Evidence on psychological side effects (PSEs) of antipsychotic medication after remission from first-episode psychosis (FEP), and their momentary impact on daily life, is limited. This study examined how Dopamine-2 (D2) affinity and antipsychotic dosage relate to momentary PSEs.

This ecological momentary assessment (EMA) study included baseline data from 56 participants in the ongoing Handling Antipsychotic Medication: Long-term Evaluation of Targeted Treatment (HAMLETT) trial. Momentary mental states indicative of reduced affect intensity, stability, and variability, as well as avolition and mental fatigue, were assessed 10×/day for eight days (N = 3,005 data points). Since these PSEs may result from D2-receptor actions, antipsychotics were classified by receptor affinity and mechanism of action. Multilevel mixed-effects regression models examined serial cross-sectional associations between D2 affinity or dosage and concurrent PSEs, both overall and separately for mornings, daytimes, and evenings.

Higher antipsychotic dosages were associated with reduced affect variability (Beta [B] = −1.40 [95% confidence interval [CI]: −2.52; −0.29]) and decreased positive affect stability (B = 0.23 [95% CI: 0.04; 0.42]) and intensity (B = −1.11 [95% CI: −1.97; −0.24]). The latter was also associated with the use of high-affinity D2 antagonists versus partial D2 agonists (B = 12.98 [95% CI: 2.43; 23.53]) and versus low-affinity D2 antagonists (B = 10.04 [95% CI: 0.59; 19.49]). Other PSEs were not associated with D2 affinity/dosage. Results were relatively consistent across daytimes.

Higher antipsychotic dosage and high-affinity D2 antagonists were associated with decreased positive affect after remission from FEP, which may partly drive the frequently reported blunting of emotional experience.

Delayed perinatal grief occurs when the grieving process for a lost baby is reactivated after the birth of a healthy child. This case presents a 39-year-old mother who, after losing her first baby at 36 weeks due to Patau syndrome, experienced delayed grief following the birth of a full-term baby two years later. Despite receiving one psychological consultation at the time of the loss, the lack of follow-up contributed to the reactivation of her grief postpartum, presenting with sadness and anxiety.

• - To describe the process of delayed perinatal grief in a mother who lost a baby due to Patau syndrome.

• - To evaluate the psychological impact of the lack of follow-up after the loss on the subsequent development of reactivated grief.

• - To propose therapeutic interventions for the management of mothers experiencing delayed perinatal grief.

We present the case of a 39-year-old mother who lost a baby at 36 weeks of gestation due to Patau syndrome. Following the loss, she received a single psychological consultation with no further follow-up. Two years later, she gave birth to a healthy baby at 40 weeks, and six weeks after delivery, she was referred to psychiatry due to symptoms of profound sadness and anxiety, consistent with delayed perinatal grief. The patient was evaluated by the psychiatry team and began treatment with psychological intervention and pharmacological management when necessary.

The psychiatric intervention led to a gradual improvement in symptoms of sadness and anxiety. The patient responded favorably to psychological treatment, incorporating cognitive-behavioral therapy techniques to manage grief. However, feelings of sadness persisted on dates related to the previous loss. Ongoing emotional support was crucial for the recovery process.

Delayed perinatal grief can reactivate after the birth of a new child, especially in cases where the original loss was not adequately followed up. Proper psychological support is essential to help mothers process their grief and prevent long-term emotional complications.

None Declared

Delusions and hallucinations can appear in various psychiatric and neurological pathologies. When these psychotic symptoms are of late onset, in geriatric age, it may be necessary to make a differential diagnosis between dementia or other psychiatric disorders.

To describe the differential diagnosis between dementia and delusional disorder.

Review of the scientific literature based on a relevant clinical case.

70-year-old woman who lives with her husband. She has two independent daughters. History of a depressive episode in her youth related to her husband’s gambling addiction. She attended the emergency department due to behavioural alteration at home with verbal heteroaggressiveness towards her sister and several neighbours. At the hospital she was approachable, with some psychomotor restlessness, reporting that a neighbour wanted to harm her and spoke of her, making delirious interpretations of harm and referring to visual hallucinations in the form of animals in the courtyard of her house. A brain CAT scan was performed, with normal results.

Her family reports that for about a year she has been saying incoherent things on occasions and behaving strangely. It was decided to admit her to the acute care unit.

During hospitalisation she didn’t present behavioural alterations. Treatment with risperidone was introduced with adequate tolerance and response, with distancing of the delusional ideation of harm. MOCA test was performed: 23/30 (suggestive of cognitive impairment), so PET-CT was requested with results not suggestive of neurodegenerative disease and neurodiagnostic tests (SCIP-S and BCSE); the results indicate heterogeneous cognitive performance, and no global cognitive impairment could be observed at the present time and a repeat assessment was recommended in one year’s time. Due to the results of the tests and the decrease in positive symptomatology with antipsychotic treatment, a diagnosis of delusional disorder was made upon discharge.

None Declared

Obsessive-Compulsive Disorder (OCD) during pregnancy can worsen due to hormonal changes, psychological stress, and concerns about the baby’s health. It presents unique challenges for diagnosis and treatment, balancing the mother’s mental health with fetal safety. This case focuses on a woman who developed OCD in her third trimester, emphasizing the challenges in managing the condition.

• - To describe the impact and progression of OCD during pregnancy.

• - To assess the effectiveness of Cognitive Behavioral Therapy (CBT) and evaluate pharmacological options.

• - To analyze the risks and benefits of managing OCD therapeutically in pregnant women.

A clinical case of a 32-year-old woman at 28 weeks of gestation, with newly diagnosed OCD, is presented. Symptoms began in the second trimester with intrusive thoughts about harming her baby and compulsive checking and cleaning behaviors. The patient was treated with CBT, and SSRIs were considered due to symptom severity. Follow-up continued through pregnancy until delivery.

CBT led to a significant reduction in compulsions and improved management of obsessive thoughts. However, moderate symptoms persisted, leading to consideration of SSRIs, which were ultimately avoided due to concerns about side effects. The patient’s delivery was uncomplicated, and continued CBT postpartum resulted in significant improvement.

This case illustrates the complexity of treating OCD during pregnancy, where hormonal changes and concerns about fetal health can exacerbate symptoms. Early intervention with CBT can be effective, and treatment decisions must carefully balance maternal and fetal well-being.

None Declared

Psilocybin, a psychedelic compound, has shown potential in treating depression, especially in cases resistant to conventional treatments. This study systematically reviews the scientific literature to assess its efficacy and safety.

The main objective of this study is to evaluate the therapeutic effects of psilocybin for the treatment of depressive disorder through a systematic review of the current scientific literature

An exhaustive search was conducted in databases such as PubMed and Web of Science, using specific MeSH term and selecting studies published between 2019-2024 that investigated the effects of psilocybin in treating depression.

The included studies demonstrated significant improvements in depressive symptoms with psylocibin compared to standard treatments. Studies reports a rapid and sustained symptom reduction, with few adverse effects.

Psilocybin could be an effective and safe alternative for treating depression, providing symptomatic relief with fewer treatment sessions and a favorable safety profile. However, further research is needed to overcome current limitations and fully understand its therapeutic potential and underlying mechanisms.

None Declared

The worldwide prevalence of Wernicke-Korsakoff syndrome is thought to range from 0-2%. Those at greatest risk include the homeless, the elderly, and psychiatric patients (1). In treatment, typical regimens include high doses of intravenous thiamine, three times daily for at least three days. Electrolyte abnormalities should be corrected and fluids replaced.

We are interested in studying the evolution of a patient with alcohol withdrawal syndrome progressing to wernicke’s encephalopathy.

We conducted a literature review by searching for articles in Pubmed.

A 40-year-old male, with no medical or surgical history of interest, alcohol consumer, was admitted to the hospital ICU for an episode of ataxia and agitation in the context of four days of alcohol abstinence. He was sedated and orotracheal intubation was performed and treatment was started with thiamine, tiapride and diazepam. After hemodynamic and respiratory stability, the patient was transferred to the Internal Medicine ward where he presented clinical symptoms compatible with Wernicke’s Encephalopathy (cerebellar ataxia and nystagmus). Psychiatry was consulted to adjust treatment and to carry out a psychosocial approach for discharge (alcohol withdrawal center).

The patient’s evolution has been favorable with the adjustment of psychopharmacological treatment. In the neurological examination we observed nystagmus and cerebellar ataxia. In the psychopathological examination the suspicious contact, psychomotor restlessness, mild generalized tremor in both MMSS are remarkable. Speech difficult to understand due to language barrier. Traits of impulsivity in the foreground. Unstructured biological rhythms. Partial insight. Intellectual functions and volitional abilities preserved.

In the complementary tests without significant remarkable alterations. In the treatment adjustment, a de-escalation of diazepam has been carried out for discharge. Treatment with pregabalin, tiaprizal, thiamine and vitamins B1-B6-B9 was also prescribed. Recommendation of absolute cessation of alcohol consumption and follow-up by internal medicine, psychiatry and social work.

Wernicke-Korsakoff syndrome is a clinical diagnosis and Wernicke’s encephalopathy should be suspected in any person at risk of thiamine deficiency presenting oculomotor findings, ataxia or confusion (1). Thus, in our patient presenting ataxia and nystagmus in the context of alcohol abstinence and some malnutrition, an early approach with thiamine can be performed to prevent progression to Korsakoff’s syndrome.

Once amnesia and executive deficit are present, Korsakoff’s syndrome should be suspected. The key to good outcomes is therefore to detect Wernicke’s encephalopathy early and treat it with thiamine (1). Severe concomitant infections, including sepsis of unknown origin, are frequent during Wernicke’s phase (2). In our patient there were no complications.

None Declared

Lewy Body Dementia (LBD) is the second most common neurodegenerative disease, after Alzheimer’s disease. Initial neuropsychiatric manifestations such as depression, delusions and hallucinations are frequently observed and sometimes make it difficult to diagnose the neurocognitive disorder underlying the symptoms, so it is important to perform a proper clinical examination, as the use of certain neuroleptics may worsen neurological symptoms.

This case aims to investigate the psychiatric clinical features of Lewy body dementia from a clinical and therapeutic perspective.

A comprehensive search on psychiatric manifestations that may cover up dementia.

71-year-old female with depressive symptoms for the last 8 years. She is admitted to a psychiatric inpatient unit due to worsening of depressive symptoms despite correct adherence to treatment. Her psychiatric history includes a diagnosis of specific phobia, obsessive-compulsive disorder and depressive episodes with inhibitory symptomatology.

During her stay at the hospital, the patient is inhibited, perplexed and experiences feelings of embarrassment and guilt, along with persistent insomnia and poor response to different lines of treatment. Initially, there is notable intolerance to antipsychotics, resulting in worsening of motor and cognitive functions, as well as hypotension, using risperidone and olanzapine. After the withdrawal of treatment, the patient begins to exhibit delusional ideas and visual hallucinations, leading us to consider that she may be suffering from depression associated with an undiagnosed organic brain pathology.

Clinical tests (MoCA,MMSE) reveals cognitive symptoms which, along with the motor symptoms, suggests a Parkinson’s-dementia complex.

A PET-CT scan with fluorodeoxyglucose-F18 reveals severe hypometabolism in the left parietotemporal and prefrontal regions. These findings are consistent with LBD.

Treatment is initiated with rivastigmine and quetiapine. However, due to the presence of hypotension, quetiapine is replaced with clozapine 25 mg, resulting in a slight improvement in rest and affective responses to the psychotic symptoms.

This case illustrates how depression and psychotic symptoms can serve as early indicators of dementia, stemming from the loss of dopaminergic and acetylcholinergic pathways as part of the neurodegenerative process.

These patients may present with a range of cognitive, neuropsychiatric, sleep, motor, and autonomic symptoms. Depression is prevalent in approximately 28% of these patients. Currently, clinicians diagnose LBD based on the presence of core clinical features and indicative biomarkers. Treatment can be complicated by patients’ sensitivity to certain medications, needing careful evaluation of potential side effects. Current guidelines recommend the use of antipsychotics such as quetiapine or clozapine at low doses, as these have a reduced risk of extrapyramidal effects.

None Declared

Current evidence on psychological adverse effects (AEs) of antipsychotic medication after remission of First Episode Psychosis (FEP), and the impact of these AEs on daily life, is limited.

To investigate serial cross-sectional associations between antipsychotic medication regimen and psychological AEs after remission of FEP.

This Ecological Momentary Assessment (EMA) study investigates baseline data of 56 participants from the HAMLETT trial (Handling Antipsychotic Medication: Long-term Evaluation of Targeted Treatment). Momentary mental states indicative of blunted affect intensity and variability, reduced initiative of social contact, avolition and tiredness were assessed 10x/day for eight consecutive days. Based on neurobiological mechanisms likely mediating these psychological AEs, antipsychotic medications were grouped based on their Dopamine-2 (D2) and Histamine-1 (H1) receptor profile. Multilevel mixed-effects regression models were employed overall and separately for mornings, daytimes and evenings, to investigate serial cross-sectional associations between medication type or dosage and concurrent psychological AEs. All models were adjusted for fixed effects of age, gender, tobacco and cannabis use in the past month and symptom severity during FEP (based on the Comprehensive Assessment of Symptoms and History, CASH).

In total, 85 out of 453 HAMLETT-participants took part in the EMA add-on study. At baseline, 56 (66%) of those participants completed >26 EMA questionnaires and were currently taking antipsychotic medication, yielding a total of 3,005 questionnaires for our analyses. The distribution of antipsychotic medication regimens was relatively equally spread (25% high affinity D2 antagonists, 48% low affinity D2 antagonists, 27% partial D2 agonists). Higher dosage (Beta (B) = -1.11 [95% Confidence Interval (CI): -1.97; -0.24]) and use of high affinity D2 antagonists, as compared with partial D2 agonists (B = 12.98 [95%CI: 2.43; 23.53]) and low affinity D2 antagonists (B = 10.04 [95% CI: 0.59; 19.49]), were associated with decreased positive affect (PA) (see Figure 1). Higher dosage was also associated with small increases in PA variability (B = 0.23 [95% CI: 0.04; 0.42]. The remaining psychological AEs were not associated with dosage or D2 profile, neither was H1 profile associated with these AEs. Results were relatively consistent across daytimes, though effect sizes were greatest in the evenings.

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After remission of FEP, higher dosage of antipsychotic medication and use of high affinity D2 antagonists, as compared with partial D2 agonists and low affinity D2 antagonists, can be associated with decreased, though not invariable, positive affect as estimated using EMA.

None Declared

Rehospitalization is common in psychosis, often due to poor adherence to antipsychotic treatments. Long-acting injectable antipsychotics (LAIs), particularly paliperidone palmitate 6-month (PP6M), have shown promise in improving adherence and reducing relapses compared to monthly or quarterly formulations . Rapid initiation of PP6M during hospitalization may further optimize post-discharge outcomes and enhance the therapeutic adherence, minimizing the risk of a new outbreak, reducing the impact of rehospitalization and improving patients’ quality of life.

To evaluate clinical outcomes and treatment adherence in schizophrenia and other psychotic disorders after rapid PP6M initiation during psychiatric hospitalization.

A retrospective analysis of 24 hospitalized patients diagnosded with schizophrenia and other psychotic disorders treated with PP6M within 7–10 days was conducted. Treatment adherence, follow-up attendance, and adverse effects were evaluated using McNemar’s test for statistical analysis.

Patients had a mean age of 36.8 years (SD=10.85), 64% were male, with an average of 2 prior hospitalizations (SD=3.16) in the past two years. Previously, 57% were on monthly LAIs. Post-discharge, 83% attended follow-ups. Antipsychotic monotherapy increased by 27% (p = .10) to 59%, while attendance at over 80% of appointments improved by 47% (p ≤ .001). Akathisia was reported in 25% of patients.

PP6M significantly improves adherence by simplifying treatment regimens. Increased follow-up attendance (47%) and greater use of monotherapy reflect better patient outcomes. These findings align with prior evidence on the efficacy of LAIs in preventing relapses. Rapid initiation of PP6M can reduce rehospitalizations and optimize hospital resources. The low incidence of akathisia (25%) supports its safety and tolerability for long-term use.

None Declared

Ekbom’s syndrome is a clinical term for delusional parasitosis, a condition characterized by the belief that one’s skin is infested by invisible parasites. Delusional infestation is a rare psychiatric disorder, is more common in the elderly, particularly in postmenopausal females. Psychiatric interventions are usually rejected by these patients and long-term treatments are frequently abandoned, they usually seek care from dermatologists. It is advocated to form a liaison between dermatology and psychiatry to ensure a full range of differential diagnoses, in order to form the most suitable management plan.

The objetive of this case is to illustrate the severity of Ekbom’s syndrome, providing detailed clinical information and highlighting the challenges in treatment.

The following patient will be presented, doing a thorough systematic bibliography review.

A 54-year-old female patient describes a clinical history of three years of visual hallucinations and generalized pruritus since a family weekend at a countryside house. She reported that, for the past three years, she has experienced itching all over her body and has occasionally seen “bugs” on her body that she believes to be fleas. She mentioned having been diagnosed with “scabies” and “seborrheic dermatitis”.Despite these diagnoses, her father noted that for the past year, the patient has been extremely anxious, spending hours examining her hair and skin, washing repeatedly, and searching for “bugs.” In recent weeks, she refused to eat.Throughout her stay in the unit attended therapy regularly, and participated actively. A psychopharmacological adjustment was made, starting with Abilify at 15 mg/day, which was well-tolerated and effective. A dermatology consult ruled out dermatological pathology. Over the days, a reduction in anxiety and partial improvement in somatic complaints were observed. As the patient’s condition improved, she committed to continuing with the treatment and attending mental health team consultations with her referring psychiatrist.

Delusional infestation is a serious and uncommon disorder that endangers the patients and the people around them, and can be complicated with secondary somatic complications, often requiring involvement of different medical specialists.The treatment is long and complicated, the effectiveness of pimozide, aripiprazol or risperidone for the Ekbom syndrome has been documented in the literature. In our case, we decided to introduce aripiprazol. The management of these patients requires a multidisciplinary approach between dermatologists and psychiatrists, as they often refuse treatment. Consultation and collaboration between both specialties are essential to ensure timely referral. Additionally, it is crucial for general physicians to have greater awareness of these conditions, perform early recognition, maintain good rapport with patients, and provide empathetic treatment.

None Declared

Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.

T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).

PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).

PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.

It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.

To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.

Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.

IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).

Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.

Psychological and existential distress is prevalent among patients with life-threatening cancer, significantly impacting their quality of life. Psilocybin-assisted therapy has shown promise in alleviating these symptoms. This systematic review aims to synthesize the evidence on the efficacy and safety of psilocybin in reducing cancer-related distress.

We searched MEDLINE, APA PsycINFO, Cochrane database, Embase, and Scopus from inception to February 8, 2024, for randomized controlled trials (RCTs), open-label trials, qualitative studies, and single case reports that evaluated psilocybin for cancer-related distress. Data were extracted on study characteristics, participant demographics, psilocybin and psychotherapy intervention, outcome measures, and results. Two authors independently screened, selected, and extracted data from the studies. Cochrane Risk of Bias for RCTs and Methodological Index for Non-Randomized Studies criteria were used to evaluate study quality. This study was registered with PROSPERO (CRD42024511692).

Fourteen studies met the inclusion criteria, comprising three RCTs, five open-label trials, five qualitative studies, and one single case report. Psilocybin therapy consistently showed significant reductions in depression, anxiety, and existential distress, with improvements sustained over several months. Adverse effects were generally mild and transient.

This systematic review highlights the potential of psilocybin-assisted therapy as an effective treatment for reducing psychological and existential distress in cancer patients. Despite promising findings, further large-scale, well-designed RCTs are needed to confirm these results and address existing research gaps.

Employment and relationship are crucial for social integration. However, individuals with major psychiatric disorders often face challenges in these domains.

We investigated employment and relationship status changes among patients across the affective and psychotic spectrum – in comparison with healthy controls, examining whether diagnostic groups or functional levels influence these transitions.

The sample from the longitudinal multicentric PsyCourse Study comprised 1260 patients with affective and psychotic spectrum disorders and 441 controls (mean age ± s.d., 39.91 ± 12.65 years; 48.9% female). Multistate models (Markov) were used to analyse transitions in employment and relationship status, focusing on transition intensities. Analyses contained multiple multistate models adjusted for age, gender, job or partner, diagnostic group and Global Assessment of Functioning (GAF) in different combinations to analyse the impact of the covariates on the hazard ratio of changing employment or relationship status.

The clinical group had a higher hazard ratio of losing partner (hazard ratio 1.46, P < 0.001) and job (hazard ratio 4.18, P < 0.001) than the control group (corrected for age/gender). Compared with controls, clinical groups had a higher hazard of losing partner (affective group, hazard ratio 2.69, P = 0.003; psychotic group, hazard ratio 3.06, P = 0.001) and job (affective group, hazard ratio 3.43, P < 0.001; psychotic group, hazard ratio 4.11, P < 0.001). Adjusting for GAF, the hazard ratio of losing partner and job decreased in both clinical groups compared with controls.

Patients face an increased hazard of job loss and relationship dissolution compared with healthy controls, and this is partially conditioned by the diagnosis and functional level. These findings underscore a high demand for destigmatisation and support for individuals in managing their functional limitations.