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ARIPIPRAZOLE-INDUCED OCULOGYRIC CRISIS (ACUTE DYSTONIA)
- L. Rodriguez Andres, C. Vallecillo, L. Gallardo Borge, C. M. Capella Meseguer, G. Guerra Valera, C. Noval Canga
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1009-S1010
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Introduction
Aripiprazole is a third generation atypical antipsychotic and a dopamine serotonin system stabilizer, effective against positive and negative symptoms of schizophrenia. Within the group of atypical antipsychotics, aripiprazole shows a relatively benign safety profile (e.g. lower metabolic impact, mild effect on cardiovascular parameters), although the reported rate of extrapyramidal side effects is measurable.
Oculogyric crisis (OGC) is a rare movement disorder characterized by a prolongued involuntary upward deviation of the eyes, lasting minutes to hours. In most cases, OCG is a drug-induced adverse event with acute or tardive onset often attributable to a functional impairment of dopaminergic neurotransmission.
ObjectivesOGC is seldom reported in children and young adults during treatment with aripiprazole, althouh it is commonly used in youths.
MethodsWe report a case of an aripiprazole-induced oculogyric crisis in a 19 year old girl who diagnosed with schizophrenia (paranoid).
ResultsThere was a complete remission of the OGC’s following aripiprazole dose reduction, suggesting the clinical manifestation was a dose-dependent phenomenon.
ConclusionsThe present report should raise awarness among clinicians for this relevant possible adverse event, that can happen also with the use of aripiprazol, not only with typical or more antidopaminergic antipsychotics. Future research in the field should emphasize neurobiological dysfunctions as the basis of EPS/OGC in patients.
Disclosure of InterestNone Declared
A clinical case of anosognosia in a CADASIL disease.
- E. Talaya Navarro, L. Gallardo Borge, E. Gómez Fernández, R. Fernández Díaz, L. Al Chaal Marcos, E. Rybak Koite
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1000-S1001
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Introduction
CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) is a cerebrovascular disease, tht appears in 1.98/100,000. It´s caused by a mutation of the Notch3 gene and is characterized by accumulation of granular osmiophilic material in the middle layer of the small and median sized cerebral arteries.
Sypmtoms are migraine, recurrent cerebral ischemic episodes, dementia, neuropsychiatric disorders (anosognosia, character disorders, apathy and cognitive impairment). It usually appears between 30-60 years, although there is an important variability. There is no curative treatment, only palliative.
ObjectivesClinical review of anosognosia and its presence in CADASIL disease.
MethodsClinical case and literatura review.
ResultsWe presented the clinical case of a 68-year-old man, who was diagnosed with CADASIL after a stroke 3 years earlier. In his family, his brother was diagnosed also with CADASIL. The patient had previously presented disturbances in impulse control (hyperorality) and important executive failures. He currently presented anosognosia, deficits in verbal memory, spatial perception and executive functions, in addition to behavioral alterations and apathy. Due to these deficits he was prohibited from certain activities (driving, hunting).
The patient was not aware of these deficits and becouse of his “no knowledge of his illness”, he disagreed with these prohibitions, so he showed rage and anger at the impotence of not understanding why certain actions are prohibited.
In the consultation, mnesic errors and in naming objects were also objectified, for which it was recommended to carry out cognitive stimulation on a daily basis. In addition, he presented failures of sphincter incontinence, especially of urine and occasionally also of the anal sphincter. He had previously had episodes of myoclonus or fasciculations.
A genetic study by massive sequencing confirmed the heterozygous presence of the pathogenic variant c.1819C>T p.(Arg607Cys) in the NOTCH3 gene, a CADASIL disease.
ConclusionsThe anosognosia that many patients with CADASIL disease present constitutes a problem because it contributes to the delay in consultation and, therefore, the delay in the adequate diagnostic approach, therapeutic possibilities and family genetic counseling. Due in part to anosognosia, CADASIL is considered an underdiagnosed entity. Due to the lack of awareness and the consequent lack of recognition of the deficit, these people are often seen as stubborn and difficult to deal with by people in their immediate environment.
In addition, there is general difficulty in the rehabilitation process, since patients do not think the neccesity to be treated. This can generate frustration and despair both in their relatives and in the health personnel.
For all these reasons, both in anosognosia and in CADASIL disease, adequate psychological support is needed for both those affected and their families.
Disclosure of InterestNone Declared
Mutism. What to expect?
- I. Santos Carrasco, J. Gonçalves Cerejeira, M. Fernández Lozano, A. Gonzaga Ramírez, M. Queipo De Llano De La Viuda, G. Guerra Valera, C. Vallecillo Adame, C. De Andrés Lobo, T. Jiménez Aparicio, B. Rodríguez Rodríguez, N. Navarro Barriga, M.J. Mateos Sexmero, E. Pérez, L. Gallardo Borge
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S588
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Introduction
Mutism is the inability or unwillingness to speak, resulting in an absence or marked paucity of verbal output. Mutism is a common manifestation of psychiatric, neurological, and drug-related illnesses. Psychiatric disorders associated with mutism include schizophrenia, affective disorders, conversion reactions, dissociative states, and dementias. Neurological disorders causing mutism affect the basal ganglia, frontal lobes, or the limbic system.
ObjectivesOutline the importance of setting a differential diagnosis of mutism in the Emergency Room.
MethodsReview of scientific literature based on a relevant clinical case.
ResultsMale, 58 years old. He has lived in a residence for 3 months due to voluntary refusal to ingest. Diagnosed with paranoid personality disorder. He is refered to the Emergency Service due to sudden mutism. During this day, he has been stable and suitable with a good functionality. For 3 hours he is mutist, oppositional attitude and stiff limbs, refusing to obey simple orders. Hyperalert and hyperproxia. Not staring. After ruling out organic pathology: normal blood tests, negative urine toxins and cranial CT without alterations, he was admitted to Psychiatry for observation and, finally, he was diagnosed with Psychotic Disorder NOS.
ConclusionsMutism most often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. The most common disorder of behavior occurring with mutism is catatonia. The differential diagnosis of mutism is complex. In some cases the diagnosis will be clarified only by careful observation and after a neurological evaluation. Published studies show neurological disorders presenting with mutism can be misdiagnosed as psychiatric.
DisclosureNo significant relationships.
Personality disorders and Juvenil Myoclonic Epilepsy
- I. Santos Carrasco, J. Gonçalves Cerejeira, M. Queipo De Llano De La Viuda, A. Gonzaga Ramírez, G. Guerra Valera, T. Jiménez Aparicio, C. De Andrés Lobo, C. Vallecillo Adame, M. Fernández Lozano, B. Rodríguez Rodríguez, N. Navarro Barriga, M.J. Mateos Sexmero, L. Gallardo Borge
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S668
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Introduction
There is a high comorbidity between psychiatric disorders and juvenile myoclonic epilepsy (JME), observed in up to 58% of these patients; specifically, mood disorders, anxiety and personality disorders (PD). In some patients with PD there are nonspecific alterations in the EEG, which nevertheless sometimes involve pathology. The presence of personality disorders along with JME has been repeatedly described. Previous studies have emphasized the difficulties in treating patients with JME, which have been attributed to some specific psychiatric, psychological and psychosocial characteristics.
ObjectivesDescribing distinctive personality traits in JME
MethodsReview of scientific literature based on a relevant clinical case.
Results19-year-old woman, single. Psychiatric history since she was 12 due to anxiety-depressive symptoms, after being diagnosed with JME. 4 admissions in Psychiatry, with a variety of diagnoses: eating disorder, attention deficit hyperactivity disorder and borderline personality disorder. The evolution of both disorders has been parallel, presenting epileptic seizures due to irregular therapeutic adherence together with pseudo-seizures, which made difficult their differential diagnosis. In addition, he has had frequent visits to the emergency room for suicide attempts and impulsive behaviors.
ConclusionsIn 1957, for the first time, distinctive personality traits were described in patients with JME: lack of control and perseverance, emotional instability, variable self-concept and reactive mood, which have been confirmed in subsequent studies. It is believed as epilepsy progresses, patients tend to develop symptoms of depression, anxiety, social problems, and attention deficit. Therefore, these patients have difficulty in following medical recommendations, especially precautions regarding precipitating factors for seizures.
DisclosureNo significant relationships.
Depressive Symptoms and Suicidal Ideation in Spanish Medical Students
- J.A. Blanco, M. Rodriguez, I. Santos Carrasco, M. Queipo De Llano De La Viuda, L. Gallardo Borge, P. Marqués Cabezas, M.J. Mateos Sexmero, J. Blanco Vilches
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S183
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Introduction
Medical students have higher rates of depression, anxiety and suicidal ideation over the general population. The onset of these disorders can be a risk factor with unfavorable impact in both medical care and their lives during the years of clinical specialization
ObjectivesTo assess the prevalence and factors involved in depression, anxiety and suicidal behavior in medical students of the University of Valladolid (Spain). The results are compared with a previous study conducted 5 years earlier
MethodsWe used an online self-administered questionnaire that included demographic variables, academic information, sanitary data, Beck Depression Inventory (BDI), Generalized Anxiety Disorder 7 (GAD7), and MINI International Neuropsychiatric Interview for suicide. Chi-Square Test was used for categorical variables, Student`s t-test for quantitative variables and Spearman’s Coefficient to evaluate correlations between variables
Results362 students of all courses enrolled in Medicine at the University of Valladolid completed the survey. There were no differences between male and female students, both with high rates of moderate-severe depression (27% vs 30,4%), anxiety (42,9% vs 54,5%), and moderate-severe suicide risk (14,2% vs 10,7%). Previous study (n=584) also showed no differences between sexes but with lower rates of moderate-severe depression (14,3% vs 16,3%). 11% reported suicidal thoughts in the past month (11,6% previous study). There was a significant inverse correlation between medical career satisfaction and BDI scores
ConclusionsFive years later, rates of depression and suicide risk could have increased in medical students at the University of Valladolid. We urgently recommend the implementation of mental health prevention programs in this population
DisclosureNo significant relationships.
Idiopathic serontonin syndrome. Can we prevent it?
- L. Gallardo Borge, I.D.L.M. Santos Carrasco, P. Marqués Cabezas, L. Rodriguez Andrés, A. Rodriguez Campos
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S724
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Introduction
Serotonin syndrome is a mild to potentially life-threatening syndrome associated with excessive serotonergic activity within the central nervous system. Serotonin syndrome is associated with medication use, drug interactions and overdose. All drugs that increase central serotonin neurotransmission at postsynaptic 5-HT1A and 5-HT 2A receptors can produce SS.
ObjectivesClinical case and literature review.
MethodsA 74-year-old female, married, diagnosed of major depressive disorder. Treated with: lithium 600 mg, quetiapine 50 mg, venlafaxine 300 mg. The doses had been maintained for the last months. Lithium levels in the normal range.
ResultsIn an emergency room, she received a tramadol injection because of strong backpain. After a few hours, she felt an overall worsening, sleepiness and lack of response to external stimuli. Given the persistence of the symptoms and decreased appetite along with decreased water intake, she attended to Hospital. She had a high fever, rigidity and myoclonus. Her language was incoherent. Blood tests showed high CK, and high AST and ALT.
ConclusionsSS is a potentially fatal iatrogenic complication of serotonergic polypharmacy. Considered idiopathic in presentation, it appears tipically after initiation or dose escalation of the offending agent to a regimen including other serotonergic agents. While serotonin syndrome is often associated with the use of selective serotonin inhibitors (SSRI), an increasing number of reports are being presented involving the use of tramadol. It is vital that clinicians are aware of the potential for SS when psychotropic and non-psychotropic agents are co-administered to certain patients, such as those with both depression and pain.
DisclosureNo significant relationships.
Comorbility symptoms in AHDH adult patients
- P. Marqués Cabezas, A.I. Segura Rodríguez, P. García Barriuso, L. Gallardo Borge, M.J. Mateos Sexmero, J.A. Blanco, M. Queipo De Llano De La Viuda, M. Perez Carranza, A. Aparicio Parras, J. Espina Barrio, A. Rodriguez Campos
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S466
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Introduction
Adults may continue suffering AHDH symptoms after this condition is recognized and typified in children. Different works provide evidence that adults have an even more complicated variety of psychiatric disorders than children, as an increased risk of problems stemming from substance abuse, depression, anxiety, increased risk of traffic accidents, and also sexual transmission diseases.
ObjectivesThere was known that adults could continue suffering symptoms derived from his infantile ADHD. We wonder if the majority of the young males derived to our consultation present compatible symptoms with adult ADHD. This condition promotes the onset of substance use and may lead to latent psychosis onset.
MethodsWe analyzed 39 patients derived by suspicion of psychiatric pathology, aged between 17 and 35. They stem to clinical psychology for study of features of personality (Million Questionnaire). Another questionnaire was used also autoapplied for sifted of the ADHD in adults (ASRS_V1:1). According to the criteria DSM-IV TR, the patient had moderate symptoms of ADHD if it was fulfilling 6 or more diagnostic criteria according to their answers in the screening questionnaire.
ResultsThe results supported the existence of impulsivity, aggression, irritability, problems with compliance and substance abuse.
ConclusionsADHD is not only a problem of distractibility or worry, but a deeper and extensive alteration caused by the deterioration of a set of cerebral activities. An early treatment in the childhood could prevent devastating consequences for their development, since they include the majority of the functional areas of the patient and it impedes their later social and labor adjustment.
DisclosureNo significant relationships.
Testosterona and suicide
- L. Gallardo Borge, I.D.L.M. Santos Carrasco, P. Marqués Cabezas, A.I. Segura Rodríguez, G. Medina Ojeda
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S842
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Introduction
Testosterone is an anabolic androgenic steroid hormone involved in brain development, reproduction, and social behavior. Several studies have shown that testosterone can cause impulsivity in humans. This impulsivity could modify the mood and increase the risk of suicidal behaviour.
ObjectivesTestosterone is an anabolic androgenic steroid hormone involved in brain development, reproduction, and social behavior. Several studies have shown that testosterone can cause impulsivity in humans. This impulsivity could modify the mood and increase the risk of suicidal behaviour.
MethodsClinical case and literature review.
ResultsA 33-years male (biological female), single, gypsy ethnicity, with an 11-years daughter. Psychiatric history of one admission in a hospitalization unit. Diagnosed of depressive disorder and personality disorder NOS. Intermittent follow-up in Mental Health consultations. 8 years later, he consulted due to gender dysphoria. He refered not to be feeling identified with his body for a long time. He rejected his sexual characteristics. After his mental evaluation, he was refered to Endocrinology Service. He had been prescribed with testosterone. Three days after starting the treatment, he maked anattempt of suicide with medication. The patient had not presented previous suicide attempts or ideation. With the withdrawal of the testosterone, the suicidal behaviour dissapeared.
ConclusionsDue to the association of testosterone and suicidal behavoiur, we consider that is important to pay attention to people who have just started the androgenic treatment in order to avoid a high risk of suicide. In the same way, we should focus on evaluating the hostility, impulsivity and irritability in patients strongly related to suicidal behaviour.
DisclosureNo significant relationships.
Emerging treatments options for narcolepsy throughout a case
- A. Alvarez Astorga, L. Gallardo Borge, H. de la Red Gallego, A. Alonso Sánchez, S. Gómez Sánchez, C. Noval Canga, E. Mayor Toranzo, S. Cepedello Pérez, L. Rodriguez Andrés, T. Ballesta Casanova
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- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S594
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Background
Narcolepsy is a neurological disorder characterized by disturbances in REM sleep. The symptoms that the patient could present are excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations and disrupted nocturnal sleep. Its etiology is unknown. Currently, there is established pharmacotherapy for symptomatic treatment, which are often unsatisfactory.
ObjectiveReview of new treatments for narcolepsy based on recent advances about its ethiopathogenesis.
MethodSeventy-five year-old female with a personal history of arterial hypertension and obstructive sleep apnea syndrome. The patient presented several episodes of abrupt muscular weakness, nightmares, sleep paralysis and excessive daytime sleepiness. Diagnosed of narcolepsy and treated with methylphenidate immediate-release (IR) 10 mg, alprazolam 1 mg, and trazodone 100 mg with good response.
ResultsDue to persistent symptoms, treatment was modified to osmotic-release oral system (OROS) – methylphenidate resulting on a substantial weight loss (12 kg) and persistence of symptoms. Another methylphenidate preparations were unsuccessfully tested. Currently she continues treatment based on methylphenidate release-release and she improved significantly though she sometimes presented daytime sleepiness.
DiscussionRecent studies have shown that a loss of the hypothalamic neuropeptide hypocretin causes Narcolepsy with cataplexy and that an autoimmune mechanism may be responsible for this loss (related to HLA DQB*0602). Pathophysiology of narcolepsy without cataplexy is less understood.
Although amphetamines and its derivatives are the mainstay of management, therapies that involve hypocretine seems to be hopeful (intranasal, peripherical or hipocretin cell transplantation). Monotherapy with GHB, H3 antagonist receptors, TRH analogs and immunotherapy are also being studied.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Autistic spectrum disorder masked by mental retardation and impulse control disorder
- L. Rodríguez Andrés, T. Ballesta Casanova, M.S. Hernández García, C. Noval Canga, L. Gallardo Borge, J.A. Espina Barrio
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- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S639
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Clinical case report
A 48-year-old male, diagnosed with impulsive control disorder, sex addiction disorder and mental retardation was followed-up by different psychiatrists for the last 20 years. He consults because of presenting depressive symptoms and behavioural disturbances related to the death of his mother two years before. The patient reports to experimenting depressed mood, irritability, insomnia and trends to cry. He has lost motivation for his job and hobbies (he used to show interest in topics such as physics, philosophy, maths, and medicine). He has feelings of loneliness, which make him look for social interaction and support through continuous calls to telephone sex lines. This act has made him spend large amounts of cash, thus, making him be in deep debts. He does not feel integrate in society.
Mental status examinationIntrovert, limited social skills, coherent language, echolalic, monotone, tangential speech, depressed mood, feelings of guilt and futility, dysphoria, partial anhedonia, ideas of hopelessness, structured death ideation, unconsciousness of his own acts, with trend to impulsiveness and compulsive behaviour and insomnia.
Complementary testWais test: no mental retardation found.
DiagnosisAutistic spectrum disorder (F84.0); major depressive disorder (F32.1); bereavement (V62.82).
DiscussionThe patient showed classic diagnostic criteria DSM 5 associated with autistic spectrum disorder (Asperger's disorder in DSM-IV); the permanent inability for social interactions and repetitive, restricted and stereotypic behavioural patterns.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Increased libido as a buproion-SR side effect: Clinical description of a case
- L. Gallardo Borge, C. Noval Canga, L. Rodíguez Andrés, I. Sevillano Benito, M. Hernández García, A. Álvarez Astorga, R. Hernández Antón, S. Gómez Sánchez, G. Isidro García, P. Marqués Cabezas
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- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S545
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Introduction
Bupropion is a dual antidepressant, a norepinephrine and dopamine reuptake inhibitor. Its main use is in affective disorders as major depression. Antidepressants have been commonly associated with sexual side effects in the libido, sexual arousal, orgasm and erectile function. Bupropion has negative influence in sexual function, even it could increase the libido. Due to this, it could be a good option in patients with active sexual life and affective disorder.
Clinical reportA 58-year-old female with a long history of depression disorder for 5 years. History of lots of side effects with different treatments, sexual dysfunction with serotonin-antidepressants. Treated with bupropion SR 150 mg/day and alprazolam, she suffered a relapse. The bupropion was increased to 300 mg/day. Three days later she appeared in the consultation room, presented a sense of pre-orgasmic of 72 hours of evolution, high increased libido, tiredness, muscle tension and insomnia. This sense did not improve after the sexual act. It had never happened previously. The side effect improved when the bupropion was reduced to 150 mg/day and disappeared with its withdrawal.
ConclusionsThe case made a relationship between the increased of bupropion's dose and the appearance of unusual sexual side effects (increased of libido and pre-orgasmic sense). Not only bupropion is one of the antidepressants that do not cause sexual dysfunction, if not it was reported in some trials that could be a treatment against this dysfunction due to its prosexual effects. The mechanism is unknown but could be related with norepinephrine or dopamine transmission.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
I am trapped in a wrong body
- R. Hernandez Anton, C. Noval Canga, E. Rybak Koite, H. De La Red Gallego, L. Gallardo Borge, A. Alonso Sanchez, I. Sevillano Benito, M.J. Garcia Cantalapiedra, P. Marques Cabezas, F. Uribe Ladron De Cegama, J.A. Espina Barrio, G. Isidro Garcia
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- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S590
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Introduction
Gender dysphoria is incoherence between the sex a person feels or expresses and the biological.
ObjectiveRevise the inclusion criteria for hormone therapy and sex reassignment surgery in gender dysphoria. Expose the multidisciplinary approach. Make differential diagnosis with other psychological disorders.
MethodologyA 45 years old male patient (biological female), who was sent from Endocrinology Unit for a psychiatric evaluation before restart a hormonal treatment. Since his childhood, he has presented dissatisfaction with his sexual characteristics; he has had fantasies and dreams, in which he belonged to the other sex. He has always chosen male activities and male stereotypes companies. He has presented preference for cross-dressing from 9 years. Always felt the sexual attraction for women. He first consulted for this reason in 1995.
ResultsIt reported favorably to start hormone treatment after completing the eligibility criteria: > 18 years old; knowledge of the effects of hormones; and more 3 months documented real-life experience. The hormone therapy caused the growth of microprolactinoma, which was treated with dopamine agonists until it disappeared and the cessation of galactorrhea. Testosterone treatment is restarted. Laboratory tests are done every 3 months during the first year and then, every 6 months.
ConclusionsIs the gender disphoria a pathology? The EU recommends a reclassification as no pathological disorders in ICD-11. The treatment of gender dysphoria is necessary, and there is no reason to postpone it. The main difficulty is the differential diagnosis; there may be comorbidity with others mental disorders which are not exclusive (psychotic disorder, OCD, personality disorders and other disorders of gender identity).
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Antidepressant-induced hyponatremia
- L. Rodríguez Andrés, S. Gómez Sánchez, A. Rodríguez Campos, R. Hernández Antón, L. Gallardo Borge, A. Álvarez Astorga
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- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S160
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Introduction
Hyponatremia is one of the electrolytic disorders most comonly observed among general hospitalized populations (2% of hospitalized patients). A form of hyponatremia is the syndrome of inappropriate antidiuretic hormone secrection (SIADH). One of its diverse causes is medication. Selective serotonine reuptake inhibitors (ISRSs) can cause hyponatremia due to SIADH, particularly among elderly population.
Clinical case reportA 81-year-old female treated with paroxetine 20 mg/day because of depression. Two weeks later she starts feeling nausea, somnolence and motor inhibition. The sodium level previous to the onset of treatment was normal but after two weeks it has decreased to 121 mEq/L, pointing to SIADH induced by ISRSs.
DiscussionThe incidence of hyponatremia among elderly patients treated with antidepressants of ISRSs class has increased. The prevalence varies between 0.5 and 25%. Although half of the patients are asymptomatic, the mortality is rate may reach 25%. It generally develops during the first month of treatment and is reversible between 2 and 28 days after the suspension of the ISRSs.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Recurrent hypersomnia: Kleine-Levin syndrome
- L. Rodríguez Andrés, A. Rodríguez Campos, L. Gallardo Borge, G. Isidro García, E. Mayor Toranzo
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- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S595
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Introduction
Kleine-Levin syndrome was first described by Kleine in 1925 and elaborated on by Levi in 1936. It is an infrequent syndrome that predominantly affects to teenagers, and boys are four times more likely to be affected than girls. It is rare for patients over 30 years although some cases have been reported. Kleine-Levin syndrome is a recurrent hypersomnia characterized by episodes of hypersomnia lasting for 2 days to 4 weeks associated with symptoms of hyperphagia, hypersexuality and cognitive impairment. It can be accompanied by other abnormal behavior such as aggression, personality changes and irritability. Deficits are resolved between episodes.
Case reportIt is presented the case report of a patient that suffers from recurrent episodes of hypersomnia associated with hyperphagia and abnormal behavior.
ElectroencephalographyEEG demonstrates slowing of drowsiness and a decrease in REM sleep. The test of multiple sleep latency is abnormal and the rest of complementary test are normal.
DiagnosisF51.1 Recurrent hypersomnia (Kleine-Levin syndrome) [307.44].
DiscussionKleine-Levin syndrome is an intriguing, severe and homogenous disease with no obvious cause or treatment. Treatment is generally supportive. It should be considered in any teenager presenting with recurrent episodes of hypersomnia concurrent with cognitive changes or disinhibition.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
A bizarre love
- C. Noval Canga, R. Hernández Antón, S. Cepedello Pérez, S. Gómez Sánchez, L. Rodríguez Andrés, L. Gallardo Borge, G. Medina Ojeda, A. Alonso Sánchez, A. Álvarez Astorga, A. Portilla Fernández
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- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S355
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Introduction
Adoption constitutes a discontinuity in child care trajectory, that falls into a separation and a lost of reference figures, and therefore, the need to set up new attachment figures into a suitable familiar atmosphere.
ObjectivesThis case is a review of how a child adoption process, that can be something positive at first, can also produce many problems in the future, added to dificulties in order to regulate stressing situations and also solving problems.
MethodsThe clinical case consists in a 25-year-old woman, who suffers from anxiety and self-injure behaviour. She has a diagnosis of non-specified personality disorder with limit characteristics. The patient was adopted a few months after her birth. At the moment she's living with her adoptive father, her adoptive mother passed away when she was 4. At the age of 21, the patient meets her biological mother and since that moment she spends most of the weekends with her. After a few medical appointments, she admits that she has allowed sexual relationships with her biological mother since six months ago.
ResultsIt's important to appreciate the value of familiar atmosphere, and in addition, the attachment between child and his parental figures. The quality of the attachment is going to have influence in emotional regulation.
ConclusionsChildren who have suffered neglect from their biological parents and have been adopted develop attachment behaviours characterized by negative experiences. In spite of being in a good familiar environment, they feel vulnerable and insecure. Early and appropriate attachment experiences can improve relationships between children and their new family.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Rasagiline and venlafaxine: The serotonin syndrome
- A. Rodriguez Campos, L. Rodríguez Andrés, G. Medina Ojeda, L. Gallardo Borge, E. Rybak Koite
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- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S759
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Rasagiline is a highly potent irreversible monoamine oxidase (MAO)-B inhibitor, antiparkinsonian drug that may be used with caution in patients treated with antidepressant drugs because of the possible appearance of severe adverse effects. It is presented the case report of a woman treated with rasagiline and venlafaxine that presents confusion and a serotonin syndrome. Pathogenesis, physiopathology and treatment are discussed. Growing evidence suggests that Parkinson disease and depression are linked. Antidepressant drugs and PD treatment should be used with caution because of possible drug interaction.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Belle De Jour: A Case of Hysteria
- C. Noval Canga, S. Gómez Sánchez, S. Cepedello Pérez, R. Hernández Antón, I. Sevillano Benito, L. Rodriguez Andrés, L. Gallardo Borge, G. Medina Ojeda, H. De la Red Gallego, A. Portilla Fernánadez
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- Journal:
- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S506
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Introduction
Histrionic Personality Disorder is one of the most common personality disorders diagnosed in Psychiatry. This disorder has been known to be present in more than 40% of patients. There is also a high tendency for those diagnosed with this disorder to be female.
ObjectivesThe case is to show all the difficulties caused by this pathology, differencial diagnosis with other personality disorders, groups of characteristics from different clusters and also, complications produced in daily routine.
MethodsThe purpose is to study a clinical case of a 27-year-old woman, with a degree in journalism, who began with a depressive episode after a failed relationship. After being diagnosed of infertility, she debuted with dissociative episodes and somatization symptoms. After that, she suffered several depressive episodes. At the moment, all the clinical symptoms support the diagnosis of histrionic personality disorder.
ResultsHistrionic Personality Disorder can be found in the cluster B group of personality disorders. They often present in an overly dramatic, erratic or emotional manner. They may fulfil their need for attention through speech and behaviour that draws one's focus of attention toward themselves, and also demanding and manipulative in interpersonal relationships. There are high comorbidity rates in those who suffer from HPD with other diagnoses.
ConclusionsHistrionic Personality Disorder appears to be one of the least threatening diagnosis among personality disorders as those affected are high functioning and do not seek relief for the disorder itself. There is also very little research on HPD which makes treatment options limitless.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Health intervention in gender violence
- R. Hernandez Anton, C. Noval Canga, N. De Uribe Viloria, I. Sevillano Benito, J.A. Espina Barrio, P. Marques Cabezas, L. Gallardo Borges, A.I. Segura Rodriguez, M. Gomez Garcia, F. Uribe Ladron De Cegama
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S572
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Introduction
Male and female social roles were built on a historical inequality. Gender violence is a public health problem of the first order. We consider it important to conduct a study to improve diagnosis and interventions. From the Theory of Roles Moreno, each role has a complementary role that maintains the link. In gender violence predominates control, domination, submission and asymmetry of functions as dysfunctional elements of a relationship, which should be symmetrical.
MethodologyWe reviewed 48 stories of women who come for abuse mental health team from 2013 to 2016. We analyzed the following aspects: socio-demographic data (age, nationality, marital status, education, jobs, dependent children); reason for consultation and number of queries; violence; roles, because of maintenance and interventions.
ResultsEighty percent Spanish. It occurs at all levels of education; 60% have children; 70% were derived from primary care for others reasons; almost 90% suffered psychological violence, 25% physical and economic, sexual only 3 women, 52.08% of women adopt a submissive role, passive-aggressive 20.83% and 25% ambivalent; maintenance of the violence is reinforced by the psychological dependence that occurs in all women (one in 45.83%).
ConclusionsRoles analysis is an effective method in the diagnosis of abuse and designing appropriate intervention. Psychotherapy, benefits of a psychopharmacological treatment that lessens the suffering and lets face their difficulties. It is important to ask about abuse at any level of care, because it contributes more to cover a hidden reality. The Psychological and economic dependence. They establish and maintain the mistreatment.
Disclosure of interestThe authors have not supplied their declaration of competing interest.