39 results
How cultural factors along with mental health diagnoses influence the treatment of a stroke patient with no previous mental health history: a case report
- P. Setién Preciados, E. Arroyo Sánchez, A. Sanz Giancola, I. Romero Gerechter, M. Martín Velasco
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S822-S823
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Introduction
Mental health awareness campaigns in the past few years have vastly improved how medical professionals treat mental health patients. However, prejudices and ignorance still interfere in medical practice. In this context, with the case presented we can see that even in presumed mental health diagnoses along with cultural factors (race, language…), the best medical assistance is not ensured.
ObjectivesReview how different intersectional factors can determine the treatment patients receive at hospitals.
MethodsPresentation of a patient’s case and review of existing literature, in regards to the influence of race, language barriers and mental health diagnoses when attending patients.
ResultsThe patient is presumed to suffer from a mental health condition after a battery of initial tests with inconclusive results do not demonstrate an organic origin. Instead of continuing with the medical study, the patient is disregarded as psychiatric even though his profile doesn´t fit beforehand of a fictitious or conversion disorder. The fact that there are also cultural factors in play (race and language) probably unconsciously influence how the medical team treats this patient’s case. Cultural social factors persistently present as barriers in clinical practice.
ConclusionsRace, language barriers and mental health diagnoses as well as other intersectional factors do have a great impact in the treatment patients receive. There is yet a lot to do when it comes to educating health professionals if we want to offer the best medical assistance.
Disclosure of InterestNone Declared
Analysis of the predictive potential of good clinical response of plasma levels of clozapine in patients with resistant schizophrenia in an area of southern Spain
- L. I. Muñoz-Manchado, F. González-Saiz, J. I. Pérez-Revuelta, N. Laherrán-Cantera, R. J. Pardo-Velasco
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S446
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Introduction
Resistant schizophrenia is a schizophrenia subtype characterized by a non-ability to respond to an appropriate antipsychotic treatment in dosage and duration by the patients. These patients show a lower prognostic and symptomatology. The unique drug which has shown efficacy for resistant schizophrenia treatment is clozapine, which is effective in suicide and aggressive behaviour prevention too. Whereas clozapine has numerous and serious adverse effects such as agranulocytosis risk. Because of this, and for guaranteeing an accurate diagnosis of resistant schizophrenia, distinguishing this from pseudo-resistance due to a poor tracing of schizophrenia, clozapine’s plasmatic levels monitoring is recommended in Spain by many clinical practise-guidelines.
ObjectivesThis studio has the objective of determining if altered clozapine’s plasmatic levels have predictive potential of therapeutical response and answering what clinical and sociodemographic variables are associated to these anormal plasmatic levels.
MethodsIn this work, a cross-sectional observational study was carried out in which clinical and sociodemographic data obtained by the Mental Health Unit of the Jerez de la Frontera University Hospital were collected within the research project entitled: "Role of social cognition as a factor psychosocial functioning of the schizophrenic patient” (ECOFUN), of all the participating patients (in total the sample was 141 patients, of which 40 are in treatment with clozapine).
ResultsThe sample of patients has a mean age of 44 years and medium-high educational levels. The vast majority are men and do not currently consume substances of abuse, and when this consumption occurs, tobacco and alcohol are the most consumed substances. Their total scores on the PANSS and Markova Barrios scales are generally very disparate, but with average values of 55 and 16. It has been obtained as results that there is no significant statistical correlation between the plasma levels of clozapine and the values of the PANSS scale and its subscales in the patients. On the other hand, patients treated with clozapine would present clinical and sociodemographic characteristics practically identical to those of patients treated with other antipsychotics, especially their values on the PANSS scale. In addition, plasma levels of clozapine are correlated, although not significantly, with an improvement in the positive symptomatology of schizophrenia.
ConclusionsAs a conclusion, unusually higher values of clozapine are correlated significantly with lower values in positive symptomatology in schizophrenia, but plasmatic levels are not correlated significantly with values of PANSS scale.
Disclosure of InterestNone Declared
Suicide behaviour after hospitalisation and related factors: a case report.
- P. Setién Preciados, A. Sanz Giancola, E. Arroyo Sánchez, M. Martín Velasco, I. Romero Gerechter
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1115
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Introduction
Suicide is a global epidemic, with the World Health Organization (WHO) estimating that there are roughly 800,000 suicides annually, accounting for 1.4% of all deaths, and making suicide the 18th leading cause of death in 2016 (World Health Organization. There is a pressing need to better understand factors that contribute to suicide risk. One important domain for suicide prevention is inpatient psychiatric treatment, as many patients are admitted precisely in order to reduce their risk of suicide. Although inpatient psychiatric treatment is often used for suicide risk prevention the risk of suicide after inpatient treatment remains high. Patients who have been recently discharged have a greater risk of suicide than non-hospitalised mentally ill people.
ObjectivesReview suicidal risk after hospitalisations and the factors that may have an influence on it.
MethodsPresentation of a patient’s case and review of existing literature, in regards to the rate of suicide after a patient is released from psychiatric hospitalisation and the factors that surround it.
ResultsThe patient in question is admitted into a psychiatric ward with a diagnosis of severe psychotic depression, after a suicide attempt trying to dissect his arms’ blood vessels. Health professionals at the hospital attend to his needs and the patient sees improvement. Not long after his release, there is a second hospital admission, which doesn’t have the same result and after his release he successfully ends his life. What comes to mind with these sorts of patients is: what kind of help would they have needed? Why hospital admission was not enough? And which factors and profile of patient is more prone to develop suicide behaviour?
ConclusionsAdmissions at psychiatric wards always have to be thought of as a beneficial resource for patients. There are some cases in which patients do not get the help they need by being hospitalised, increasing the risk of comitting suicide. A lot more studies will have to be carried out to understand what variables play a part in this. Meanwhile an improvement in outpatient care to support patients after hospital release is crucial.
Disclosure of InterestNone Declared
New-Onset Bipolar Disorder in Late Life: a case report and review of literature
- A. Sanz Giancola, E. Arroyo Sánchez, P. Setién Preciados, M. Martín Velasco, I. Romero Gerechter, C. Díaz Mayoral
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S691
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Introduction
The elderly represents the fastest growing group of the population. It is fair to assume that the portion of old age patients suffering from bipolar disorder will grow in a similar manner. Elderly patients represent approximately 25% of the bipolar population. Summarizing, 5–10% of patients were 50 years of age when they experienced their first manic episode, constituting the subgroup of late onset bipolar disorder (LOBD).
ObjectivesThe purpose of this case report and literature review is to emphasise the importance of LOBD in old population and to highlight its still sparse-knowledge.
MethodsDescriptive case study and review of literature (Arnold,I. et al. Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment. Medicina 2021,57,587; Baldessarini et al. Onset-age of bipolar disorders at six international sites. J Affect Disord 2010;121(1-2):143-6).
ResultsA 60-year-old woman is brought to the emergency department for evaluation by her family. Over the past 7 days, the patient has become increasingly irritable and argumentative, is sleeping less, is talking faster than usual and has begun to express paranoid concerns about her students “stealing my exam”. The patient is a university professor.
In the assessment interview she is hyperverbal, expansive, and grandiose. The family has also just recently discovered that she has spent a large sum of money on the Internet.
She has no history of psychiatric contact or substance use disorders; however, she has a family history of severe depression.
In the absence of any plausible non-psychiatric condition that could mimic or induce mania, the working diagnosis is bipolar I disorder, most recent episode (MRE) manic with psychotic features.
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ConclusionsThe share of older age bipolar disorder will grow constantly in the next decades and further research on this neglected patient group is urgently required.
Disclosure of InterestNone Declared
Lithium management in pregnant patients with bipolar disorder
- I. Romero Gerechter, M. Martín Velasco, A. Sanz Giancola, E. Arroyo Sánchez, C. Díaz Mayoral, P. Setien Preciados
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S198
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Introduction
Women with bipolar disorder often ask their treating clinician for information about family planning, as they are concerned about the impact of their illness on offspring. Pregnancy places additional stress on patients, and physiological changes are particularly acute during postpartum. On the other hand, the risk of abnormalities and teratogenicity from psychotropic drugs is significant. The decision wether resuming or discontinuating lithium is discussed.
ObjectivesWe present a theoretical review on the topic.
MethodsA bibliographic review is presented.
ResultsThe choice to continue medication during pregnancy balances the risks of an untreated illness with the risks of medication exposure. Abrupt discontinuation of psychotropic medications is associated with an increased risk for illness recurrence. Women with BD who discontinue their medications before or during pregnancy have a 71% risk of recurrence with new episodes occurring most frequently in the first trimester. Recurrent illness during pregnancy is associated with a 66% increase in the risk of postpartum episodes. Untreated or under-treated BD during pregnancy is associated with poor birth outcomes independent of pharmacotherapy exposure, including preterm birth, low birth-weight, intrauterine growth retardation, small for gestational age, fetal distress, and adverse neurodeve- lopmental outcomes. Women with untreated BD also have behavioral risk factors such as decreased compliance with prenatal care, poor nutrition, and high-risk behaviors. Impaired capacity to function may result in loss of employment, health care benefits, and social support. The biological and psychosocial risks of a BD episode are the justification for the risk of medication exposure.
Fetal exposure to lithium has been associated with an increased risk for cardiac abnormalities. The risk for Ebstein’s anomaly with first trimester exposure is 1 (0.1%) to 2 in 1000 (0.2%), but the absolute risk remains low. Folate supplementation with 5 mg reduces the risk and severity of congenital heart disease. Lithium toxicity causes lethargy, hypotonia, tachycardia, coma, cyanosis, and chronic twitching in the newborn.
Strategies to minimize fetal exposure and maintain efficacy include using the lowest effective dose, prescribing lithium twice daily to avoid high peak serum concentrations, and regular monitoring of lithium serum concentrations. The effective serum concentration must be established before pregnancy. If a therapeutic concentration has not been established, the lithium dose is titrated to a concentration within the therapeutic range. Breast feeding is discouraged in women taking lithium because of the high rate of transmission to the infant.
ConclusionsTreatment decisions for pregnant women with mood disorders must weigh the potential for increased risks of lithium during pregnancy, especially during the first trimester, against its effectiveness at reducing relapse.
Disclosure of InterestNone Declared
Clozapine use in drug induced psychosis in Parkinson´s disease: a case report and review of literature.
- A. Sanz Giancola, P. Setién Preciados, E. Arroyo Sánchez, I. Romero Gerecther, M. Martín Velasco, C. Díaz Mayoral
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1041
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Introduction
The occurrence of psychotic symptoms induced by dopaminergic drugs marks a new phase in the course of Parkinson’s disease (PD). The term drug induced psychosis may be used when other significant psychiatric diseases are excluded in patients with no history of psychosis. The prevalence of dopaminomimetic psychosis varies from 5% to 20%. Therefore, knowledge of the psychopharmacological management of this condition is essential.
ObjectivesThe purpose of this case report and literature review is to to learn the psychopharmacological management of this not uncommon medical complication.
MethodsDescriptive case study and review of literature
ResultsWe present the case of a 71-year-old man with a medical history of Parkinson’s disease with partial response to treatment with high doses of levodopa and carbidopa.
He was brought to the emergency department by his family due to the presence of behavioural alterations at home.
The patient reported seeing men in foam trying to harm his family. In a disjointed way in his speech, he links this idea with the delusional belief that he is being watched by electronic devices placed throughout the house. In a variegated manner he links this with a coelotypical type of discourse, however the delusional ideation remains unstructured throughout.
With no previous personal or family history of mental health and ruling out underlying organic conditions, a diagnosis of psychosis secondary to pharmacological treatment for Parkinson’s disease is presumed.
Considering the risks and benefits, it was decided to maintain the anti-Parkinson’s dose in order to avoid worsening the patient’s motor function. Therefore, after reviewing the literature, the best option was to introduce clozapine at low doses, up to 50 mg at night, with the respective analytical control. After a week’s admission, the patient began to improve psychopathologically, achieving an ad integrum resolution of the psychotic symptoms.
ConclusionsDespite the availability of other antipsychotic treatments such as quetiapine or the more recent pimavanserin, clozapine remains the treatment of choice for drug-induced psychosis in Parkinson’s disease.
Disclosure of InterestNone Declared
Clinical management of psychotic pregnancy denial: what do we know? Case report and narrative review.
- M. Martín Velasco, I. Romero Gerechter
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1128-S1129
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Introduction
Denial of pregnancy is the lack of awareness of being pregnant. It associates with increased morbidity and mortality of mother and child and can be classified as non-psychotic or psychotic. There is few literature regarding the latter, making it difficult to recognize, let alone to treat, since we do not have robust data on the incidence nor approved interventions.
ObjectivesTo get a better understanding on the standard of care for patients with psychotic denial of pregnancy.
MethodsWe present a case report alongside a narrative literature review on the topic.
ResultsWe report the case of a 39-year-old caucasian woman, foreign, undomiciled, who was admitted to a Psychiatry unit due to psychotic symptoms. Her birthplace and prior medical records were unknown. She did not recognize being pregnant and showed great irritability when asked; her responses ranged from delusional attributions of symptoms related to the pregnancy to partially acknowledging her state but refusing to answer questions. Obstetric ultrasound revealed a low risk 35 weeks pregnancy. Treatment included quetiapine up to 700mg daily and psychological approach. A multidisciplinary team managed the case and arranged a plan for delivery. Eventually, delusional symptoms remitted and she accepted the gestation. She showed full collaboration during delivery, giving birth to a healthy female and presented transient recovery. After being separated from her daughter, her clinical situation worsened.
Psychotic denial of pregnancy is rather uncommon. It is usually seen in patients with prior history of major mental illness, most frequently schizophrenia, and important psychosocial vulnerability. It associates with several negative outcomes for mother and baby, including neonaticide. Most studies agree on the need of a multidisciplinary intervention including obstetrics, psychiatry, and others (social agents, ethical consultants…) to generate a plan for mother and baby. Biopsychosocial aspects should always be considered and each case individually formulated. Pregnant women must be given clear and concise information about the process. For some, seeing obstetric ultrasound might help them accept the pregnancy. Some authors propose labour induction prior to 39 weeks and performing a C-section, especially in cases of uncontrolled psychosis or risk of noncompliance. Most studies also recommend antipsychotic treatment. In cases of persistent denial or acute crisis, especially during the third trimester, patients should be admitted to a psychiatry unit with easy access to obstetric care. Supportive psychotherapy and psychosocial intervention should try to identify precipitating stressors for denial, such as prior or anticipated custody loss, which has been linked to psychotic denial.
ConclusionsPsychotic denial is a serious illness which requires a multidisciplinary treatment including biopsychosocial and obstetrical aspects.
Disclosure of InterestNone Declared
Psychotic denial of pregnancy: case report and narrative literature review.
- M. Martín Velasco, I. Romero Gerechter, C. Díaz Mayoral, E. Arroyo Sánchez, A. Sanz Giancola, P. Setién Preciados
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1129
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Introduction
Denial of pregnancy is the phenomenon where a woman fails to recognize or accept her pregnancy at >20 weeks gestational age. It associates with increased morbidity and mortality of mother and child, and can be classified as non-psychotic or psychotic. There is fewer medical literature regarding the latter, making it difficult to recognize, let alone to treat, since we do not have robust data regarding incidence nor approved interventions or treatment.
ObjectivesTo describe this unfamiliar entity in order to be able to perform a proper diagnosis and thus prevent possible negative outcomes.
MethodsWe present a case report alongside a narrative literature review on the topic.
ResultsWe report the case of a 39-year-old caucasian woman, foreign, undomiciled, with an advanced pregnancy, who was admitted to a Psychiatry in-patient unit due to psychotic symptoms such as mistrust and delusions. She showed scarce collaboration during assessment and did not give any plausible information about her identity. Her birthplace and prior medical records were therefore unknown. Apparently, she had no family nor social support network. Despite the obvious signs, she did not recognize being pregnant and showed great irritability when asked; her responses ranged from claiming she was suffering from a gastric tumor and making delusional attributions of symptoms clearly related to the pregnancy to partially acknowledging her state but refusing to answer any questions on the matter. Blood work showed no significant abnormalities and obstetric ultrasound revealed a low risk 35 weeks pregnancy.
With an estimated prevalence of 1:475 in general population, denial of pregnancy is not as rare as it may seem. The psychotic variant, however, is rather uncommon. Typically, women with psychotic pregnancy denial have prior history of major mental illness, most frequently schizophrenia, and suffer from extreme psychosocial vulnerability. They usually present previous or anticipated child custody loss, which hampers the process of developing antenatal attachment behaviours. Psychotic denial does not associate with concealing, since these women are mentally detached from the gestation and tend to create delusional explanations to their pregnancy symptoms. Not all of them show complete denial, some being able to acknowledge it, though mostly in an inconsistent way. These patients often fail to seek prenatal care or are noncompliant, they are at greater risk of drug exposure, and some are unable to recognize symptoms of labour, all of which increases the rate of negative outcomes for mother and baby, including neonaticide.
ConclusionsPsychotic denial is a rare diagnosis which should be properly assessed due to its clinical implications and the need to prevent potential negative outcomes for mother and baby.
Disclosure of InterestNone Declared
Application of family therapy in a case of anorexia nervosa
- C. Díaz Mayoral, I. Romero Gerechter, E. Arroyo Sánchez, M. Martín Velasco, A. Sanz Giancola, M. Martín de Argila
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S848
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Introduction
Anorexia nervosa is a behavioral mental disorder, characterized by body dysmorphia, an intense fear of gaining weight and behaviors that interfere with this, in addition to a restriction of food intake, associated usually with medical complications, even a considerable risk of death.
Several psychotherapeutic approaches have been used along last decades. Until relatively recently, parents have been recognized as part of the problem, but nowadays we involve them into the therapeutic process through family therapy based on a systemic approach, recommended in current published clinical guidelines and research findings, with consistent evidence, as the first-line treatment of patients with anorexia nervosa.
ObjectivesA case of a patient with anorexia nervosa, is presented followed by a theoretical review on the topic.
MethodsA case is presented with a bibliographic review.
ResultsA 24-yeard-old female was hospitalized for renutrition due to a significant weight loss and multiple physical symptoms. After 4 months without progress, the patient was transferred to the psychiatric ward.
Once there, physical stabilisation was achieved with family therapy and pharmacological treatment, based on progressive administration of Clomipramine, previously assessed by Cardiology, which improved rumination and obsessive behaviour. We conduct daily individual and weekly family interviews, working on family dynamics, emotional regulation strategies and more adaptive ways of communication. Likewise, several lines of action were found in the systemic work: peripheral father; maternal over-involvement; fraternal rivalry; difficulties of interaction between all of them, derived from “the role of the sick person” and intra-family communication around the illness. Finally, showed effectiveness in terms of an improvement in interpersonal relationships, greater assertiveness and an optimistic attitude with an active search for coping strategies.
ConclusionsHistorically, parents have been recognized by a causal factor in the pathogenesis of this disorder. Nevertheless, the abolition of the emphasis on family responsibility, motivated by a philosophic and evidence-based, has allowed us to see them as an essential resource in aiding the patient in the improvement process. This parental involvement has resulted in a relevant reduction in morbidity, as well as a significant decrease treatment attrition rates. It has been noted a re-establishment in other individual and family factors such as self-esteem, quality of life, and some aspects of the experiences of caregiving, and behavioral symptoms have been resolved.
Disclosure of InterestNone Declared
Patient satisfaction in an “open-door” acute inpatient psychiatric unit
- M. Campillo, L. Rius, S. Garcia, M. Olivero, G. Sanchez Tomico, M. Martinez Garcia, I. Garcia Velasco, C. Monserrat, A. Pratdesava, R. Sanchez
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S903
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Introduction
Traditionally, psychiatric wards had established a “locked door” policy but secluded conditions may increase patient’s discomfort1 that could affect the perception of health quality of care2. Recently, the “open-door” policy is being adopted in several European countries but its impact on patient satisfaction remains unknown (Schreiber, LK. BMC Psychiatry. 2019 May 14;19(1):149). Since 2019 our psychiatric hospital has implemented the open-door policy.
ObjectivesThe aim of this study is to investigate the impact of the “open-door” policy on patient satisfaction during their stay in the acute inpatient unit of our psychiatric hospital.
MethodsThis is an observational study. Prior to the implementation of the open door policy 31 patient satisfaction data was collected between October 2018 to April 2019 and it was also assessed with 31 subjects between July to October 2019, after the implementation of the open “door-policy”. The inclusion criteria were being >18 years old, reading Spanish correctly and with a length of stay >72 hours. The patients with dementia disorder and intellectual disability where excluded from the study. We used the Satispsy-22-E scale, a self-administered questionnaire (Frías, V., et al. 2018. Psychiatry Res. Oct;268:8-14). It assesses patient’s experience of hospitalization through 22 items distributed into 6 dimensions. The score range is from 0 to 100. Differences in Satispsy-22-E scores were analysed by applying ANOVA using the IBM-SPSS (v. 25).
ResultsTotal scores in Satispsy-22 are provided in Figure 1. We found that patient satisfaction was increased in the dimensions of “personal experience” and “food” (p<0.05). No significant differences were found in staff, quality of care, information, activity dimensions and Total score (Table 2).
Dimension F-Test Statistic Value Staff 1.402 p=0.241 Quality of Care 841 p=0.362 Personal Experience 4.071 p=0.048* Information 656 p=0.420 Activity 434 p=0.512 Food 4.507 p=0.037* TOTAL 3.645 p=0.61 Image:
ConclusionsOur results provide preliminary evidence indicating that the open-door policy could have a positive impact on patient satisfaction, especially in relation to the personal experience on an acute inpatient psychiatric unit.
Disclosure of InterestNone Declared
Mania induced after corticosteroid treatment: a case report
- E. Arroyo Sánchez, A. Sanz- Giancola, P. Setién Preciados, I. Romero Gerechter, M. Martín Velasco, C. Díaz Mayoral
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S697
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Introduction
Corticosteroids are drugs widely used in clinical practice for their anti-inflammatory and immunosuppressive properties. Despite their beneficial effects, a high association of these drugs with neuropsychiatric adverse effects such as psychosis, mania, depression, delirium or increased risk of suicide, among others, has been observed. We present the case of 54-year-old man who started treatment with hydroaltesone 20 mg/8h after undergoing surgery for a pituitary macroadenoma who began with maniform clinic.
ObjectivesTo know the prevalence, risk factors and treatment of mania as a side effect of corticosteroid drugs.
MethodsPresentation of the case and review of the available literature on the risk of developing mania after corticosteroid treatment.
ResultsSeveral studies confirm that the incidence of psychiatric adverse effects after the use of corticosteroids is around 6% if we refer to severe reactions; 28% moderate reactions; and 72% if we consider milder reactions. The direct relationship between these drugs and affective symptoms ranges in rates between 1-50% of cases, the most frequent being depression and mania. The risk of mania after treatment with corticosteroids is 4-5 times higher than if we compare it with a group of population not exposed to these drugs. There is a dose-response relationship, increasing the risk from a daily dose of 40 mg/day, with an average duration of symptoms of around 21 days. Female sex seems to be a risk factor in relation to the fact that diseases requiring this type of treatment are more common in this gender. As first-line treatment for mania secondary to corticosteroids, a decrease in treatment dose or its interruption, whenever possible, is proposed. Adjuvant treatment may be required, with atypical antipsychotics being the first choice.
ConclusionsCorticosteroid therapy has a direct dose-response relationship with the presence of psychiatric adverse effects such as mania. Dose and sex have been studied as possible adverse effects. Therefore, the pharmacological treatment of choice consists of a reduction in the dose of corticosteroids administered or withdrawal, if possible, and may be combined with an atypical antipsychotic such as olanzapine, quetiapine or risperidone. Re-evaluation is recommended until complete resolution of the clinical picture and then antipsychotic treatment can be progressively withdrawn.
Disclosure of InterestNone Declared
On the legal implications of a ‘permanent’ constituent power
- Mariana Velasco-Rivera, Joel I Colón-Ríos
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- Journal:
- Global Constitutionalism / Volume 12 / Issue 2 / July 2023
- Published online by Cambridge University Press:
- 17 January 2023, pp. 269-297
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This article examines the development of the doctrine of the ‘permanent constituent power’ in Mexico. This doctrine reflects a long tradition in constitutional theory according to which the exercise of constituent power is a one-time event: once a constitution is adopted, there will be no legal mechanism in place for the exercise of the people’s original constitution-making authority. This view is nonetheless in tension with a notion that has also been historically embraced by liberal constitutionalism: that the people has an inalienable right to alter the form of government. The constitutional provisions that reflect that idea, we will see, can have important implications in terms of the nature and scope of the amending authority and, at the same time, point toward alternative mechanisms for the exercise of constituent authority. By closely examining the operation of those kinds of provisions in the Mexican constitution, we seek to illustrate a tension central to the liberal constitutional tradition and to suggest a way out of it. In so doing, we aim to draw some lessons from the Mexican case that can contribute to current discussions about constituent power and fundamental constitutional change in liberal constitutional orders.
Finite orbit width effects in large aspect ratio stellarators
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- Vincent d'Herbemont, Felix I. Parra, Iván Calvo, José Luis Velasco
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- Journal of Plasma Physics / Volume 88 / Issue 5 / October 2022
- Published online by Cambridge University Press:
- 17 October 2022, 905880507
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New orbit-averaged equations for low collisionality neoclassical fluxes in large aspect ratio stellarators with mirror ratios close to unity are derived. The equations retain finite orbit width effects by employing the second adiabatic invariant $J$ as a velocity-space coordinate and they have been implemented in the orbit-averaged neoclassical code KNOSOS (Velasco et al., J. Comput. Phys., vol. 418, 2020, 109512; Velasco et al., Nucl. Fusion, vol. 61, 2021, 116013). The equations are used to study the $1/\nu$ regime and the lower collisionality regimes. For generic large aspect ratio stellarators with mirror ratios close to unity, as the collision frequency decreases, the $1/\nu$ regime transitions directly into the $\nu$ regime, without passing through a $\sqrt {\nu }$ regime. An explicit formula for the neoclassical fluxes in the $\nu$ regime is obtained. The formula includes the effect of particles that transition between different types of wells. While these transitions produce stochastic scattering independent of the value of the collision frequency in velocity space, the diffusion in real space remains proportional to the collision frequency. The $\sqrt {\nu }$ regime is only recovered in large aspect ratio stellarators close to omnigeneity: large aspect ratio stellarators with large mirror ratios and optimized large aspect ratio stellarators with mirror ratios close to unity. Neoclassical transport in large aspect ratio stellarators with large mirror ratios can be calculated with the orbit-averaged equations derived by Calvo et al. (Plasma Phys. Control. Fusion, vol. 59, 2017, 055014). In these stellarators, the $\sqrt {\nu }$ regime exists in the collisionality interval $(a/R) \ln (R/a) \ll \nu _{ii} R a/\rho _i v_{ti} \ll R/a$. In optimized large aspect ratio stellarators with mirror ratios close to unity, the $\sqrt {\nu }$ regime occurs in an interval of collisionality that depends on the deviation from omnigeneity $\delta$: $\delta ^{2} |\ln \delta | \ll \nu _{ii} R a/\rho _i v_{ti} \ll 1$. Here, $\nu _{ii}$ is the ion–ion collision frequency, $\rho _i$ and $v_{ti}$ are the ion gyroradius and thermal speed, and $a$ and $R$ are the minor and major radii.
Pediatric complex regional pain syndrome: a review
- A.M. Matas Ochoa, R. Martinez De Velasco, S. Bravo Herrero, I. Moreno Alonso
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S477
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Introduction
Complex regional pain syndrome (CRPS) is a chronic localized pain condition that can have a significant impact on the quality of life. It affects children and adolescents as well as adults, but is more common among adolescent girls.
ObjectivesTo present up-to-date clinical information regarding CRPS in pediatric population.
MethodsA review of recent literature.
ResultsIn contrast to adults, CRPS appears after an initial event that is typically a minor trauma and occurs more frequently in the lower extremity than in the upper extremity. This syndrome is characterized by spontaneous or stimuli-induced pain, which is disproportionate to the actual incident trauma/stimulus, in the presence of a wide variety of autonomic and motor disturbances. The exact mechanism of CRPS is unknown, although several different mechanisms have been suggested. In many cases, CRPS follows a relatively minor trauma, in some cases, no previous injury was recalled and there are psychological factors implicated. It has been found a high prevalence of anxiety and depression in patients with CRPS and it is considered stress has an important role in inducing or perpetuating CRPS. Standard care consists of a multidisciplinary approach with the implementation of intensive physical therapy in conjunction with psychological counseling; in some patients, pharmacological treatments may help to reduce pain.
ConclusionsA multidisciplinary approach with psychological and psychiatric counseling are needed for effective management of CRPS. Further research in targeting specific mechanisms involved in the pathophysiology of CRPS should lead to prevention of this condition.
DisclosureNo significant relationships.
“I’ve discovered the COVID-19 vaccine”. Approach of a bipolar disorder clinical case in the Mental Health Day Hospital of Salamanca during the pandemic
- A. Gonzalez-Mota, C. Fombellida Velasco, A. Gonzalez Gil, P. Gómez Hernández, I. Vicente Torres, M. Covacho Gonzalez, C. Payo-Rodriguez, E. Beltran-Mercado, C. Roncero
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S412
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Introduction
A 21-year-old woman diagnosed with bipolar disorder was hospitalized in the Mental Health Day Hospital of Salamanca during the Covid pandemic. The patient engaged with 4 different jobs and a master’s degree, beginning with verbose speech, dysphoria, global insomnia, grandiose delusions, extremely high energy and thinking she has the vaccine. She works the following objectives:illness insight, risk factors, psychopathological stabilization, social skills, slowing down of activities and taking responsibilities.
ObjectivesThe objective is do a follow-up of the patient during her hospitalization in the Mental Health Day Hospital and to carry out a structured search in PubMed and Up-to-Date about psychotherapy and bipolar disorder.
Methods3-month follow-up of a 21-year-old woman diagnosed with bipolar disorder during her hospitalization in the Mental Health Day Hospital in Salamanca and a structured search in PubMed and Up-to-Date in April 2021 in English, French and Spanish, including the last 10 years with the keywords “psychotherapy”, “psychotherapies” and “bipolar disorder “.77 studies were analyzed: 12 included, 65 excluded.
ResultsSeveral randomized trials highlight the efficacy of group psychoeducation and cognitive-behavioural therapy in relapse prevention, improving illness insight, medical adherence and less hospitalizations. Therapeutic alliance plays a significant role in the process. Our patient improved her knowledge of her illness and treatment, her social skills and reconnected with her relatives and slowed down her activity. She then was referred to her community mental heath center psychiatrist.
ConclusionsThe insight in bipolar disorder plays an important role in medical adherence and prevention of relapses. Therapeutic alliance improves their insight, their functionality in their daily life and enables close monitoring. Medical treatment should be accompanied by psychotherapy for a complete approach of the treatment.
DisclosureNo significant relationships.
Gut microbiota and its implications for psychiatry
- A. Matas Ochoa, A. Rodriguez Quiroga, R. Martinez De Velasco, P. Nava Garcia, C. Banzo Arguis, I. Moreno Alonso
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S471
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Introduction
In recent years there has been increasing interest in knowing the function of the microbiota, especially its role in the gut-brain axis. The microbiota is the set of millions of microorganisms that coexist in a symbiotic way in our body and are located in the digestive tract mainly. Numerous evidences show that the microbiota could modulate the information directed to the brain and therefore the pathogenic basis of numerous psychiatric and neurological disorders.
ObjectivesA better understanding of the microbiota and its interaction with the brain and mental health.
MethodsReview of recent literature about the implications of the gut microbiota in psychiatry.
ResultsThe connection between the microbiota and the central nervous system (gut-brain axis) occurs through the vagus nerve, the systemic pathway (through the release of hormones, metabolites and neurotransmitters) and the immune system (through the action of cytokines). Changes in the microbiota are associated not only with gastrointestinal diseases, but also with disorders such as depression, anxiety, autism, anorexia, attention deficit and hyperactivity, Alzheimer’s disease and Parkinson’s disease. As some research indicates, changes in diet and composition of the microbiota can reduce the risk of suffering these diseases or reduce their symptoms. Other therapeutic alternatives postulated are the use of probiotics or fecal microbiota transplantation.
ConclusionsDespite growing interest in the microbiota in the last few years, little is known about the mechanisms underlying this communication. More research is expected to contribute to the design of strategies that modulate the gut microbiota and its functions in order to improve mental health.
Suicidal behaviour and cognition: A systematic review with special focus on prefrontal deficits
- J. Fernández-Sevillano, A. González-Pinto, J. Rodríguez-Revuelta, S. Alberich-Mesa, L. González-Blanco, I. Zorrilla-Martínez, Á. Velasco, P. López-Pena, I. Abad-Acebedo, P.A. Saiz
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S584
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Introduction
Suicidal behaviour and cognition: A systematic review with special focus on prefrontal deficits Introduction: Suicide is a major health concern worldwide, thus, identifying risk factors would enable a more comprehensive understanding and prevention of this behaviour. Neuropsychological alterations could lead to difficulties in interpreting and managing life events resulting in a higher risk of suicide.
ObjectivesObjective: Bibliographic review about the influence of neuropsychological deficits on suicidal behaviour.
MethodsMethod: A systematic literature search from 2000 to 2020 was performed in Medline (Pubmed), Web of Science, SciELO Citation Index, PsycInfo, PsycArticles and Cochrane Library databases regarding studies comparing cognition of attempters versus non-attempters that share same psychiatric diagnosis. Results: 1.885 patients diagnosed with an Affective Disorder (n = 1512) and Schizophrenia/ Schizoaffective Disorder (n = 373) were included.
ResultsIn general comparison, attention was found to be clearly dysfunctional. Regarding diagnosis, patients with Schizophrenia and previous history of suicidal behaviour showed a poorer performance in executive function. Patients with current symptoms of an Affective Disorder and a previous history of suicidal attempt had poorer performance in attention and executive function. Similarly, euthymic affective patients with history of suicidal behaviour had worse decision-making, attention and executive function performance compared to euthymic non-attempters.
ConclusionsPatients who have attempted suicide have a poorer neuropsychological functioning than non-attempters with a similar psychiatric disorder in attention and executive function. These alterations increase vulnerability for suicide.
Conflict of interestJessica Fernández-Sevillano is beneficiary of the Pre-PhD Training Programme of the Basque Government. Dr. Gonzalez-Pinto has received grants and served as consultant, advisor or CME speaker for the following entities: Almirall, AstraZeneca, Bristol-Myers
The mediating role of impulsivity in the relationship between suicidal behaviour and early traumatic experiences in depressed subjects
- F. Dal Santo, J.J. Carballo, Á. Velasco, L. Jiménez-Treviño, J. Rodríguez-Revuelta, C. Martínez-Cao, I. Irene Caro-Cañizares, L. De La Fuente-Tomás, I. Menéndez-Miranda, L. González-Blanco, M.P. García-Portilla, J. Bobes, P.A. Saiz
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S583
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Introduction
Depressed patients with early traumatic experiences may represent a clinically distinct subtype with worse clinical outcome. Since early traumatic experiences alter the development of systems that regulate the stress response, certain personality features may influence coping strategies, putting individuals with depression and a history of early traumatic experiences at greater risk of suicidal behaviour.
ObjectivesTo determine whether impulsivity mediates the relationship between early traumatic experiences and suicidal behaviour in patients with major depressive disorder (MDD).
MethodsThe sample included 190 patients [mean age (SD)=53.71 (10.37); females: 66.3%], with current MDD. The Childhood Trauma Questionnaire-Short Form (CTQ-SF), the List of Threatening Experiences (LTE), and the Barratt Impulsiveness Scale-11 (BIS-11) were used to assess childhood and adulthood adverse life events and impulsivity. We developed mediation models by bootstrap sampling methods.
Results81 (42.6%) patients had previous suicide attempts (SA). CTQ-SF-Total and BIS-11-Total scores were higher in MDD patients with previous SA. Correlation analyses revealed significant correlations between the CTQ-SF-Total and BIS-11-Total, CTQ-SF-Total and HDRS-Total, and BIS-11-Total and HDRS-Total scores. Regression models found that CTQ-SF-Total, BIS-11-Total, and HDRS-Total scores were associated with SA. Mediation analyses further revealed the association between CTQ-SF-Total and SA was mediated by the indirect effect of the BIS-11-Total score (b=0.007, 95% CI=0.001, 0.015), after controlling for sex, HDRS-Total, and LTE-Total.
ConclusionsImpulsivity could mediate the influence of childhood trauma on suicidal behaviour. This will help understand the role of risk factors in suicidal behaviour and aid in the development of prevention interventions focused on modifiable mediators when risk factors are non-modifiable.
Turbulent impurity transport simulations in Wendelstein 7-X plasmas
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- J. M. García-Regaña, M. Barnes, I. Calvo, F. I. Parra, J. A. Alcusón, R. Davies, A. González-Jerez, A. Mollén, E. Sánchez, J. L. Velasco, A. Zocco
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- Journal:
- Journal of Plasma Physics / Volume 87 / Issue 1 / February 2021
- Published online by Cambridge University Press:
- 02 February 2021, 855870103
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A study of turbulent impurity transport by means of quasilinear and nonlinear gyrokinetic simulations is presented for Wendelstein 7-X (W7-X). The calculations have been carried out with the recently developed gyrokinetic code stella. Different impurity species are considered in the presence of various types of background instabilities: ion temperature gradient (ITG), trapped electron mode (TEM) and electron temperature gradient (ETG) modes for the quasilinear part of the work; ITG and TEM for the nonlinear results. While the quasilinear approach allows one to draw qualitative conclusions about the sign or relative importance of the various contributions to the flux, the nonlinear simulations quantitatively determine the size of the turbulent flux and check the extent to which the quasilinear conclusions hold. Although the bulk of the nonlinear simulations are performed at trace impurity concentration, nonlinear simulations are also carried out at realistic effective charge values, in order to know to what degree the conclusions based on the simulations performed for trace impurities can be extrapolated to realistic impurity concentrations. The presented results conclude that the turbulent radial impurity transport in W7-X is mainly dominated by ordinary diffusion, which is close to that measured during the recent W7-X experimental campaigns. It is also confirmed that thermodiffusion adds a weak inward flux contribution and that, in the absence of impurity temperature and density gradients, ITG- and TEM-driven turbulence push the impurities inwards and outwards, respectively.
Global calculation of neoclassical impurity transport including the variation of electrostatic potential
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- Keiji Fujita, S. Satake, R. Kanno, M. Nunami, M. Nakata, J. M. García-Regaña, J. L. Velasco, I. Calvo
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- Journal:
- Journal of Plasma Physics / Volume 86 / Issue 3 / June 2020
- Published online by Cambridge University Press:
- 25 June 2020, 905860319
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Recently, the validity range of the approximations commonly used in neoclassical calculation has been reconsidered. One of the primary motivations behind this trend is observation of an impurity hole in LHD (Large Helical Device), i.e. the formation of an extremely hollow density profile of an impurity ion species, such as carbon $\text{C}^{6+}$, in the plasma core region where a negative radial electric field ($E_{r}$) is expected to exist. Recent studies have shown that the variation of electrostatic potential on the flux surface, $\unicode[STIX]{x1D6F7}_{1}$, has significant impact on neoclassical impurity transport. Nevertheless, the effect of $\unicode[STIX]{x1D6F7}_{1}$ has been studied with radially local codes and the necessity of global calculation has been suggested. Thus, we have extended a global neoclassical code, FORTEC-3D, to simulate impurity transport in an impurity hole plasma including $\unicode[STIX]{x1D6F7}_{1}$ globally. Independently of the $\unicode[STIX]{x1D6F7}_{1}$ effect, an electron root of the ambipolar condition for the impurity hole plasma has been found by global simulation. Hence, we have considered two different cases, each with a positive (global) and a negative (local) solution of the ambipolar condition, respectively. Our result provides another support that $\unicode[STIX]{x1D6F7}_{1}$ has non-negligible impact on impurity transport. However, for the ion-root case, the radial $\text{C}^{6+}$ flux is driven further inwardly by $\unicode[STIX]{x1D6F7}_{1}$. For the electron-root case, on the other hand, the radial particle $\text{C}^{6+}$ flux is outwardly enhanced by $\unicode[STIX]{x1D6F7}_{1}$. These results indicate that how $\unicode[STIX]{x1D6F7}_{1}$ affects the radial particle transport crucially depends on the profile of the ambipolar-$E_{r}$, which is found to be susceptible to $\unicode[STIX]{x1D6F7}_{1}$ itself and the global effects.