1217 results
Effect of depression treatment on health behaviors and cardiovascular risk factors in primary care patients with depression and elevated cardiovascular risk: data from the eIMPACT trial
- Matthew D. Schuiling, Aubrey L. Shell, Christopher M. Callahan, John I. Nurnberger, Jr., Krysha L. MacDonald, Robert V. Considine, Wei Wu, Adam T. Hirsh, Christopher A. Crawford, Michelle K. Williams, Timothy C. Lipuma, Samir K. Gupta, Richard J. Kovacs, Bruce L. Rollman, Jesse C. Stewart
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- Psychological Medicine , First View
- Published online by Cambridge University Press:
- 10 September 2024, pp. 1-14
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Background
Depression is an independent risk factor for cardiovascular disease (CVD), but it is unknown if successful depression treatment reduces CVD risk.
MethodsUsing eIMPACT trial data, we examined the effect of modernized collaborative care for depression on indicators of CVD risk. A total of 216 primary care patients with depression and elevated CVD risk were randomized to 12 months of the eIMPACT intervention (internet cognitive-behavioral therapy [CBT], telephonic CBT, and select antidepressant medications) or usual primary care. CVD-relevant health behaviors (self-reported CVD prevention medication adherence, sedentary behavior, and sleep quality) and traditional CVD risk factors (blood pressure and lipid fractions) were assessed over 12 months. Incident CVD events were tracked over four years using a statewide health information exchange.
ResultsThe intervention group exhibited greater improvement in depressive symptoms (p < 0.01) and sleep quality (p < 0.01) than the usual care group, but there was no intervention effect on systolic blood pressure (p = 0.36), low-density lipoprotein cholesterol (p = 0.38), high-density lipoprotein cholesterol (p = 0.79), triglycerides (p = 0.76), CVD prevention medication adherence (p = 0.64), or sedentary behavior (p = 0.57). There was an intervention effect on diastolic blood pressure that favored the usual care group (p = 0.02). The likelihood of an incident CVD event did not differ between the intervention (13/107, 12.1%) and usual care (9/109, 8.3%) groups (p = 0.39).
ConclusionsSuccessful depression treatment alone is not sufficient to lower the heightened CVD risk of people with depression. Alternative approaches are needed.
Trial Registration:ClinicalTrials.gov Identifier: NCT02458690
Predictors of postpandemic preparedness for special pathogens
- Morgan M. Kuhnly, Caitlin M. Adams Barker, Kathleen O. Stewart, Justin J. Kim
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- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 4 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 09 September 2024, e122
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In this survey of 31 hospitals, large metropolitan facilities had a 9.5-fold odds of reporting preparedness for special pathogens; hospitals with special pathogens teams had a 14.3-fold odds of reporting preparedness for special pathogens. In the postpandemic world, healthcare institutions must invest in special pathogen responses to maximize patient safety.
Liquor for breakfast, fighting against alcohol consumption
- N. Navarro Barriga, P. Marqués Cabezas, M. B. Arribas Simón, B. Rodríguez Rodríguez, C. Alario Ruiz, G. Guerra Valera, A. Aparicio Parras, M. J. Mateos Sexmero, M. Fernández Lozano, P. Martínez Gimeno, M. A. Andreo Vidal, M. Calvo Valcárcel, M. P. Pando Fernández, M. D. L. A. Guillén Soto, T. Jimenez Aparicio, M. D. C. Vallecillo Adame, C. De Andrés Lobo
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S408-S409
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Introduction
The harmful consumption of alcohol is known for how tortuous its management can be in mental health, encouraging introspection of it as a serious problem is perhaps the main key to starting to battle against its damaging influence on the development of a functional and full life.
ObjectivesTo describe a clinical case showing an unpredictible complication in an alcohol detoxification process.
Methods54-year-old man, native of Cádiz, widowed for half a decade, without children. He resides with his parents in the family home. Currently unemployed for approximately a year. He has previously worked in the IT sector. As a notable somatic history, we found long-established arterial hypertension and a total hip replacement. He has been under irregular follow-up with a mental health team for anxiety-depressive symptoms in the context of grief. He goes to the emergency service brought by his family to begin the detoxification process in the hospital setting. He acknowledges ethanol consumption since he was widowed, which began when he awakes; quantities that ranged between one or up to three bottles of distilled liquor per day, generally consumption is in the home environment. A little less than a year ago, he began to isolate himself in his room and abandon his self-care, eating increasingly insufficient food intake, refusing to receive professional care to quit the habit, mainly because he did not recognize it as disruptive.
The patient was admitted to hospital with symptoms suggestive of withdrawal, making it extremely difficult to control blood pressure levels. On the third day of admission to the acute care unit, fever peaks, blood pressure levels well below normal parameters, and compromised level of consciousness began to be evident.
ResultsBlood tests were performed that, together with the clinical picture, suggested imminent septic shock, so critical care was contacted for transfer and stabilization. A germ of probable urinary etiology sensitive to a broad spectrum of antibiotics was isolated in blood cultures, and the medication of the detoxification process was progressively optimized. Once clinical stability was achieved at all levels, an inpatient cessation resource was managed, which the patient accepted and considered suitable for his complete recovery.
ConclusionsA holistic approach to the alcoholic patient is important, since serious problems of an organic nature often arise. This is why a multidisciplinary intervention is necessary, as well as a holistic approach to care, involving both classic pharmacology and assiduous long-term psychotherapeutic intervention.
Disclosure of InterestNone Declared
A man stitches his mouth in the context of a personality disorder
- A. Monllor Lazarraga, P. Marques Cabezas, L. Rojas Vazquez, M. Rios Vaquero, G. Lorenzo Chapatte, T. Jimenez Aparicio, C. De Andres Lobo, C. Vallecillo Adame, M. J. Mateos Sexmero, N. Navarro Barriga, B. Rodriguez Rodriguez, M. Fernandez Lozano, M. A. Andreo Vidal, M. Calvo Valcarcel, M. P. Pando Fernandez, P. Martinez Gimeno, G. Guerra Valera
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S654-S655
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Introduction
A 28 year old patient will be presented. This paramilitary man was brought to the Emergency Room due to an autolytic attempt with Benzodiazepines, along with a mouth suture, in the context of a soon to be resolved problematic ankle osteosynthesis procedure. The patient claimed to be suffering pain, furthermore struggling due to the fact he could not be working due to his ankle issue. Language barrier was a problem during the interview.
ObjectivesThe objetives of this case is to try to explain the issues that may arise in patients with personality disorders in the context of an autolytic attempt
MethodsThis patient will be presented, along with systematic bibliography review of the topic.
ResultsThe following results were extracted upon the attention given to this patient which was admitted to the Psychiatric Unit.
First of all, the mouth stitches were removed, along with a petition for toxicological analysis. The results gave positive for cannabis and benzodiazepines. The patient was also brought previously this year with another autolytic attempt, this time on cocaine consumption too. Furthermore, a thorough review was made of the other autolytic attempts, including those which happened in his country of origin. The patient has hundreds of small cuts among his arms, from previews cuts made in the past. Furthermore, subcutaneous wounds were auto inflicted in the ER, with a small blade.
Among the whole interview, it was clear he had a personality disorder, with high impulsivity levels and lack of control once the situation overflows.
We also tried to understand the outcome of suturing his mouth. The patient referred his acts of impulsiveness due to his overwhelming situation of both having no job at this moment and the pain he was suffering due to his ankle procedure.
The patient was admitted to our Unit due to the high risk he could repeat this act. Upon arrival, the same day he was admitted, the patient asked if he had to stay at the unit. When explaining the following already told event, furthermore insisting in the possibility of been evaluated by the Traumatology team, he proceeded to try and hang himself with his medical-hospital clothing.
The patient was treated with antipsychotics. Along with Lormetazepam at night. At the end of the hospitalization, and after been evaluated by the Psychiatrist of this Unit, the patient was also treated with Lithium due to its effectiveness in the treatment of autolytic attempts.
ConclusionsPersonality disorders are one of the psychiatric pathologies that prevail with greater frequency in autolytic attempts 1. Additionally, it should be taken into account the possible ongoing consumption of psychoactive drugs that could also derive in psychopathological decompensation. On top of the following, the use of antipsychotic treatment is indicated for the managing of conduction altercations 2, besides Lithium being a great option in managing suicidal temptations 3.
Disclosure of InterestNone Declared
From schizotypy to psychosis: is it a natural continuum?
- M. A. Andreo Vidal, M. B. Arribas Simón, M. Calvo Valcárcel, M. P. Pando Fernández, P. Martínez Gimeno, M. D. L. Á. Guillén Soto, B. Rodríguez Rodríguez, N. Navarro Barriga, M. Fernández Lozano, M. J. Mateos Sexmero, C. De Andrés Lobo, M. D. C. Vallecillo Adame, T. Jiménez Aparicio, Ó. Martín Santiago, A. Monllor Lazarraga, M. Ríos Vaquero, L. Rojas Vázquez, L. Sobrino Conde, A. Apario Parra, G. Lorenzo Chapatte
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S658-S659
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Introduction
Schizotypal personality is a condition suffered by 4% of the population. It is defined by presenting interpersonal, behavioral and perceptual features similar to the clinical features of psychotic disorders, such as schizophrenia, in less intensity and dysfunctionality, but at risk of reaching psychosis.
ObjectivesPresentation of a clinical case about a patient with premorbid schizotypal personality traits presenting with an acute psychotic episode.
MethodsLiterature review on association between schizotypal personality and psychosis.
ResultsA 57-year-old woman with a history of adaptive disorder due to work problems 13 years ago, currently without psychopharmacological treatment, goes to the emergency room brought by the emergency services due to behavioral alteration. She reports that “her husband and son wanted to sexually abuse her”, so she had to run away from home and has been running through the streets of the town without clothes and barefoot.
Her husband relates attitude alterations and extravagant behaviors of years of evolution, such as going on diets of eating only bread for 40 days or talking about exoteric and religious subjects, as believing that the devil got inside her husband through a dental implant. He reports that these behaviors have been accentuated during the last month. She has also created a tarot website, and has even had discussions with several users. She is increasingly suspicious of him, has stopped talking to him and stays in his room all day long, with unmotivated laughter and soliloquies.
It was decided to admit him to Psychiatry and risperidone 4 mg was started. At the beginning, she was suspicious and reticent in the interview. As the days went by, communication improved, she showed a relaxed gesture and distanced herself from the delirious ideation, criticizing the episode.
ConclusionsIn recent years, there has been increasing interest in understanding the association between schizotypy and serious mental disorder. Several theories understand schizotypy as a natural continuum of personality that reveals genetic vulnerability and that can lead to psychotic disorder when added to precipitating factors. Other theories define schizotypy as a “latent schizophrenia” where symptoms are contained and expressed in less intensity.
Around 20% evolves to paranoid schizophrenia or other serious mental disorders. It is complex to distinguish between those individuals in whom schizotypy is a prodrome and those in whom it is a stable personality trait. To date, studies applying early psychotherapeutic or pharmacological interventions have had insufficient and contradictory results, and the follow-up and treatment of these individuals could be a stress factor and a stigma. Some studies are looking for reliable markers of evolution to schizophrenia in order to establish adequate protocols for detention, follow-up and treatment.
Disclosure of InterestNone Declared
Conversive and Factitious disorders: Differential diagnosis based on a case report
- M. Fernandez Lozano, B. Rodriguez Rodriguez, N. Navarro Barriga, M. J. Mateos Sexmero, C. Alario Ruiz, L. Rodriguez Andrés, G. Medina Ojeda, T. Jimenez Aparicio, C. Vallecillo Adame, C. De Andres Lobo, M. A. Andreo Vidal, P. Martínez Gimeno, M. Calvo Valcarcel, M. P. Pando Fernández, L. Rojas Vazquez, M. Rios Vaquero, G. Lorenzo Chapatte, A. Monllor Lazarraga
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S444
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Introduction
Conversive disorder is characterised by the presence of one or more involuntary neurological symptoms that are not due to a clear medical pathology. On the other hand, consciously simulated illnesses fall into two diagnostic categories: factitious disorders and malingering, which are differentiated by both the motivation for the behaviour and the awareness of that motivation. Factitious disorder behaviours are motivated by an unconscious need to assume the sick role, whereas malingering behaviours are consciously driven to achieve external secondary gains.
ObjectivesStudy of the differences between conversion disorder and factitious disorder and their repercussions from a case of difficult diagnosis.
MethodsBibliographic review of scientific literature based on a relevant clinical case.
ResultsWe present the case of a 14-year-old male patient. Adoptive parents. Studying in high school. Social difficulties since childhood. He comes to the emergency department on several occasions referring stereotyped movements and motor tics in the four extremities with left cervical lateralization. Increase of these symptoms in the last month, so it was decided to admit him to the pediatric hospital. After observation and study of the patient’s movements with normal complementary tests he should return home. The following day he returned to the emergency department after an episode of dizziness, mutism and emotional block. It was decided to admit him to Psychiatry for behavioral observation and differential diagnosis.
ConclusionsIn the assessment of patients it is essential to make an appropriate diagnosis taking into account the patient’s symptomatology and the patient’s background and life context. Conversion disorder is the unintentional production of neurological symptom, whereas malingering and factitious disorder represent the voluntary production of symptoms with internal or external incentives. They have a close history and this has been frequently confounded. Practitioners are often confronted to medically unexplained symptoms; they represent almost 30% of neurologist’s consultation. The first challenge is to detect them, and recent studies have confirmed the importance of “positive” clinical bedside signs based on incoherence and discordance. Multidisciplinary therapy is recommended with behavioral cognitive therapy, antidepressant to treat frequent comorbid anxiety or depression, and physiotherapy. Factitious disorder and malingering should be clearly delineated from conversion disorder. Factitious disorder should be considered as a mental illness and more research on its physiopathology and treatment is needed, when malingering is a non-medical condition encountered in medico-legal cases.
Disclosure of InterestNone Declared
“God speaks to me through a dove”. The evidence of clozapine in treatment-refractory psychosis
- B. Rodríguez Rodríguez, P. Marqués Cabezas, M. Queipo de Llano de La Viuda, N. Navarro Barriga, G. Guerra Valera, M. B. Arribas Simón, C. Alario Ruiz, M. J. Mateos Sexmero, M. Fernández Lozano, P. Marínez Gimeno, M. Calvo Valcárcel, M. A. Andreo Vidal, M. P. Pando Fernández, A. Monllor Lazarraga, M. Ríos Vaquero, G. Lorenzo Chapate, L. Rojas Vázquez, C. De Andrés Lobo, T. Jiménez Aparicio, M. D. C. Vallecillo Adame
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S740
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Introduction
Clozapine is an atypical antipsychotic synthesised in 1958. It was withdrawn from the market in the 1970s due to the appearance of agranulocytosis, but was reintroduced due to strong evidence of its efficacy and superiority over other antipsychotics in treatment-resistant schizophrenia.
ObjectivesTo describe the adequate response to clozapine in treatment-refractory psychosis.
MethodsReview of the scientific literature based on a relevant clinical case.
ResultsA 16-year-old woman was admitted to a psychiatric inpatient unit for psychotic symptoms and behavioural disorders. She lives with her father and older sister; she has not been in contact with her mother, who lives in another country, for several years. She attends secondary school, with poor academic performance. Maternal diagnosis of schizophrenia. She started using cannabis two years ago, with a progressive increase up to 20 grams per week. He reports the onset of a feeling of strangeness a year ago, with progressive isolation in his room, referring to delirious ideation of harm towards classmates and people from his town, self-referentiality and delirious interpretations of religious mystical content (“God speaks to me through a dove”). He comments on the phenomenon of theft and thought-reading. Soliloquies and unmotivated laughter are observed.
ConclusionsTreatment was started with risperidone, progressively increasing the dose up to optimisation, without achieving a decrease in positive symptoms, but with the appearance of excessive sedation and sialorrhoea. It was combined with aripiprazole up to 20mg, maintained for a couple of weeks, without significant clinical improvement. Given the failure of two lines of therapy, it was decided to change to clozapine up to a dose of 75mg, with adequate tolerance and response, achieving a distancing of the delirious ideation. Regular haematological controls were performed, with no alterations in haemogram or troponins.
Disclosure of InterestNone Declared
Lithium withdrawal and relapse in bipolar disorder when kidney function deteriorates
- C. De Andrés-Lobo, M. D. C. Vallecillo Adame, T. Jiménez Aparicio, A. Rodríguez Campos, N. Navarro Barriga, M. J. Mateos Sexmero, B. Rodríguez Rodríguez, M. Fernández Lozano, M. Calvo Valcárcel, M. Andreo Vidal, P. Martínez Gimeno, M. P. Pando Fernández, L. Rojas Vázquez, G. Lorenzo Chapatte, M. Ríos Vaquero, A. Monllor Lazarraga
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S427-S428
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Introduction
Lithium was the first mood stabilizer and today continues to be a first-line treatment in the treatment of bipolar disorder despite its adverse effects, which make it important to monitor blood levels and control kidney function.
ObjectivesPresentation of a case of litium withdrawal and relapse in bipolar disorder. Literature review relating to the risk of relapse when lithium treatment is interrupted.
MethodsWe present a clinical case of a patient who suffers a deterioration in renal function that requires the withdrawal of lithium and who consequently suffers a relapse. We conducted a bibliographic research of articles in Pubmed on this topic.
ResultsA 49-year-old male, with a history of multiple admissions to UHB since the age of 18 with a diagnosis of bipolar disorder and treatment with lithium. Decompensations towards the manic pole have always been related to interruptions in lithium treatment. On several occasions when the patient was feeling well emotionally, he believed himself to be “cured” and abandoned the treatment, triggering a manic episode, showing verbal aggression, increased self-esteem and delusional ideation of harm. Remission was usually achieved with the reintroduction of lithium and the addition of high-dose quetiapine. Between episodes, constant overvalued ideas of economic scarcity seemed to persist, which were accentuated in the form of delusional ideas of ruin in depressive decompensations. After 7 years of stability, control analysis showed blood litemia of 2.2 mEq/L with deterioration of kidney function and generalized tremor was observed, without improvement after serum therapy. He was admitted for dialysis and lithium was suspended. Treatment with valproate was started and a consultation scheduled in a week to adjust the dose. The patient did not attend that consultation and was admitted three days later to Psychiatry Hospitalization showing a challenging attitude, evident dysphoric mood, accelerated speech, with derailments and echolalia. Delusional ideation of harm with auditory hallucinations. Insomnia and hyporexia. Chronic renal failure persisted.
ConclusionsLithium is a very effective drug but with a narrow therapeutic range that requires adequate monitoring due to the possible consequences of its use at different organs and systems of the body. when lithium is found in the blood at toxic levels with deterioration of kidney function and glomerular filtration fails to recover, lithium treatment should be suspended. Sudden withdrawal of lithium significantly increases the risk of relapse due to rebound effect. More than 50% of patients experience a recurrence within 10 weeks of withdrawal.
Disclosure of InterestNone Declared
Understanding the Occurrence of Psychiatric Disorders in Epilepsy in Brazil: An Epidemiological Investigation
- L. Bardini Goulart, A. Roloff Krüger, G. Moreno Xavier, G. Fiorio Grando, J. Michelon, L. F. Alves Nascimento, J. Adames, A. T. Konzen, G. Pereira Bernd, C. Fontes Augusto, H. Wolmeister, I. Fachinetto Thoen, Y. de França, P. H. Filipin Von Muhlen, F. J. Carvalho da Costa, V. Kayser, P. H. Paesi Dutra, R. Rahal de Albuquerque, T. Garcia Furtado, G. Macelaro, A. C. Castelo, H. Vieira Rodrigues, E. Rockenbach Fidélis, D. Crusius, E. Guidugli, M. F. Valentim de Paula, Y. Marques Loureiro, E. Paiva Borsa, L. de Paula e Souza, G. Ferreira Cruz
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S98
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Introduction
Epilepsy is one of the most common serious brain illness, with symptoms influenced by multiple risk factors and a strong genetic predisposition, rather than having a single expression and cause¹. Neuropsychiatric symptoms in epilepsy can encompass manifestations such as mood alterations, anxiety, sleep disturbances, psychosis, and behavioral disorders. While the motor and sensory manifestations of epileptic seizures are widely recognized, neuropsychiatric symptoms accompanying epilepsy are often underestimated. Therefore, it is essential to understand the most prevalent epidemiological profile of these patients to improve the diagnosis and management of these symptoms.
ObjectivesOur goal was to evaluate the neuropsychiatric behavior of epilepsy patients in Brazilian over the past 3 years through hospitalization data in order to outline an epidemiological and behavioral profile.
MethodsA cross-sectional, descriptive, retrospective, and quantitative study was conducted on hospitalizations of individuals simultaneously diagnosed with epilepsy, schizotypal and delusional disorders, and mood disorders in all five regions of Brazil (South, Southeast, Midwest, North, and Northeast) between February 2020 and December 2022. Data from January 2020 were not available. The data used were collected through the Department of Health Informatics of the Brazilian Unified Health System (DATASUS) in the “Hospital Information System of SUS” section, gathering information regarding the nature of care, age range, gender, and ethnicity of the patients.
ResultsThe analysis covers the years 2020 to 2022, totaling 503,045 hospitalizations. In 2022, the highest number of cases occurred (≈ 37.55%), followed by 2021 (≈ 33.62%) and 2020 (≈ 28.81%). Urgent hospitalizations represented ≈ 90.85% of the total. The most affected age group was 30 to 39 years old (≈ 18.30%). Men were more affected than women (≈ 52.03% and ≈ 47.96%, respectively), and Caucasians accounted for ≈ 36.07% of the hospitalizations. The average length of stay was 19.1 days, and the mortality rate was 1.4%.
ConclusionsThus, there is a gradual and annual increase in the number of hospitalizations during the observed period. While there is a minimal disparity between the affected genders, it is evident that the profile of male, caucasian, and adult patients is the most prevalent. Moreover, the predominantly urgent nature of hospitalizations points to an alarming scenario regarding this issue. From the analysis of the data obtained in the study, there is a clear need for interventions capable of reducing the prevalence of hospitalizations for neuropsychiatric symptoms in epilepsy patients in Brazil.
Disclosure of InterestNone Declared
Mental and Behavioral Disorders Associated with the Use of Psychoactive Substances and Alcohol: An Epidemiological Analysis in Southern Brazil
- L. Bardini, A. Roloff Krüger, G. Moreno Xavier, G. Fiorio Grando, J. Michelon, L. F. Alves Nascimento, J. Adames, A. T. Konzen, G. Pereira Bernd, C. Fontes Augusto, H. Wolmeister, I. Fachinetto Thoen, Y. de França, P. H. Filipin Von Muhlen, F. J. Carvalho da Costa, V. Kayser, P. H. Paesi Dutra, R. Rahal de Albuquerque, T. Garcia Furtado, G. Macelaro, A. C. Castelo, H. Vieira Rodrigues, E. Rockenbach Fidélis, D. Crusius, E. Guidugli, M. F. Valentim de Paula, Y. Marques Loureiro, E. Paiva Borsa, L. de Paula e Souza, G. Ferreira Cruz
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S831
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Introduction
Neuropsychiatric disorders are the leading cause of disability worldwide, as seen in cases such as depression, anxiety, bipolar mood disorder and schizophrenia, which can be developed or exacerbated by the use of psychoactive substances. Most mental disorders have an early onset, often leading to early and/or permanent disability, increasing the need and cost of healthcare. Therefore, it is necessary to improve the identification of the epidemiological profile of these cases in the South of Brazil in order to enhance the diagnosis and reduce the costs associated with managing these disorders.
ObjectivesThe present study aimed to analyze statistical data regarding hospitalizations related to mental disorders caused by the use of psychoactive substances and alcohol in the southern region of Brazil, highlighting the pathological scenario and identifying the most prevalent profiles of these disorders in this region.
MethodsA cross-sectional, descriptive, retrospective, and quantitative study was conducted on hospitalizations of individuals diagnosed with mental and behavioral disorders due to the use of psychoactive substances and alcohol in the states of the Southern region of Brazil (Paraná, Santa Catarina, and Rio Grande do Sul) between February 2020 and December 2022. Data of January 2020 were not available. The data used were collected through the Department of Health Informatics of the Brazilian Unified Health System (DATASUS) in the “Hospital Information System of SUS” section, gathering information regarding the nature of the care, age range, gender, and ethnicity of the patients.
ResultsThe study covers the years 2020 to 2022, indicating a total of 81,608 hospitalizations, with the year 2022 having the highest number of cases (≈ 37.13%), followed by 2021 (≈ 33.30%) and 2020 (≈ 29.55%). The states with the highest number of hospitalizations were Rio Grande do Sul (≈ 54.90%), Paraná (≈ 29.29%), and Santa Catarina (≈ 15.79%). Urgent hospitalizations accounted for ≈ 87.29% of the total. The most affected age group was 30 to 39 years old (≈ 25.61%). Men were more affected than women (≈ 81.70% and ≈ 18.28%, respectively). Caucasians accounted for ≈ 64.29% of the hospitalizations. The average length of stay was 20.8 days, and the mortality rate was 0.32%.
ConclusionsThere is a clear increase in the number of hospitalizations related to mental disorders caused by the use of psychoactive substances in the period from 2020 to 2022 in the southern region of Brazil, with the highest number of cases in the state of Rio Grande do Sul. The most affected population consisted of Caucasian men aged 30 to 39 years old. Furthermore, these results may be related to the increasing trend of psychoactive substance use among the Brazilian population and also the COVID-19 pandemic, which led to a period of underreporting due to social isolation.
Disclosure of InterestNone Declared
Delusional parasitosis: the importance of a multidisciplinary approach
- M. Calvo Valcárcel, G. Guerra Valera, M. A. Andreo Vidal, O. Martín Santiago, M. Lorenzo Hernando, M. P. Pando Fernández, P. Martinez Gimeno, M. D. L. Á. Guillén Soto, B. Rodríguez Rodríguez, N. Navarro Barriga, M. Fernández Lozano, M. J. Mateos Sexmero, C. De Andrés Lobo, M. D. C. Vallecillo Adame, T. Jimenez Aparicio, A. Monllor Lazarraga, M. Ríos Vaquero, L. Rojas Vázquez, L. Sobrino Conde, A. Aparicio Parra, G. Lorenzo Chapatte
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- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S750
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Introduction
Delusional parasitosis, also known as delusional infestation or Ekbom’s syndrome, is a rare psychotic disorder characterized by the false belief that a parasitic skin infestation exists, despite the absence of any medical evidence to support this claim. These patients often see many physicians, so a multidisciplinary approach among clinicians is important. Many patients refuse any treatment due to their firm belief that they suffer from an infestation, not a psychiatric condition, so it is crucial to gain the trust of these patients.
ObjectivesThe comprehensive review of this clinical case aims to investigate Ekbom syndrome, from a historical, clinical and therapeutic perspective.
MethodsLiterature review based on delusional parasitosis.
ResultsA 65-year-old woman comes to the psychiatry consultation referred by her primary care physician concerned about being infested by insects that she perceives through scales on her skin for the last three months. She recognizes important impact on her functionality. She is also convinced that her family is being infected too. As psychiatric history she recognizes alcohol abuse in the past (no current consumption) and an episode of persecutory characteristics with a neighbor, more than ten years ago. On psychopathological examination, she shows delusional ideation of parasitosis, with high behavioral repercussions, cenesthetic and cotariform hallucinations, as well as feelings of helplessness and anger. Treatment with Pimozide was started and the patient was referred to dermatology for evaluation, a plan she accepted. Her primary care physician and dermatology specialist were informed about the case and the treatment plan. In the recent reviews, the patient is calmer, however, despite the corroboration of dermatology and in the absence of organic lesions in cranial CT, she is still unsatisfied with the results, remaining firm in her conviction of infestation. It was decided to start treatment with atypical neuroleptics (Aripiprazole), with progressive recovery of her previous functionality.
ConclusionsDespite the increase in the number of studies in recent years, there are still few studies on this type of delirium. The female:male ratio varies in the bibiliography (between 2:1 and 3:1). The onset is usually insidious, generally appearing as a patient who comes to his primary care physician convinced of having parasites in different skin locations. It is usual to observe scratching lesions or even wounds in search of the parasite. In the past, the most used and studied treatment was Pimozide. Currently the treatment of choice is atypical neuroleptics due to their lower side effects. The latest reviews on the prognosis of this disorder show data with percentages of complete recovery between 51% and 70%, and partial responses between 16.5% and 20%. Finally, for a good diagnosis and therapeutic management, it is important to achieve a multidisciplinary approach.
Disclosure of InterestNone Declared
From adjustment disorder to schizotypal personality disorder
- C. De Andrés-Lobo, M. D. C. Vallecillo Adame, T. Jiménez Aparicio, A. Rodríguez Campos, N. Navarro Barriga, M. J. Mateos Sexmero, B. Rodríguez Rodríguez, M. Fernández Lozano, M. Calvo Valcárcel, M. Andreo Vidal, P. Martínez Gimeno, M. P. Pando Fernández, L. Rojas Vázquez, G. Lorenzo Chapatte, M. Ríos Vaquero, A. Monllor Lazarraga
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S652-S653
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Introduction
Individuals with schizotypal personality disorder are characterized by tendencies to magical thinking, unusual perceptions, discomfort in social situations, and restricted affect. It is frecuent that they have social anxiety and have difficulty in understanding the motivations and thoughts of others.
ObjectivesPresentation of a case of a patient who was first diagnosed with adjustment disorder, but on a closer study, was discovered to have a schizotypal personality disorder.
MethodsWe conducted a bibliographic review by searching for articles about schizotypal personality disorder and theory of mind in Pubmed.
ResultsWe present the case of a 39-year-old woman, diagnosed with adjustment disorder after a conflict at work with a colleague that caused her anxiety-depressive symptoms. In consultations, the patient shows verbiage without expansiveness or euphoria, with rambling speech. She expresses feelings of indignation and injustice, she is irritable, with contained anger. She refers that she prefers to be distrustful of others because she does not understand their intentions. Her thoughts are very rigid, which leads her to have avoidant and phobic attitudes, having no relationships of friendship throughout her life.
A neuropsychological evaluation is carried out, resulting in a surprising WAIS with a TIC of 128. However, the Mayer‐Salovey‐Caruso Emotional Intelligence Test (MSCEIT) shows difficulties in Perception, Comprehension and Emotional Management
Considering the patient’s symptomatology as a whole, it is noteworthy:
– Sustained social isolation throughout their life history
– Superficiality of interpersonal relationships
– Distrust and slight self-referentiality. Deficit in inferring the feelings and thoughts of others
– Peculiar speech with ideas of magical content, superstitions and rituals…
Which together supported a diagnosis of schizotypal personality disorder and generalized anxiety disorder. From this point we started to work on her self-esteem, modification of irrational beliefs and cognitive distortions, interpersonal communication and metacognitive therapy, with good results.
ConclusionsThe type of schizotypal patients who come to consultations most frequently are the actively isolated/timorous profile due to their intense social anxiety and difficulties in understanding and adapting to the social world around them. Initial therapy should be empathic support. The theory of mind is the ability to infer the other’s mental states and therefore predict their behavior, this ability being diminished in the schizotypal patient. Mentalization tasks, metacognitive therapy, cognitive flexibility training, social skills training, and promoting self-worth are useful. On some occasions it may be necessary to start psychopharmacological treatment to control anxiety and unusual perceptions when they cause discomfort.
Disclosure of InterestNone Declared
Epidemiological analysis of hospitalizations for Schizophrenia, Schizotypal Disorders and Delirium in Rio Grande do Sul over the last 5 years
- L. Bardini, A. Roloff Krüger, G. Moreno Xavier, G. Fiorio Grando, J. Michelon, L. F. Alves Nascimento, J. Adames, A. T. Konzen, G. Pereira Bernd, C. Fontes Augusto, H. Wolmeister, I. Fachinetto Thoen, Y. de França, P. H. Filipin Von Muhlen, F. J. Carvalho da Costa, V. Kayser, P. H. Paesi Dutra, R. Rahal de Albuquerque, T. Garcia Furtado, G. Macelaro, A. C. Castelo, H. Vieira Rodrigues, E. Rockenbach Fidélis, D. Crusius, E. Guidugli, M. F. Valentim de Paula, Y. Marques Loureiro, E. Paiva Borsa, L. de Paula e Souza, G. Ferreira Cruz
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, pp. S390-S391
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Introduction
In recent years, mental health has gained prominence in public health, prompting thorough investigations into psychiatric condition trends. This study conducts a comprehensive epidemiological analysis of hospitalizations for Schizophrenia, Schizotypal, and Delirium Disorders in Rio Grande do Sul (RS) over the past five years. By revealing these patterns, it enhances our understanding of regional mental health dynamics and offers insights for intervention strategies, resource planning, and improved mental healthcare. The ultimate goal is to advance more effective and accessible mental healthcare in RS and beyond.
ObjectivesThis study aims to analyze the prevalence and epidemiological profile of hospitalizations due to psychiatric disorders to assist in the diagnosis and outcome of affected patients.
MethodsA cross-sectional, descriptive, retrospective, and quantitative study was conducted regarding hospitalizations for Schizophrenia, Schizotypal Disorders, and Delirium in the state of RS between January 2018 and November 2022. Data were collected from the Department of Informatics of the Brazilian Unified Health System (DATASUS) in the “Hospital Information System of SUS” section, focusing on the nature of care, age group, gender, and ethnicity of the patients. The information was aggregated over the five-year period based on the four mentioned descriptors and subsequently analyzed to establish a profile of hospitalizations during that period.
ResultsThe analysis spans from 2018 to 2022, encompassing a total of 28,345 hospitalizations. In 2019, there was the highest number of cases (22.21%), followed by 2018 (21.08%). Urgent care admissions constituted 85.34% of the total. The age group most affected was 35 to 39 years (11.8%). Men were more affected than women (60.18%), and the majority of hospitalizations were among the Caucasian ethnicity (75.12%). The average length of stay was 23.7 days, and the mortality rate stood at 0.26%.
ConclusionsThe increasing trend in hospitalizations, peaking in 2019, highlights the need for preventive measures. Urgent admissions (85.34%) underscore the demand for accessible mental health resources. Men in the 35 to 39 age group are disproportionately affected, suggesting specific risk factors. The predominance of Caucasian ethnicity emphasizes the need for culturally sensitive care. A longer average length of stay (23.7 days) underscores treatment complexity, while a low mortality rate (0.26%) signals effective medical care. In essence, these findings inform tailored mental health policies to enhance service quality and prioritize patient-centered approaches.
Disclosure of InterestNone Declared
Mental health impact of fentanyl abuse, a case report
- G. Lorenzo - Chapatte, G. Guerra Valera, P. Marqués Cabezas, L. R. Vázquez, M. Ríos Vaquero, A. Monllor Lazarraga, M. P. Pando Fernández, P. Martínez Gimeno, M. A. Andreo Vidal, M. Calvo Valcárcel, B. Rodríguez Rodríguez, N. Navarro Barriga, M. J. Mateos Sexmero, M. Fernández Lozano, T. Jiménez Aparicio, C. De Andrés-Lobo, M. D. C. Vallecillo Adame, M. D. L. Á. Guillén Soto, L. Sobrino Conde, A. Aparicio Parras
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S409
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Introduction
In recent years, there has been an increase in the prevalence of illicit use of fentanyl and other opioids in the United States population. This has led to an increase in medical, psychopathological and abuse-associated comorbidity, an increase in deaths and a decrease in the age of consumption, and has become a serious emerging problem in young people.
We present the case of an 18-year-old woman from the United States who recently settled in Spain and started a follow-up in Mental Health due to opioid and other substance abuse problems.
ObjectivesTo address the growing problem surrounding the illicit use of fentanyl and opioids as drugs of abuse based on the presentation of the clinical case mentioned above.
MethodsBibliographic search and description of a clinical case of a patient under follow-up by Mental Health at the “Hospital Clínico Universitario de Valladolid”.
ResultsAn 18-year-old woman from the United States who has been living with her father in Spain since the summer of 2023, having moved to Spain due to problems related to substance abuse.
With no previous medical or surgical history and with a history of follow-up in Mental Health in her country of origin for depressive symptomatology, dysfunctional personality traits and abuse of different toxic substances since adolescence.
After a brief and erratic follow-up in Psychiatry for anxious-depressive symptoms reactive to a complex and conflictive relationship with his mother and marked academic difficulties during the first years of adolescence, at the age of 15 he started using cannabis and alcohol, thus beginning a period marked by relationships with marginalized sectors of the population, substance abuse and school failure.
As his cannabis consumption intensified, he began to consume fentanyl prescribed to his mother, as well as other opioids to which he had access illegally, for which reason he had to be admitted twice to detoxification centers without results, which is why his family finally decided to move him to Spain.
ConclusionsIn recent years, fentanyl abuse has become a serious public health problem that is mainly centered in the young population.
High levels of impulsivity and lack of frustration tolerance predispose to the use of illicit substances for elusive purposes.
Substance abuse carries with it not only an important organic comorbidity, but also a marked socio-familial and economic repercussion.
Disclosure of InterestNone Declared
Psychopharmacological management in patients with Di George syndrome
- L. Rojas Vázquez, P. Marqués Cabezas, G. Lorenzo Chapatte, M. Ríos Vaquero, A. Monllor Lazarraga, M. P. Pando Fernández, M. A. Andreo Vidal, M. Calvo Valcárcel, P. Martínez Gimeno, M. J. Mateos Sexmero, B. Rodríguez Rodríguez, M. Fernández Lozano, N. Navarro Barriga, T. Jiménez Aparicio, C. De Andrés Lobo, C. Vallecillo Adame, L. Sobrino Conde, M. D. L. Á. Guillén Soto, A. Aparicio Parra
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S455
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Introduction
It is widely described in the scientific literature that patients who suffer from some type of congenital syndrome such as Di George Syndrome are more likely to present some type of psychopathological alteration during their development that may require intervention and treatment by infant and juvenile mental health teams in coordination with neuropediatrics (1). On this occasion, we will present the clinical case of a patient who regularly attends psychiatry consultations for management of anxious symptoms with impulse control deficits associated with intellectual disability, diagnosed since childhood with tetralogy of Fallot and later with Di George syndrome. In this type of case, treatment is usually considered taking into account possible comorbidities at the organic level (since there may be cardiological involvement, which can be an added difficulty when taking into account the adverse effects of some psychotropic drugs) (2).
ObjectivesThis is followed by the presentation of the clinical case, which can serve to exemplify this type of case and clarify any doubts that may arise regarding treatment.
MethodsPresentation of the clinical case and review of updated scientific literature on the subject.
ResultsPatient who first came to the infantile-junior consultations at the age of 8 years due to delay in the acquisition of verbal language and impulsivity. The patient had a history of pediatric follow-up since birth for different physical symptoms that finally led to the diagnosis of Di George syndrome.
Given the difficulties he presented both at home and at school, different psychometric tests were performed and it was determined that it could be beneficial to initiate treatment with extended-release methylphenidate. Prior to treatment, psychomotor restlessness (without aggressiveness) and difficulty in concentration prevailed, which improved significantly after upward adjustment of the dose to a guideline corresponding to his age and weight. It was not necessary in this case to administer other treatments (the possibility of starting Aripiprazole in case of episodes of agitation was considered, but it was not necessary). The patient has continued to be monitored by cardiology to assess the possible side effects of the treatment (since it can increase heart rate and blood pressure (3), but so far no complications have been detected).
Thanks to psychotherapeutic and educational intervention, language acquisition was achieved, although to date he still requires support due to the difficulties he still presents.
ConclusionsIt is important to take into account the possible side effects of psychopharmacological treatment in patients with an associated congenital syndrome. Intensive and comprehensive follow-up by psychiatry and pediatrics (and later by their primary care physician) should be performed.
Disclosure of InterestNone Declared
Impulse phobias during pregnancy: a case report of a 37 year-old woman pregnant of her first child
- M. Ríos-Vaquero, G. Lorenzo-Chapatte, L. Rojas-Vázquez, A. Monllor-Lazarraga, L. Sobrino-Conde, M. J. Mateos-Sexmero, T. Jimenez-Aparicio, M. Calvo-Valcarcel, M. A. Andreo-Vidal, M. P. Pando-Fernández, P. Martínez-Gimeno, M. D. L. A. Guillen-Soto, B. Rodriguez-Rodriguez, N. Navarro-Barriga, M. Fernández-Lozano, A. Aparicio-Parras, M. D. C. Vallecillo-Adame, C. De Andres-Lobo, A. Rodríguez-Campos
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- Journal:
- European Psychiatry / Volume 67 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 27 August 2024, p. S801
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Introduction
Pregnancy and puerperium are two critical stages for women’s mental health due to the biological stress of pregnancy itself, as well as the emotional stress that surrounds this vital moment. (1) Debut and aggravation of psychiatric symptoms may occur, as well as relapse in women previously diagnosed with Severe Mental Disorder (SMD).
Symptoms of the anxious spectrum are the most frequent within the perinatal mental pathology, being impulse phobias an entity that appears in about 25% of women previously diagnosed with OCD and up to 10-15% of women without previous psychopathology (2)
ObjectivesExposing the importance of Perinatal Mental Health from the presentation of a clinical case.
MethodsReview of the literature available in PubMed. Presentation of the pathobiography and evolution of the patient.
ResultsOur case is about a 37-year-old woman, 30 weeks pregnant with her first child and history of having required admission to Psychiatry with subsequent follow-up in Mental Health for anxious-depressive symptoms with the presence of self-injurious ideas who, after two weeks with multiple life stressors, came to the Emergency Department for the presence of impulse phobias focused on pregnancy with significant internal anguish and ideas of death as a resolution to it, which is why it was decided to hospitalize her. During admission, and taking into account the patient’s gestational state, treatment was started with diluted Mirtazapine and Aripiprazole solution at minimal doses, which in this case were sufficient for symptom control.
The latest guidelines addressing psychopharmacology during pregnancy and lactation point to sertraline among the antidepressants and Lorazepam among the benzodiazepines as the safest drugs during pregnancy (3).
Conclusions- The exacerbation of anxious symptomatology and the presence of gestation-focused impulse phobias are frequent during pregnancy and their intensity increases as the time of delivery approaches.
- Sertraline, Lorazepam, Mirtazapine and Aripiprazole are safe drugs during pregnancy.
- In these women, a close and multidisciplinary follow-up by Psychiatry and Gynecology is advisable.
Disclosure of InterestNone Declared
Mobile toolbox (MTB) remote measures of executive function and processing speed: development and validation
- Miriam A. Novack, Stephanie Ruth Young, Elizabeth M. Dworak, Aaron J. Kaat, Jerry Slotkin, Cindy Nowinski, Lihua Yao, Hubert Adam, Jordan Stoeger, Zahra Hosseinian, Saki Amagai, Sarah Pila, Maria Varela Diaz, Anyelo Almonte Correa, Keith Alperin, Sonia Carlson, Michael Kellen, Larsson Omberg, Monica R. Camacho, Bernard Landavazo, Rachel L. Nosheny, Michael W. Weiner, Richard C. Gershon
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- Journal of the International Neuropsychological Society , First View
- Published online by Cambridge University Press:
- 11 July 2024, pp. 1-9
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Objective:
The ability to remotely monitor cognitive skills is increasing with the ubiquity of smartphones. The Mobile Toolbox (MTB) is a new measurement system that includes measures assessing Executive Functioning (EF) and Processing Speed (PS): Arrow Matching, Shape-Color Sorting, and Number-Symbol Match. The purpose of this study was to assess their psychometric properties.
Method:MTB measures were developed for smartphone administration based on constructs measured in the NIH Toolbox® (NIHTB). Psychometric properties of the resulting measures were evaluated in three studies with participants ages 18 to 90. In Study 1 (N = 92), participants completed MTB measures in the lab and were administered both equivalent NIH TB measures and other external measures of similar cognitive constructs. In Study 2 (N = 1,021), participants completed the equivalent NIHTB measures in the lab and then took the MTB measures on their own, remotely. In Study 3 (N = 168), participants completed MTB measures twice remotely, two weeks apart.
Results:All three measures exhibited very high internal consistency and strong test-retest reliability, as well as moderately high correlations with comparable NIHTB tests and moderate correlations with external measures of similar constructs. Phone operating system (iOS vs. Android) had a significant impact on performance for Arrow Matching and Shape-Color Sorting, but no impact on either validity or reliability.
Conclusions:Results support the reliability and convergent validity of MTB EF and PS measures for use across the adult lifespan in remote, self-administered designs.
One-Dimensional Neutron Diffraction Study of a Vermiculite
- J. M. Adams, C. Riekel
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- Clays and Clay Minerals / Volume 28 / Issue 6 / December 1980
- Published online by Cambridge University Press:
- 01 July 2024, pp. 444-445
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The Diffusion of Interlamellar Water in the 23.3 Å Na-Montmorillonite:Pyridine/H2O Intercalate by Quasielastic Neutron Scattering
- J. M. Adams, C. Breen, C. Riekel
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- Clays and Clay Minerals / Volume 27 / Issue 2 / April 1979
- Published online by Cambridge University Press:
- 01 July 2024, pp. 140-144
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The diffusion of water in the title intercalate has been measured by quasielastic neutron scattering. The diffusion coefficient (6.1 × 10−7 cm2 s−1 at 23.5°C) is one order less than that found previously for a sodium-exchanged montmorillonite which, however, contained 4 times as much water in the interlamellar space. The activation energy for the motion has been deduced to be 18 kJ mol−1. Also it has been demonstrated that upon the time scale of the neutron scattering events (faster than 10−9 s) the hydroxyl groups of the clay lattice are not in motion.
Exchange and Selective Surface Uptake of Cations by Layered Silicates Using X-Ray Photoelectron Spectroscopy (XPS)
- J. M. Adams, S. Evans
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- Clays and Clay Minerals / Volume 27 / Issue 4 / August 1979
- Published online by Cambridge University Press:
- 01 July 2024, pp. 248-252
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The cation-exchange capacities (CEC) of a previously well-characterized beidellite have been estimated nondestructively from X-ray photoelectron spectroscopy (XPS) data following exchange by various cations. The CEC obtained as an atomic ratio to silicon from Na- and Ca-clays are close to that derived chemically, i.e., 0.10(2), and 0.10(1), respectively, compared with 0.12(1). However, the apparent CEC obtained following K-, Pb-, and Ba-exchange are all about 50% greater. These measurements are complemented by XPS studies of clay exchanged in a solution containing both Ca and Ba ions where XPS gave a total apparent exchange capacity relative to Si of 0.16, with 0.10 from Ca and 0.06 from Ba. Bulk chemical analysis has, however, shown that the true Ba value is only 0.01. It is concluded that the cation excess detected by XPS—a technique with a total sampling depth of only about 100 Å—is concentrated at the surfaces of the clay particles.