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Suicidality and social cognition: the association between hypomentalizing and suicide lethality
- J. Andreo-Jover, K. March, E. Fernández-Jiménez, J. Fernandez Fernandez, A. Garcia Fernandez, M. P. Lopez Peña, M. Ruiz Veguilla, B. Crespo Facorro, N. Garrido Torres, A. Cebria, I. Grande, N. Roberto, W. Ayad-Ahmed, A. Pemau Gurumeta, A. Garcia Ramos, M. Diaz-Marsa, M. F. Bravo-Ortiz, A. Palao-Tarrero, V. Perez-Sola
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S183
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Introduction
Suicide attempts (SA) leading to highly lethal consequences have been associated with heightened suicide planning (Barker et al., 2022), along with deficits in social cognition (Levi-Belz et al., 2022). Hypomentalizing, characterized by excessive uncertainty regarding mental states, may contribute to heightened social withdrawal and an increased risk of SA (Nestor & Sutherland, 2022). Although certain studies have identified a connection between hypomentalizing profiles and self-harm (Badoud et al., 2015), research into the lethality of SA remains limited.
ObjectivesThis study aimed to explore the association between hypomentalizing and SA lethality.
MethodsOur study encompassed a cohort of 1,371 patients who committed a SA. We conducted assessments of mentalizing using the RFQ-8 instrument, and evaluations of suicidal ideation and behavior employing the CSRSS questionnaire. Demographic and clinical characteristics were compared using the T-student and Chi-square tests. To investigate the relationship between hypomentalizing and the SA lethality, we employed logistic regression models.
ResultsDescriptive date are presented in Table 1. Our results show that hypomentalizing do not predict a higher SA lethality. Additionally, hypomentalizing increased the risk of SA planning (p≤0.001, B=-0.182), and SA planning predicted a higher SA lethality (see Table 2).
Table 1. Means Comparison for low and high lethality (N=1371)
Low lethality N=539 High lethality N=832 p value Effect size Age, mean (SD) 38.65 (15.65) 41.91 (15.37) ≤0.001 -0.209a Female sex, N (%) 392 (72.7) 571 (68.6) 0.116 0.044b Educational years, mean (SD) 12.45 (2.99) 12.43 (3.41) 0.890 0.0076a Employed, N (%) 220 (41.2) 332 (40) 0.692 0.012b Suicide Ideation, N (%) 475 (88.1) 742 (89.2) 0.541 0.016b Suicide Planning, N (%) 159 (39.2) 400 (58.1) ≤0.001 0.183b Number of attempts, mean (SD) 3.28 (5.48) 3.63 (5.74) 0.269 -0.169a RFQ, mean (SD) 4.68 (1.27) 4.56 (1.32) 0.087 0.095a Table 2. Logistic regression analyses for high SA lethality (N=1371).
Univariate analysis Multivariate analysis OR p value OR p value Age 1.014 (1.007-1.021) ≤0.001 1.014 (1.005-1.022) 0.001 Female sex 0.820 (0.646-1.042) 0.105 Educational years 0.998 (0.965-1.031) 0.890 Employed 0.952 (0.763-1.187) 0.660 Suicide ideation 1.111 (0.790-1.562) 0.545 Suicide planning 2.150 (1.674-2.761) ≤0.001 2.183 (1.697-2.808) ≤0.001 Number SA 1.012 (0.990-1.034) 0.277 RFQ 0.929 (0.854-1.011) 0.088 ConclusionsWhile the association between hypomentalizing and high SA lethality was not significant, a discernible trend toward such relationship can be noted. Further studies examining the moderating effects of planning in the association between hypomentalizing and SA lethality are required.
Disclosure of InterestNone Declared
Transcranial Magnetic Stimulation and its Efficacy in Alleviating Depressive Symptoms in Patients with Suicidal Ideation
- A. Moleon, M. Martín-Bejarano, P. Alvarez de Toledo, I. Perez, J. Narbona, M. García-Ferriol, R. Perea, J. M. Oropesa, J. Torres
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S181
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Introduction
Suicide is a global public health issue. According to the latest available data from the National Institute of Statistics, 4,003 people died by suicide in 2021, reaching a new historical high. Approximately 90% of suicide victims suffer from one or more severe psychiatric disorders, and there is a documented 20-fold higher risk of suicide in individuals with affective disorders compared to healthy subjects (Abdelnaim et al., 2020). Repetitive transcranial magnetic stimulation (rTMS) has been established as an effective alternative or complementary treatment option for patients with depressive disorders, but little is known about its effects on suicide risk.
ObjectivesTo assess the efficacy of rTMS in reducing depressive symptoms in patients with suicidal ideation and behaviors.
MethodsPopulation and Methods: A retrospective analysis was conducted on a sample of 28 psychiatric patients (23 females; mean age 49.36 ± 16.23) with suicidal ideation identified by item 3 (suicidality) of the Hamilton Depression Rating Scale (HDRS), who were treated with rTMS. All patients received a minimum of 30 sessions, consisting of the application of a high-frequency (>10Hz) or intermittent theta burst stimulation (TBS) over the left dorsolateral prefrontal cortex (DLPFC) at an intensity of 120% of the resting motor threshold (RMT), and repeated low-frequency pulses (1Hz) or continuous TBS over the right DLPFC with an intensity of 110% of the RMT.
ResultsResults: The results show a statistically significant improvement in depressive symptoms following rTMS intervention (p < 0.001). Furthermore, remission was observed in 46% of the sample (HDRS < 8).
ConclusionsDiscussion: In line with recent studies (Abdelnaim et al., 2020; Hines et al., 2022) and systematic reviews (Cui et al., 2022; Bozzay et al., 2020) on suicidal ideation in the context of psychiatric disorders, the findings of this study demonstrated that rTMS achieved satisfactory results in reducing depressive symptoms and suicidal ideation.
Conclusions: This clinical study indicates preliminary promise for the prevention of suicidal acts and underscores the need for more detailed and specific research on rTMS in the field of suicide.
Keywords: rTMS, neuromodulation, depression, suicide.
Disclosure of InterestNone Declared
Unveiling Koro’s diverse conceptualizations across cultures
- D. Seabra, I. Lopes, J. Moura, J. Leal, T. Rocha, J. Cunha, S. Torres, D. Santos, G. Santos, N. Ramalho
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S266
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Introduction
Koro, also known in Cantonese as Shook Yang, which literally translates to “shrinking penis”, has its roots in a cultural belief that a mythological figure would steal the penis of his victims. Predominantly reported in Southeast Asia, it involves an acute fear of genital retraction, often accompanied by the belief that this retraction may lead to death. Over the last two centuries, Koro has undergone several attempts to establish its definition and classification, without a true consensus having been reached.
ObjectivesThis study aims to explore the cultural nuances surrounding Koro and reflect on the various conceptualizations that modulated its definition and nosological classification, from Ancient China until the present.
MethodsA non-systematic literature review with the keywords “koro” and “culture” was conducted.
ResultsKoro was only introduced to the Western world during colonial expansion, drawing the attention of several psychiatrists who, in Asian territory, reported numerous cases in natives, making the very first attempts at a nosological classification, whether as an anxiety neurosis, or as an obsessive-compulsive disorder. The literature reveals significant cultural variations in the manifestation of Koro, challenging the traditional psychiatric understanding rooted in Western diagnostic categories. Cultural factors, including societal beliefs, religious practices, and regional variations, emerged as influential contributors to the prevalence and presentation of Koro. Additionally, the study identified instances of Koro evolving in response to cultural shifts and globalization, emphasizing the dynamic nature of this syndrome.
ConclusionsThis review underscores the need for a comprehensive understanding of Koro that acknowledges its diverse conceptualizations across cultures. Its occurrence, not only in multiple parts of the world, but also in close relation with various comorbidities, has contributed to the dissolution of its primary identity as a culture-bound syndrome, turning Koro into a moving target.
Disclosure of InterestNone Declared
The European Portuguese version of the Reproductive Concerns After Cancer Scale for male cancer survivors: A preliminary psychometric validation study
- J. Silva, A. Bártolo, I. S. Silva, A. F. Oliveira, A. Louro, A. Torres, I. M. Santos, S. Monteiro
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S316-S317
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Introduction
Cancer treatments can affect male fertility. However, the reproductive concerns of this population remain little explored. There is a need to invest in understanding how concerns related to fertility and parenting affect psychosocial adjustment, in order to improve counseling in this context. To this end, it is a priority to provide reliable and valid measures for assessing this construct.
ObjectivesThis study aimed to translate, adapt and preliminarily explore the psychometric properties of the Portuguese version of the Reproductive Concerns After Cancer Scale - Male Version (RCAC-M).
MethodsTranslation and back-translation were carried out by two independent translators. A reconciled version was obtained and evaluated by a panel of experts who ensured its cultural adaptation. Before studying the psychometric properties, a pre-test was carried out involving a focus group of 5 male cancer survivors who assessed the adequacy of the measure. The preliminary validation included 32 male cancer survivors aged between 18 and 55. Recruitment was carried out by providing an online questionnaire. A principal component analysis was carried out to explore the factor structure of the measure and to analyze the reliability and convergent validity of the measure.
ResultsThe results showed good internal consistency of a version consisting of 17 items, grouped into four factors: fertility potential, child health and future life, personal health and future life, and acceptance. Significant moderate associations were found between reported concerns and other constructs that are consistently related to this variable in the literature, namely the importance of parenting and symptoms of anxiety and depression.
ConclusionsThe original structure of the scale was not corroborated. However, this study suggests the promising character of the Portuguese version of the RCAC-M as a reliable and valid tool for assessing the reproductive concerns of male cancer survivors.
Disclosure of InterestNone Declared
What do patients find most helpful in group treatment? Importance of group therapeutic factors in standardized psychological group treatments
- A. Rodríguez-Rey, F. Piazza, X. Segú, A. Ruiz, C. Sorroche, G. Virgili, X. Torres, I. Morilla
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S385-S386
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Introduction
There are numerous structured group psychological treatments (GPT), especially in the cognitive behavioral paradigm, which have proven effective. In these TPG, strategies, guidelines, knowledge, etc. are worked and, in many cases, homework is prescribed as an integral part of the treatment. A group context is also generated where people relate, generally with a similar culture, ages, mental health states and life problems
ObjectivesElucidate which group therapeutic factors (GTF) are valued as most important by patients in their psychological improvement process. Know what our patients consider has helped them most in their GPT, whether the GTF or the content of the therapy (CT), conceptualized as the set of guidelines, knowledge, strategies, exercises and learning carried out with the therapists intrasession and with the material provided intersessions
MethodsA total of 36 patients(mean age=51.04 (9.21)); 69.44% women (n=25); with main diagnoses (77.77%, n=28) of adaptive disorder, 6 patients of major depression (16.66%) and 2 unspecified anxiety disorders (5.55%) are included in GPT based on acceptance and commitment therapy (ACT) of Hayes’s (2012) for primary care patients, and on a treatment protocol developed in our clinical health psychology section (Segú et al. PaP 2023; 25 6-18) in long covid patients
Patients are recruited and cared for in the collaboration program with the primary care centers (CPPC), n=22(61.11%), and 12 patients (38.89%) diagnosed with long covid in the specialized post-covid unit of internal medicine, and treated in the clinical health psychology section on the Hospital Clínic of Barcelona (HCB)
Post-treatment evaluation is carried out using the GTF questionnaire, based on Yalom’s Q-short(1985), validated with 11 items, adapted to Spanish (Ribé et al. RAEN 2018; 38(134) 473-89). Patients rate from 1 to 10 how much they consider each FTG has helped them in their improvement process
ResultsThe relevance of the GTF are: Altruism(8.16), catharsis(7.61), cohesiveness(7.94), corrective recapitulation(6.15); socialization techniques (6.41); self-awareness of reality(6.65); imitative behavior(6.43); participated information(6.69), instill hope(6.39); interpersonal learning (7.07), universality(8.27).
Regarding the other objective, 44.44%(n=16) consider the GTF more important than the content of the therapy in their improvement; 36.11%(n=13) equal importance; 13.88%(n=5) plus the CT and 2 consider that none of it has helped them (5.55%). Total importance CT(7.18/10) and GTF(7.44/10). The perceived help in their improvement process in the GPT(CT + GTF)=7.61/10.
ConclusionsIn two structured group treatments, based on ACT, a greater percentage of patients value that the GTFs have helped them more in their improvement process than the CT. The GTFs considered most relevant were universality, altruism, cohesiveness and catharsis.
Disclosure of InterestNone Declared
Development and psychometric testing of the Acceptability regarding Cognitive Rehabilitation Interventions Survey – Cancer Survivors (ACRIS-CS)
- A. F. Oliveira, A. Bártolo, L. Loureiro, I. M. Santos, A. Torres
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S204
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Introduction
Cognitive rehabilitation interventions (CRIs) for cancer-related cognitive impairment (CRCI) have shown promising results. However, the acceptability of CRIs in the context of CRCI treatment has not yet been assessed among cancer survivors. Due to the absence of suitable instruments designed to assess the acceptability of CRIs in this population, we developed the Acceptability regarding Cognitive Rehabilitation Interventions Survey for Cancer Survivors (ACRIS-CS).
ObjectivesThis study aimed to develop and test the psychometric properties of the newly created instrument, ACRIS-CS.
MethodsThe study was conducted in two stages: (1) the creation of scale items derived from a comprehensive literature review, considering the Theoretical Framework of Acceptability (TFA); and (2) the assessment of the scale’s psychometric properties with cancer survivors. At the end of stage 1, the questionnaire was revised by four clinicians and researchers with expertise in the field of CRCI, and the final item selection was determined by the authors, considering redundancy, item relevance, and face validity. The final scale comprised 11 items, answered on a 5-point Likert scale (ranging from “strongly disagree” to “strongly agree”). Higher scores indicated more positive perceptions related to the acceptability of CRIs. Data were collected online and analyzed using IBM SPSS Statistics (version 28.0). Construct validity (exploratory factor analysis, EFA) and reliability (internal consistency) analyses were performed.
ResultsIn this study, 154 cancer survivors were included. The Kaiser-Meyer-Olkin (KMO) measure of 0.847 confirmed the adequacy of sampling (KMO>0.5), and Bartlett’s test of sphericity yielded statistical significance (Χ² (55) = 864.431, p < 0.001), validating the structure of the correlation matrix. The EFA results indicated the presence of three factors, each with eigenvalues exceeding the Kaiser criterion of 1. The scree plot confirmed the existence of three factors beyond the inflection point. All items demonstrated factor loadings higher than 0.40, indicating their relevance to the identified factors. This factor structure was conceptually justifiable. These factors were labeled as follows: 1) Affective attitude and effectiveness (6 items); 2) Perceived benefits and self-efficacy (3 items); and 3) Perceived burden (2 items). Collectively, these factors accounted for 68.7% of the total variance. The ACRIS-CS total scale and subscales demonstrated good internal consistency, with Cronbach’s alpha coefficients ranging from 0.727 to 0.848.
ConclusionsThe results of the EFA and internal consistency analysis were satisfactory. The ACRIS-CS appears to be a valid and reliable scale for assessing the acceptability of CRIs among cancer survivors.
Disclosure of InterestNone Declared
Treatment Interruptions and Mortality Among Puerto Rican Women With Gynecologic Cancers in Puerto Rico After Hurricanes Irma and María: A Retrospective Cohort Study
- Fabiola A. Rivera-Gastón, Sharee Umpierre-Catinchi, Jeslie M. Ramos-Cartagena, Karen J. Ortiz-Ortiz, Carlos R. Torres-Cintrón, Sandra I. García-Camacho, William A. Calo, Guillermo Tortolero-Luna, Liz M. Martínez-Ocasio, Ana P. Ortiz
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- Disaster Medicine and Public Health Preparedness / Volume 18 / 2024
- Published online by Cambridge University Press:
- 21 May 2024, e105
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Objective:
Cancer patients are among the most vulnerable populations during and after a disaster. We evaluated the impact of treatment interruption on the survival of women with gynecologic cancer in Puerto Rico following Hurricanes Irma and María.
Methods:A retrospective cohort study among a clinic-based sample of women with gynecological cancer diagnosed between January 2016 and September 2017 (n = 112) was done. Women were followed from their diagnosis until December 2019, to assess vital status. Kaplan-Meier survival curves and Cox proportional hazards models were performed.
Results:Mean age was 56 (± 12.3) years; corpus uteri (58.9%) was the most common gynecologic cancer. Predominant treatments were surgery (91.1%) and chemotherapy (44.6%). Overall, 75.9% were receiving treatment before the hurricanes, 16.1% experienced treatment interruptions, and 8.9% died during the follow-up period. Factors associated with treatment interruption in bivariate analysis included younger age (≤55 years), having regional/distant disease, and receiving > 1 cancer treatment (P < 0.05). Crude analysis revealed an increased risk of death among women with treatment interruption (HR: 3.88, 95% CI: 1.09-13.77), persisting after adjusting for age and cancer stage (HR: 2.49, 95% CI: 0.69-9.01).
Conclusions:Findings underscore the detrimental impact of treatment interruption on cancer survival in the aftermath of hurricanes, emphasizing the need for emergency response plans for this vulnerable population.
Electron Microscopy and X-Ray Analysis of Lacustrine Clays from the Charo Canyon, State of Michoacán, Mexico
- G. Carbajal de la Torre, I. Israde Alcántara, J. Serrato Rodríguez, J. Reyes-Gasga
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- Clays and Clay Minerals / Volume 46 / Issue 3 / June 1998
- Published online by Cambridge University Press:
- 28 February 2024, pp. 330-339
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In this paper we analyzed by electron microscopy and X-ray diffraction (XRD) the exposed lacustrine clay in a stratigraphic column at Charo Canyon, State of Michoacán, Mexico. Smectite, cris-tobalite, albite and quartz are the main mineral species in the sediments. Smectite is the most abundant and has a nanometric twinned small particle habit. The low crystallinity of the smectite detected in some of the samples seems to be associated with instability of the paleohydrological regime in which clayey material was deposited. Iron from underlying volcanic ash is apparently responsible for the iron concentration detected in the smectite structure.
Iron Influence in the Aluminosilicate Zeolites Synthesis
- E. I. Basaldella, R. M. Torres Sánchez, J. C. Tara
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- Clays and Clay Minerals / Volume 46 / Issue 5 / October 1998
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- 28 February 2024, pp. 481-486
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The level of Fe impurities in 2 well-crystallized kaolinites was modified (by addition or chemical removal treatment) to analyze the Fe influence in the aluminosilicate zeolite synthesis.
The original and modified clays were heat-treated in order to change their reactivity for zeolite A synthesis, and their thermal transformations were studied by X-ray diffraction (XRD), determination of point of zero charge (PZC) and infrared (IR) techniques. It was established that many structural changes took place, regardless of the Fe clay content. Furthermore, the presence of Fe species in alkaline solution or in the solid phase did not seem to greatly influence the zeolite crystallization, because only small differences in the conversion values among samples with different Fe contents were registered. The crystallization process seemed to be related mainly to AI coordination changes produced by the thermal and Fe removal treatments used.
Performance of Low-Grade Calcined Clays as Supplementary Cementitious Material in Relation to their Geological Characteristics
- Oscar O. Vásquez-Torres, Francisco D. Cabrera-Poloche, Jorge I. Tobón
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- Clays and Clay Minerals / Volume 70 / Issue 2 / April 2022
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- 01 January 2024, pp. 233-251
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Calcined clays are used as a supplementary cementitious material (SCM) because, as hydrated aluminosilicates of the phyllosilicate group, they can be activated thermally, promoting dehydroxylation and structural disorder, i.e. making them reactive. The main effect of using calcined clay as an SCM is that CO2 emissions into the atmosphere are reduced by the reduction in the clinker/cement factor due to substitution of a proportion of clinker by calcined clay. Clays rich in kaolinite (1:1) group minerals offer most promise in terms of thermal activation. However, increased costs caused by demand for kaolinite from other industries means that type 2:1 calcined clays and mixtures of them have begun to be investigated as possible pozzolanic materials. The physical, chemical, and mineralogical characteristics that control the performance of these calcined clays as SCMs are still under discussion. Few in-depth studies of the behavior of these characteristics have been reported. The origin and geological history of raw materials, as well as their impact on the thermal activation and performance as SCM, are not well understood or, in some cases, have not been considered. The objective of the current work, therefore, was to study multicomponent clays from metamorphic rocks with low-grade kaolinite (<50%) from a tropical region of Colombia for possible use as SCMs. The clay deposit was identified by geological exploration techniques and classified in depth according to horizons of the weathering profile. The samples were extracted from the first 50 m of the deposit and characterized physically, chemically, and mineralogically; they were calcined at 650, 750, and 850°C; their degree of alteration was estimated by the Chemical Index of Alteration (CIA); and their performance as an SCM was evaluated by the Strength Activity Index (SAI) and Frattini test. As a main result, a relationship was found between the weathering profile of the deposit and the CIA of raw clays, which confirmed the high weathering and degree of alteration of the parent rock in the deposit (weathered rock and residual soil with a CIA > 80%). Furthermore, pozzolanic (physical and chemical) tests demonstrated the potential use of calcined clays from this deposit as SCMs, as well as their thermal activation at low temperature (≤750°C). In addition, the pozzolanic activity increased with the kaolinite/(muscovite+illite+vermiculite) ratio mainly, and, in turn, the thermal activation temperature increased with the mica and type 2:1 clay content.
EARLY ONSET AGGRESSIVE BEHAVIOR INDUCED BY PERAMPANEL IN THE TREATMENT OF CHRONIC INSOMNIA: A CASE REPORT
- I. Esteban-Avendaño, J. Torres Cortés, J. Padín Calo
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1102-S1103
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Introduction
Chronic insomnia, resistant to different treatments (pharmacological, sleep hygiene and cognitive-behavioral therapy) remains one of the greatest challenges in our daily practice as psychiatrists. The pharmacological options include benzodiazepines and their analogues (zolpidem, zopiclone, etc.). However, when trying to treat chronic insomnia the use of off-label drugs, including antidepressants with sedative action (such as trazodone), antipsychotics or antiepiletic drugs, is not uncommon.
Perampanel is a non-competitive AMPA receptor antagonist, marketed for the treatment of partial onset epilepsy and primary generalized tonic-clonic seizures. It has been used in the treatment of chronic insomnia with positive results and it has shown to improve the quality of sleep in a recent observational retrospective cohort study.
The most frequent adverse effects of Perampanel include dizziness and drowsiness. Perampanel can also cause psychiatric and behavioral adverse effects, aggression and irritability in up to 10% of patients, as well as depression, and suicidal ideation, with higher rates in patients with psychiatric history.
ObjectivesTo draw attention to possible adverse effects of Perampanel and to add knowledge to improve the treatment for chronic insomnia.
MethodsCase report and non-systematic literature review of the current data.
ResultsA 33 year old woman with Anorexia Nervosa was admitted to the psychiatric hospitalization unit due to suicidal ideation and a history of chronic insomnia. Perampanel was started at a dose of 2mg/day, progressively titrated to 6mg/day, following patient’s informed consent. A week after the initiation of treatment, her sleep pattern had improved but she became aggressive, showed low tolerability to minor frustrations and suffered from an intensification of suicidal ideation. She became extremely hostile to the personnel, had severe tantrums and deliberate self injurious behavior. Perampanel was discontinued and in less than a week her aggressive behavior succumbed. Although she was not re-exposed to Perampanel the symptoms she presented are considered a very likely adverse drug reaction. Levomepromazine 20mg/day and Lormetazepam 0.5mg/day were reinstated as a treatment for insomnia.
ConclusionsPsychiatric comorbidity is known to be a risk factor for behavioral adverse effects of Perampanel. Therefore Perampanel as a treatment for chronic insomnia needs a careful individual benefit-risk assessment and monitoring for adverse effects.
Disclosure of InterestNone Declared
Charles- Bonnet Syndrome: a case review. The objective of this poster is to contribute a case to the existing series, and thus get closer to the knowledge of this clinical entity.
- L. Huerga García, I. Careno Baez, G. Oropeza Hernández, A. Marcos Rodrigo, C. Delgado Torres, G. Garriga Rocío
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S936
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Introduction
Charles-Bonnet syndrome was described in 1760 by the Swiss philosopher Charles-Bonnet, who reported that his grandfather’s visual hallucinations were due to eye disease rather than mental illness.
It is characterized by the presence of visual hallucinations, which are usually complex and structured, in elderly patients with preserved cognitive status, significant deterioration in visual acuity and no evidence of associated psychiatric or neurological disease.
ObjectivesThe objective of this poster is to contribute a case to the existing series, and thus get closer to the knowledge of this clinical entity.
MethodsTo review the case, a search was made in Pubmed with the terms hallucinations and Charles Bonnet’s Syndrome.
ResultsThis is a 76-year-old man, in follow-up by the ophthalmology service in the context of bilateral cataract, which causes severe visual disturbance. He went to our hospital, accompanied by his wife, reporting that for some months he has had complex visual hallucinations of various animals, colors in space, as well as children playing around him. All this generates a lot of anxiety, although the patient makes adequate criticism of them.
The neurological examination performed was normal. The CT scan and laboratory tests were also within normal limits. Cognitive impairment was explored using the MMSE scale, which did not show any alteration. In addition, after a psychiatric evaluation, the patient does not meet the criteria for any disorder included in the DSM V. After reviewing the literature and taking into account the clinical picture described, the case is framed within a Charles-Bonnet syndrome.
Regarding the therapeutic plan carried out, it was decided to start treatment with Gabapentin up to a maximum dose of 900 mg/day, with a considerable improvement in the hallucinatory symptoms. In addition, given the repercussion at the affective level, especially with a predominance of anxious symptoms, it was decided to start sertraline at a dose of 50 mg/day, with an adequate therapeutic response.
ConclusionsCharles-Bonnet syndrome refers to hallucinosis, generally of a visual nature, that appear in patients with a sensory deficit associated with the type of sensory-perceptive alteration. It is important to take it into account in the differential diagnosis of the elderly patient with hallucinosis. There is no established treatment, although neuroleptics, benzodiazepines, antidepressants and antiepileptics are used.
Disclosure of InterestNone Declared
Gastric bezoar in a patient hospitalized in an eating disorder unit. Case report
- J. Torres Cortés, I. Esteban Avendaño, J. B. González del Valle, R. González Lucas, J. J. Padín Calo, J. P. Morillo González
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S850-S851
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Introduction
It is well known that eating disorders are related to comorbidity. At least, half of these patients have other mental disorders and, in addition to it, the presence of physical comorbidity (cardiovascular, kidney, nervous system, digestive tract, metabolic or endocrine disorders) comes with a decline in life expectancy.
ObjectivesDescription of a patient with a diagnosis of anorexia nervosa (AN) who developed a gastric bezoar during hospitalization.
MethodsCase treated in a specific Eating Disorder Unit in a Third-Level Hospital.
Results26 years old woman with a diagnosis of AN hospitalized in General Psychiatric Unit with BMI of 11,78 kg/m2. Nasogastric tube was necessary and, after 1 month with a progressive weight recovery (BMI 13,84 kg/m2), the patient was transferred to the Eating Disorder Unit in order to follow specific psychological therapy. No incidence related to physical exploration or clinical analyses happened during this month apart from pancytopenia due to malnutrition.
However, 8 days after, patient developed nausea and had 3 vomit episodes, constant abdominal pain at hipogastrium (moderate intensity), dizziness, instability and constipation. The patient refused possibility of pregnancy. The physical exam showed bowel sounds augmented but no mass or peritoneal irritation appeared. Blood test results were normal. Abdominal X-Ray showed gastric dilatation with small bowel faeces sign, which suggested diagnosis of gastric bezoar.
The treatment was the dissolution of the bezoar by Coca-Cola, solving the symptoms completely.
The patient refused having eaten hair or any other kind of object or indigestible material but admitted to be following a strict vegan diet. Finally, after an endoscopy was done, the patient was diagnosed of phytobezoar.
ConclusionsBased on literature, bezoars are rare in AN, being phytobezoars the most common between the types of bezoars. Nevertheless, there are some risk factors, such as delayed gastric emptying, dehydration or, in the case of phytobezoar, ingestion of food containing high amount of cellulose, hemi-cellulose, lignin, and tannins (celery, pumpkin, grape skins, prunes, raisins and, in particular, persimmons). Some of the symptoms caused by phytobezoar can be similar to those of the AN (abdominal pain, intestinal obstruction, poor appetite, vomiting, malnutrition, weight loss). Therefore, gastric bezoar could be an underdiagnosed or even undiagnosed disease in this group of patients. Taking this into account could reduce time until diagnosis and treatment, decreasing the risks associated.
Disclosure of InterestNone Declared
Antiandrogenic treatment of obsessive compulsive neurosis: A case review
- L. Huerga García, I. Careno Baez, G. Oropeza Hernández, A. Marcos Rodrigo, C. Delgado Torres, G. Garriga Rocío, P. Gómez Pérez
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S927
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Introduction
Obsessive-compulsive disorder (OCD) is a mental disorder in which patients who suffer from it have repetitive and undesirable thoughts, feelings, ideas, sensations (obsessions) and behaviors that drive them to do something over and over again (compulsions).
Often the person tries to get rid of the obsessive thoughts through compulsions, but this only provides short-term relief. Not carrying out the obsessive rituals can cause enormous anxiety and suffering.
ObjectivesTo describe a 23-year-old male patient, who suffers from anxiety and mood symptoms, reacts to ego-dystonic obsessive ideas and sexual content, of months of evolution, and who manages to calm down through compulsive masturbation or watching sexual videos on the internet. All this clinic negatively interferes with their quality of life, asking the patient for medical help to calm these ideas.
MethodsWe carried out a review in Pubmed with the terms Antiandrogens and TOC, in order to make a better description of the clinical case.
ResultsAfter several treatment attempts (Sertraline, Paroxetine, Clomipramine, Clomipramine + SSRI), reaching maximum doses according to clinical guidelines, and with poor therapeutic response, it was decided to discuss the case with the endocrinology department of our hospital, deciding to start treatment with antiandrogens, in order to alleviate the persistent intrusive ideas of a sexual nature. The administration of antiandrogens in men can cause a decrease or increase in the development or involution of secondary sexual characteristics in men, reducing the activity or function of accessory sexual organs, and hyposexuality, with decreased sexual desire or libido.
After several weeks, there was improvement in the obsessive symptoms with a decrease in compulsive rituals. However, after the 3rd mo, some symptoms reappeared, but not with the same severity and intensity as before treatment. In addition, we cannot ignore the adverse effects that have occurred, such as involution of secondary sexual characteristics. However, and taking into account the negative repercussion that this clinic had on the patient’s quality of life, the benefit obtained exceeded the risk, having noted clear improvement with this therapy, and maintaining evolutionary controls by both psychiatry and endocrinology.
ConclusionsPatients suffering from obsessive-compulsive disorder can be effectively treated with anti-androgenic pharmacological agents with various modes of action. The most effective group of such agents is the long-acting analogues of the gonadotropin-releasing hormone. The objective of this review is to elucidate the possibility of using such powerful anti-androgenic agents in the treatment of obsessive-compulsive disorder.
Disclosure of InterestNone Declared
Comorbid Obsessive-Compulsive Symptoms in Schizophrenia - Diagnostic and Treatment Challenges
- J. A. Leal, J. C. Moura, T. C. Rocha, J. F. Cunha, S. P. Torres, D. Seabra, I. M. Lopes, M. E. Carneiro, S. M. Esteves, R. Cajão, G. Lima
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1061
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Introduction
The comorbidity between Schizophrenia and Obsessive-Compulsive Symptoms represents almost 25% of schizophrenic patients and it is believed that almost 12% match the diagnostic criteria for Obsessive-Compulsive Disorder. Some second-generation antipsychotics may worsen or even induce those symptoms, which makes the treatment of this patients a difficult challenge.
ObjectivesTo assess the link between Schizophrenia and Obsessive-Compulsive Symptoms, to discuss the diagnostic challenges and treatment options. To present a clinical case report of a schizophrenic patient with Obsessive-Compulsive Symptoms, which improved with proper treatment.
MethodsWe performed a non-systematic review of the existent literature with the keywords “Schizophrenia” and “Obsessive-Compulsive Symptoms”. Description of a clinical case report.
ResultsWe present the case report of a male, 21 years old, single, diagnosed with Schizophrenia. In the past year, he was admitted twice in a psychiatric ward for persecutory and mystic delusions, which lead him to erratic behaviour. Since his adolescence he manifested repeated washing and compulsive cleaning associated with the fear of being contaminated with multiple diseases. Those compulsions worsened when he started being treated with antipsychotics. However, with therapeutic adjustments and with the introduction of an antidepressant we were able to control those symptoms.
ConclusionsSome antipsychotics may induce or even aggravate Obsessive-Compulsive Symptoms in psychotic patients. It is of extreme relevance to differentiate those symptoms as comorbid in Schizophrenia or if they existed prior to the first positive symptoms, since they can be representative of an Obsessive-Compulsive Disorder. Understanding this diagnostic and treatment complexity enables us to be more familiar with the development of Obsessive-Compulsive Symptoms in schizophrenic patients.
Disclosure of InterestNone Declared
Effects of cognitive rehabilitation interventions on non-central nervous system cancer survivors: A meta-analysis
- A. F. Oliveira, J. D. Reis, I. M. Santos, A. Torres
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S116-S117
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Introduction
Cancer treatments can have a detrimental impact on cancer survivors’ cognitive function. Cognitive rehabilitation is considered the first-line intervention to address cognitive difficulties of cancer survivors. Nevertheless, its efficacy remains unclear.
ObjectivesThis meta-analysis aimed to understand the effects of cognitive rehabilitation in non-central system (non-CNS) cancer survivors, through the assessment of the overall efficacy on subjective cognitive outcomes.
MethodsThis meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. An electronic search on the databases PubMed, Scopus, and Web of Science was conducted in May 2021, considering the past 15 years, by two independent authors. Studies were eligible if they included cancer survivors (excluding CNS cancers) who were exposed to cognitive rehabilitation interventions, in which the subjective cognitive effects were measured through self-report questionnaires. The quality of studies was assessed using the Cochrane Risk of Bias Tool for Randomized Trials. The effect size was the standardized mean difference in the cognitive assessment, between baseline and post-intervention. Statistical heterogeneity was assessed using I2 Statistic. Publication bias was evaluated with Egger’s test. P<0.05 was considered statistically significant. The meta-analysis was performed using R software.
ResultsAmong 14 studies, with 1115 cancer survivors, one study included a pediatric population, other young adult survivors, and the remaining adult population. The most used scale for measuring cognitive changes was the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) and, as recommended, the Perceived Cognitive Impairments (PCI) subscale was used as the primary measure of subjective cognitive function. Results indicated beneficial effects following cognitive rehabilitation, with an overall standard mean difference between pre- and post-treatment of 3.4447, with CI95% [1.5543; 5.3350], p-value<0.0004. The subgroup analysis between the measures of cognitive outcomes showed that the heterogeneity is Group=Other 0.00% (I2) and for the Group=FACT-Cog PCI is 86% (I2). Analyzing the FACT-Cog PCI, the CI95% [-2.93; 6.43] includes 0, meaning that the overall effect in this subgroup is non-significant. The meta-analysis does not demonstrate publication bias (p-value of the Egger test=0.3220).
ConclusionsImprovement of cognitive function in non-CNS survivors throughout cognitive rehabilitation appears to be effective. The findings of this meta-analysis can help inform clinical practice and assist practitioners in recommending and developing interventions of cognitive rehabilitation and deciding how to evaluate them. Further research is required to strengthen this evidence.
Disclosure of InterestNone Declared
Autism spectrum disorders - gender differences and the diagnosis dilemma
- J. D. C. Moura, J. Leal, J. F. Cunha, D. Seabra, S. Torres, T. Rocha, I. Lopes, B. Barata
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S726
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Introduction
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by social and communication deficits and restricted and repetitive or stereotyped behaviours. The prevalence of ASD has been thought to be higher in men, which may reflect aspects of the own aetiology of the disorder. Still, it may also be associated with misdiagnosis or missed diagnosis of females with autism due to specific phenotypic traits.
ObjectivesTo explore the differences between sex/gender in autism’s clinical presentation.
MethodsNon-systematic literature review using the most relevant papers found on PubMed and Google Scholar using the following keywords: “autism spectrum disorder”, “gender differences”, and “autistic women”.
ResultsAutistic women seem to have a “camouflage” phenomenon, characterized by a high level of functioning, less unusual play or restricted interests, better socio-emotional reciprocity and coping behaviours. Therefore, women with ASD commonly have an anteriority of multiple diagnoses, which delays their access to the support and care they need.
ConclusionsProfessionals must be aware of the sex/gender clinical differences to prevent the misdiagnosis or missed diagnosis of females with autism. Moreover, the current clinical criteria used to diagnose ASD may underserve the female population and deserve to be reviewed.
Disclosure of InterestNone Declared
Evaluation of factors that may influence the development of chronic kidney disease in patients with bipolar disorder treated with lithium.
- N. Gutiérrez Mora, J. Torres Cortés, I. Esteban Avendaño, V. Burguera Vion, J. M. Montes Rodríguez
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S83-S84
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Introduction
Bipolar disorder (BD) is a serious and chronic mental disease of mood. Lithium is used for treatment and studies have demonstrated that it is the most efficient drug, reducing suicide risk in a high percentage of patients. However, this drug has well known side effects, such as kidney damage. Lithium could cause chronic kidney disease, specially with the presence of other risk factors.
ObjectivesObservational and retrospective study of creatinine levels and glomerular filtration rates observed in blood analysis (follow-up period of 11 years). Sample size of 263 patients diagnosed of BD I and BD II in treatment with lithium. We used socio-demographic (age, sex) and clinic variables (diabetes mellitus, hypertension, use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or diuretics) to generate bivariate and multivariate analysis.
MethodsOur main objective is to analyze the deterioration of kidney function and the development of chronic kidney disease that chronic treatment with lithium can induce in patients with BD. Our secondary objective is to determine variables which could promote the development of chronic kidney disease, and to assess if these variables could be considered as risk factors during the treatment with lithium.
Results11,3 % of patients in our study developed chronic kidney disease during monitoring. The deterioration of GFR in patients in treatment with lithium was significantly associated with female sex and NSAIDs consumption. A trend towards statistical significance was found regarding the use of diuretics (p=0,060). No statistical significance was found between diabetes mellitus, hypertension or type of BD and the deterioration of kidney function in our sample. An inverse association was found between the GFR decline and the age but no statistical significance was demonstrated.
ConclusionsWe conclude that female sex and use of NSAIDs are predicting factors of GFR decline in patients with BD in chronic treatment with lithium. We must take into account these drugs or even avoid concomitant treatment (lithium and NSAIDs) in order to prevent chronic kidney disease. In addition to it, we should recommend careful use of diuretics during treatment with lithium because of risk of dehydration. Diabetes mellitus and hypertension have universally been associated to increase risk of development of chronic kidney disease. However, we have not found statistical significance in our study. Therefore, research should be done in order to determine specific risk factors in this group of patients and, consequently, optimize their treatment.
Disclosure of InterestNone Declared
Psychiatric comorbidity profiles among suicidal attempters: A cohort study
- Y. Sanchez-Carro, M. Diaz-Marsa, V. Fernandez-Rodrigues, W. Ayad-Ahmed, A. Pemau, I. Perez-Diaz, A. Galvez-Merlin, P. de la Higuera-Gonzalez, V. Perez-Sola, P. Saiz, I. Grande, A. Cebria, J. Andreo-Jover, P. Lopez-Peña, M. Ruiz-Veguilla, A. de la Torre-Luque
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S318-S319
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Introduction
More than 700,000 people die by suicide in 2019 globally (World Health Organitation 2021). Mental health problems constitute a risk factor for suicidal behavior and death by suicide (Hoertel et al. Mol Psychiatry 2015; 20 718–726). Different mental disorders have been related to different forms of suicidal ideation and behavior (Conejero et al. Curr Psychiatry Rep 2018; 20, 33) (Quevedo et al. Compr Psychiatry 2020; 102 152194). However, little is known on comorbidity profiles among suicide attempters.
ObjectivesThe aim of our work was to identify the psychiatric comorbidity profiles of individuals who were admitted a hospital emergency department due to a suicide attempt. Moreover, it intended to know their clinical characteristics according to comorbidity profile.
MethodsA sample of 683 attempters (71.30% female; M age= 40.85, SD= 15.48) from the SURVIVE study was used. Patients were assessed within the 15 days after emergency department admission. Sociodemographic (i.e., sex, age, marital status and employment status) and clinical data were collected. The International Neuropsychiatric Interview (MINI) was used to assess DSM-V Axis 1 mental health diagnoses and the Columbia Suicide Rating Scale (C-SSRS) to assess suicidal ideation and behavior. The Acquired Capacity for Suicide-Fear of Death Scale (ACSS-FAD), the Patient Health Questionnaire (PHQ-9) to assess the frequency of depressive symptoms during the past 2 weeks, and the General Anxiety Disorder-7 (GAD-7) scale to assess symptoms of worry and anxiety were also conducted. For the identification of comorbidity profiles, latent class analysis framework was followed considering diagnosis to each individual disorder as clustering variables. On the other hand, binary logistic regression was used to study the relationship between comorbidity profile membership and clinical factors.
ResultsTwo classes were found (Class I= mild symptomatology class, mainly featured by emotional disorder endorsement; and Class II= high comorbidity class, featured by a wide amount of endorsed diagnoses) (see figure 1). Individuals from the High comorbidity class were more likely to be female (OR= 0.98, p<.05), younger in age (OR= 0.52, p< .01), with more depressive symptoms (OR=1.09, p<.001) and have greater impulsivity (OR= 1.01, p<.05).
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ConclusionsWe found two profiles of people with suicidal behavior based on the presence of mental disorders. Each of the suicidal subtypes had different associated risk factors. They also had a different profile of suicidal behavior.
Disclosure of InterestNone Declared
Life stress and Bipolar Disorder: regarding a clinical case
- T. Coelho Rocha, J. F. Cunha, S. Torres, J. Alves Leal, J. Carvalho Moura, D. Seabra, I. Monteiro Lopes, A. Lopes, G. Lima
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S712
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Introduction
Research on life stress in bipolar disorder largely fails to account for the possibility of a dynamic relationship between psychosocial stress and episode initiation. The kindling hypothesis states that over the course of recurrent affective disorders, there is a weakening temporal relationship between major life stress and episode initiation that could reflect either a progressive sensitization or progressive autonomy to life stress.
ObjectivesTo explore the concept of the Kindling model applied to bipolar disorder and to present a clinical case of a bipolar patient whose latter mood episodes were caused by adverse life events.
MethodsWe performed a non-systematic literature review using the most relevant papers found on the database PubMed with the keywords “kindling effect”, “allostatic load”, “bipolar disorder” and “prevention”. Description of the clinical case report.
ResultsThe phenomenon of kindling was first discovered by Goddard in 1967 who described it in epilepsy. Later, Post applied it to the bipolar disorder, arguing that the initial episodes of both unipolar and bipolar affective disorders are often precipitated by psychosocial stressors, but after multiple recurrences, not only do precipitated episodes continue to occur, but so do spontaneous ones as well. We present the case report of a 62 years old woman, divorced, diagnosed with type 1 bipolar disorder since she was 20 years old. She always have had poor adherence to her medication and follow-up with Psychiatry consultation, with a non-containing sociofamily environment that does not promote clinical stability. Over the time, her admissions on the Psychiatry ward were more frequent and precipitated by adverse life events, mainly caused by the deteriorated relationship with her children.
ConclusionsThe kindling model clarifies aspects of the longitudinal course of episode development, recurrence, and progression to spontaneity, as well as further conceptual and theoretical rationales for intervention in order to prevent illness progression.
Disclosure of InterestNone Declared