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A man stitches his mouth in the context of a personality disorder
- A. Monllor Lazarraga, P. Marques Cabezas, L. Rojas Vazquez, M. Rios Vaquero, G. Lorenzo Chapatte, T. Jimenez Aparicio, C. De Andres Lobo, C. Vallecillo Adame, M. J. Mateos Sexmero, N. Navarro Barriga, B. Rodriguez Rodriguez, M. Fernandez Lozano, M. A. Andreo Vidal, M. Calvo Valcarcel, M. P. Pando Fernandez, P. Martinez Gimeno, G. Guerra Valera
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S654-S655
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Introduction
A 28 year old patient will be presented. This paramilitary man was brought to the Emergency Room due to an autolytic attempt with Benzodiazepines, along with a mouth suture, in the context of a soon to be resolved problematic ankle osteosynthesis procedure. The patient claimed to be suffering pain, furthermore struggling due to the fact he could not be working due to his ankle issue. Language barrier was a problem during the interview.
ObjectivesThe objetives of this case is to try to explain the issues that may arise in patients with personality disorders in the context of an autolytic attempt
MethodsThis patient will be presented, along with systematic bibliography review of the topic.
ResultsThe following results were extracted upon the attention given to this patient which was admitted to the Psychiatric Unit.
First of all, the mouth stitches were removed, along with a petition for toxicological analysis. The results gave positive for cannabis and benzodiazepines. The patient was also brought previously this year with another autolytic attempt, this time on cocaine consumption too. Furthermore, a thorough review was made of the other autolytic attempts, including those which happened in his country of origin. The patient has hundreds of small cuts among his arms, from previews cuts made in the past. Furthermore, subcutaneous wounds were auto inflicted in the ER, with a small blade.
Among the whole interview, it was clear he had a personality disorder, with high impulsivity levels and lack of control once the situation overflows.
We also tried to understand the outcome of suturing his mouth. The patient referred his acts of impulsiveness due to his overwhelming situation of both having no job at this moment and the pain he was suffering due to his ankle procedure.
The patient was admitted to our Unit due to the high risk he could repeat this act. Upon arrival, the same day he was admitted, the patient asked if he had to stay at the unit. When explaining the following already told event, furthermore insisting in the possibility of been evaluated by the Traumatology team, he proceeded to try and hang himself with his medical-hospital clothing.
The patient was treated with antipsychotics. Along with Lormetazepam at night. At the end of the hospitalization, and after been evaluated by the Psychiatrist of this Unit, the patient was also treated with Lithium due to its effectiveness in the treatment of autolytic attempts.
ConclusionsPersonality disorders are one of the psychiatric pathologies that prevail with greater frequency in autolytic attempts 1. Additionally, it should be taken into account the possible ongoing consumption of psychoactive drugs that could also derive in psychopathological decompensation. On top of the following, the use of antipsychotic treatment is indicated for the managing of conduction altercations 2, besides Lithium being a great option in managing suicidal temptations 3.
Disclosure of InterestNone Declared
From schizotypy to psychosis: is it a natural continuum?
- M. A. Andreo Vidal, M. B. Arribas Simón, M. Calvo Valcárcel, M. P. Pando Fernández, P. Martínez Gimeno, M. D. L. Á. Guillén Soto, B. Rodríguez Rodríguez, N. Navarro Barriga, M. Fernández Lozano, M. J. Mateos Sexmero, C. De Andrés Lobo, M. D. C. Vallecillo Adame, T. Jiménez Aparicio, Ó. Martín Santiago, A. Monllor Lazarraga, M. Ríos Vaquero, L. Rojas Vázquez, L. Sobrino Conde, A. Apario Parra, G. Lorenzo Chapatte
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S658-S659
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Introduction
Schizotypal personality is a condition suffered by 4% of the population. It is defined by presenting interpersonal, behavioral and perceptual features similar to the clinical features of psychotic disorders, such as schizophrenia, in less intensity and dysfunctionality, but at risk of reaching psychosis.
ObjectivesPresentation of a clinical case about a patient with premorbid schizotypal personality traits presenting with an acute psychotic episode.
MethodsLiterature review on association between schizotypal personality and psychosis.
ResultsA 57-year-old woman with a history of adaptive disorder due to work problems 13 years ago, currently without psychopharmacological treatment, goes to the emergency room brought by the emergency services due to behavioral alteration. She reports that “her husband and son wanted to sexually abuse her”, so she had to run away from home and has been running through the streets of the town without clothes and barefoot.
Her husband relates attitude alterations and extravagant behaviors of years of evolution, such as going on diets of eating only bread for 40 days or talking about exoteric and religious subjects, as believing that the devil got inside her husband through a dental implant. He reports that these behaviors have been accentuated during the last month. She has also created a tarot website, and has even had discussions with several users. She is increasingly suspicious of him, has stopped talking to him and stays in his room all day long, with unmotivated laughter and soliloquies.
It was decided to admit him to Psychiatry and risperidone 4 mg was started. At the beginning, she was suspicious and reticent in the interview. As the days went by, communication improved, she showed a relaxed gesture and distanced herself from the delirious ideation, criticizing the episode.
ConclusionsIn recent years, there has been increasing interest in understanding the association between schizotypy and serious mental disorder. Several theories understand schizotypy as a natural continuum of personality that reveals genetic vulnerability and that can lead to psychotic disorder when added to precipitating factors. Other theories define schizotypy as a “latent schizophrenia” where symptoms are contained and expressed in less intensity.
Around 20% evolves to paranoid schizophrenia or other serious mental disorders. It is complex to distinguish between those individuals in whom schizotypy is a prodrome and those in whom it is a stable personality trait. To date, studies applying early psychotherapeutic or pharmacological interventions have had insufficient and contradictory results, and the follow-up and treatment of these individuals could be a stress factor and a stigma. Some studies are looking for reliable markers of evolution to schizophrenia in order to establish adequate protocols for detention, follow-up and treatment.
Disclosure of InterestNone Declared
Conversive and Factitious disorders: Differential diagnosis based on a case report
- M. Fernandez Lozano, B. Rodriguez Rodriguez, N. Navarro Barriga, M. J. Mateos Sexmero, C. Alario Ruiz, L. Rodriguez Andrés, G. Medina Ojeda, T. Jimenez Aparicio, C. Vallecillo Adame, C. De Andres Lobo, M. A. Andreo Vidal, P. Martínez Gimeno, M. Calvo Valcarcel, M. P. Pando Fernández, L. Rojas Vazquez, M. Rios Vaquero, G. Lorenzo Chapatte, A. Monllor Lazarraga
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S444
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Introduction
Conversive disorder is characterised by the presence of one or more involuntary neurological symptoms that are not due to a clear medical pathology. On the other hand, consciously simulated illnesses fall into two diagnostic categories: factitious disorders and malingering, which are differentiated by both the motivation for the behaviour and the awareness of that motivation. Factitious disorder behaviours are motivated by an unconscious need to assume the sick role, whereas malingering behaviours are consciously driven to achieve external secondary gains.
ObjectivesStudy of the differences between conversion disorder and factitious disorder and their repercussions from a case of difficult diagnosis.
MethodsBibliographic review of scientific literature based on a relevant clinical case.
ResultsWe present the case of a 14-year-old male patient. Adoptive parents. Studying in high school. Social difficulties since childhood. He comes to the emergency department on several occasions referring stereotyped movements and motor tics in the four extremities with left cervical lateralization. Increase of these symptoms in the last month, so it was decided to admit him to the pediatric hospital. After observation and study of the patient’s movements with normal complementary tests he should return home. The following day he returned to the emergency department after an episode of dizziness, mutism and emotional block. It was decided to admit him to Psychiatry for behavioral observation and differential diagnosis.
ConclusionsIn the assessment of patients it is essential to make an appropriate diagnosis taking into account the patient’s symptomatology and the patient’s background and life context. Conversion disorder is the unintentional production of neurological symptom, whereas malingering and factitious disorder represent the voluntary production of symptoms with internal or external incentives. They have a close history and this has been frequently confounded. Practitioners are often confronted to medically unexplained symptoms; they represent almost 30% of neurologist’s consultation. The first challenge is to detect them, and recent studies have confirmed the importance of “positive” clinical bedside signs based on incoherence and discordance. Multidisciplinary therapy is recommended with behavioral cognitive therapy, antidepressant to treat frequent comorbid anxiety or depression, and physiotherapy. Factitious disorder and malingering should be clearly delineated from conversion disorder. Factitious disorder should be considered as a mental illness and more research on its physiopathology and treatment is needed, when malingering is a non-medical condition encountered in medico-legal cases.
Disclosure of InterestNone Declared
“God speaks to me through a dove”. The evidence of clozapine in treatment-refractory psychosis
- B. Rodríguez Rodríguez, P. Marqués Cabezas, M. Queipo de Llano de La Viuda, N. Navarro Barriga, G. Guerra Valera, M. B. Arribas Simón, C. Alario Ruiz, M. J. Mateos Sexmero, M. Fernández Lozano, P. Marínez Gimeno, M. Calvo Valcárcel, M. A. Andreo Vidal, M. P. Pando Fernández, A. Monllor Lazarraga, M. Ríos Vaquero, G. Lorenzo Chapate, L. Rojas Vázquez, C. De Andrés Lobo, T. Jiménez Aparicio, M. D. C. Vallecillo Adame
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S740
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Introduction
Clozapine is an atypical antipsychotic synthesised in 1958. It was withdrawn from the market in the 1970s due to the appearance of agranulocytosis, but was reintroduced due to strong evidence of its efficacy and superiority over other antipsychotics in treatment-resistant schizophrenia.
ObjectivesTo describe the adequate response to clozapine in treatment-refractory psychosis.
MethodsReview of the scientific literature based on a relevant clinical case.
ResultsA 16-year-old woman was admitted to a psychiatric inpatient unit for psychotic symptoms and behavioural disorders. She lives with her father and older sister; she has not been in contact with her mother, who lives in another country, for several years. She attends secondary school, with poor academic performance. Maternal diagnosis of schizophrenia. She started using cannabis two years ago, with a progressive increase up to 20 grams per week. He reports the onset of a feeling of strangeness a year ago, with progressive isolation in his room, referring to delirious ideation of harm towards classmates and people from his town, self-referentiality and delirious interpretations of religious mystical content (“God speaks to me through a dove”). He comments on the phenomenon of theft and thought-reading. Soliloquies and unmotivated laughter are observed.
ConclusionsTreatment was started with risperidone, progressively increasing the dose up to optimisation, without achieving a decrease in positive symptoms, but with the appearance of excessive sedation and sialorrhoea. It was combined with aripiprazole up to 20mg, maintained for a couple of weeks, without significant clinical improvement. Given the failure of two lines of therapy, it was decided to change to clozapine up to a dose of 75mg, with adequate tolerance and response, achieving a distancing of the delirious ideation. Regular haematological controls were performed, with no alterations in haemogram or troponins.
Disclosure of InterestNone Declared
Lithium withdrawal and relapse in bipolar disorder when kidney function deteriorates
- C. De Andrés-Lobo, M. D. C. Vallecillo Adame, T. Jiménez Aparicio, A. Rodríguez Campos, N. Navarro Barriga, M. J. Mateos Sexmero, B. Rodríguez Rodríguez, M. Fernández Lozano, M. Calvo Valcárcel, M. Andreo Vidal, P. Martínez Gimeno, M. P. Pando Fernández, L. Rojas Vázquez, G. Lorenzo Chapatte, M. Ríos Vaquero, A. Monllor Lazarraga
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S427-S428
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Introduction
Lithium was the first mood stabilizer and today continues to be a first-line treatment in the treatment of bipolar disorder despite its adverse effects, which make it important to monitor blood levels and control kidney function.
ObjectivesPresentation of a case of litium withdrawal and relapse in bipolar disorder. Literature review relating to the risk of relapse when lithium treatment is interrupted.
MethodsWe present a clinical case of a patient who suffers a deterioration in renal function that requires the withdrawal of lithium and who consequently suffers a relapse. We conducted a bibliographic research of articles in Pubmed on this topic.
ResultsA 49-year-old male, with a history of multiple admissions to UHB since the age of 18 with a diagnosis of bipolar disorder and treatment with lithium. Decompensations towards the manic pole have always been related to interruptions in lithium treatment. On several occasions when the patient was feeling well emotionally, he believed himself to be “cured” and abandoned the treatment, triggering a manic episode, showing verbal aggression, increased self-esteem and delusional ideation of harm. Remission was usually achieved with the reintroduction of lithium and the addition of high-dose quetiapine. Between episodes, constant overvalued ideas of economic scarcity seemed to persist, which were accentuated in the form of delusional ideas of ruin in depressive decompensations. After 7 years of stability, control analysis showed blood litemia of 2.2 mEq/L with deterioration of kidney function and generalized tremor was observed, without improvement after serum therapy. He was admitted for dialysis and lithium was suspended. Treatment with valproate was started and a consultation scheduled in a week to adjust the dose. The patient did not attend that consultation and was admitted three days later to Psychiatry Hospitalization showing a challenging attitude, evident dysphoric mood, accelerated speech, with derailments and echolalia. Delusional ideation of harm with auditory hallucinations. Insomnia and hyporexia. Chronic renal failure persisted.
ConclusionsLithium is a very effective drug but with a narrow therapeutic range that requires adequate monitoring due to the possible consequences of its use at different organs and systems of the body. when lithium is found in the blood at toxic levels with deterioration of kidney function and glomerular filtration fails to recover, lithium treatment should be suspended. Sudden withdrawal of lithium significantly increases the risk of relapse due to rebound effect. More than 50% of patients experience a recurrence within 10 weeks of withdrawal.
Disclosure of InterestNone Declared
Delusional parasitosis: the importance of a multidisciplinary approach
- M. Calvo Valcárcel, G. Guerra Valera, M. A. Andreo Vidal, O. Martín Santiago, M. Lorenzo Hernando, M. P. Pando Fernández, P. Martinez Gimeno, M. D. L. Á. Guillén Soto, B. Rodríguez Rodríguez, N. Navarro Barriga, M. Fernández Lozano, M. J. Mateos Sexmero, C. De Andrés Lobo, M. D. C. Vallecillo Adame, T. Jimenez Aparicio, A. Monllor Lazarraga, M. Ríos Vaquero, L. Rojas Vázquez, L. Sobrino Conde, A. Aparicio Parra, G. Lorenzo Chapatte
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S750
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Introduction
Delusional parasitosis, also known as delusional infestation or Ekbom’s syndrome, is a rare psychotic disorder characterized by the false belief that a parasitic skin infestation exists, despite the absence of any medical evidence to support this claim. These patients often see many physicians, so a multidisciplinary approach among clinicians is important. Many patients refuse any treatment due to their firm belief that they suffer from an infestation, not a psychiatric condition, so it is crucial to gain the trust of these patients.
ObjectivesThe comprehensive review of this clinical case aims to investigate Ekbom syndrome, from a historical, clinical and therapeutic perspective.
MethodsLiterature review based on delusional parasitosis.
ResultsA 65-year-old woman comes to the psychiatry consultation referred by her primary care physician concerned about being infested by insects that she perceives through scales on her skin for the last three months. She recognizes important impact on her functionality. She is also convinced that her family is being infected too. As psychiatric history she recognizes alcohol abuse in the past (no current consumption) and an episode of persecutory characteristics with a neighbor, more than ten years ago. On psychopathological examination, she shows delusional ideation of parasitosis, with high behavioral repercussions, cenesthetic and cotariform hallucinations, as well as feelings of helplessness and anger. Treatment with Pimozide was started and the patient was referred to dermatology for evaluation, a plan she accepted. Her primary care physician and dermatology specialist were informed about the case and the treatment plan. In the recent reviews, the patient is calmer, however, despite the corroboration of dermatology and in the absence of organic lesions in cranial CT, she is still unsatisfied with the results, remaining firm in her conviction of infestation. It was decided to start treatment with atypical neuroleptics (Aripiprazole), with progressive recovery of her previous functionality.
ConclusionsDespite the increase in the number of studies in recent years, there are still few studies on this type of delirium. The female:male ratio varies in the bibiliography (between 2:1 and 3:1). The onset is usually insidious, generally appearing as a patient who comes to his primary care physician convinced of having parasites in different skin locations. It is usual to observe scratching lesions or even wounds in search of the parasite. In the past, the most used and studied treatment was Pimozide. Currently the treatment of choice is atypical neuroleptics due to their lower side effects. The latest reviews on the prognosis of this disorder show data with percentages of complete recovery between 51% and 70%, and partial responses between 16.5% and 20%. Finally, for a good diagnosis and therapeutic management, it is important to achieve a multidisciplinary approach.
Disclosure of InterestNone Declared
From adjustment disorder to schizotypal personality disorder
- C. De Andrés-Lobo, M. D. C. Vallecillo Adame, T. Jiménez Aparicio, A. Rodríguez Campos, N. Navarro Barriga, M. J. Mateos Sexmero, B. Rodríguez Rodríguez, M. Fernández Lozano, M. Calvo Valcárcel, M. Andreo Vidal, P. Martínez Gimeno, M. P. Pando Fernández, L. Rojas Vázquez, G. Lorenzo Chapatte, M. Ríos Vaquero, A. Monllor Lazarraga
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S652-S653
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Introduction
Individuals with schizotypal personality disorder are characterized by tendencies to magical thinking, unusual perceptions, discomfort in social situations, and restricted affect. It is frecuent that they have social anxiety and have difficulty in understanding the motivations and thoughts of others.
ObjectivesPresentation of a case of a patient who was first diagnosed with adjustment disorder, but on a closer study, was discovered to have a schizotypal personality disorder.
MethodsWe conducted a bibliographic review by searching for articles about schizotypal personality disorder and theory of mind in Pubmed.
ResultsWe present the case of a 39-year-old woman, diagnosed with adjustment disorder after a conflict at work with a colleague that caused her anxiety-depressive symptoms. In consultations, the patient shows verbiage without expansiveness or euphoria, with rambling speech. She expresses feelings of indignation and injustice, she is irritable, with contained anger. She refers that she prefers to be distrustful of others because she does not understand their intentions. Her thoughts are very rigid, which leads her to have avoidant and phobic attitudes, having no relationships of friendship throughout her life.
A neuropsychological evaluation is carried out, resulting in a surprising WAIS with a TIC of 128. However, the Mayer‐Salovey‐Caruso Emotional Intelligence Test (MSCEIT) shows difficulties in Perception, Comprehension and Emotional Management
Considering the patient’s symptomatology as a whole, it is noteworthy:
– Sustained social isolation throughout their life history
– Superficiality of interpersonal relationships
– Distrust and slight self-referentiality. Deficit in inferring the feelings and thoughts of others
– Peculiar speech with ideas of magical content, superstitions and rituals…
Which together supported a diagnosis of schizotypal personality disorder and generalized anxiety disorder. From this point we started to work on her self-esteem, modification of irrational beliefs and cognitive distortions, interpersonal communication and metacognitive therapy, with good results.
ConclusionsThe type of schizotypal patients who come to consultations most frequently are the actively isolated/timorous profile due to their intense social anxiety and difficulties in understanding and adapting to the social world around them. Initial therapy should be empathic support. The theory of mind is the ability to infer the other’s mental states and therefore predict their behavior, this ability being diminished in the schizotypal patient. Mentalization tasks, metacognitive therapy, cognitive flexibility training, social skills training, and promoting self-worth are useful. On some occasions it may be necessary to start psychopharmacological treatment to control anxiety and unusual perceptions when they cause discomfort.
Disclosure of InterestNone Declared
Psychopharmacological management in patients with Di George syndrome
- L. Rojas Vázquez, P. Marqués Cabezas, G. Lorenzo Chapatte, M. Ríos Vaquero, A. Monllor Lazarraga, M. P. Pando Fernández, M. A. Andreo Vidal, M. Calvo Valcárcel, P. Martínez Gimeno, M. J. Mateos Sexmero, B. Rodríguez Rodríguez, M. Fernández Lozano, N. Navarro Barriga, T. Jiménez Aparicio, C. De Andrés Lobo, C. Vallecillo Adame, L. Sobrino Conde, M. D. L. Á. Guillén Soto, A. Aparicio Parra
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S455
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Introduction
It is widely described in the scientific literature that patients who suffer from some type of congenital syndrome such as Di George Syndrome are more likely to present some type of psychopathological alteration during their development that may require intervention and treatment by infant and juvenile mental health teams in coordination with neuropediatrics (1). On this occasion, we will present the clinical case of a patient who regularly attends psychiatry consultations for management of anxious symptoms with impulse control deficits associated with intellectual disability, diagnosed since childhood with tetralogy of Fallot and later with Di George syndrome. In this type of case, treatment is usually considered taking into account possible comorbidities at the organic level (since there may be cardiological involvement, which can be an added difficulty when taking into account the adverse effects of some psychotropic drugs) (2).
ObjectivesThis is followed by the presentation of the clinical case, which can serve to exemplify this type of case and clarify any doubts that may arise regarding treatment.
MethodsPresentation of the clinical case and review of updated scientific literature on the subject.
ResultsPatient who first came to the infantile-junior consultations at the age of 8 years due to delay in the acquisition of verbal language and impulsivity. The patient had a history of pediatric follow-up since birth for different physical symptoms that finally led to the diagnosis of Di George syndrome.
Given the difficulties he presented both at home and at school, different psychometric tests were performed and it was determined that it could be beneficial to initiate treatment with extended-release methylphenidate. Prior to treatment, psychomotor restlessness (without aggressiveness) and difficulty in concentration prevailed, which improved significantly after upward adjustment of the dose to a guideline corresponding to his age and weight. It was not necessary in this case to administer other treatments (the possibility of starting Aripiprazole in case of episodes of agitation was considered, but it was not necessary). The patient has continued to be monitored by cardiology to assess the possible side effects of the treatment (since it can increase heart rate and blood pressure (3), but so far no complications have been detected).
Thanks to psychotherapeutic and educational intervention, language acquisition was achieved, although to date he still requires support due to the difficulties he still presents.
ConclusionsIt is important to take into account the possible side effects of psychopharmacological treatment in patients with an associated congenital syndrome. Intensive and comprehensive follow-up by psychiatry and pediatrics (and later by their primary care physician) should be performed.
Disclosure of InterestNone Declared
Impulse phobias during pregnancy: a case report of a 37 year-old woman pregnant of her first child
- M. Ríos-Vaquero, G. Lorenzo-Chapatte, L. Rojas-Vázquez, A. Monllor-Lazarraga, L. Sobrino-Conde, M. J. Mateos-Sexmero, T. Jimenez-Aparicio, M. Calvo-Valcarcel, M. A. Andreo-Vidal, M. P. Pando-Fernández, P. Martínez-Gimeno, M. D. L. A. Guillen-Soto, B. Rodriguez-Rodriguez, N. Navarro-Barriga, M. Fernández-Lozano, A. Aparicio-Parras, M. D. C. Vallecillo-Adame, C. De Andres-Lobo, A. Rodríguez-Campos
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S801
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Introduction
Pregnancy and puerperium are two critical stages for women’s mental health due to the biological stress of pregnancy itself, as well as the emotional stress that surrounds this vital moment. (1) Debut and aggravation of psychiatric symptoms may occur, as well as relapse in women previously diagnosed with Severe Mental Disorder (SMD).
Symptoms of the anxious spectrum are the most frequent within the perinatal mental pathology, being impulse phobias an entity that appears in about 25% of women previously diagnosed with OCD and up to 10-15% of women without previous psychopathology (2)
ObjectivesExposing the importance of Perinatal Mental Health from the presentation of a clinical case.
MethodsReview of the literature available in PubMed. Presentation of the pathobiography and evolution of the patient.
ResultsOur case is about a 37-year-old woman, 30 weeks pregnant with her first child and history of having required admission to Psychiatry with subsequent follow-up in Mental Health for anxious-depressive symptoms with the presence of self-injurious ideas who, after two weeks with multiple life stressors, came to the Emergency Department for the presence of impulse phobias focused on pregnancy with significant internal anguish and ideas of death as a resolution to it, which is why it was decided to hospitalize her. During admission, and taking into account the patient’s gestational state, treatment was started with diluted Mirtazapine and Aripiprazole solution at minimal doses, which in this case were sufficient for symptom control.
The latest guidelines addressing psychopharmacology during pregnancy and lactation point to sertraline among the antidepressants and Lorazepam among the benzodiazepines as the safest drugs during pregnancy (3).
Conclusions- The exacerbation of anxious symptomatology and the presence of gestation-focused impulse phobias are frequent during pregnancy and their intensity increases as the time of delivery approaches.
- Sertraline, Lorazepam, Mirtazapine and Aripiprazole are safe drugs during pregnancy.
- In these women, a close and multidisciplinary follow-up by Psychiatry and Gynecology is advisable.
Disclosure of InterestNone Declared
15 Exploratory Factor Analysis of Cognitive and Positive Valence Measures for the RDoC
- Emily T Sturm, John R Duffy, Anastasia G Sares, Andrea Mendez-Colmenares, Lauren Sarabia, Eve Delao, Max Henneke, Raana Manavi, Donald C Rojas, Jason R Tregellas, Jared W Young, Michael L Thomas
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 698-699
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Objective:
As part of the Research Domain Criteria (RDoC) initiative, the NIMH seeks to improve experimental measures of cognitive and positive valence systems for use in intervention research. However, many RDoC tasks have not been psychometrically evaluated as a battery of measures. Our aim was to examine the factor structure of 7 such tasks chosen for their relevance to schizophrenia and other forms of serious mental illness. These include the n-back, Sternberg, and self-ordered pointing tasks (measures of the RDoC cognitive systems working memory construct); flanker and continuous performance tasks (measures of the RDoC cognitive systems cognitive control construct); and probabilistic learning and effort expenditure for reward tasks (measures of reward learning and reward valuation constructs).
Participants and Methods:The sample comprised 286 cognitively healthy participants who completed novel versions of all 7 tasks via an online recruitment platform, Prolific, in the summer of 2022. The mean age of participants was 38.6 years (SD = 14.5, range 18-74), 52% identified as female, and stratified recruitment ensured an ethnoracially diverse sample. Excluding time for instructions and practice, each task lasted approximately 6 minutes. Task order was randomized. We estimated optimal scores from each task including signal detection d-prime measures for the n-back, Sternberg, and continuous performance task, mean accuracy for the flanker task, win-stay to win-shift ratio for the probabilistic learning task, and trials completed for the effort expenditure for reward task. We used parallel analysis and a scree plot to determine the number of latent factors measured by the 7 task scores. Exploratory factor analysis with oblimin (oblique) rotation was used to examine the factor loading matrix.
Results:The scree plot and parallel analyses of the 7 task scores suggested three primary factors. The flanker and continuous performance task both strongly loaded onto the first factor, suggesting that these measures are strong indicators of cognitive control. The n-back, Sternberg, and self-ordered pointing tasks strongly loaded onto the second factor, suggesting that these measures are strong indicators of working memory. The probabilistic learning task solely loaded onto the third factor, suggesting that it is an independent indicator of reinforcement learning. Finally, the effort expenditure for reward task modestly loaded onto the second but not the first and third factors, suggesting that effort is most strongly related to working memory.
Conclusions:Our aim was to examine the factor structure of 7 RDoC tasks. Results support the RDoC suggestion of independent cognitive control, working memory, and reinforcement learning. However, effort is a factorially complex construct that is not uniquely or even most strongly related to positive valance. Thus, there is reason to believe that the use of at least 6 of these tasks are appropriate measures of constructs such as working memory, reinforcement learning and cognitive control.
Quality of life of depressed patients with chronic diseases
- M. G. Rojas, V. Guajardo, P. Martinez
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S837
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Introduction
Chronic diseases are a public health problem and high prevalent on depressed patients.
ObjectivesTo describe the sociodemographic characteristics and the quality of life of a sample of depressed patients with hypertension and oder diabetes as comorbidity.
MethodsIt is the baseline evaluation of 361 persons participating in a clinical trial that studies the effectiveness of a psychoeducational intervention for this type of patients.
Persons with moderate or severe depression and with hypertension and or diabetes attending 8 primary care centers in Santiago were invited to participate .
ResultsThe sample consisted of 361 study participants,the majority female(89.97%).The mean age was 59.81 years(de=10.28),with an age range observed from 26 to 83 years.Most of the participants had primary(35,91%)or secondary (43.21%)education level.More than a third of the participants reported houshold chores(34.09%) and a quarter were working for income(28.41%).About half of the participants were married(44.48%).The mean PHQ-9 score was 18.73(sd=2.81).Most of the participants had a previous diagnoses of depression(60.39%).The sample obtained an average of 34.99 points(sd=20.82) in the mental health component of the 12-item Short Form Health Survey indicative of poor quality of life related to mental health.
ConclusionsDepressed patients with chronic diseases ,users of primary care clinics, have poor quality of life,so it is urgent to review care protocols to achieve better health results.
Disclosure of InterestNone Declared
Sociodemographic and clinical characteristics of the population with a first psychotic episode attended in the mental health services of area 5 of Madrid (Spain)
- J. Garde González, P. Herrero Ortega, A. Oliva Lozano, I. I. Louzao Rojas, M. P. Vidal-Villegas, A. Muñoz-Sanjosé, M. P. Sánchez-Castro, G. Lahera, S. Sánchez Quílez, M. F. Bravo-Ortiz, O. B. O. A.-M. Group
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S443
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Introduction
Risk of functional impairment and progression to chronic illness in people with a first episode of psychosis (FEP) has motivated early intervention programs, showing promising results. Defining the characteristics of people with FEP at local level enables the clinicians to adjust interventional models to the reality of the population. The area 5 of Madrid (Spain) is referred to La Paz University Hospital and it serves a catchment area of roughly 527,000 people.
ObjectivesWe aim to identify sociodemographic and clinical characteristics of patients in the area 5 of Madrid (Spain) who meet the criteria of FEP.
MethodsA descriptive retrospective study including 179 people (age range 18-40 years) who were attended in mental health services of La Paz University Hospital (area 5 of Madrid, Spain), between January 2019 and May 2020, having suffered a psychotic episode in the last five years.
ResultsThe average age of people with FEP was 29.32 years, with a higher proportion of men (62%). The mean duration of untreated psychosis (DUP) was 3.64 months and 47% of patients consume cannabis. We found disparities in DUP among the different districts in the area and we also observed differences depending on the district for inclusion in rehabilitation programs or psychotherapy. The following averages were obtained for the aggregate sample: 1.01 hospitalization/year, 1.42 emergency room visits/year, 1.81 years of illness and a mean dosage equivalent to olanzapine 6.75 mg/day. The incidence of psychosis in our area has been 7.01 cases per 100000 inhabitants/year.
ConclusionsThe incidence of psychosis has been as expected according to data recorded at previous studies in Spain. The results obtained in our sample have included a lower DUP and a higher use of cannabis than those described in the literature. We have also found differences when observing the inclusion of patients in different treatments (psychotherapy, rehabilitation), which may be related to the differences in the DUP by districts. Further exploration in this field is needed to draw causal conclusions.
Disclosure of InterestNone Declared
Umm Huwaiwitat: a Neolithic site near Petra, Jordan
- Daniel Plekhov, Cristiano Nicosia, Luiza Osorio G. Silva, Sarah Newman, Felipe Rojas
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Studies of the rural landscapes around the Nabataean/Roman city of Petra in Jordan have tended to assume a developmental trajectory based on that of the urban centre. Recent archaeological investigations at the site of Umm Huwaiwitat, however, shed light on the longer-term histories of human occupation and land use in the region north of Petra. Excavation has revealed Late Neolithic deposits formed by the burning of animal dung and the disposal of ash. These deposits underlie walls, today serving as agricultural terraces, which date to at least the Early Bronze Age. Umm Huwaiwitat therefore provides a microcosm of the long-lived and constantly reworked agricultural landscapes of the Middle East.
Male attraction of Gymnandrosoma aurantianum (Lepidoptera: Tortricidae), from Guatemala, to its sex pheromone major component is not affected by the addition of secondary components
- R. Aranda-Arguello, J.C. Rojas, E.A. Malo, G. López-Guillén, L. Cruz-López
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- Journal:
- The Canadian Entomologist / Volume 154 / Issue 1 / 2022
- Published online by Cambridge University Press:
- 12 December 2022, e51
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The macadamia nut borer, Gymnandrosoma aurantianum Lima (Lepidoptera: Tortricidae), is the main pest of Macadamia integrifolia Maiden and Betche (Proteaceae) in Central America. We identified five compounds in female sex pheromone gland extracts, (E)-8-dodecenyl acetate, tetradecyl acetate, dodecyl acetate, (E)-8-dodecenol, and (Z)-8-dodecenyl acetate, in a ratio of 100:44.9:33.4:6.5:1.2, respectively, from Guatemalan populations of this insect. All compounds except tetradecyl acetate elicited electroantennography responses in two- to five-day-old males. In field tests, traps baited with single compounds did not capture males, except for the major component (E)-8-dodecenyl acetate. Mixtures of (E)-8-dodecenyl acetate with secondary components were active in field tests, but the number of G. aurantianum males trapped did not differ between these mixtures and (E)-8-dodecenyl acetate alone. Doses of more than 1 mg (1.5 or 2 mg) of the major component did not significantly increase capture. The gradual loss of the amount of (E)-8-dodecenyl acetate in rubber septa under field conditions indicates that septa should be renewed every four weeks. In conclusion, the addition of secondary components to the major component of the sex pheromone gland contents does not improve capture of G. aurantianum males. Our results demonstrate that 1 mg of (E)-8-dodecenyl acetate could be used as an attractant for monitoring populations of this moth.
Mindfulness-based interventions and employment: Descriptive analysis of the MER-ACT project
- T. Castellanos Villaverde, G. Navarro Oliver, I. Torrea Araiz, E. Vidal Bermejo, A. Hospital Moreno, I. Louzao Rojas, E. Fernández-Jiménez
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S696-S697
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Introduction
Evidence shows unemployment as a negative impact factor on a variety of health outcomes. Regarding mental health, unemployment is considered one of the most consolidated risk factors for morbidity. This relationship is considered bi-directional. Prevention and wellness promotion are essential guidelines for mental health providers.
ObjectivesTo describe the work status in a sample of patients with anxiety disorders after two types of group mindfulness-based interventions in the MER-ACT project.
MethodsA descriptive analysis was conducted on work status before and 6 months after two types of mindfulness-based interventions. The group treatments were Acceptance and Commitment Therapy and a Mindfulness-based Emotional Regulation intervention, during 8 weeks, guided by two Clinical Psychology residents. The employment change was calculated (percentage of change from unemployed or temporary incapacity to employed).
ResultsThe work status of participants of the sample (n = 40), before and 6 months after interventions, were employed: 55% vs. 60%; temporary incapacity: 12.5% vs. 12.5%; unemployed: 25% vs. 20% and others: 7.5% vs. 7.5%. In the same period, the unemployment rate in the Spanish general population was from 13.8% to 14.5%. After 6 months the percentage of change on work status was 25% (15% improved their employment situation).
ConclusionsPreliminary results show worse work status of participants compared to the Spanish general population. It is recommendable to include well-established risk factor measurements to establish the effectiveness of interventions in mental health. More research is required to determine the impact of interventions on the employment status.
DisclosureNo significant relationships.
Descriptive analysis of adherence to mindfulness-based group therapies: online versus face-to-face interventions
- G. Navarro Oliver, T. Castellanos Villaverde, I. Torrea Araiz, E. Vidal Bermejo, A. Hospital Moreno, I. Louzao Rojas, E. Fernández-Jiménez
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S323-S324
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Introduction
The use of technological supports in psychotherapeutic interventions has been widespread in recent years. Since the COVID-19 pandemic, the increase has been greater. The feasibility of online group interventions has been proved in previous studies. Research comparing dropout rates in group interventions with clinical population that include mindfulness training is infrequent.
ObjectivesTo compare the difference in dropout rates between online and face-to-face mindfulness-based group interventions.
MethodsThis study was carried out in a Mental Health Unit in Colmenar Viejo (Madrid, Spain). One hundred thirty-five adult patients with anxiety disorders were included in group interventions (74 face-to-face; 61 online). The group treatments were Acceptance and Commitment Therapy and a Mindfulness-based Emotional Regulation intervention, during 8 weeks, guided by two Clinical Psychology residents. A descriptive analysis of dropout rates (participants attending 3 or fewer sessions out of the total number of participants starting the intervention) was performed.
ResultsOf the 135 patients included, 8 did not participate in the interventions (5 face-to-face; 3 online), which represents a 5.93% rejection rate; 6.76% for the face-to-face intervention and 4.92% for the online intervention. Of the remaining sample (127 participants), a total dropout rate of 12.6% was obtained, with 8.69% in the face-to-face intervention versus 17.24% online.
ConclusionsA higher dropout rate was obtained in online interventions compared to face-to-face, with an increase of almost double. Research on specific factors that may interfere with treatment adherence to online group interventions is needed.
DisclosureNo significant relationships.
A collaborative, computer-assisted, psychoeducational intervention for depressed patients with chronic disease at primary care: protocol for a cluster-randomized controlled trial
- G. Rojas, P.A. Martinez Diaz, V. Guajardo, S. Campos, P. Herrera, P. Vöhringer, V. Gomez, W. Szabo, R. Araya
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S293-S294
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Introduction
Depression treatment recommendations seldom include chronic illness comorbidity.
ObjectivesTo describe the rationale and methods for a cluster-randomized trial (CRT) in primary care clinics (PCC) comparing a computer-assisted psychoeducational (CAPE) intervention to usual care (UC) for depressed patients with hypertension or diabetes.
MethodsTwo-arm, single-blind CRT in Santiago, Chile. Eight PCC will be randomly assigned to the intervention or UC. A total of 360 depressed individuals aged 18 or older PHQ-9 scores ≥ 15 and hypertension or diabetes will be recruited. Patients with alcohol/substance abuse; current treatment for depression, bipolar disorder, or psychosis; illiteracy; severe impairment; and residents in long-term care facilities will be excluded. Patients in the intervention will receive eight CAPE sessions by trained therapists, structured telephone calls to track progress, and usual medical care for chronic diseases. Psychologists and psychiatrists will regularly supervise therapists. To ensure continuity of care, the PCC team will meet monthly with a research team member. Patients in UC will receive standard medical and depression treatment. Three, six, and twelve months after enrollment, outcomes will be assessed. The primary outcome will be a 50% reduction in baseline PHQ-9 scores at six months. Intention-to-treat analyses will be used.
ResultsA previous, small-scale pilot study provided valuable insights for study design.
ConclusionsThis study will provide first-hand evidence on the effectiveness of a CAPE for depressed patients with chronic diseases at PCC in a Latin American country.
DisclosureNo significant relationships.
Mental health service requirements after hospitalization due to COVID-19: a 1- year follow-up study
- J. Andreo Jover, M.P. Vidal-Villegas, R. Mediavilla, I. Louzao Rojas, S. Cebolla Lorenzo, E. Fernández Jiménez, A. Muñoz-Sanjosé, M.F. Bravo-Ortiz, G. Martinez-Ales, C. Bayón-Pérez
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S381
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Introduction
Long-term COVID-19 effects has been recently described as persistent and prolonged symptoms after an acute and severe SARS-COV-2 (1). An important concern is that the sequelae of severe COVID-19 may suppose a substantial outpatient 's burden for the specialized services in reopening pandemic phase (2).
ObjectivesTo describe the frequency of mental health service use in COVID-19 hospitalized patients after discharge and to estimate the costs associated to the post- discharge consultations.
MethodsWe used a 1-year follow-up cohort of 1455 COVID-19 inpatients hospitalized in La Paz University Hospital of Madrid, Spain between March 16th and April 15th, 2020. Data were retrieved from Psychiatry Service (PS) electronic health records and we described the frequency of mental health reason for consultation. We used information published by the Madrid health Office to estimate the cost of initial and following appointments.
ResultsOur sample consisted of 1,455 patients admitted with a COVID-19 diagnosis between March 16th and April 15th, 2020, and then discharged. Roughly half of them were men (776, 53%), 238 (16%) had a prior history of mental health problems, and 44 (3%) died. 193 participants (13%) visited the mental health department after being discharged. The total cost was estimated in 103,581 USD, of which two-thirds corresponded to patients with prior history of mental health problems.
ConclusionsOur results indicate that the mental health burden of severe COVID-19 inpatient s after discharge was substantial during the first year of follow-up. This generate important economic impact to mental health providers and society at large.
DisclosureNo significant relationships.
Structural gender inequalities and symptoms of postpartum depression in 40 countries
- P.A. Martinez Diaz, J. Nazif-Munoz, I. Magaña, G. Rojas
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S852
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Introduction
The extent to which structural gender inequality contributes to macro-level differences in postpartum depression (PPD) remains largely unknown.
ObjectivesTo examine the association of structural gender inequalities with national-level prevalence estimates of PPD symptoms.
MethodsMeta-analytically derived national-level estimates for the prevalence of PPD symptoms – based on the Edinburgh Postnatal Depression Scale (EPDS) – were combined with economic (e.g., income inequality), health (e.g., infant mortality rate), sociodemographic (e.g., urban population), and structural gender inequality variables (e.g., abortion policies) for 40 countries (276 primary studies). Data came from a prior meta-analysis on PPD prevalence and international agencies (e.g., UNICEF). Meta-regression techniques and traditional p-value based stepwise procedures, complemented with a Bayesian model averaging approach, were used for a robust selection of variables associated with national-level PPD symptom prevalence. Sensitivity analyses excluded primary studies with small sample sizes or countries lacking evidence for psychometric properties of the EPDS.
ResultsIncome inequality (β = 0.04, 95% CI = 0.02 to 0.07) and abortion policies (β = 0.02, 95% CI = 0.00 to 0.03) were the only variables included in the final, adjusted model, accounting for 60.7% of the variance in PPD symptoms across countries. Gradual liberalizations of abortion policies were associated with a 2% decrease in national-level PPD symptom prevalence. Results were robust to sensitivity analyses.
ConclusionsStructural gender inequalities might be social determinants of PPD, as the liberalization of abortion policies seem to impact women’s perinatal mental health on a population level. More research on structural gender inequality is needed to guide policy and practice.
DisclosureNo significant relationships.
Multiplet Structure for the Perovskite Vanadium-doped BCZT using EELS
- G. Herrera-Pérez, R. Borja-Urby, C. Ornelas-Gutierrez, A. Reyes-Rojas, F. Paraguay-Delgado, L. Fuentes-Cobas
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- Journal:
- Microscopy and Microanalysis / Volume 28 / Issue S1 / August 2022
- Published online by Cambridge University Press:
- 22 July 2022, pp. 2418-2419
- Print publication:
- August 2022
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