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Mental Illness Stigma among professionals at a Portuguese Medical Center
- D. F. Rodrigues, C. Adão, A. S. Sequeira
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S353
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Introduction
Mental Illness Stigma is a barrier in access to healthcare. Stigma also influences population health outcomes by worsening, undermining adequate processes. The healthcare professionals show several stigmatising behavirous and cognitions, which may impair the adequate provision of care of this population with mental illness.
ObjectivesWe aimed to measure mental health stigma in healthcare professionals at a portuguese hospital center.
MethodsA cross-sectional study of health profissionals was performed using a survey that included socio-economic and job related questions, personal and familiar questions regarding mental health, and Attribution Questionnaire 27 (AQ-27), a translated and validated stigma questionnaire with nine stigma sub-scales (Responsability, Pity, Anger, Dangerousness, Fear, Help, Coercion, Segregation and Avoidance).
ResultsThe sample included a total of 388 participants. The majority of the respondants were female (82,5%). The age ranged from 22 to 69 (mean = 40,05). According to the job place distribution, we found statistically significant differences in various stigma subscales among several healthcare settings within our center. The inpatient unit professionals showed lesser stigmatising attitudes in anger, coercion, segregation and avoidance domains; and higher stigmatising attitudes in pity and help domains. However, professionals who work at surgery room showed higher stigmatising attitudes in danger and fear, but lesser levels of help domains. We also found differences in five stigma subscales among various health professions. The study didn’t show differences in stigma domains regarding personal or professional contact with mental illness, neither academic studies in mental health.
ConclusionsOur findings suggest that workplace environment and profession may impact mental ilness stigma levels in healthcare professionals. We propose that future studies could be done to investigate methods to mitigate mental illness stigma, tailored to address different stigma domains in different workplace settings.
Disclosure of InterestNone Declared
Clozapine in First Episode Psychosis: The best is delayed
- J. B. Rodrigues, A. P. João, C. Adão, P. Trindade
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1061
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Introduction
Only two out of three patients diagnosed with First Episode Psychosis (FEP) achieve symptom remission after the administration of two different antipsychotics, illustrating the high prevalence of treatment-resistance in FEP. Of those, 84% are treatment-resistant since illness onset. Response to initial treatment is one of the main long-term illness course predictors. The only medication approved for treatment-resistant psychosis is clozapine and studies have demonstrated its superior antipsychotic effect among this drug class.
ObjectivesThe aims of this communication are to describe a clinical case of FEP with symptom remission achieved only with clozapine and to review the literature regarding the pattern of clozapine use in FEP, the main difficulties of implementing it and its impact on the prognosis of this patients.
MethodsRelevant data from the patient’s medical record were collected. Pubmed database was searched using the terms “clozapine” and “first episode psychosis”.
ResultsA 50 year old woman without previous contact with psychiatric services was taken to the emergency room following behavioural disorganisation and heteroagressive conduct. Poisoning and referential delusions, as well as alienation of personal action and elementary auditory hallucinations were found and the patient was admitted in the psychiatric unit. She began treatment with Aripiprazole without therapeutic benefit and a switch to Paliperidone was made, with the same result. Clozapine was then titrated to a dose of 100mg/day, with resolution of all the positive symptoms mentioned above and she acquired total insight to the disease and need for treatment, being discharged with a diagnosis of schizophrenia. 9 articles, all from 2017 onwards, were collected from the Pubmed database.
ConclusionsThere’s reluctance in prescribing clozapine in treatment-resistance FEP. This is evidenced by the mean number of antipsychotic prescribed before clozapine - 2.74 to 4.85 - as well as the delay on its prescription - 294 to 2447 days - and its prescription to only 16% in a cohort of patients with FEP. The main reasons for this hesitation are the serious, albeit rare, side-effects, such as agranulocytosis and myocarditis, as well as the difficulty in implementing it in community services, with mandatory weekly blood tests and very slow titration of the drug and treatment compliance issues, making it a very resource-consuming drug. However, in that same cohort, there was a significant reduction of the number of admissions, re-admissions and duration of hospitalisation, highlighting the need for earlier consideration in treatment-resistant FEP. The identification of treatment-resistance should then be proactive by the mental-health services, ensuring an earlier clozapine initiation with the goal of greatly improving the prognosis of these patients
Disclosure of InterestNone Declared
Therapeutic challenge in delusional disorder: a case report and literature review
- P. Trindade, C. Laginhas, C. Adão, H. Canas-Simião, A. Ribeirinho Marques, R. Caetano
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S767
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Introduction
Delusional disorder (DD) is defined by the presence of one or more delusions, of at least one month’s duration, in the absence of prominent hallucinations or other symptoms of schizophrenia. Although functioning may not be markedly impaired, the delusion(s) or its ramifications may have a significant impact in the patient’s life. With a life-time prevalence of 0.18%, DD is still neglected in terms of approved treatment recommendations.
ObjectivesWe present the case of a patient diagnosed with DD and discuss the treatment of DD according to current evidence.
MethodsRelevant clinical information was extracted from the patient’s clinical process. A non-systematic review was made in Pubmed database with the terms “Delusional Disorder” and “Treatment”.
ResultsMale, 76 years old, divorced, living alone, autonomous. First admitted at age 62 in our inpatient psychiatry ward for a persecutory delusion regarding his neighbors. He was discharged with the diagnosis of DD and started a follow-up in a mental health community team. He abandoned treatment and psychiatric consultation after 9 years. During 17 years he moved home more than 10 times due to a progressive dynamism of the delusion, leading to recent marked behavior changes towards his neighbors. He is again admitted in our inpatient psychiatry ward.
ConclusionsThis case illustrates the impact that untreated DD can have on its patients. Although consensus using antipsychotics, there are still insufficient studies to make evidence-based recommendations to treat people with DD. Further research is needed in this sense.
DisclosureNo significant relationships.
Electroconvulsive therapy in treatment resistant schizophrenia: Old beacon of hope when nothing else works
- C. Adão, A.A. Quintão, A. Velosa, P. Trindade, C. Almeida
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S782-S783
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Introduction
Electroconvulsive therapy (ECT) is one of the oldest psychiatric treatments used to this day. It is particularly useful in cases of schizophrenia resistant to treatment with antipsychotics. 49% of patients with schizophrenia experience little or no response with one trial of antipsychotics, 71% do not achieve remission and up to 20% of patients are also resistant to clozapine.
ObjectivesDescription of a clinical case where ECT is used in the treatment of resistant schizophrenia and review of the literature.
MethodsDescription of a clinical case. Non systematic review of the literature, searching the terms “treatment resistant”; “schizophrenia”; “ect” in the databases Pubmed, Medline, Cochrane and Uptodate.
ResultsMale, 38-year-old patient, diagnosed with schizophrenia for 20 years, with history of multiple hospitalizations, institutionalized for 9 years. Treated with risperidone 50 mg intramuscular fortnightly, clozapine 750 mg daily, aripiprazol 30 mg daily and diazepam 10 mg daily. He presented with increased delusional intensity for a year. Hospitalized for treatment with ECT, submitted to 12 sessions with bitemporal stimuli, with effective convulsions. MoCA, PANSS and BPRS were applied before and after treatment, with an increase of 25% in MoCA and a decrease of 47.3% and 57.9% respectively, in the psychotic symptoms scales.
ConclusionsWe present a case of schizophrenia resistant to treatment with multiple antipsychotics, including clozapine. ECT was used, with clinically demonstrated efficacy. In the future, it might be interesting to study in detail the mechanism of action of this treatment with the goal of deepening the knowledge of the neurobiology of schizophrenia.
DisclosureNo significant relationships.
Psychopathology after epilepsy surgery: a retrospective study
- C. Adão, D.F. Rodrigues, A.S. Sequeira, B. Silva, A. Velosa
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S454
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Introduction
In patients submitted to refractory epilepsy surgery, psychiatric comorbidity is high (affecting 1 in every 3 patients), with descriptions of improvement, worsening and emergence of de novo psychopathology.
ObjectivesIdentifying the prevalence of psychopathology and associated risk factors in a group of patients submitted to refractory epilepsy surgery.
MethodsRetrospective observational study. Non systematic literature review.
ResultsWe observed 42 patients, 45.2% female and 54.8% male, with an average age of 46.5 years (SD±11.6). The average age of presentation of epilepsy was 18.8 years (SD±12.7), 97.6% with temporal lobe epilepsy and 2.4% with parietal lobe epilepsy, 50% in each hemisphere. 19% had surgical complications and 40.5% had post-surgical recurrence of crisis. 45.2% presented with pre-surgical psychopathology (33.3% affective disorders, 16.7% anxiety disorders, 2.4% psychotic disorders, 2.4% neurodevelopmental disorders and 2.4% substance use disorders). Post-surgically, 50% improved, 20.8% maintained and 29.2% worsened their psychopathology and 21.4% had de novo psychopathology. We didn’t find associations between the analyzed variables and the worsening or appearance of de novo psychopathology.
ConclusionsThe worsening or appearance of de novo psychopathology is a well known phenomenon in patients submitted to refractory epilepsy surgery. In our sample there were cases of improvement, maintenance, worsening and emergence of de novo psychopathology, however we weren’t able to identify the factors associated with these different outcomes. Our study was retrospective and had a small sample, as limitations. Further, better-designed studies are necessary to identify risk factors for psychiatric disorders, allowing their effective prevention and treatment.
DisclosureNo significant relationships.
Menstrual psychosis diagnosis: Does it still hold?
- C. Adão, I. Donas-Boto, A. Velosa, P. Trindade, R. Caetano
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S195
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Introduction
Menstrual psychosis was first described in the 18th century. Brockington defined its characteristics: acute onset; brief duration with full recovery; confusion, stupor and mutism, delusions, hallucinations, or a manic syndrome and periodicity in temporal association with the menstrual cycle.
ObjectivesDescription of a clinical case of menstrual psychosis and review of the literature.
MethodsDescription of a clinical case. Non systematic review of the literature, searching the terms “psychosis”; “menstrual”; “catamenial” in the databases Pubmed, Medline and Cochrane.
ResultsFemale, 39-year-old patient. No psychiatric history until the postpartum period of a traumatic vaginal birth, when she developed stupor and mutism which lasted for two days. During the following 2 years, she progressively presented with sadness, asthenia, anhedonia, insomnia and incapacity for self-care. She was prescribed paroxetine and olanzapine, with partial recovery. Subsequently, she had at least 6 episodes with about 3-day duration of asthenia, food refusal, insomnia, incapacity for self-care, disorganization of thought and behavior and mystical and persecutory delusions, coincident with the beginning of menstruation. She was hospitalized in two of them and received treatment with venlafaxine 75mg and paliperidone 6mg, with psychotic symptoms remission after a week.
ConclusionsThis case presents the characteristics of menstrual psychosis. This is a rare condition, with only 30 reported cases worldwide. According to current classification systems, this condition fulfills diagnostic criteria for brief psychotic disorder. Nonetheless, studying in more detail this disorder could be interesting, with the goal of deepening the knowledge of the neurobiology of psychosis, particularly the effects of estrogen on this disorder.
DisclosureNo significant relationships.
A case report of de novo psychosis after epilepsy surgery
- C. Adão, D.F. Rodrigues, A.S. Sequeira, P. Trindade, A. Velosa
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S783
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Introduction
Epilepsy is a common and severe neurologic condition, with a high prevalence of psychiatric comorbidity. Epilepsy surgery has been used for its treatment, resulting in remission or significant reduction of crisis. An improvement of previously existing psychopathology has been more frequently described, however its exacerbation or de novo psychopathology post-surgery has also been reported. The prevalence rate for post-surgery psychosis is 1.1%. There are no clear risk factors associated to this condition, or a proposed pathological mechanism. However, most cases described in the literature are of patients submitted to temporal lobectomy.
ObjectivesDescription of a clinical case of a first-episode psychosis post-epilepsy surgery and review of the literature.
MethodsDescription of a clinical case. Non systematic review of the literature, searching the terms “psychiatric”; “psychosis”; “epilepsy surgery” in the databases Pubmed, Medline and Cochrane.
ResultsMale, 29-year-old patient, diagnosed with refractory temporal lobe epilepsy. Neuropsychiatric history of mixed adaptation disorder, treated with escitalopram 10 mg daily. Submitted to anterior temporal lobectomy with no complications. On the 6th day post-surgery, he developed persecutory and self-referent delusions. There’s no evidence of other causal factors. Treated with paliperidone 3 mg daily with symptom remission after one week. The diagnosis of brief psychotic disorder was made.
ConclusionsWe present a case of a de novo psychotic disorder, a rare complication of epilepsy surgery. In the future, it might be interesting to study this association in detail, with the goal of deepening the knowledge of the neurobiology of psychosis, particularly the involvement of temporal circuits.
DisclosureNo significant relationships.