inpatient mental health unit since its opening on April 2021.
Results205 patients were admitted April 2021 until October 2021. The most common reason for admission (RFA) was suicidal ideation/attempt (57.07%), eating disorders (15.1%), mood disorders (11.2%), conduct disorders/challenging behaviors (7.8%) and psychosis (7.3%). Adolescents with eating disorders had the longest length of stay, with an average of 23.8 days. They were followed by those suffering from psychosis (17.8 days) and suicidal ideation/attempts (17.1 days). Mood disorders average length of stay was 15.1 days and conduct disorders/challenging behaviors was the shortest one with a LOS of 12.5 days.
ConclusionsAdolescents with eating disorders seem to need longer lentgh of stay, what differs from Zeshan et al study that concludes that patients with schizophrenia might need longer LOS. Nevertheless, just as Zeshan et al study, we conclude that patients admitted with conduct disorders/challenging behaviors have the shortest LOS.
DisclosureNo significant relationships.
Neurofibromatosis type 1 comorbid with attention deficit and hyperactivity disorder. Case report
- P. Del Sol Calderón, R. Paricio Del Castillo, L. Mallol Castaño, A. Izquierdo De La Puente, M. Garcia Moreno
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S431
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Introduction
A 9-year-old girl under pediatric follow-up since the age of 4 years after diagnosis of neurofibromatosis type 1
ObjectivesTo present a case of neurofibromatosis and ADHD comorbidity to raise awareness of the importance of screening for neurodevelopmental disorders.
MethodsCase report and literature review
ResultsThe patient had an adequate control and follow-up of the disorder with periodic check-ups and magnetic resonance imaging during her follow-up. She was referred due to symptoms of inattention with failure to perform exams and impulsivity in interpersonal relationships, affecting her social functioning. In addition, the patient presented simple motor tics of eye contraction and shoulder elevation. The patient was diagnosed with attention deficit hyperactivity disorder together with tic disorder. She was treated with stimulant medication with worsening of tics and marked hyporexia. Therefore, medication with guanfacine was started up to 4 mg per day, adjusted by weight. With this dose there was a control of the tics, with improvement of the symptoms of inattention and impulsivity. In different spheres an improvement in their functionality was observed, with improvement in mood, self-esteem and academic performance.
ConclusionsNeurofibromatosis type 1 is a rare monogenic disorder with a varied presentation (ophthalmologic, dermatologic and predisposition to tumor development). Patientshave been shown to present with symptoms of inattention and executive function impairment, along with other neurodevelopmental disorders such as autism spectrum disorders, learning disabilities or intellectual disability. The literature shows that up to 60% of them has ADHD criteria.
DisclosureNo significant relationships.
Pots syndrome: the importance of organic screening in anxiety patients. Case report
- P. Del Sol Calderón, L. Mallol Castaño, R. Paricio Del Castillo, A. Izquierdo De La Puente, M. Garcia Moreno
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S475
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Introduction
16-year-old female who starts psychiatric follow-up due to episodes of anxiety crises with dizziness and tremors.
ObjectivesTo expose a case in which it is essential to rule out organic pathology in cases where there is anxiety and physical symptoms.
MethodsCase report and literature review
ResultsThe patient explains that she was in a situation of conflict with her ex-partner, commenting that he did not accept the breakup. Sertraline was prescribed in ascending doses up to 100 mg per day with complete remission of anxiety. 8 months later, she went to the emergency room for loss of consciousness and tremor of the lower limbs. She was diagnosed with conversive disorder and was prescribed lorazepam up to 3 mg per day. Since then, there has been a worsening in the frequency of syncope occurring up to 10 times a day, limiting her academic and social life. She was evaluated by a cardiologist who diagnosed Pots Syndrome (postural orthostatic tachycardia syndrome) and started treatment with ivabradine and mineralocorticoids. With this treatment, the episodes were drastically reduced and spaced out to 1-2 per week. The dose of lorazepam is decreased until its withdrawal without worsening of the anxious symptomatology.
ConclusionsThis disorder consists of an involvement of the autonomic nervous system in which there is a sudden drop in blood pressure together with an abrupt increase in heart rate. Its treatment is based on increasing blood volume with drugs such as corticosteroids as well as postural measures with adequate water intake.
DisclosureNo significant relationships.
ADHD in a patient with eating disorder. Case report
- P. Del Sol Calderón, A. Izquierdo De La Puente, M. Garcia Moreno, R. Paricio Del Castillo, L. Mallol Castaño
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S384
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Introduction
15-year-old female referred to outpatient unit after COVID lockdown for binge eating and purging with depressive symptoms and anxiety.
ObjectivesTo show the importance of a correct diagnosis in an impulsive patient with eating disorder
Methodscase report and literature review
ResultsThe patient presents emotional instability with interpersonal difficulties with high fear of rejection. She suffered from fear of gaining weight and desires to lose weight with rejection of her body image. Fluoxetine and lorazepam are started together with low doses of olanzapine. During the follow up she presented a worsening of mood, onset of self-injuries and an episode of suicidal attempt. A biographical examination was performed, expressing a feeling of academic failure with difficulty concentrating and performing simple tasks. As a child she is described as impulsive, with frequent arguments with classmates. CPT III was performed with a high probability of ADHD. Treatment was started with lisdexamfetamine up to 50 mg with good tolerance. From the beginning of the treatment the patient expressed a feeling of improvement in the control of emotions as well as in the management of her impulsivity. There was an improvement in her academic performance with a decrease in self-injury episodes. The patient was able to express improvement in the sense of incapacity she felt.
ConclusionsThis case shows how marked emotional dysregulation and impulsive symptoms improves after diagnosis and subsequent treatment of ADHD, also improving eating symptoms. ADHD is present in eating disorders, especially in those with impulse dyscontrol such as binge eating disorder or bulimia nervosa.
DisclosureNo significant relationships.
Electroconvulsive therapy in children and adolescents
- M. Esperesate Pajares, C. Pastor Jordá, M. Taracena Cuerda, R. Puente García, A.M. Jiménez Bidón
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S445
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Introduction
Despite its good results and tolerability in adults, electroconvulsive therapy (ECT) is barely administered in children and adolescents, with scarce evidence in these patients.
ObjectivesWe aim to summarize the data available to give a clearer view of how children and adolescents might benefit from ECT.
MethodsWe’ve done a bibliographic review in PubMed and Cochrane Library searching for articles that include the terms “electroconvulsive therapy” and “adolescents” and/or “children” and their variations.
ResultsCurrent evidence supports the use of ECT in various indications as mood disorders, schizophrenia spectrum disorders, catatonia, neuroleptic malignant syndrome and self-injurious behaviours associated with autism, Tourette’s syndrome or intellectual disability. The efficacy and safety it’s comparable to adults and there are no absolute contraindications. Side-effect profile it’s also similar to the general population, reporting as the most frequent adverse effects headache, generalized body aching, and nausea or vomiting.
ConclusionsECT is an effective and safe treatment for severe mental disorders in children and adolescents.
DisclosureNo significant relationships.
Descriptive analysis of patients admitted to a new adolescent inpatient unit in Madrid
- M. Taracena Cuerda, M. Esperesate Pajares, M. Feito Garcia, C. Arranz Martin, E. Sánchez Sampedro, A.M. Jiménez Bidón, R. Puente García, C. Pastor Jordá
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S443
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Introduction
Adolescent mental health problems may have increased after COVID-19 worldwide pandemic. Therefore it seems necessary to study the state of mental health inpatient adolescent units.
ObjectivesAdolescent mental health problems may have increased after COVID-19 worldwide pandemic. Therefore it seems necessary to study the state of mental health inpatient adolescent units.
MethodsAn observational and descriptive analysis of the sample of patients between 12 and 17 years-old, that were admitted to the inpatient mental health unit since its opening on April 2021.
ResultsA total of 205 patients were admitted from April 2021 until October 2021. We have observed sex diferences within patients admitted, as the 82.9% of them were female. The mean age was 14.7, being 14.6 for girls and 15.3 for boys. The most common reason for admission (RFA) were suicidal ideation/attempt, eating disorders, affective disorders, conduct disorders/challenging behaviors and psychosis. Suicidal ideation/attempt was the most common RFA (57.07%) in both sexes, being higher among females (60.3%) than males (42.9%). Eating disorders were the second most common RFA in girls (17.7%) while psychosis (17.1%) and mood disorders (17.1%) were the second most common RFA within boys.
ConclusionsFindings on how COVID-19 affected adolescents mental health are controversial in the literature, our data suggest that there is a need of developing quality studies that analyse how the pandemic might be influencing adolescents suicidal ideation/attempt and its protective and risk factors.
DisclosureNo significant relationships.