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Body dysmorphia in a 23 year old patient with obsessive compulsive disorder: a case report
- P. Setién Preciados, E. Arroyo Sánchez, C. Díaz Mayoral
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S629
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Introduction
Body dysmorphic disorder (BDD) was considered an anxiety disorder in the DSM-IV, but in the DSM-V was added to the obsessive-compulsive and related disorders category. BDD is a psychiatric disorder characterised by an excessive, persistent, and distressful preoccupation with a perceived defect in appearance. These perceived defects are slight and are unnoticed by others. People with BDD usually have poor insight and are preoccupied with a perceived physical defect which causes them to check on it repeatedly. This leads to an impairment in psychosocial functioning, depression, and an increase in suicide risk.
ObjectivesReview how dismorphophobia (BDD) and obsessive compulsive syndrome intersect, the differences they present in symptomatology, prevalence and treatment.
MethodsPresentation of a patient’s case and review of existing literature, in regards to body dysmorphic syndrome and its similarities and differences with respect to obsessive compulsive syndrome.
ResultsThere are common features between both disorders, which are genetic overlap, physical past traumatic events, sex ratio, trait of perfectionism and body image disturbance.
Studies have found the prevalence of BDD in patients with OCD in a large patient sample was 8.7% to 15% compared to 3% in non-OCD.
The risk of comorbidity of OCD-BDD is three times higher in samples with a primary diagnosis of BDD compared to those with a primary diagnosis of OCD with 27.5% and 10.4%, respectively.
BDD as well as OCD must be managed with pharmacological and psychotherapy treatment. A selective serotonin reuptake inhibitor is the recommended first-line medication for BDD, even if appearance beliefs are delusional in nature.
Serotonin reuptake inhibitor (SRI) doses and trial durations are similar to those used for OCD; higher doses and a longer treatment trial are recommended than those typically used for depression and most other disorders. Cognitive-behavioral therapy that is specifically tailored to BDD is the psychosocial treatment of choice. Simply treating BDD as if it were OCD is not recommended.
ConclusionsThere are limitations included a restricted number of studies overall, an absence of studies comparing biological parameters, and the frequent inclusion of participants with comorbid body dysmorphic disorder and obsessive-compulsive disorder. The current nosological status of body dysmorphic disorder is somewhat tenuous and requires further investigation, with particular focus on dimensional, biological and aetiological elements.
Disclosure of InterestNone Declared
Family systemic therapy in patients with eating disorders
- P. Setién Preciados, C. Díaz Mayoral, E. Arroyo Sánchez
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S708
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Introduction
Eating disorders are a group of pathologies in which negative beliefs about food, body type and weight are associated with conducts that include food restriction, binge eating, excessive exercise, induced vomiting and the use of laxatives. They can be really severe, affecting quality of life and lead to multiple physical and psychiatric complications, even with a deadly fate.
ObjectivesPresentation of a patient’s case with an eating disorder and the intervention with her family, as well as, doing a review of the family interventions in these kinds of patients.
MethodsPresentation of a patient’s case and review of existing literature, in regards to the use of family therapy in patients with eating disorders and its effects.
ResultsAs in the patient’s case, there are a lot of studies that support the evidence of improvement using family therapy in patients with eating disorders. However, the difficulty to isolate the necessary variables in order to do studies about psychological treatments, complicates finding scientific evidence that supports the clinical evidence that we see in our patients day by day with these types of interventions.
ConclusionsThere are studies that support the efficacy of these types of family interventions. However, there needs to be a more thorough investigation with the objective of finding the more precise optimal family intervention, and specifically, determining for who and under what conditions, certain types of family interventions would be more effective.
Disclosure of InterestNone Declared
Socio-demographic characteristics and pharmacological treatment options in patients with delirium
- F. J. Cruz Aviña, A. Salazar Rodriguez, D. N. M. Sanchez, E. A. C. Martinez, L. C. Rocha Reza, S. V. Nuñez Pichardo, H. A. Barranco Rogel, M. G. Ochoa Madrigal, O. Meneses Luna
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S368-S369
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Introduction
Delirium is common in hospital settings, with approximately 3% to 45% of older patients in hospitals developing delirium during their stay. Among the elderly and those with severe or advanced medical conditions, the reported percentage of patients with delirium is over 56%. The three motor subtypes of delirium are hyperactive, hypoactive, and mixed. Another way to characterize delirium is based on whether it is reversible, irreversible, or terminal.
ObjectivesIdentifying appropriate pharmacological treatment options among antipsychotics and their correlation with various precipitating and predisposing factors in the in-hospital context
MethodsThis was a retrospective, cross-sectional, observational study that utilized a database created by the psychiatry department at the National Medical Center 20 de Noviembre, with data collected from April 2021 to April 2022. The database contains anonymized administrative and clinical data of patients who were seen in the psychiatry department for the diagnosis of any type of delirium, using the CAM scale for classification. The database includes records and data of hospitalized patients, encompassing all specialties at this medical center
ResultsA total of 139 patients were included in the study, of which 39% were female and 61% were male, with a mean age of 67 and a median age of 68 years. It was observed that the average duration of delirium symptoms, from receiving the consultation to remission, was approximately 6 days (p <0.005) (OR 5.12-6.62), and the average length of hospital stay was approximately 20 days (OR 17.3-22.09). Among the patients, 50.39% were overweight, 63% had hypertension (HTA), 29% had chronic kidney injury, 24% had a history of delirium, and 73% had recent surgical interventions. Patients with diabetes mellitus had a 3.1 times higher risk, those with HTA had a 2.8 times higher risk, and those with kidney injury had a 3.8 times higher risk of having a positive CAM result. It was observed that haloperidol, used in 84% of the patients, showed the highest percentage reduction in CAM scores
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ConclusionsThe results of this study emphasize the importance of identifying risk factors associated with delirium and implementing effective treatment for this condition. It was observed that the average duration of delirium symptoms was approximately 6 days, which is relevant for understanding the course and management of this illness. Furthermore, it was found that the average hospital stay was 20 days, underscoring the burden that delirium can place on healthcare systems.
In conclusion, this study highlights the importance of identifying risk factors and providing appropriate treatment, such as the use of haloperidol, to improve outcomes in patients with delirium.
Disclosure of InterestNone Declared
Family systemic therapy: intervention in autism spectrum disorder
- C. Díaz Mayoral, P. Setién Preciados, E. Arroyo Sánchez, J. Gimillo Bonaque
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S710-S711
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Introduction
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by communication impairments and difficulties in social interaction. These impairments can affect relationships with family members, increase stress and frustration for both the patient and family members, and contribute to behavioral disturbances in these patients. They are frequently associated with high rates of psychiatric comorbidity.
ObjectivesGiven the impact of this disorder on the family unit, we set out to assess the clinical effectiveness of systemic family therapy, its influence on improving communication and coping with this disorder, strengthening relationships and mental health in these patients and their families.
MethodsA literature review was performed by searching for articles in Pubmed on May 24, 2023, focusing the terminology used on “Autism Spectrum Disorder” and “Systemic Family Therapy”. The search was limited to full text articles in English and Spanish, published in the last 10 years.
ResultsSeveral authors have stated that systemic family therapy could be beneficial:
- Providing education.
- Reporting additional educational resources.
- Focusing sessions on improving social and communication skills, mood and coping behaviors.
- Providing therapy to all family members to cope with this disorder and what it implies. It will be very important that the patient with ASD understands his condition and can receive support from his family, working with siblings on the bonding and coping with this condition.
- Contributing to facilitate mourning the loss of the condition of “neurotypical” person, exploring emotions, feelings and belief systems, valuing the social and cultural context of the family.
ConclusionsReviewing a variety of literature on this therapeutic approach, the authors concluded that “strategic, narrative and structural interventions can be applied from multiple approaches, especially suited to the challenges often faced by patients with ASD and their families”. Therapeutic work needs to involve different family members at different times. Therapeutic conversations will consider the child, the family and the family unit in context. Studies so far have not been able to establish whether particular systemic approaches have more favorable outcomes than others, which warrants further research.
Disclosure of InterestNone Declared
The influence of the experience of trauma in childhood and the later development of psychosis. A case report
- C. Díaz Mayoral, P. Setién Preciados, E. Arroyo Sánchez
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S754
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Introduction
The increasingly well-established links between psychosis and distant traumas (often established in childhood) oppose purely neurobiological explanations. The influence of psychosocial factors on the development of a later disorder has been studied. In studies, a strong association has been found between psychosis and childhood sexual abuse, especially when sexual intercourse was involved.
ObjectivesA case of a patient with psychotic symptoms is presented followed by a theoretical review on the topic.
MethodsA case is presented with a bibliographic review.
ResultsA 37-year-old woman was admitted to the Acute Hospitalisation Unit for behavioural alterations in the form of heteroaggressiveness towards family members in the context of psychopathological decompensation.
On arrival at the unit, she presented psychomotor restlessness, ideas of harm in relation to her neighbours and an attitude of referentiality, especially towards her father.
At the pharmacological level, Quetiapine 100 mg was replaced by Aripiprazole 10 mg and sleep was occasionally supported with Lormetazepam 1 mg.
Progressively her rest is normalising, she remains calm, behaviourally adequate, approachable and cooperative. She does not spontaneously allude to delusional ideation and no hallucinatory attitude is observed.
Daily individual psychotherapeutic interviews and family meetings are held with her parents, in which they refer to experiences of abandonment by her parents during her upbringing, persistent irritability and ideation of harm towards the family, which seems to be of long standing. They also report that prior to the first psychiatric admission, the patient reported being sexually abused at the age of 6 and suffered repeated physical aggression by a teacher at the age of 9. Both the patient and her parents relate the origin of the current malaise to all these events.
Upon discharge from the unit, throughout the follow-up carried out in the resource specialised in first psychotic episodes, during psychotherapeutic interviews, the feelings and emotions related to the traumatic experiences mentioned above are worked on. This therapy, associated with the pharmacological regimen previously indicated, has promoted a notable psychopathological improvement.
ConclusionsA review of 46 studies in women, both inpatients and outpatients, many of whom had a diagnosis of psychosis, revealed that 48% reported having suffered sexual abuse, 48% physical abuse in childhood and 69% of them both. Among men, the figures were 28%, 50% and 59%, respectively. Childhood abuse has been shown to play a causal role in many mental health problems.
There is clear evidence that physical and sexual abuse during childhood is related to symptoms of psychosis and schizophrenia, particularly hallucinations and paranoid delusions. Also, studying possible variables, a greater severity has been observed the more intense the abuse has been.
Disclosure of InterestNone Declared
Concurrent mood pathology in patients with autism spectrum disorder (ASD). A case report.
- C. Díaz Mayoral, M. Martín de Argila Lorente, E. Arroyo Sánchez, P. Setién Preciados
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S382
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Introduction
Mood disorders in patients with ASD (Autism Spectrum Disorder) have a significant impact on their well-being. Major depression and bipolar disorder are among the most common co-occurring psychiatric diagnoses in autism. Prevalence estimates range from 10-50% for depression and approximately 5% for bipolar disorder. These figures are markedly higher than those reported in the general population.
The diagnosis of these disorders in patients with autism poses several challenges: mood problems may be “overshadowed” by the diagnosis itself, symptoms vary between individuals and may present “atypically” (psychomotor agitation, regression, reduced self-care, and severe irritability). The use of assessment tools based largely on criteria developed and validated in the general population is common.
ObjectivesA case of a patient diagnosed with ASD and co-occurring mood disorder is presented followed by a theoretical review on the topic.
MethodsA case is presented with a bibliographic review.
ResultsA 20-year-old patient with a diagnosis of severe autism spectrum disorder was referred to the emergency department for behavioral disturbances based on episodes of heteroaggressiveness and self-aggressiveness, with a daily frequency, in the last 2 months. His parents attribute this decompensation to the introduction of Sertraline and changes in his routine, which has implied less stimulation. Having ruled out underlying organic pathology, given that her father refers to frequent episodes of crying and abandonment of leisure activities of his liking, we suspect a mood disorder.
In hospitalization, Sertraline was withdrawn and Valproic Acid was introduced. Likewise, Risperidone dose was increased, already prescribed in outpatient care. Progressively, a notable improvement was observed.
ConclusionsCurrent clinical recommendations on the use of selective serotonin reuptake inhibitors (SSRIs) for mood problems are largely based on evidence from typically developing groups. However, it has been shown that some individuals with autism show different neural responses to pharmacological challenge compared to neurotypical individuals. In addition, the use of SSRIs in ASD may result in increased adverse side effects, such as agitation, impulsivity, hyperactivity, stereotypy, and insomnia, and it has been suggested that they should therefore only be considered on a “case-by-case” basis. A systematic review reported that mood stabilizers (Lithium, Valproic Acid) are preferable to atypical antipsychotics, which are associated with a large number of side effects.
Because of the lack of strong evidence on the efficacy of pharmacologic interventions and issues regarding safety and side effects, risperidone and aripiprazole are among the few medications approved by the FDA for the treatment of irritability in people with autism. More research aimed at effective medications to treat mood problems in ASD needs to be advocated.
Disclosure of InterestNone Declared
Avoidant Restrictive Food Intake Disorder in a 28 year old man: a case report
- P. Setién Preciados, E. Arroyo Sánchez, C. Díaz Mayoral
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S557-S558
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Introduction
Avoidant Restrictive Food Intake Disorder is a disorder included among the eating disorders criteria group. Prevalence and incidence rates of ARFID in the general population remain largely unknown. Despite ongoing variability in the interpretation of diagnostic criteria in clinical practice, good progress has been made regarding recognition and assessment of ARFID. Different approaches to treatment are currently being explored, with reported outcomes for ARFID vary, consistent with the heterogeneity of the disorder. At present, there is insufficient evidence to determine the likely course and prognosis.
ObjectivesReview what avoidant restrictive food intake disorder consists of, the challenges it presents, as well as its prognosis and potential treatments.
MethodsPresentation of a patient’s case and review of existing literature, in regards to ARFID.
ResultsThe patient in question is not clear he can be diagnosed of avoidant restrictive food intake disorder given his OCD symptoms, which are intertwined. That said, he does not have body dysmorphophobia and does check for all the ARFID criteria. Their prognosis is not good, having failed several psychological and pharmacological treatments.
In literature, there is not much evidence around the disease because of its novelty, being recently included in the DSM 5 as a new class of eating disorders (EDs), not finding high quality studies (meta analysis, systematic review). ARFID is characterised by a lack of interest in eating or avoiding specific types of foods because of their sensory characteristics. This avoidance results in decreased nutritional intake, eventually causing nutritional deficiencies. In severe cases, ARFID can lead to dependence on oral nutritional suplemments, which interferes with psychosocial functioning. The prevalence of ARFID can be as high as 3% in the general population, and it is often associated with gastrointestinal symptom. Given the high prevalence of ARFID, a rapid and systematic nutrition survey should be conducted during every consultation. Its treatment should also be adapted depending on the severity of the nutritional problem and may involve hospitalisation with multidisciplinary care (paediatrician, nutritional therapist, dietitian, psychologists, and speech therapists).
In regards to potential treatments, there is no evidence-based psychological treatment suitable for all forms of ARFID at this time. Several groups are currently evaluating the efficacy of new psychological treatments for ARFID, particularly, family-based and cognitive-behavioural approaches, but results have not yet been published.
ConclusionsFuture directions for research could be usefully informed by closer collaboration with other fields, including feeding disorders, emotion processing and regulation, neurodevelopment, and appetite.
Disclosure of InterestNone Declared
Dermatitis artefacta in a 60 year old man: a case report
- P. Setién Preciados, C. Díaz Mayoral, E. Arroyo Sánchez
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S825-S826
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Introduction
Dermatitis artefacta (DA), also known as factitial dermatitis, is a condition among factitious disorders, whereby self-induced skin damage is the means used to satisfy a conscious or unconscious desire to assume the sick role, particularly in those with an underlying psychiatric diagnosis or external stress. DA should be distinguished from malingering, in which skin damage may be inflicted for the purpose of secondary gain.
ObjectivesReview what dermatitis artefacta and factitious disorders in general consist of and the challenges they present.
MethodsPresentation of a patient’s case and review of existing literature, in regards to factitial dermatitis and factitious disorders.
ResultsIn general, in regards to factitious disorders in literature, the majority of patients were female with mean age at presentation at thirty. A healthcare or laboratory profession was reported most frequently, as well as a current or past diagnosis of depression was described more frequently than personality disorder in cases reporting psychiatric comorbidity, and more patients elected to self-induce illness or injury than simulate or falsely report it. Patients were most likely to present with endocrinological, cardiological and dermatological problems. In our patient’s case, common factors described previously are dermatological lesions, comorbid psychiatric disorder and the beginning of the disorder at an earlier age.
Specifically, when it comes to DA, the hallmarks of diagnosis include self-inflicted lesions in accessible areas of the face and extremities that do not correlate with organic disease patterns. Importantly, patients are unable to take ownership of the cutaneous signs.
Management in these cases is challenging, and different modalities may be employed, including topical therapies, oral medications, and cognitive behavioural therapy; adopting a multidisciplinary team approach has been shown to be beneficial in allowing patients to come to terms with their illness in an open, non judgmental environment.
ConclusionsDA is a rare cutaneous condition that must be considered when the clinical presentation is atypical and investigations do not yield an alternate diagnosis. Few are referred to psychiatric services and even fewer accept care. They have a protracted course, complicated by repeated hospitalizations, ultimately leading to their premature deaths. Clear guidelines on the management of these patients need to be set to protect both patients and providers in light of the ethical and legal considerations.
Disclosure of InterestNone Declared
Cognitive reserve in Older Adults with Bipolar Disorder and its relationship with cognitive performance and psychosocial functioning
- L. Montejo, C. Torrent, S. Martín, A. Ruiz, M. Bort, G. Fico, V. Oliva, M. De Prisco, J. Sanchez-Moreno, E. Jimenez, A. Martinez-Aran, E. Vieta, B. Sole
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S324-S325
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Introduction
Cognitive reserve (CR) refers to the ability of the brain to cope with damage or pathology. In bipolar disorder (BD), it has been seen that the effects of the disease may potentially reduce CR, thus compromising cognitive outcomes. This concept takes on special relevance in late life in BD, due to the increased risk of cognitive decline because of the accumulative effects of the disease and the potential effects of aging. Therefore, we believe that CR may be a protective factor against cognitive decline in older adults with bipolar disorder (OABD).
ObjectivesThe aim of this study was to study the CR in OABD compared with healthy controls (HC) and to analyze its association with psychosocial functioning and cognitive performance.
MethodsA sample of euthymic OABD, defined as patients over 50 years old, and HC were included. CR was assessed using the CRASH scale. Differences in demographic, clinical, and cognitive variables between patients and HC were analyzed by t-test or X2 as appropriated. Lineal simple and multiple regressions analyses were used to study the association of CR and several clinical variables with functional and cognitive performance.
ResultsA total of 83 participants (42 OABD and 41 HC) were included. Compared to HC, OABD exhibited poorer cognitive performance (p<0.001), psychosocial functioning (p<0.001) and lower CR (p<0.001). Within the patient’s group, the linear simple regression analysis revealed that CR was associated with psychosocial functioning (β=-2.16; p=0.037), attention (β= 3.03; p=0.005) and working memory (β = 2.98; p=0.005) while no clinical factors were associated. Age and CR were associated with processing speed and verbal memory, but after applying multiple regression model, only the effect of age remained significant (β =-2.26; p= 0.030, and β =-2.23; p= 0.032 respectively). CR, age, and number of episodes were related to visual memory, but the multiple regression showed that only age (β = -2.37; p= 0.023) and CR (β = 3.99; p<0.001) were associated. Regarding executive functions only the number of manic episodes were significant. CR and age at onset were associated with visuospatial ability, but multiple regression only showed association of CR (β =2.23; p=0.032). Other clinical factors such as number of depressive or hypomanic episodes, illness duration, admissions, type of BD, and psychotic symptoms were not associated.
ConclusionsTo the best of our knowledge, this is the first report that studies the CR in a sample of OABD. We demonstrated that OABD had lower CR than HC. Importantly, we observed that CR was associated with cognitive and psychosocial functioning in OABD, even more than disease-related factors. These results suggest the potential protector effect of CR against cognitive impairment, supporting that improving modifiable factors associated with the enhancement of CR can prevent cognitive decline.
Disclosure of InterestL. Montejo: None Declared, C. Torrent Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00344) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluacio ́n and the Fondo Europeo de Desarrollo Regional (FEDER), S. Martín: None Declared, A. Ruiz: None Declared, M. Bort: None Declared, G. Fico Grant / Research support from: Fellowship from “La Caixa” Foundation (ID 100010434 - fellowship code LCF/BQ/DR21/11880019), V. Oliva: None Declared, M. De Prisco: None Declared, J. Sanchez-Moreno Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00060) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluacio ́n and the Fondo Europeo de Desarrollo Regional (FEDER),, E. Jimenez Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00060)integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluacio ́n and the Fondo Europeo de Desarrollo Regional (FEDER),, A. Martinez-Aran: None Declared, E. Vieta Grant / Research support from: Spanish Ministry of Science and Innovation (PI18/ 00805, PI21/00787) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIIISubdireccio ́n General de Evaluacio ́n and the Fondo Europeo de Desarrollo Regional (FEDER); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), the CERCA Programme, and the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357; the European Union Horizon 2020 research and innovation program (EU.3.1.1. Understanding health, wellbeing and disease: Grant No 754907 and EU.3.1.3. Treating and managing disease: Grant No 945151)., B. Sole: None Declared
Manic episode with psychotic symptoms in a patient with Pseudologia Fantastica of years of evolution. A case report
- C. Díaz Mayoral, E. Arroyo Sánchez, P. Setién Preciados, M. Martín de Argila Lorente
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S766-S767
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Introduction
Pseudologia Fantastica (PF) also called “mythomania” is a disorder centred on the tendency of the sufferer to distort reality through constant lies. These patients find it difficult to moderate their sense of self and their self-esteem. Therefore, they display significant grandiosity, which seems to defend them from intense psychological disturbance, pretending to counteract deep feelings of unworthiness, emptiness and alienation.
Notable characteristics include: normal or above average IQ, absence of formal thought disorder, poor sense of identity, poor sexual adjustment, low frustration tolerance, strong dependency needs and narcissism. The phenomenon of “imposture” (the person’s claim of achievement or having connections to famous or influential people) is frequent. The patient’s history often shows that one or both parents were experienced as rejecting figures. They are more likely to be involved in legal problems and 20% receive some form of psychiatric treatment.
The aetiology and pathogenesis of this disorder requires consideration of developmental disturbances, personal history and current life stressors.
ObjectivesA case of a patient with PF is presented followed by a theoretical review on the topic.
MethodsA case is presented with a bibliographic review.
ResultsWe admitted a 47-year-old man to the Acute Hospitalisation Unit for a suspected “psychotic episode with clinical mania”.
He presented manic and psychotic symptoms, with delusional ideation of months of evolution, megalomaniacal and fantastic discourse, centred on his work with high-ranking government officials and other implausible events. Multiple academic, work and personal life failures, with a diagnosis of depression 15 years earlier.
During admission, he constantly confirms his history. He tends to present a rationalising discourse and a minimising attitude towards behavioural alterations. He appears cooperative and docile at certain times, while at others he is irritable, complaining and threatening.
As for medication, olanzapine was initially prescribed at a dose of 20 mg per day, which was reduced to 10 mg given the psychopathological improvement and the difficulties of adherence.
On discharge, the presumptive diagnosis was “delusional disorder and probable personality disorder with narcissistic traits, with a history of PF, which in recent months has presented a manic episode with psychotic symptoms”.
ConclusionsTheir management poses challenges in terms of engaging with treatment and building a therapeutic alliance. It is important to assess the social and legal implications. Ensuring that they have stable relationships and adequate social supports is essential for successful treatment. Further exploration and research into this disorder is needed to better understand its manifestations and psychiatric consequences.
Disclosure of InterestNone Declared
Sex differences in neurocognitive performance in older adults with bipolar disorder
- S. Martín-Parra, C. Torrent, A. Ruiz, M. Bort, G. Fico, V. Oliva, M. D. Prisco, J. Sanchez-Moreno, E. Jimenez, A. Martinez-Aran, E. Vieta, B. Sole, L. Montejo
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S440
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Introduction
In recent years, research has focused on the older adults with bipolar disorder (OABD), aged 50 years and over, a constantly growing population due to the increased of life expectancy. Actually, some authors suggest that these individuals constitute a distinct subtype with a specific and different needs such as seen in epidemiologic, clinical and cognitive features. Further research has revealed significant differences between females and males with BD in clinical and cognitive variables in middle-aged and young patients, but this topic among OABD population remains unclear.
ObjectivesThe aim of this study is to identify the distinctive profile in clinical, functional and neurocognitive variables between females and males in OABD.
MethodsA sample of OABD and Healthy Controls (HC) were included. Euthymic patients or in partial remission were included. Neurocognition was measured with a battery of tests that included premorbid intelligence quotient, working memory, verbal and visual memory, processing speed, language and executive functions. Independent t-test and Chi-squared test analysis were performed as appropriated.
ResultsAccording to the analysis, statistically significant differences were seen between females and males. A more impaired cognitive profile is observed in women. They performed worse in the subscales of Arithmetic (F= 6.728, p = <0.001), forward digits (F= 0.936, p= 0.019) and Total Digits (F= 1.208, p= 0.019) of the WAIS-III, in the Stroop Color Word Test, color reading (F= 0.130, p= < 0.001), in the Continuous Performance Test, block change measure (F= 2.059, p= 0.037), in the Rey-Osterrieth Complex Figure-copy (F= 0.005, p= 0.029) and in the Boston Naming Test (F= 0.011, p= 0.024). Nor significant differences were found in clinical neither in psychosocial functioning variables.
ConclusionsIn view of the following results, and since no differences were observed between women and men in terms of clinical and functional outcomes, it could be said that the differences observed in cognition cannot be explained by disease-related factors. Furthermore, these results highlight the need to develop a gender-specific cognitive interventions in OABD population. In this way, we could have an impact on the course of the illness to reach a better quality of life.
Disclosure of InterestS. Martín-Parra: None Declared, C. Torrent Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00344) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIIISubdireccion General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), A. Ruiz: None Declared, M. Bort: None Declared, G. Fico Grant / Research support from: Fellowship from “La Caixa” Foundation (ID 100010434 - fellowship code LCF/BQ/DR21/11880019), V. Oliva: None Declared, M. Prisco: None Declared, J. Sanchez-Moreno Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00060) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), E. Jimenez Grant / Research support from: Spanish Ministry of Science and Innovation (PI20/00060) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), A. Martinez-Aran: None Declared, E. Vieta Grant / Research support from: Spanish Ministry of Science and Innovation (PI18/ 00805, PI21/00787) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), the CERCA Programme, and the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357; the European Union Horizon 2020 research and innovation program (EU.3.1.1. Understanding health, wellbeing and disease: Grant No 754907 and EU.3.1.3. Treating and managing disease: Grant No 945151), B. Sole: None Declared, L. Montejo: None Declared
Psychiatry resident physician duty hours, resting times and European Working Time Directive compliance in Spain
- J. P. Carrasco Picazo, D. A. Sánchez Martínez, P. Estrella Porter, R. Ruiz-Montero, A. H. Aginagalde Llorente, E. García-Camacho, J. Navarro, A. Cerame del Campo
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S393-S394
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Introduction
There is a growing interest in understanding the impact of duty hours and resting times on training outcomes and the well-being of resident physicians. Psychiatry resident’s duty hours in Spain comprise a regular working schedule of 37.5h per week and a minimum of 4 mandatory on-call shifts. The most recent duty hours regulations in Spain were transposed from the European Working Time Directive (EWTD). According to Spanish Law, doctors cannot work for more than 48h per week and need to have resting times per day (at least 12h), per week (at least 36h) as well as annual leave (at least a month). However, there is practically no data on this situation in psychiatry resident physicians.
ObjectivesOur aim is firstly, to describe the number of shifts performed by psychiatry resident physicians in Spain. Secondly, to describe compliance with the daily and weekly rests compared to those set in national and European law. Finally, to analyse the difference by demographic variables (gender and year of residency), in both the number of on-call duty shifts and compliance with rests.
MethodsA descriptive cross-sectional study was designed through an online survey adapted from the existing literature. The target population were Spanish psychiatry resident physicians undergoing PGT who started their specialist training during the years 2018–2021. The survey was disseminated through the Spanish regional medical councils to all active psychiatry resident physicians by mail as well as through informal communication channels. The study was authorised by the Spanish Medical Organization’s General Assembly which is the highest ethical and deontological body of physicians in Spain.
Results55 responses were obtained, of which 61.82% identified as females. The mean number of on-call shifts in the last 3 months was 14.05. This mean was highest in women 14,32 and in the cohort of 2020 15.46 (first year of residency). Among the resident physicians surveyed, 66.07% exceeded the 48h per week limit set by the EWTD and 7% of them did not rest after a 24-h on-call shift. Furthermore, 22% of respondents did not have a day-off after a Saturday on-call shift. The mean working hours when not resting after an on-call-shift were 7 hours. The comparison by gender and year of residency of the main variables can be seen in figures 1 and 2 respectively.
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Image 2:
ConclusionsPsychiatry resident physicians in Spain greatly exceed the established 48 h/week EWTD limit. Likewise, non-compliance with labour regulations regarding mandatory rest after on-call duty and minimum weekly rest periods are observed. Differences can be seen by gender and year of residency. The situation described could potentially create a high-risk situation for the health and psychosocial well-being of resident physicians, hinder learning outcomes and could lead to suboptimal patient care.
Disclosure of InterestNone Declared
Differential diagnosis of acute psychosis after cocaine consumption: a case report
- J. Gimillo Bonaque, E. Arroyo Sánchez, P. Setién Preciados, C. Díaz Mayoral
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S735
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Introduction
Psychosis is a common clinical presentation of mental disorder in many psychiatric patients, however, an etiological diagnosis is important when it occurs for the first time in a patient. Regarding a case seen in the Emergency Department recently, with major depression and acute cocaine use, a differential diagnosis was made after adequate organic screening. When presenting delusion of infestation after the consumption of the substance, the main hypothesis was what we call Ekbom syndrome. However, among other possibilities we consider a toxic psychosis or a major depression with psychotic symptoms.
ObjectivesReview the different causes of acute psychosis and the importance of a good clinical history to achieve a specific diagnosis. Perform a differential diagnosis between the main causes of psychosis in a patient with depression who has recently consumed cocaine.
MethodsPresentation of the case and review of the available literature on the risk of developing psychosis after cocaine use and depression concomitantly.
ResultsThere is a low number of reported cases of delusional infestation after acute cocaine use, being more likely toxic psychosis or major depression with psychotic symptoms. A good anamnesis, with systematic questions about toxic habits, can lead us to a more accurate main hypothesis.
ConclusionsWe mark the importance of a systematic anamnesis to achieve a better diagnosis, as well as a correct study by the clinician of the specific syndromes described in phenomenology such as Ekbom syndrome, to make a correct association of ideas in the differential diagnosis.
Disclosure of InterestNone Declared
Kambó as a drug that can induce psychotic or manic symptoms. A case report
- E. Arroyo Sánchez, C. Díaz Mayoral, P. Setién Preciados
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S419
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Introduction
Kambó, also known as the “frog medicine,” is a traditional Amazonian medicine derived from the secretions of the Phyllomedusa bicolor tree frog. It has gained global attention for its purported therapeutic properties, including its use in addressing mental health issues. However, the psychiatric effects of kambó remain poorly understood, particularly concerning manic symptoms or psychosis.
ObjectivesThe primary objective of this review is to comprehensively analyze and evaluate the available literature regarding the connection between kambó use and psychosis or manic symptoms. Specifically, this review seeks to determine the prevalence of psychosis among kambó users, identify potential risk factors for the development of psychosis or manic symptoms in this context, explore the mechanisms underlying any observed psychiatric effects, and provide insights into the clinical implications of kambó use.
MethodsA case report of a 34-year-old man with chronic delusional disorder who presented to the emergency department with manic symptoms coinciding in time with the use of Kambó.
ResultsThe findings of this bibliographical review suggest that there is limited empirical evidence to establish a direct link between kambó use and psychosis. Most available studies are anecdotal or based on qualitative reports, making it challenging to draw definitive conclusions. While some case reports and interviews suggest that kambó use may be associated with transient psychotic-like symptoms, including visual and auditory hallucinations, more rigorous research is needed to confirm and characterize these effects. Several case reports and qualitative studies suggest that individuals who have undergone kambó ceremonies may experience transient manic-like symptoms, such as elevated mood, increased energy, and impulsivity. However, these reports lack systematic assessment and standardized measurement of manic symptoms. Mechanisms underlying these effects remain speculative, with some researchers proposing altered neurotransmitter systems as a potential explanation.
ConclusionsIn conclusion, this review underscores the scarcity of scientific literature on the potential association between kambó use and psychosis or maniac symptoms. Although anecdotal reports and qualitative studies suggest a link, there is a notable lack of robust empirical research to support or refute this claim. Future research should focus on conducting controlled studies to elucidate the psychiatric effects of kambó, including its potential to induce psychosis and maniac symptoms, while also considering cultural and individual factors that may influence outcomes. Such research would contribute to a more comprehensive understanding of kambó’s psychopharmacological profile and its implications for mental health.
Disclosure of InterestNone Declared
Family intervention in schizophrenia: A case report
- E. Arroyo Sánchez, C. Díaz Mayoral, P. Setién Preciados
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S709-S710
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Introduction
Schizophrenia is a chronic mental illness that has a lifetime prevalence worldwide of about 1% regardless of culture, social class and race. This implies that it affects a large number of families. Family therapy has been used for years as a promising approach to intervene with people suffering from such pathology. It has been shown that families with a high level of hostility, critical comments and over-involvement are related to a higher number of relapses in the family member diagnosed with schizophrenia.
ObjectivesThe objectives are to examine whether systemic interventions could help to decrease the emotion expressed in these family members and thus decrease the number of relapses of patients as an alternative to pharmacological treatment.
MethodsA case report and a literature review on the impact of family therapy in patients with a diagnosis of schizophrenia. The search strategy included keywords such as “family intervention”, “schizophrenia” and “systemic therapy”. Selection criteria included randomized controlled trials (RCTs) and meta-analyses published between 2010 and 2021. Studies focused on the impact of family intervention on symptom management, relapse prevention and general functioning were included.
ResultsThe findings consistently demonstrated the effectiveness of family intervention in improving outcomes for people with schizophrenia. These interventions generally involved psychoeducation, communication skills training, problem-solving techniques, and emotional support for family members. Results showed significant reductions in symptom severity, decreased relapse rates, improved adherence to pharmacological treatment, and better overall functioning among people who received family intervention compared with those who received only standard care. In addition, family intervention was associated with reduced caregiver burden, improved family communication, as well as increased knowledge about schizophrenia and its management.
ConclusionsFamily intervention has become a valuable adjunctive treatment for people with schizophrenia. The findings of this review highlight its positive impact on symptom management, relapse prevention, and overall functioning. Family intervention offers a holistic approach that recognizes the importance of involving and supporting the family system in the treatment process. This intervention provides families with the tools and resources necessary to effectively cope with the challenges associated with schizophrenia and promotes a supportive and nurturing environment for the individual. Future research should focus on long-term outcomes and implementation of the family intervention in routine clinical practice.
Disclosure of InterestNone Declared
Postpartum insomnia in a woman who has given birth to twins : A case report
- E. Arroyo Sánchez, P. Setién Preciados, C. Diaz Mayoral
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S774
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Introduction
Postpartum insomnia is a significant and often overlooked mental health concern affecting mothers during the postnatal period. Sleep disturbances during this critical time can have far-reaching implications for maternal well-being and the quality of care provided to newborns.
ObjectivesThe primary objective of this review is to analyze recent clinical literature on postpartum insomnia to gain a deeper understanding of its epidemiology, clinical features, and management approaches. By synthesizing the latest research findings, this review aims to inform healthcare professionals and policymakers about the significance of postpartum insomnia and promote early recognition and intervention.
MethodsA case report of a 43-year-old woman in the fifth month postpartum after a twin birth who comes to the emergency department accompanied by her partner with thoughts of death and impulse phobias due to insomnia of months of evolution. Also a systematic search of the PubMed database was conducted using the keyword “Postpartum insomnia,” and articles published between 2013 and 2023 were included. A total of 20 clinical articles meeting the inclusion criteria were analyzed to provide a comprehensive overview of postpartum insomnia.
ResultsThe review reveals that postpartum insomnia is a prevalent and often underdiagnosed condition, affecting a significant proportion of new mothers. Risk factors such as maternal age, parity, social support, and hormonal fluctuations have been identified. Diagnostic challenges arise due to the overlap of symptoms with postpartum mood disorders, necessitating a comprehensive clinical assessment. Recent research emphasizes the importance of non-pharmacological interventions, including sleep hygiene education, cognitive-behavioral therapy for insomnia (CBT-I), and mindfulness-based approaches, as the first-line treatment options. However, pharmacotherapy may be considered in severe cases. Untreated postpartum insomnia has been associated with adverse maternal and infant outcomes, including impaired bonding, increased risk of postpartum depression, and developmental delays in infants.
ConclusionsIn conclusion, postpartum insomnia is a prevalent yet often underrecognized mental health concern with multifaceted clinical implications. This review highlights the importance of early detection and intervention to mitigate its impact on maternal well-being and infant development. The integration of non-pharmacological interventions, particularly CBT-I and mindfulness-based strategies, into routine postpartum care holds promise in improving sleep quality and overall postnatal mental health. Healthcare providers should be vigilant in assessing and addressing postpartum insomnia to optimize the well-being of both mothers and infants
Disclosure of InterestNone Declared
Hyperammonemic encephalopathy in a 46 year old patient treated with valproic acid as treatment for borderline personality disorder: a case report.
- P. Setién Preciados, E. Arroyo Sánchez, C. Díaz Mayoral, J. Gimillo Bonaque
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S696-S697
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Introduction
Valproic acid (VPA) has been used in clinical practice since the 60’s, with a relatively favourable safety and efficacy profile. Pancreatitis, hepatotoxicity and teratogenicity are the most significant adverse drug reactions. VPA is also known for causing hyperammonemia, which may be asymptomatic or can present with encephalopathy. VPA-induced hyperammonemic encephalopathy (VHE) is a serious but reversible condition, which requires high clinical suspicion for diagnosis. It may occur acutely or after chronic use of VPA.
ObjectivesReview how frequent is for valproic acid to cause hyperammonemic encephalopathy, signs to watch out for and how it can be treated.
MethodsPresentation of a patient’s case and review of existing literature, in regards to encephalopathy caused by valproic acid as a result of ammonia elevation.
ResultsIn the case displayed here, the patient is diagnosed of hyperammonemic encephalopathy after being treated with valproic acid as treatment for borderline personality disorder.
Reviewing literature, cases of hyperammonemia are rarely reported as VPA-induced, probably because this increased level of ammonia in blood can vary between asymptomatic, and clinically relevant levels. Symptomatology due to VPA-induced hyperammonemia include: lethargy, impaired consciousness, focal neurological signs and symptoms and increased seizure frequency. More rare described symptoms are: aggression, ataxia, asterixis, vomiting and coma.
There are multiple treatment modalities for patients diagnosed with VHE, the primary treatment being the discontinuation of VPA. Other treatments frequently used are Lactulose and Carnitine.
ConclusionsVHE is a rare occurrence, however can have fatal outcomes if not recognized and managed in time. Physicians should be vigilant while initiating Valproate therapy to patients. Clinicians should consider the possibility of VHE in patients with unexplained altered mental status, regardless of the duration of VPA therapy. A timely diagnosis is essential to prompt effective treatment, thus ensuring the patient’s safety and decreasing the length of hospitalisation and the cost of care in hospitals.
Disclosure of InterestNone Declared
Ekbom síndrome (Parasitosis delirium): Cocaine Use vs. Psychotic Depression. A case report
- E. Arroyo Sánchez, J. Gimillo Bonaque, P. Setién Preciados, C. Díaz Mayoral
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S413
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Introduction
Parasitosis delirium represents a rare mono-symptomatic psychosis characterized by the delirious firm belief of the patient, against all evidence, of being infested by cutaneous parasites. The syndrome affects in particular middle-aged women, and can be the single manifestation of psychological uneasiness or represent one of the aspects of a more complex psychiatric case, compromising almost totally any normal daily work and/or social activity. It is often accompanied by a refusal to seek psychiatric care. This condition can be associated with various underlying causes, including substance use disorders and psychotic depression. Understanding the differences and similarities between delirium of infestation in the context of cocaine use and psychotic depression is crucial for accurate diagnosis and effective treatment.
ObjectivesThis study aims to compare and contrast the clinical features, etiology, and treatment approaches of delirium of infestation in individuals with cocaine use and those with psychotic depression. By examining these two distinct populations, we can gain insights into the unique challenges and considerations associated with each condition.
MethodsA case report of a 44-year-old woman with delirium of parasitosis, depressive symptoms and cocaine use in the last three days. Also a comprehensive literature review using the PubMed database to identify relevant clinical articles on delirium of infestation, cocaine use, and psychotic depression.
ResultsCocaine use and psychotic depression can both cause delirium of infestation. Cocaine-induced delirium is characterized by agitation, paranoia, and delusions of infestation. Psychotic depression is characterized by a depressed mood, delusions, and hallucinations. Delusions of infestation are a common feature of bothconditions. However, the underlying mechanisms and treatment approaches differ. Cocaine-induced delirium is primarily associated with the acute effects of cocaine on the central nervous system, while psychotic depression involves a complex interplay of biological, psychological, and environmental factors. Treatment for cocaine-induced delirium involves addressing the underlying cocaine use, while treatment for psychotic depression involves antidepressant and antipsychotic medications. Otherwise, Anti-Parkinson drugs were most frequently associated with delusional infestation
ConclusionsDelirium of infestation can occur in individuals with cocaine use and those with psychotic depression, albeit with different etiologies. Clinicians should consider the underlying cause when diagnosing and treating patients with this condition. Further research is needed to explore the specific neurobiological mechanisms and optimal treatment strategies for delirium of infestation in these distinct populations.
Disclosure of InterestNone Declared
Schizophreniform disorder. Clinical manifestations and diagnosis. Purposely a case
- S. M. Bañón González, N. Ogando Portilla, B. Gamo Bravo, M. E. González Laynez, N. Sekade Gutiérrez, F. García Sánchez
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S742
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Introduction
Schizophreniform Disorder is described pretty similar to schizophrenia, but with the difference of the symptoms duration which have to last for at least 1 month but less than 6 months. Patients have to be back at their baseline functional level once the disorder has resolved. This is a heterogeneous group of patients who have either a disorder similar to schizophrenia or something closer to a mood disorder.
ObjectivesTo analyze clinical, psychopathological and epidemiological characteristics of schizophreniform disorder and also review causes, incidence, prevalence, diagnostic, therapeutic tools and the importance of maintaining the treatment, because of the abandonment of the treatment, which is a predictor of relapses.
MethodsA review of the main impact literature concerning schizophreniform disorder is done during the last five years: prevalence, incidence, pathogenesis and its relationship with other psychiatric disorders encoded in DSM-V are studied.
ResultsThe etiology is unknown. Psychotic symptoms can be treated with antipsychotics for 3 to 6 months. They usually respond faster than patients with schizophrenia (75% vs 20% respond within 8 days).
ConclusionsThe disease has a favorable prognosis, and has similarities with mood disorders. However, some data suggest a close relationship to schizophrenia. In support of the relationship with mood disorders, patients have more affective symptoms and a better outcome than patients with schizophrenia.
Disclosure of InterestNone Declared
Intractable Singultus: Causes, diagnosis and treatment. A case report
- C. Díaz Mayoral, E. Arroyo Sánchez, A. Martínez Pillado, P. Setién Preciados
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S496
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Introduction
Hiccups are involuntary, spasmodic contractions of the diaphragm and intercostal muscles that cause inspiration and are interrupted by closure of the glottis. Most sources define the term “persistent hiccups” as lasting more than 2 days and “intractable” as lasting more than 1 month. Both are most likely associated with a pathologic process. “Intractable hiccups” should lead to investigation of organic pathology. If it does not improve, it can interfere with the patient’s ability to eat, socialize and sleep, leading to a significant worsening of quality of life. “Intractable hiccups” are more frequent in men (91%), over 50 years of age. Women suffer from psychogenic hiccups more frequently than men. Anxiety or stress can trigger hiccups. Multiple neurotransmitters are involved.
ObjectivesWe present a theoretical review on the topic.
MethodsA bibliographic review on the topic.
ResultsIn recent years, new trials and case series have been published, and regulatory agencies have issued new recommendations on the use of pharmacologic agents for this indication. The literature has described the efficacy of several pharmacologic agents in the empiric treatment of persistent and intractable hiccups. Most of these target dopaminergic and GABAergic receptors.
Based on limited efficacy and safety data, Baclofen and Gabapentin can be considered as first-line treatment for intractable and persistent hiccups, as they suggest efficacy and are less likely to cause long-term side effects than standard neuroleptic agents. Dopamine blocking agents such as Metoclopramide, Chlorpromazine, and Haloperidol, could be used as second line. In one study, withdrawal of Benzodiazepines or addition of Pregabalin was found to help reduce hiccups.
The patient we consulted came for persistent hiccups or singultus of 2 years of evolution. Organic pathology was ruled out. She related the onset of the symptoms to different stressors that had caused her anxiety. We administered Escitalopram and Gabapentin and indicated withdrawal of Bromazepam, which she started taking months ago. In follow-up appointments she reported a decrease in the intensity and frequency of the symptoms, with a notable improvement in her quality of life.
ConclusionsConsidering all available evidence, a treatment algorithm with Baclofen is recommended as first-line therapy for persistent and intractable hiccups. Gabapentin may also be safe and effective in the long-term treatment of this condition, especially for patients with CNS disease. Metoclopramide is no longer recommended for long-term treatment of hiccups. Clinical experience also supports the use of Chlorpromazine and other neuroleptics for acute, but not long-term, treatment. Going forward, large multicenter studies will be needed to create an adequate evidence base for the treatment of persistent and intractable hiccups. Until then, guidelines will continue to be based on unreliable data and clinical experience.
Disclosure of InterestNone Declared