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How much or how often? Examining the screening properties of the DSM cross-cutting symptom measure in a youth population-based sample
- João Pedro Gonçalves Pacheco, Christian Kieling, Pedro H. Manfro, Ana M. B. Menezes, Helen Gonçalves, Isabel O. Oliveira, Fernando C. Wehrmeister, Luis Augusto Rohde, Maurício Scopel Hoffmann
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- Psychological Medicine , First View
- Published online by Cambridge University Press:
- 19 April 2024, pp. 1-12
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Background
The DSM Level 1 Cross-Cutting Symptom Measure (DSM-XC) allows for assessing multiple psychopathological domains. However, its capability to screen for mental disorders in a population-based sample and the impact of adverbial framings (intensity and frequency) on its performance are unknown.
MethodsThe study was based on cross-sectional data from the 1993 Pelotas birth cohort in Brazil. Participants with completed DSM-XC and structured diagnostic interviews (n = 3578, aged 22, 53.6% females) were included. Sensitivity, specificity, positive (LR+), and negative (LR−) likelihood ratios for each of the 13 DSM-XC domains were estimated for detecting five internalizing disorders (bipolar, generalized anxiety, major depressive, post-traumatic stress, and social anxiety disorders) and three externalizing disorders (antisocial personality, attention-deficit/hyperactivity, and alcohol use disorders). Sensitivities and specificities >0.75, LR+ > 2 and LR− < 0.5 were considered meaningful. Values were calculated for the DSM-XC's original scoring and for adverbial framings.
ResultsSeveral DSM-XC domains demonstrated meaningful screening properties. The anxiety domain exhibited acceptable sensitivity and LR− values for all internalizing disorders. The suicidal ideation, psychosis, memory, repetitive thoughts and behaviors, and dissociation domains displayed acceptable specificity for all disorders. Domains also yielded small but meaningful LR+ values for internalizing disorders. However, LR+ and LR− values were not generally meaningful for externalizing disorders. Frequency-framed questions improved screening properties.
ConclusionsThe DSM-XC domains showed transdiagnostic screening properties, providing small but meaningful changes in the likelihood of internalizing disorders in the community, which can be improved by asking frequency of symptoms compared to intensity. The DSM-XC is currently lacking meaningful domains for externalizing disorders.
FC23: Dementia and Triadic (Doctor-Patient-Carer) Interactions in Primary Care
- C. Balsinha, F. Barreiros, M.J. Marques, S. Dias, S. Iliffe, M. Gonçalves-Pereira
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, pp. 84-85
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Objective:
Primary care visits of persons with dementia often bring together triads composed of patients, family carers and general practitioners (GPs), as previously discussed (1). Communication dynamics potentially affect dementia outcomes, not least because primary care is a health setting where these triad encounters often occur naturally. Our aim is to present further data from Portuguese primary care consultations with persons with dementia, their carers and GPs.
Methods:We refer to the conclusion of our study ‘Dementia in Primary Care: the Patient, the Carer and the Doctor in the Medical Encounter - Bayer Investigation Grant | NOVAsaúde Ageing 2018’ (1). Fieldwork was interrupted during the COVID-19 pandemic and resumed in 2022. Sixteen consultations with persons with dementia, their carers and GPs (purposive sampling) were audio- recorded and transcribed verbatim. Interactions were thematically analysed using NVIVO® software. The analytical framework combined codes derived from the transcripts with codes from the literature.
Results:Dementia-related content took up less than half of consultations’ time, despite their considerable length (as compared to the average in primary care). Most GPs assessments lacked breadth, although efforts towards positive attitudes were present. Themes specifically related to social health in dementia were not (or were poorly) covered. Frequently, carers facilitated GPs’ assessment of dementia consequences, but their own needs were neglected. Patients’ self-expression tended to be limited.
Discussion:Our findings suggest that doctor-patient interactions in many GPs’ consultations seemingly compromise patient-centred approaches. There are challenges regarding how to assess the biopsychosocial consequences of dementia in a context of fragmented care (2,3). Given the scarcity of evidence from live-recorded primary care consultations about triadic dynamics, our findings are important to guide further explorations.
P123: Cognitive Disorders and Impact on Caregivers: The COGCARE Study protocol
- M. Gonçalves-Pereira, B. Pedrosa, M. Braga, M.J. Marques, C. Balsinha, A. Verdelho, E. Albanese, for the COGCARE Study Group
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- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, pp. 252-253
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Introduction and objectives:
Dementia is associated with a high burden of disease, impacting patients, families and society. Nevertheless, related epidemiological data is becoming outdated, given the difficulties of implementing costly and laborious fieldwork surveys. Data is also difficult to retrieve from health and social services’ information systems. Overall, we must improve the feasibility and validity of case definition regarding dementia and the assessment of caregivers’ consequences. The 10/66 Dementia Research Group diagnostic algorithm is a cross-culturally valid method(1). A ‘short 10/66’ was also validated(2), but not in Portugal. We intend to assess its feasibility and validity in Portuguese samples, using REDcap (a browser-based, metadata-driven software) in mobile devices. Additionally, we aim to assess dementia family caregivers’ subjective burden and psychological distress, contrasting primary care and hospital outpatient settings.
Methods:A multicentre mixed-methods study will be conducted on fifty dyads of older people with dementia and their caregivers, plus 150 dyads of ‘controls’ and their close family members, as informants. The ‘short 10/66’ will be administered. Dementia caregivers’ assessments include the Zarit Burden Interview and Self-report Questionnaire. Quantitative analyses will estimate the sensitivity and specificity of the ‘short 10/66’ dementia case definition. Semi-structured qualitative interviews will be conducted with participants and research assistants, exploring their experiences with the assessment process; thematic analysis will then be used.
Implications:We expect this study to facilitate the diagnosis of dementia and data collection in health/social services on a routine basis, which will potentially improve the feasibility and decrease the costs of epidemiological surveys and allow for prevalence monitoring in Portugal.
The impact of COVID-19 pandemic on inpatient admissions for bipolar disorder
- C. Portela, C. Oliveira, D. Areias, M. Gonçalves
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S781
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Introduction
In 2019, there were 39.5 million patients suffering from bipolar disorder worldwide, resulting in around 8.5 million disability-adjusted life years (DALYs) and in a significant economic burden. Bipolar disorder is known to be susceptible to factors that disrupt biological and social rhythms. The COVID-19 pandemic and the measures taken to control it, such as social distancing, home confinement and lockdowns, pose a risk to the stability of bipolar patients. Other factors, for example, reduced access to treatment and stress associated with the disease could also contribute to relapses. Studies have shown that, in 2020, more people with bipolar disorder were hospitalised compared to previous years, including patients without previous history of hospitalizations.
ObjectivesThis study aims to assess the impact of the COVID-19 pandemic on inpatient admissions for bipolar disorder.
MethodsSocio-demographic and clinical data were collected from electronic medical records. A retrospective observational study of patients who were admitted to a psychiatric ward between March 2019 and February 2021 was conducted. The characteristics of patients admitted before the pandemic (March 2019 to February 2020) and after (March 2020 to February 2021) were compared statistically.
ResultsA total of 850 patient admissions were obtained, 15% of which had a main diagnosis of bipolar disorder. The authors will analyze all the variables in the population admitted. The authors expect to find differences between patients hospitalized before and after the beginning of the pandemic, both in clinical presentation (manic, depressive or mixed episode), psychiatric history, comorbidities, suicide attempts and socio-demographic factors.
ConclusionsThe COVID-19 pandemic had a significant impact on mental health on a global level, plenty of which is still unknown. The findings of this study will likely show the effects of this crisis on bipolar disorder patients.
Disclosure of InterestNone Declared
Online pornography use during the COVID-19 pandemic: a review
- C. Portela, R. Dionísio, S. M. Sousa, M. Gonçalves
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S782
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Introduction
The Coronavirus (COVID-19) pandemic and the regulations enforced to control it caused significant alterations in daily routines worldwide. Lockdowns, remote working and schooling favoured virtual interactions and increased “free-time”, with the internet posing as a preferential means of distraction. Statistics from pornographic websites have shown a rise in traffic during lockdown periods, with problematic use of pornography (POPU) emerging as a potential mental health concern.
ObjectivesThe authors aim to summarize current knowledge on the effects of the COVID-19 pandemic on online pornography use.
MethodsNarrative review of articles referenced on PubMed and Google Scholar.
ResultsThe increased exposure to the internet during the pandemic, combined with psychosocial factors such as social isolation, diminished physical contact and intimacy may have contributed to the reported surge in online pornography use. Other associated factors include emotional distress and less availability of other addictive substances and behaviours during confinement periods. Besides the spike in pornography consumption, other aspects were also affected, such as time of usage, search keywords and type of content, with an increase in engagement in illegal pornography. In susceptible individuals, these circumstances may lead to the development of POPU, characterized by impaired control, excessive time spent and perceived negative consequences. Currently, there is a lack of consensual diagnostic criteria for POPU, hindering the detection of these patients and timely management.
ConclusionsBehavioural addictions are an emerging mental health problem, particularly the ones related to internet use. In the aftermath of the pandemic, considering the reported rise in online pornography use, an increase in POPU prevalence is expected. Therefore, more accurate and consensual diagnostic criteria are required, as well as a greater amount of evidence on the treatment of this disorder, in order to improve the approach to these patients.
Disclosure of InterestNone Declared
LATE ONSET PSYCHOSIS AND VERY LATE ONSET PSYCHOSIS: WHAT ARE THE POSSIBLE ETHIOLOGIES?
- A. C. Ramos, S. C. Martins, T. M. Afonso, N. B. Santos, P. Gonçalves, T. Maia
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1039
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Introduction
Psychotic symptoms have long been known to show up earlier in life, typically during adolescence and early adulthood. Late Onset Psychosis (LOP), in which symptoms start between 40 and 60 years of age, and Very Late Onset Psychosis (VLOP), in which onset of symptoms happens after 60 years of age, although classically rare, have had a growing prevalence in the last decades.
ObjectivesTo access the definition and main etiologies of LOP and VLOP, based on the current literature.
MethodsNon-systematic review of literature using the terms “late onset psychosis” and “very late onset psychosis”. Case report of a patient who was admitted and treated in our inward patient field.
Results51-year-old female patient. She is divorced (two previous marriages) and has two daughters (26 and 16, respectively). She was brought by police officers because of behavior problems at the shelter where she was living. She was evicted from the house she was living in because of delay in paying the rent. On observation, she verbalizes persecutory and prejudicial delusions and auditory hallucinations on the 2nd and 3rd person (commenting voices) with at least 5 years of duration. She was hospitalized for almost 3 months, with slow but progressive clinical improvement on haloperidol 7,5mg/day. At the date of discharge, she did not spontaneously verbalize her symptoms, although she did not recognize them as delusional. Recent studies have shown that the prevalence of Schizophrenia in the typical age range is 75-80%, which means that an important proportion of diagnosis is made after that age span. Primary causes of LOP and VLOP are schizophrenia (of late onset), schizophrenia-like very late onset psychosis, delusion disorder, unipolar depression with psychotic symptoms and bipolar disorder. Secondary causes should also be considered, such as delirium, dementia (Alzheimer’s, Lewi bodies and vascular), and substances abuse; even more rare, other conditions should be considered, as cerebrovascular accident, encephalitis, epilepsy, and multiple sclerosis.
ConclusionsLOP and VLOP have been a growing diagnosis in the past decades. In the assessment of these patients, we must consider the importance of secondary etiologies besides the primary psychiatric ones. Primary psychosis is a diagnosis of exclusion, and the clinician must rule out secondary causes. Recent data point out these symptoms as markers for an increased risk of dementia in these patients. Further research involving individuals with LOP and VLOPs is required to increase the evidence base for treatment and improve outcomes of care.
Disclosure of InterestNone Declared
Late diagnosis of attention deficit hyperactivity disorder and cocaine abuse
- C. De Andrés Lobo, C. Vallecillo Adame, T. Jiménez Aparicio, M. Queipo de Llano de la Viuda, G. Guerra Valera, A. A. Gonzaga Ramírez, M. Fernández Lozano, N. Navarro Barriga, M. J. Mateos Sexmero, B. Rodríguez Rodríguez, M. Calvo Valcárcel, M. Andreo Vidal, M. P. Pando Fernández, P. Martínez Gimeno, I. D. L. M. Santos Carrasco, J. I. Gonçalves Cerejeira, A. Rodríguez Campos
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S335-S336
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Introduction
Adult ADHD diagnosis sometimes represents a challenge for the clinician, due to the comorbid psychiatric diseases that are often associated and which complicate de recognition of the primary symptoms of ADHD. The prevalence of ADHD in adult populations is 2’5% and it is a relevant cause of functional impairment.
ObjectivesPresentation of a clinical case of a male cocaine user diagnosed with adult ADHD.
MethodsLiterature review on adult ADHD and comorbid substance abuse.
ResultsA 43-year-old male who consulted in the Emergency Department due to auditory hallucinosis in the context of an increase in his daily cocaine use. There were not delusional symptoms associated and judgment of reality was preserved. Treatment with olanzapine was started and the patient was referred for consultation. In psychiatry consultations, he did not refer sensory-perceptual alterations anymore, nor appeared any signals to suspect so, and he was willing to abandon cocaine use after a few appointments. He expressed some work concerns, highlighting that in recent months, in the context of a greater workload, he had been given several traffic tickets for “distractions.” His wife explained that he had always been a inattentive person (he forgets important dates or appointments) and impulsive, sometimes interrupting conversations. In the Barkley Adult ADHD Rating Scale he scored 32 points.
He was diagnosed with adult ADHD and treatment with extended-release methylphenidate was started with good tolerance and evolution, with improvement in adaptation to his job and social environment. Since then, the patient has moderately reduced the consumption of drugs, although he continues to use cocaine very sporadically.
ConclusionsEarly detection of ADHD and its comorbidities has the potential to change the course of the disorder and the morbidity that will occur later in adults. Comorbidity in adult ADHD is rather the norm than the exception, and it renders diagnosis more difficult. The most frequent comorbidities are usually mood disorders, substance use disorders, and personality disorders. Treatment of adult ADHD consists mainly of pharmacotherapy supported by behavioral interventions. When ADHD coexists with another disorder, the one that most compromises functionality will be treated first and they can be treated simultaneously. The individual characteristics of each patient must be taken into account to choose the optimal treatment.
Disclosure of InterestNone Declared
COVID-19 pandemic and involuntary admitted patients in a Psychiatric Service
- C. Portela, C. Oliveira, M. Gonçalves
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S781-S782
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Introduction
The COVID-19 pandemic had a major impact on mental health globally, resulting in a need for adaptation of mental health services. The psychosocial consequences of this crisis, such as psychological stress, reduction of community care and social support, are known factors that increase the risk of psychiatric decompensation. Compulsory admission is the last line of intervention in individuals who suffer from severe mental disorders and refuse treatment, based on the principles of therapeutic need and social protection. In Portugal, the last law regulating the compulsory admission is in forme since 2004 (Law 36/98 of 24 July), and configures this measure as a hospitalization by court order, happening the same in other European countries. The literature shows that in 2020 there was a significant increase in the proportion of involuntary inpatient admissions for all psychiatric diagnosis.
ObjectivesThis study aims to assess the impact of the COVID-19 pandemic on involuntary admissions to an acute psychiatric service.
MethodsSocio-demographic and clinical data were collected from electronic medical records. A retrospective observational study of patients who were admitted in a General Psychiatric Unit of Hospital Magalhães Lemos between March 2019 and February 2021 was conducted. The characteristics of patients admitted before the pandemic (March 2019 to February 2020) and after (March 2020 to February 2021) were compared statistically.
ResultsA total of 850 patient admissions were obtained, of which 28% were involuntary. The authors expect to find differences between involuntary inpatient admissions before and after the COVID-19 pandemic in proportion of patients, socio-demographic and clinical factors.
ConclusionsThe findings of this study will likely show an increase in involuntary admissions during the pandemic, in agreement with current knowledge. More studies are needed to assess the long-term impact of the pandemic on mental health.
Disclosure of InterestNone Declared
Prescription drug abuse in migrants from Middle Eastern and North African countries: a review
- C. Portela, C. Oliveira, M. Gonçalves
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S658-S659
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Introduction
In recent years, there has been a rise in misuse of low-cost prescription pills across Middle Eastern and North African (MENA) countries. In Algeria, Tunisia and Morocco, for example, the consumption of prescription medications has dramatically increased, particularly amongst young and marginalized groups. Drugs such as clonazepam and pregabalin are extremely popular in these regions, as they are relatively inexpensive and perceived as safe. With the migration of MENA citizens to Europe, it is likely that mental health services will come across substance use disorders related to these medications.
ObjectivesThe authors aim to analyse prescription medication misuse reports from MENA countries, specifically pregabalin and clonazepam, and review the pharmacological, neurobiological and social factors that contribute to their potential for abuse.
MethodsNarrative review of articles referenced on PubMed and Google Scholar.
ResultsPregabalin and clonazepam are widely used in psychiatry and neurology. Pregabalin is an alpha 2 omega ligand with supposed GABA-mimetic properties. Anecdotal reports suggest that pregabalin, used recreationally in amounts up to 3-20 times the therapeutic doses, possesses both sedative and psychedelic effects. Experimenters are mainly individuals with a history of recreational polydrug use, who are aware that pregabalin is not included in standard drug monitoring tests, with this molecule being used in some instances as a legal substitute of common illegal drugs. Clonazepam is a benzodiazepine that combines high potency and a long duration of action and is said to cause euphoria at doses over 8mg. It is very popular and affordable, placing consistently in the top three of benzodiazepines sales across the globe. Clonazepam has potential for tolerance build up and severe withdrawal symptoms. These medications are frequently used together and in combination with other substances such as alcohol and opiates, increasing the risk for respiratory failure and death.
ConclusionsPrescription medications such as pregabalin and clonazepam are extremely accessible, inexpensive and highly addictive substances, whose abuse is well disseminated across MENA countries. With migratory flows from this region, the prevalence of misuse of these drugs in Europe is expected to increase. Therefore, physicians should be aware of their potential for abuse and carefully evaluate patients’ previous history before prescribing these medications.
Disclosure of InterestNone Declared
“The cat and the calcium”. A case of delirium secondary to hypercalcaemia.
- T. Jiménez Aparicio, C. Vallecillo Adame, C. de Andrés Lobo, G. Medina Ojeda, M. Queipo de Llano de la Viuda, A. A. Gonzaga Ramírez, G. Guerra Valera, M. Fernández Lozano, M. J. Mateos Sexmero, B. Rodríguez Rodríguez, N. Navarro Barriga, M. A. Andreo Vidal, M. Calvo Valcárcel, P. Martínez Gimeno, M. P. Pando Fernández, I. D. L. M. Santos Carrasco, J. I. Gonçalves Cerejeira
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S946-S947
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Introduction
Interconsultation with the psychiatry service is frequently requested from other specialties for the assessment and treatment of patients who present neuropsychiatric symptoms secondary to organic alterations. On the other hand (and in relation to this case), within the possible causes for the elevation of calcaemia figures, the most frequent are hyperparathyroidism and neoplasms, representing between these two entities 90% of cases (1).
Among the organic mental disorders, Delirium stands out, with an approximate prevalence between 1 and 2% (general population), which increases in hospitalized and elderly patients (2).
ObjectivesPresentation of a clinical case about a patient with delirium secondary to hypercalcemia, with hallucinations and behavioral disturbance.
MethodsBibliographic review including the latest articles in Pubmed about delirium (causes and treatment) and hypercalcaemia secondary to neoplasms.
ResultsWe present a 52-year-old male patient, who went to the emergency room accompanied by his wife, due to behavioral alteration. Two days before, he had been evaluated by Neurology, after a first epileptic crisis (with no previous history) that resolved spontaneously. At that time, it was decided not to start antiepileptic treatment.
The patient reported that he had left his house at midnight, looking for a cat. As he explained, this cat had appeared in his house and had left his entire bed full of insects. His wife denied that this had really happened, and when she told the patient to go to the emergency room, he had become very upset.
As background, the patient used to consume alcohol regularly, so the first hypothesis was that this was a withdrawal syndrome. However, although the consumption was daily, in recent months it was not very high, and at that time no other symptoms compatible with alcohol withdrawal were observed (tremor, tachycardia, sweating, hypertension…).
We requested a general blood test and a brain scan. The only relevant finding was hypercalcaemia 12.9mg/dL (which could also be the origin of the previous seizure). It was decided to start treatment with Diazepam and Tiapride in the emergency room, with serum perfusion, and keep under observation. After several hours, the patient felt better, the hallucinations disappeared, and calcium had dropped to 10.2mg/dL. A preferential consultation was scheduled, due to suspicion that the hypercalcaemia could be secondary to a tumor process.
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ConclusionsIt is important to rule out an organic alteration in those patients who present acute psychiatric symptoms. Hypercalcaemia is frequently associated with tumor processes (1) due to secretion of PTH-like peptide (4), so a complete study should be carried out in these cases.
Delirium has a prevalence between 1 and 2% in the general population (2).
Psychopharmacological treatment is used symptomatically, with antipsychotics (3). For the episode to fully resolve, the underlying cause must be treated.
Disclosure of InterestNone Declared
My stomach is full
- M. Queipo De Llano De La Viuda, A. Gonzaga Ramírez, N. De Uribe Viloria, G. Guerra Valera, T. Jiménez Aparicio, C. Vallecillo Adame, C. De Andrés Lobo, I. Santos Carrasco, J. Gonçalves Cerejeira, N. Navarro Barriga, M.J. Mateos Sexmero, B. Rodríguez Rodríguez, M. Fernández Lozano
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S583
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Introduction
Anorexia nervosa is an eating behavior disorder that is often related to various personality factors. The relationship between obsessive compulsive disorder and eating Disorders has been highlighted.
ObjectivesTo present a clinical case of a patient with eating disorder and gastric bezoar, secondary to compulsive hair ingestion.
MethodsBibliographic review of articles published in relation to the comorbidity of these disorders, based on articles published in the last 5 years in Pubmed.
Results26-year-old female. Diagnosis of restrictive anorexia nervosa. She was admitted to the hospital on two occasions for nutritional disorders. In the last admission, she reported greater anxiety and significant weight loss. She reports that she has limited her food intake, but she does feel thin and is unable to eat for fear of gaining weight. Ruminative thoughts about her body image. During admission, the patient expressed a sensation of fullness, nausea and vomiting, later observing in abdominal X-ray and gastroscopy, the presence of a gastric trichobezoar, which was finally resolved conservatively.
ConclusionsTrichotillomania is observerd in 1 in 2000 people, trichophagia is even less frequent. According to DSM- V, these disorders are grouped within obsessive-compulsive spectrum disorders. A Trichobezoar is a conglomerate that can be found in the stomach or intestine, composed mainly of hair, previously ingested. Trichotillomania can be associated with anorexia nervosa, especially in patients with obsessive personality traits, which occurs frequently. The gastric slowing that patients with anorexia often present is a factor that favors the formation of the bezoar
DisclosureNo significant relationships.
Alcohol abuse among women: a review with a gender perspective
- J. Gonçalves Cerejeira, I. Santos Carrasco, C. Vallecillo Adame, C. De Andrés Lobo, T. Jiménez Aparicio, M. Queipo De Llano De La Viuda, A. Gonzaga Ramírez, G. Guerra Valera
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S820
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Introduction
The harmful use of alcohol is an important risk factor for the health of the population around the world. The incidence of alcohol dependence in women is increasing and both its consumption pattern and its consequences have unique characteristics.
ObjectivesTo present a literature review focused on alcohol use disorder with a gender perspective.
MethodsLiterature review.
Results- Women use to start using alcohol sooner than men and this seems to be a risk factor to become addicted. - Due to physiological and psychological factors women experience more negative health effects from excessive alcohol use than men and it occurs at lower levels of use. - Psychiatric comorbidity associated with alcohol abuse such as anxiety and depression is more common in women and this in turn worsens the alcohol use disorder. - Alcohol consumption increases the vulnerability of women on several levels, including an increased risk of physical abuse.
ConclusionsAlcohol abuse among women deserves special attention and a specific intervention focused on the gender perspective.
DisclosureNo significant relationships.
Something inside my head
- T. Jiménez Aparicio, G. Medina Ojeda, C. De Andrés Lobo, C. Vallecillo Adame, J. Gonçalves Cerejeira, I. Santos Carrasco, G. Guerra Valera, A. Gonzaga Ramírez, M. Queipo De Llano De La Viuda, N. Navarro Barriga, M. Fernández Lozano, B. Rodríguez Rodríguez, M.J. Mateos Sexmero, N. De Uribe Viloria
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S740
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Introduction
Electroconvulsive therapy (ECT) is a medical treatment for those patients with high suicide risk or refractory psychiatric disorders. It is currently a safe technique, and its effectiveness has been widely demonstrated.
ObjectivesPresentation of a clinical case about a patient with drug-resistant delusional disorder and high suicide risk, who eventually received ECT treatment.
MethodsBibliographic review including the latest articles in Pubmed about ECT procedure, effects and use.
ResultsWe present a 45-year-old man, who visited different doctors several times by reporting he had the feeling of “having a brain tumor or a vascular disorder”, so he requested imaging tests (computed tomography and magnetic resonance). These tests were absolutely normal, but he kept thinking something was wrong, and eventually attempted suicide by hanging (his family founded him before it was too late). The patient was admitted to hospital, and started psychopharmacological treatment, with minimal response. He desperately insisted that he had “something inside his head”. At this point, it was proposed to start ECT, and the patient accepted. After 6 bilateral ECT sessions, he was visibly more relaxed and less worried, and he no longer presented autolytic ideation. He was still a little bit suspicious about the feeling of having a neurological disease. Currently, the patient runs a follow-up consultation.
ConclusionsElectroconvulsive therapy is a safe and effective technique for those patients with high suicide risk. It may be useful to perform imaging tests in certain cases, for detecting intracranial pressure, acute hemorrhage, tumors… A follow-up of these patients must be performed
DisclosureNo significant relationships.
The phenomenology of motivation
- R. André, J. Romão, F. Azevedo, M. Gonçalves, C. Sereijo, R. Saraiva, M. Croca, M. Abreu
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S705
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Introduction
The concept of motivation pervades our professional and personal lives. Motivation is almost impossible to be observed directly, it is a construct for the interpretation of a behaviour that “calls the attention”.
ObjectivesThis work reviews the current available data on the phenomenological description of motivation and the abnormalities of motivation.
MethodsNon-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “motivation”, “psychopathology”, “phenomenology”.
ResultsAbnormalities in motivation may involve diminution or exacerbation. Anhedonia is the absence of pleasure in relation to usually pleasurable activities, it occurs in depression and schizophrenia where the pleasurable intrinsic motivation that acts as incentive for behaviour may be lost. In mania it may be increased so that mundane activities become unduly fascinating and rewarding.
ConclusionsCountless theories have been proposed to explain human motivation but each sheds light on specific aspects of motivation, neglecting others. This diversity creates confusion because most theories have areas of conceptual overlap and disagreement. To facilitate the development of studies, an agreement should be achieved on an operational definition of motivation.
DisclosureNo significant relationships.
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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- Journal:
- 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.
Covid-19 pandemic and suicidal risk among adolescents
- J. Gonçalves Cerejeira, C. Vallecillo Adame, S. Uribe, I. Santos Carrasco, T. Jiménez Aparicio, C. De Andrés Lobo, M. Queipo De Llano De La Viuda, A. Gonzaga Ramírez, G. Guerra Valera
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S436
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Introduction
The Covid-19 pandemic has had a significant impact on the mental health of adolescents. Several descriptive studies and systematic reviews have shown an increase in suicide rates in this age group.
Objectives- To present a literary review on the impact of the Covid-19 pandemic on the mental health and suicidal behavior of adolescents around the world. - To present data on admission rates due to suicidal behavior during the first year of the Covid-19 pandemic in a Spanish child-adolescent psychiatric hospitalization unit.
Methods- We will present a literature review and a retrospective cross-sectional study on admission rates for suicidal behavior in a child-adolescent psychiatric hospitalization unit. - Admission rates for suicidal behavior during the year prior to the pandemic will be compared with rates relative to the first year of the pandemic.
Results- We have found a significant increase in admission rates for suicidal behavior during the year of the pandemic. Similar results have been found in different studies and meta-analyzes. - The socio-demographic characteristics of the patients are quite similar in the two periods of time analyzed, but the reference to intra-family problems has been more frequent in the year of the pandemic.
ConclusionsOur data is in line with other studies suggesting that the Covid-19 pandemic has had a strong impact on teenage suicidal behavior.
DisclosureNo significant relationships.
Traumatic brain injury, antisocial personality disorder and alcohol
- C. De Andrés Lobo, T. Jiménez Aparicio, C. Vallecillo Adame, M. Queipo De Llano De La Viuda, A. Gonzaga Ramírez, G. Guerra Valera, I. Santos Carrasco, J. Gonçalves Cerejeira, M. Fernández Lozano, B. Rodríguez Rodríguez, N. Navarro Barriga, M.J. Mateos Sexmero, N. De Uribe Viloria, G. Medina Ojeda
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S667
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Introduction
Traumatic brain injury (TBI) can cause changes in the personality and behaviors. History of TBI has been associated with violent behavior and substance abuse.
ObjectivesPresentation of a clinical case of a patient with antisocial personality traits who suffered a TBI and abuses alcohol.
MethodsWe conducted a bibliographic review by searching for articles published the last 5 years in Pubmed
ResultsWe present the case of a 48-year-old male patient with a history of myoclonic epilepsy, who suffered a TBI in a car crash. During his stay at ICU antisocial and borderline personality traits were found. When he came to consultations, he presented signs of alcohol intoxication (verbiage with hasty and dysarthric speech, and psychomotor incoordination). He acknowledges daily alcohol intake, although he minimizes it. During the interview he is irritable, prone to anger when contradicted and boasts of episodes of heteroaggressiveness and violence that he has carried out in the past. He reports morning sickness and tremors, but does not accept that they may be due to alcohol withdrawal. There is no motivation for change.
ConclusionsIt has been determined that history of TBI is more frequent in individuals with antisocial personality. TBI has been linked to violent behaviors, poor inhibitory control, engaging in illegal acts and higher rates of substance abuse. However, the causal relationship between antisocial behavior and TBI has yet to be clarified, as the available evidence does not show which comes first. More research is needed in the future that takes into account the temporal sequence of events.
DisclosureNo significant relationships.
Migration and psychosis: the link between them
- C. De Andrés Lobo, T. Jiménez Aparicio, C. Vallecillo Adame, A. Gonzaga Ramírez, G. Guerra Valera, I. Santos Carrasco, J. Gonçalves Cerejeira, M. Fernández Lozano, B. Rodríguez Rodríguez, N. Navarro Barriga, M.J. Mateos Sexmero, N. De Uribe Viloria
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S217
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Introduction
Migrations are a source of stress for patients, which can have repercussions on their Mental Health. We present the case of a native Senegalese patient who presented a first psychotic episode.
ObjectivesPresentation of a clinical case of an immigrant patient with a psychotic disorder.
MethodsBibliographic review on migration and psychosis by searching for articles in Pubmed.
ResultsWe present the case of a patient of 20 years, a native of Senegal, who has been living in Spain for 3 months in a shelter home. He has no family or relations in Spain, and only speaks Wolof, presenting serious difficulties in communication with healthcare workers. He came to Hospital with his social worker because strange behaviors had been observed. He presented delusional ideation of self-referential and mystical-religious content, related to “the prophet” and “the need to fulfill a mission”. He also presented auditory hallucinations that he identified as of divine origin, and ordered him to perform behaviors such as picking hairs from the ground and various rituals. He acknowledges cannabis and alcohol use in the previous days. Paliperidone treatment was started. Throughout the admission, he begins to show concern for the state of his relatives in Senegal and the need to send them money.
ConclusionsMultiple studies indicate that migrants are at higher risk of psychosis, specially those from countries where the majority of population was black, according to some series. The challenge lies in understanding the mechanisms underlying this increased incidence, taking into account psychosocial factors such as social isolation and trauma.
DisclosureNo significant relationships.
Psychosis: Risk Factors and Prognosis
- M. Fernández Lozano, I. Santos Carrasco, B. Rodríguez Rodríguez, N. Navarro Barriga, M.J. Mateos Sexmero, T. Jiménez Aparicio, C. De Andrés Lobo, C. Vallecillo Adame, M. Queipo De Llano De La Viuda, G. Guerra Valera, A. Gonzaga Ramírez, J. Gonçalves Cerejeira, O. Segurado Martín
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S313
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Introduction
There are life events that may increase the possibilities of suffering some kind of Psychopathology. The most validated model for understanding the aetiology of psychosis is based on genetic and environmental risk factors and their interaction, likely involving epigenetic mechanisms. It is necessary to consider those events as risk factors for Mental Health.
ObjectivesStudy of risk and prognostic factors in psychosis.
MethodsReview of scientific literature based on a relevant clinical case.
ResultsWe present the case of a 28-year-old male patient from Peru, currently living in Germany. History of sexual abuse in childhood. He started taking drugs at the age of 8. In the emergency department, he reports that since the beginning of the pandemic, after listening to a speech by the Pope, he begins to interpret signals about situations occurring around him. He begins to read about mystical-religious subjects, changes the style of music he listens to and recognises changes in his personality. He says for months he has been feeling watched, persecuted and expresed someone wants to kill him. He says hears voices and that they communicate with him through bodily sensations.
ConclusionsChildhood trauma, immigration and cannabis use are significantly associated with an increased risk of functional psychosis. A neurotic personality also independently contributes to this risk. The accumulation of these factors increases vulnerability to mental disorders and leads to a worse prognosis and evolution of these pathologies. These findings could help to improve the prevention of psychosis and the development of specific treatment strategies in this particular population.
DisclosureNo significant relationships.