Repetitive negative thinking (RNT) in major depressive disorder (MDD) involves a persistent focus on negative self-related experiences. Resting-state fMRI shows that the functional connectivity (FC) between the anterior insula and the superior temporal sulcus is associated with RNT intensity. This study examines how insular FC patterns differ between resting state and RNT induction in MDD and healthy control (HC) participants.

Forty-one individuals with MDD and 28 HCs (total n = 69) underwent resting-state and RNT-induction fMRI scans. Seed-to-whole brain analysis using insular subregions as seeds was performed.

No diagnosis-by-run interaction effects were observed across insular subregions. MDD participants showed greater FC between the bilateral anterior, middle, and posterior insular regions and the cerebellum (z = 4.31–6.15). During RNT induction, both MDD and HC participants demonstrated increased FC between bilateral anterior/middle insula and prefrontal cortices, parietal lobes, posterior cingulate cortex (PCC), and medial temporal gyrus, encompassing the STS (z = 4.47–8.31). In exploratory correlation analyses, higher trait RNT was associated with increased FC between the right dorsal anterior/middle insula and the PCC, middle temporal gyrus, and orbital frontal gyrus in MDD participants (z = 4.31–6.15). Greater state RNT was linked to increased FC in similar insular regions, as well as the bilateral angular gyrus and right middle temporal gyrus (z = 4.47–8.31).

Hyperconnectivity in insula subregions during active rumination, especially involving the default mode network and salience network, supports theories of heightened self-focused and negative emotional processing in depression. These findings emphasize the neural basis of RNT when actively elicited in MDD.

Schizophrenia (SCZ) and Autism Spectrum Disorder (ASD) are complex neurodevelopmental disorders with overlapping cognitive, social, and behavioral symptoms. Although each has distinct diagnostic criteria, shared traits such as impaired social cognition, communication difficulties, and atypical behaviors, often blur the distinction between them. This overlap is particularly challenging in cases of very early onset psychosis (before age 13), where symptoms like social withdrawal, unusual behaviors, and communication difficulties closely mirror those of ASD, complicating accurate diagnosis.

This study aims to explore the diagnostic challenges of distinguishing between ASD and early psychosis through a comprehensive review of published literature and a case report.

A bibliographic review was conducted using articles from PubMed, focusing on the terms “Autism Spectrum Disorder”, “Early Psychosis”, and “Early Onset Schizophrenia”. Additionally, a case report was presented to illustrate the complexities in differentiating these overlapping conditions.

This study highlights the difficulty of distinguishing ASD from early psychosis due to overlapping symptoms, particularly in young patients. ASD is typically characterized by persistent social communication difficulties and repetitive behaviors, while early psychosis involves hallucinations, delusions, and disorganized thinking. However, some children with ASD may also exhibit psychotic-like symptoms, such as paranoia or unusual perceptual experiences, mimicking early-onset schizophrenia. These findings underscore the importance of comprehensive diagnostic assessments that include developmental history, symptom trajectory, and family background. Increasing evidence shows that ASD and early psychosis share genetic, neurobiological, and environmental risk factors, supporting the idea of a neurodevelopmental continuum where both conditions may be viewed as different points along a shared spectrum of neurodevelopmental disruption.

This work calls for a more integrated approach to diagnosing ASD and early psychosis, especially in cases of very early onset. A continuum model suggests these disorders may represent points along a spectrum of neurodevelopmental disorders rather than entirely separate entities. Future research should prioritize long-term studies to identify specific markers, such as genetic, brain imaging, and cognitive profiles, that can better differentiate between ASD and early psychosis and guide more targeted, personalized interventions.

None Declared

Suicide involves not only patients but also families and communities, causing long-lasting effects on those who “survive”. The term “second victim” is used to define people who experience significant distress after a patient suicide (PS). For mental health professionals, PS could be considered an “occupational hazard”.

To assess the impact of patient death on psychiatric trainees and early career psychiatrists (ECPs), comparing PS to other causes of death.

Participants completed a socio-demographic section and a section about the experience of PS. Impact of event scale–revised version (IES-R) based on the last 7 days and the 7 days after the most recent patient death, Suicide Knowledge and Skills Questionnaire (SKSQ), the Impact of a Patient’s Suicide on Professional and Personal Lives Scale and the Maslach Burnout Inventory (MBI) were administered.

110 subjects were recruited from 23 European and 1 Asian countries. The mean age was 31.9 (SD=4.7). Most were trainees (66.4%, n=73), worked in a psychiatric ward (61.8%, n=68), and in general adult psychiatry (83.6%, n=92). Patient death was experienced by 51.8 % (n=57) of the participants. 17.3% (n=19) experienced a PS, 12.7% (n=14) experienced multiple PS, 13.6% (n=15) had patients who died both by suicide and other medical conditions, and 8.2% (n=9) had patients who died from other medical conditions. The most reported feelings were sadness, regret, guilt, helplessness and frustration. Among participants who experienced at least one PS, 89.7% (n=35) developed symptoms. The most common were increased awareness of risk (40.4%; n=19), low mood (34.0%; n=16), anxiety (32.6%; n=15) and lack of concentration (26.1%; n=12). 6.5% (n=3) experienced suicidal thoughts/passive death wishes, and 6.5% (n=3) received individual psychotherapy treatment for their symptomatology. Having experienced a patient loss influenced clinical practice in 33.3% (n=19) of the sample, with 10.5% (n=6) reporting the affliction of the ability to carry out clinical duties. 12.7% (n=14) considered changing careers, 10.5% (n=6) took sick leave, 57.8% (n=33) received helpful support from colleagues. However, 52.3% (n=30) felt they needed additional support. According to the total score of IES-R scored on the 7 days after the most recent patient death, 22.9% (n=11) of the sample who experienced at least one PS had a score indicating a risk of PTSD, compared to 22.2% (n=2) of participants who experienced other type of patient death. No difference in all scales was observed in those experienced PS rather than any other kind of patient death (p>0.05).

Our results confirm that PS affects the mental health of ECPs and psychiatric trainees, and impacts their daily lives. A larger sample should be collected to strengthen our results and better characterize the impact of these events.

None Declared

A 26-year-old man presented with his first-episode psychosis (FEP) following a 15-month period marked by a progressive sense of estrangement from his surroundings, ideas of reference, persistent anxiety, difficulty focusing, and social withdrawal. Two years prior, he began stimulant treatment for suspected attention-deficit/hyperactivity disorder (ADHD), though he discontinued the medication shortly after, as he perceived no improvement. Over the past year, he became increasingly distant from friends and eventually resigned from his job. About three months before hospitalization, he began experiencing first-rank symptoms of schizophrenia. This case will serve as a starting point to discuss the complexities of diagnosing the prodromal phase of FEP.

This clinical review aims to examine the phenomenology of the prodromal phase of FEP and address the diagnostic challenges posed by symptom similarities between this phase and neurodevelopmental conditions like ADHD.

A literature review was conducted using the PubMed database, covering studies from the past 20 years. Studies were selected if they included phenomenological descriptions of the prodromal phase in FEP and/ or examined the impact of neurodevelopmental conditions on the emergence of psychosis.

The review identified several key phenomenological markers characterizing the prodromal phase of FEP, which can aid in distinguishing it from other psychiatric conditions. The prodromal phase of FEP is frequently marked by subtle but progressive alterations in cognition, perception, and affect, including experiences such as derealization-depersonalization, ideas of reference, paranoid ideation, and social withdrawal. Evidence suggests that prodromal symptoms intensify over time, evolving from vague unease to specific disruptions in reality testing. Although ADHD and the prodromal phase of a FEP may share some overlapping characteristics - particularly when symptoms are assessed in a cross-sectional manner - ADHD symptoms are generally regarded as stable traits that persist consistently into adulthood.

This case underscores the need for careful differential diagnosis, especially when evaluating individuals in high-risk age groups for psychosis who present with subtle symptoms that do not clearly fit a single diagnostic category. In such cases, clinicians should avoid premature conclusions and instead adopt a longitudinal and comprehensive approach, considering whether genetic, neurodevelopmental, or social risk factors may be contributing to the presentation. A phenomenological perspective can help clinicians detect subtle yet significant shifts in perception, cognition, and affect, enhancing diagnostic accuracy and enabling timely intervention.

None Declared

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

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

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

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

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

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

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

None Declared

Social isolation (SI) is defined as the lack of social contact or support. Older adults have a higher risk of social isolation because of the changes in health and social relationships that can occur during ageing. Several studies have shown that SI is independently associated with poorer physical and mental health and worsened quality of life. However, limited evidence is available on SI predictors in old public housing populations.

To assess the risk of SI and dependency in Basic and Instrumental Activities of Daily Living (BADL; IADL) in a sample of older people living alone in public housing. To identify predictors of SI, namely whether ADL dependency is one of them.

As part of the ongoing “Porto Importa-se” project, this study included a sub-sample of older persons aged 70 years and over living alone in public housing communities in Porto City, Portugal. All participants were assessed with a comprehensive multidimensional assessment protocol, which encompassed the Barthel and Lawton Indexes (BADLs and IADLs dependency) and the Lubben Social Network Scale-6 (SI risk). Loneliness was measured with a categorical question. A multiple logistic regression model was performed to identify predictive factors for SI. Odds Ratio (OR) and its 95% Confidence Interval (95%CI) were calculated. A p<0.05 was considered statistically significant.

The final sample (n=716) was namely female (84%), with an average age of 80.4 years (SD=6.2). Around 36% presented a risk of SI, and 24% reported feeling lonely almost always to always. About 53% had moderate dependency on IADLs, and 11% dependency on BADLs. The proportion of participants dependent on BADLs and at risk of SI is more than double the proportion of cases considered not to be at risk (17%v.s.8%; p<0.001). Similarly, the proportion of cases considered to be severely dependent on IADLs and at risk of SI is about four times higher than the proportion of cases considered not to be at risk (13%v.s.3%; p<0.001). Based on the logistic regression model, severe dependence on IADLs (OR=5.16, 95%CI[2.37;11.24], p<0.001) and loneliness (OR=2.87, 95%CI[2.02;4.09], p<0.001) were significant predictors of the risk of SI. The model has a modest explanatory power (Nagelkerke R2=0.126).

The rate of SI found in this study aligns with the results reported in other studies with similar objectives. The identification of loneliness and dependence in ADL as predictors of SI also complies with previous studies. These results reinforce the importance of monitoring elderly people who find themselves alone and dependent on the fulfilment of their ADLs more closely.

This work was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDP/4255/2020)

None Declared

Electroconvulsive Therapy (ECT) is a proven treatment for treatment-resistant depression (TRD), especially in elderly patients. Managing depression in this population is challenging due to comorbidities and medication intolerance. Research suggests that factors like melancholic features and early symptom improvement predict a positive response to ECT. ECT offers rapid and sustained antidepressant effects.

To present the case of a 74-year-old woman with TRD who successfully underwent ECT after failing multiple medications.

A literature review was conducted on ECT for TRD in elderly patients. The clinical case is detailed, focusing on treatment, ECT application, and outcomes.

The patient had a history of severe depressive episodes. Previous hospitalizations were managed with tricyclic antidepressants, lithium, and olanzapine. However, lithium was discontinued after discharge due to subclinical hypothyroidism and renal function impairment. Although the patient remained stable for a time, her mood progressively worsened, leading to a marked decline in daily functioning and eventual admission to the psychiatric unit. Upon admission, the patient presented with severe depression, including loss of functionality, self-neglect, and passive suicidal ideation, hyporeactive state, significant vegetative symptoms, and moderate-to-severe anxiety. Given the lack of response to a comprehensive pharmacological regimen, ECT was initiated. The patient underwent six sessions of ECT, with initial improvements observed after the first session. By the third session, she showed marked improvements in mood, energy, and anxiety levels. By the end of the ECT course, she had regained full functionality and emotional stability.

This case underscores the effectiveness of ECT in managing psychotic depression in elderly patients when pharmacological treatments are ineffective or poorly tolerated. The patient’s rapid response aligns with previous findings suggesting that early symptom improvement predicts favorable ECT outcomes. Additionally, the presence of melancholic features may have contributed to the success of ECT, as described in the literature. Given the patient’s history of lithium intolerance and multiple pharmacological failures, ECT emerged as the most viable treatment option. ECT also demonstrated long-term benefits.

This case also highlights the importance of considering ECT earlier in the treatment process for elderly patients and demonstrates the crucial role of ECT in achieving rapid and sustained recovery in elderly patients with psychotic depression resistant to pharmacological treatments. Early intervention with ECT was essential for the patient’s full functional recovery, reinforcing its value as a therapeutic option in severe, treatment-resistant cases.

None Declared

Treatment resistance affects 20-60% of patients, leading to substantial personal and economic impact. Repetitive transcranial magnetic stimulation (rTMS) is effective, with theta burst stimulation (TBS) providing similar benefits more efficiently.

To assess high-dose TBS effectiveness and to explore how demographic and clinical factors influence treatment outcomes.

Accelerated high-dose (30 sessions) cTBS and iTBS was administered targeting the right and left dorsolateral prefrontal cortex (DLPFC) respectively (3600 pulses per session), with MRI-guided neuronavigation. Pre- and post-treatment HAM-D and HAM-A scores were analyzed with mixed-effects models. Response and remission rates were further examined using generalized linear models (GLM). All analyses were conducted using the R Studio.

The study included a total of 101 participants, of whom 89 had data available for HAM-D (56 [38.8–65] years; 69.7% females), and 82 had data available for HAM-A (56 [39–65] years; 70.7% females). 29.2% achieved HAM-D remission, 22% achieved HAM-A remission, with response rates of 46.1% for depression and 50% for anxiety.

Mixed-effects models showed a highly significant reduction in both HAM-D and HAM-A scores after TMS treatment (HAM-D: β = -12, p = 2.2e−15; HAM-A: β = -14.484, p = 1.1×10−14) (Fig. 1). For HAM-D, family history was associated with reduced treatment effectiveness (β = 5.302, p = 0.011). Sex also influenced HAM-D scores, with males showing a greater response than females (p = 0.018), although this trend was only marginally significant for HAM-A (p = 0.073).

Fig. 1. Pre- and post-treatment scores on the HAM-D and HAM-A showing significant reductions following rTMS.

The GLM analysis for HAM-D and HAM-A remission did not reveal statistically significant overall results. However, specific predictors were significantly associated with treatment response. A family history of mental health conditions was linked to a lower likelihood of response, based on HAM-D (OR = 0.058, p = 0.016) and HAM-A (OR = 0.074, p = 0.049). Age was a significant predictor for response on both HAM-D (OR = 1.1, p = 0.048) and HAM-A (OR = 1.115, p = 0.032) (Fig. 2). Additionally, regarding employment status individuals identified as “Housekeeper” or “Retired” had reduced likelihood of positive response (p < 0.05).

Figure 2. Influence of age on HAMA and HAM-D response outcomes in patients undergoing TMS treatment.

Image:

Image 2:

High-dose accelerated bilateral TBS using the Sevilla Protocol significantly reduced depression and anxiety symptoms in treatment-resistant patients, with notable response and remission rates. Family history, age, and certain employment statuses significantly influenced treatment response, suggesting that TBS may benefit from tailored approaches. Larger, balanced samples are needed to confirm these findings and improve prediction models.

None Declared

Psychotic depression, a severe subtype of major depressive disorder with delusions or hallucinations, increases suicide risk due to distressing symptoms and hopelessness. Suicide attempts in psychotic depression can be severe and violent. Combining antidepressants and antipsychotics shows promise in reducing suicidal ideation and improving prognosis. This case presents a patient with a severe suicide attempt and self-harm in the context of psychotic depression, highlighting successful treatment with a combination of antidepressants and antipsychotics.

To present a case study of a patient with a depressive episode that progressed to psychotic features.

A comprehensive literature search was conducted to identify relevant studies on the treatment of depression with psychotic features. A case report was then developed, detailing the patient’s clinical presentation, diagnosis, and treatment regimen.

A 53-year-old male was hospitalized following a serious suicide attempt. The patient had a history of a recent work-related accident, leading to a depressive episode that progressed to psychotic features, including delusions of guilt and economic ruin, attempted suicide using a firearm, leading to significant self-inflicted injuries. Emergency surgical intervention was required for tendon and arterial damage. Psychiatrically, the patient exhibited profound hopelessness, delusional guilt, and active suicidal ideation. Following hospital admission, the patient was treated with a combination of sertraline, olanzapine, and mirtazapine, which resulted in significant improvement in mood, a reduction of delusions, and cessation of suicidal ideation over a three-weeks period. The patient returned to social activities and expressed interest in resuming his professional responsibilities, with no recurrence of psychotic symptoms or suicide attempts.

This case illustrates the severity of suicidal behavior in psychotic depression and the critical importance of combining antidepressants with antipsychotics for effective management. Research has consistently shown that psychotic depression carries a heightened risk of severe suicide attempts due to the intensity of delusions and hopelessness. Antidepressant-antipsychotic combinations, particularly those involving selective serotonin reuptake inhibitors (SSRIs) like sertraline, and atypical antipsychotics such as olanzapine, have demonstrated efficacy in reducing both depressive and psychotic symptoms, thereby mitigating suicide risk. In this case, the patient’s marked improvement and remission of psychotic features underscore the role of combined pharmacotherapy in stabilizing mood and preventing future suicidal behavior.

None Declared

Fluoxetine, the first selective serotonin reuptake inhibitor, is the world’s most prescribed antidepressant. Several mechanisms of action underpin the effect of this antidepressant, such as enhancing serotonin (5-HT) neurotransmission, increasing hippocampal neurogenesis, neuronal survival and cerebral angiogenesis. The effects of fluoxetine on stem cell behaviour and tissue regeneration beyond the central nervous system have been little studied to date.

We investigated whether fluoxetine (FLX) might have broader peripheral regenerative properties using a recognized regenerative medicine paradigm such as the animal model of ad integrum muscle regeneration.

To investigate the impact of fluoxetine (FLX) on muscle at steady state, FLX was delivered per os at 18 mg/kg daily for six weeks to uninjured wild-type and specific transgenic mice. To investigate FLX´s regenerative capacity on skeletal muscles, we delivered FLX for six weeks and then performed notexin-induced injuries (phospholipase that induces a severe muscle necrosis) of the tibialis anterior muscle in wild-type and specific transgenic mice. Muscle force, muscle stem cells number, dividing muscle stem cells, differentiating muscle stem cells number, vessels number and muscle fiber parameters were specifically assessed.

After prolonged administration (6 weeks) of fluoxetine to male mice, we showed that prolonged FLX treatment increased the number of muscle stem cells and muscle angiogenesis in mice. FLX also improved skeletal muscle regeneration after single and multiple injuries induced by intramuscular notexin injection. The acceleration of muscle regeneration induced by FLX resulted from a triple action marked by an increase in the muscle stem cell pool, an increase in vessel density and a reduction in fibrotic lesions and inflammation. In vitro, we showed that the proliferative effects of FLX on immortalized myoblasts were dependent on 5-HT and 5-HT1B receptor activation. In vivo, mice lacking peripheral 5-HT treated with FLX did not show positive effects during muscle regeneration. Moreover, pharmacological, and genetic inactivation of the 5-HT1B receptor in muscle stem cells also abolished the FLX-induced improvement in muscle regeneration.

We show that FLX promotes a harmonious muscle regeneration underpinned by a combined action on myogenesis, angiogenesis and inflammation. These results highlight the serotonergic identity of skeletal muscle and point to a promising therapeutic strategy for endogenous muscle diseases. Beyond muscle and brain, this work opens new perspectives of investigation both on the role of serotonin and the 5-HT1B receptor in other types of stem cells and on the therapeutic potential of antidepressants in regenerative medicine.

None Declared

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

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

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

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

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

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

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

None Declared

Careful qualitative analysis of medical comorbidities in psychogeriatric patients is frequently overlooked in clinical practice, although these individuals often present with complex clinical pictures where multiple age-related somatic conditions can influence or alter the psycopathological presentation of mental disorders. This interplay can significantly affect both diagnosis and management, complicating the therapeutic approach and influencing prognosis.

We present the case of an 81-year-old male with a history of schizoaffective disorder admitted to our Psychiatry Unit due to an episode of marked motor inhibition and delusions. This case is notable for its complex clinical presentation, requiring a broad differential diagnosis, and serves as a representative example of the challenges in managing psychogeriatric patients with overlapping psychiatric and neurological comorbidities.

1. 1) To describe the clinical particularities of this case, focusing on relevant psychogeriatric comorbidities and related changes in pathoplasticity.

2. 2) To review the available evidence regarding the characteristics and management of comorbid neurological disorders in psychogeriatric patients.

The patient’s clinical history was reviewed, including complementary tests such as brain MRI and PET-CT scans. Additionaly, a literature search was carried out, focusing on psychiatric and neurological comorbidities in elderly patients with a history of psychotic and affective disorders.

The patient’s clinical course reveals a significant change in the presentation of symptoms starting at the age of 70. Prior to this age, episodes were characterized mainly by inhibition, mutism, and delusional guilt. However, from the age of 70, there is a notable shift to more complex presentations with both manic and psychotic symptoms, including persecutory delusions, hyperactivity, and religious ideation, alongside periods of mixed affective states with significant affective lability. The development of probable drug-induced parkinsonism, confirmed by a negative DaTSCAN, and neuroimaging findings suggestive of a neurodegenerative process akin to Alzheimer’s disease further complicated the clinical picture. Therapeutic interventions included psychopharmacological adjustments and electroconvulsive therapy, resulting in partial stabilization.

1. 1. Managing psychogeriatric patients requires addressing comorbidities with a flexible, symptom-based approach.

2. 2. Neurodegenerative processes can alter prognosis by increasing relapse risk and changing symptom patterns.

3. 3. A multidisciplinary approach is crucial for optimizing care in complex psychogeriatric cases.

None Declared

Drug-induced movement disorders are a rare side effect of which some cases have been reported and published. It may be due to antidepressants, antipsychotics or other drugs. In these cases it is important to realize differential diagnosis, identify the medication that may have caused it and implement appropriate management to solve it.

To present the case of a 16-year-old adolescent diagnosed with major depressive disorder with movement disorders after treatment with escitalopram.

A literature review was conducted on movement disorders and treatment with antidepressants in child-adolescent population.

Our case is about a 16-year-old adolescent who is living with his family and he is studying at the high school. The patient has no personal psychiatric history and in his family only his father has an adaptive disorder treatment. The first time he comes to consultation, he said that in the last few weeks he has anxiety attacks in different environments and an increase in basal anxiety. He has been in a low mood for about two years with apathy, which has increased in recent weeks. He is diagnosed of major depressive disorder and we decided to continue with escitalopram 10 mg and chlorazepate dipotassium prescribed a week ago by his family doctor. After one month, he goes to the second consultation with difficulty in walking, stiffness and instability that is related to the introduction of treatment. In addition, he comments on mild improvement of anxiety and mood. Due to the timing of the onset of movement disorder and the onset of escitalopram, it is decided to suspend it. Chlorazepam dipotassium is maintained and short-term for evaluation of evolution. In the following consultation, no movement disorder symptoms are seen and the onset of another antidepressant with a different course of action is assessed.

Drug-induced movement disorders as in the case described are a rare side effect of which some cases have been reported and published. Different studies reveal the different behavior of antidepressants in the adult and child-adolescent population. In a meta-analysis on antidepressants and depression in the child-and-youth population (1), the results indicated that sertraline, escitalopram, duloxetine and fluoxetine could be considered as the first option although cases with associated extrapyramidal symptoms (EPS) were reported. According to a study on the association of antipsychotics, antidepressants with movement disorders in children and adolescents (2), the risk-benefit profile of antipsychotic use should be considered as an adjuvant to reduce EPS. In addition, in a post-marketing study (3), a potentially harmful association was found between movement disorders and the use of antidepressants mirtazapine, vortioxetine, fluvoxamine, citalopram, paroxetine, duloxetine, escitalopram, fluoxetine, sertraline, venlafaxine, among others.

None Declared

Schizophrenia is a complex psychotic disorder characterized by positive symptoms (such as delusions, hallucinations, and disorganized speech and behavior), negative symptoms, and cognitive impairment. Cognitive deficits, including impairments in executive function, memory, and social cognition, are particularly persistent and significantly impact daily functioning and overall quality of life. While cognitive remediation has proven effective, recent research has explored the potential of board games as a therapeutic tool.

This study aims to assess the therapeutic benefits of board games on cognitive function, specifically executive function, in patients with schizophrenia.

A literature review was conducted using articles from PubMed, focusing on the terms “board game”, “schizophrenia” and “cognition”.

Cognitive deficits in schizophrenia contribute significantly to poor functional outcomes and daily functioning. Improving cognitive function and social behaviors has been a major focus of psychiatric rehabilitation techniques. Board games have been found to improve various aspects of cognitive function, including attention, working memory, speed of processing, verbal learning, visual learning, reasoning and problem solving, as well as social cognition. They are expected to enhance knowledge, interpersonal interactions, and increase participant motivation. Ideally, an effective board game for this population should be behaviorally oriented, emphasize positive reinforcement and shaping, and be sensitive to cognitive limitations through repetition and procedural learning. Additionally, they should be engaging and fun to address negative symptoms.

Board games present a promising therapeutic avenue for managing schizophrenia, particularly in enhancing cognitive function and social skills. While cognitive remediation programs have already demonstrated efficacy, board games offer a more accessible and engaging alternative. Despite these positive findings, the limited number of studies and inconsistent long-term data highlight the need for further research. Future studies should evaluate the durability of cognitive and functional improvements from board game interventions and explore their integration into comprehensive treatment programs for schizophrenia.

None Declared

Psychiatric symptoms in vascular dementia occur in up to 95 % of patients. These symptoms can be of a depressive or manic type, among others. For this reason, it is essential to carry out a proper differential diagnosis between vascular dementia and other types of pathology that include psychiatric symptoms.

1. 1) To describe the main psychiatric symptoms that could guide the diagnosis of vascular dementia.

2. 2) To make an appropriate differential diagnosis in order to carry out the most suitable therapeutic approach in each specific case.

A review of the most recent literature related to psychiatric symptomatology in patients with vascular dementia.

Vascular dementia can present with very diverse psychiatric pathology. Depending on the subcortical area affected, a particular symptomatology will predominate. For this reason, it is of vital importance to carry out a proper differential diagnosis. When the brain area affected is the ventromedial prefrontal cortex, the predominant symptomatology is depressive, with a higher percentage of patients with abulia. If the area most affected is the orbitofrontal cortex, disinhibition will predominate. However, if it is the dorsolateral prefrontal area, it will lead to executive dysfunctions.

On the other hand, it should be noted that psychiatric symptomatology due to vascular damage often has an atypical presentation in patients. For example, if what predominates is depressive symptomatology, what might appear relatively frequently would be late onset anxiety, irritability, or excessive somatic preoccupation. However, sadness or crying would not be as representative. If what predominates is the manifest symptomatology, in this case, with a high probability it would manifest itself in the form of behavioural disinhibition.

Because of these peculiarities, it is essential to make a proper screening between vascular dementia, late onset depression or Alzheimer’s disease, as the therapeutic approach to each pathology will be very different, as will be the prognosis.

• - Atypical psychiatric symptomatology may be the key to a diagnosis of vascular dementia.

• - A proper differential diagnosis between vascular dementia, late onset depression and Alzheimer’s disease is essential.

• - There is no clear benefit in the use of ACE inhibitors and NMDA receptor antagonists in cognitive impairment. However, there is evidence of improvement in cognitive function with SSRI antidepressants in patients with and without depression.

None Declared

Eating disorders (EDs), including binge-eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa (AN), represent serious mental health conditions characterized by disturbances in eating behavior and body image concerns. These disorders significantly impair health, psychosocial functioning, and quality of life. Evidence-based psychotherapies have shown effectiveness in treating EDs.

This study aims to evaluate and compare the effectiveness of various psychotherapies for treating BED, BN, and AN, with a focus on both short-term and long-term outcomes. A secondary objective is to assess the applicability of transdiagnostic psychotherapy approaches across different EDs.

A literature review was conducted using articles from PubMed, focusing on the terms “eating disorders”, “evidence-based psychotherapy”, “cognitive-behavioral therapy”, and “interpersonal psychotherapy”. The selection prioritized the most relevant clinical trials and meta-analyses.

Cognitive-behavioral therapy (CBT) consistently demonstrated significant short-term effects in reducing binge-eating episodes and EDs psychopathology, particularly in BED and BN. It outperformed both inactive controls (e.g., wait-lists) and other psychotherapies. Long-term, CBT continued to show sustained improvements in symptom reduction, particularly for BED, though it was less effective for BN and AN.

For the treatment of AN, most guidelines recommended psychological interventions, particularly family-based therapy (FBT) for younger patients. CBT and structured therapies like Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) were also recommended. Interpersonal psychotherapy (IPT) received limited support due to insufficient evidence.

In BN, CBT was widely endorsed as the first-line treatment. IPT was recommended as an alternative, noted for its slower symptom \reduction but equivalent long-term efficacy. FBT was recommended for younger patients.

For BED, CBT was consistently recommended as the first-line treatment, with growing evidence supporting guided CBT self-help. IPT was recommended by several guidelines as an alternative.

CBT was the most consistently recommended treatment for all EDs, particularly for BN and BED, offering faster symptom reduction, higher remission rates, and better long-term outcomes. While IPT is a viable alternative, particularly for BED, it generally takes longer to achieve comparable results. The findings emphasize the need for more personalized treatment approaches and the exploration of adjunctive therapies to improve outcomes, especially for AN. Further research is required to refine therapy selection and address the distinct challenges posed by different ED subtypes, particularly in achieving long-term treatment success.

None Declared

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

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

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

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

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

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

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

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

None Declared

Many patients suffering from schizophrenia have symptoms suggesting depression during the course of their illness. It can appear both in the prodrome of a psychotic decompensation and in the acute phase, as well as after its resolution. But is it part of the disease itself? Is it an experiential reaction to the assumption of the sickness or is it an independent entity? Can it be produced or exacerbated by antipsychotics?

This case study aims to analyze the clinical presentation of depressive symptoms in a patient with schizophrenia.

A review of the literature on affective symptomatology which may occur in psychosis.

A 34-year-old male with a history in Mental Health since the age of 16, with diagnosis of paranoid schizophrenia. He has presented at least 5 depressive episodes and several severe self-harming attempts. He is on treatment with olanzapine, clonazepam, quetiapine and aripiprazole.

During a follow-up, he reports intensification of low mood in the last few weeks due to sentimental break-up, clinophilia and social isolation. He spends the day in his room with the curtains lowered, he has neglected his personal hygiene, and verbalizes thoughts of death. He shows poor functioning, slowed thinking and lack of energy.

His mother reports that he has had self-aggressive behaviors, such as hitting his face and eating his faeces. Sensory and perceptual disturbances are not excluded. Given the current depressive affective state and risk of commiting suicide, it is decided to admit him to the hospital and to start treatment with fluoxetine.

A few weeks after hospital discharge, he continues with poor functioning and isolation, but his mood is better and his thoughts of death have disappeared.

Although clear differentiation between depressive and psychotic symptomatology has been classically described, both symptoms are often associated. Affective symptoms can be part of different stages of the disease, secondary to medication, due to insight phenomena or part of schizoaffective disorder and psychotic depressions.

Depressive symptomatology can also be confused with the presentation of negative symptoms. They both share clinical manifestations such as anergy, social isolation and lack of interest; but while in depression there is a sad mood, in negative symptons there is emotional flattering. Also, positive symptomatology can simulate social withdrawal, usually seen in depression.

Depression in an acute phase has historically been related to a better prognosis, although several studies indicate that depression in a chronic phase causes a higher risk of suicide and relapses. Therefore, early diagnosis and treatment are essential.

In our case, the patient suffers from major affective symptoms regarding his life situation, which may be overlapped by isolation due to a likely positive symptomatology, without dismissing possible negative symptomatology as a result of many years of evolution of his disease.

None Declared

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

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

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

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

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

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

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

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

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

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

None Declared