25 results
Psychiatric Comorbidity and Length of Stay in a general hospital
- R. Fernández Fernández, P. del Sol Calderón, Á. Izquierdo de la Puente, R. Blanco Fernández, M. Martín García
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S588-S589
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Psychiatric comorbidity has a significant impact on the patient’s overall health, with an increased risk of death for those patients with mental-physical comorbidity (Tan et al., 2021). This impacts, among other things, the average hospital stay of a patient with psychiatric comorbidity. For example, an American study shows that psychiatric comorbidity was associated with greater inpatient utilization, including the risk of additional hospitalizations, days of stay, and hospitalization charges (Sayers et al., 2007). Our study aims to confirm these results in patients admitted to a general hospital for any cause and presenting psychiatric comorbidity.
ObjectivesTo compare the mean length of stay of patients admitted to a general hospital for any cause according to whether they have psychiatric comorbidity or not.
MethodsWe made a descriptive retrospective study through the use of electronic medical records. The drug use history and average day of hospitalization were obtained for all patients admitted to the inpatient service of a general hospital during a 3-year period.
ResultsThe mean length of stay was longer in patients with psychiatric comorbidity (mean = 9.87 days, SD = 15.45) than in patients without psychiatric comorbidity (mean = 5.23 days, SD = 7.16), the difference being statistically significant for the analysis of variance with a small effect size (F = 18.2; p < 0.001, η²=0.038). The assumption of the equality of variances of the two groups is not fulfilled (Levene F = 29.0; p < 0.01) so Welch’s nonparametric test was applied, whose results do not modify those obtained.
N Mean SD SE No psychiatric comorbidity 296 5.23 7.16 0.416 Psychiatric comorbidity 238 9.87 15.45 1.002 ConclusionsOur results are in line with other studies, showing a longer mean length of stay in those patients admitted for any cause and with associated psychiatric comorbidity. This highlights the importance of having an integrated psychiatry service in a general hospital, as Bronson points out, where they find a shorter mean length of stay in units that have integrated, proactive psychiatric care (Bronson et al., 2019).
ReferencesBronson, B. D., Alam, A., & Schwartz, J. E. (2019). The Impact of Integrated Psychiatric Care on Hospital Medicine Length of Stay: A Pre-Post Intervention Design With a Simultaneous Usual Care Comparison. Psychosomatics.
Sayers, S. L., Hanrahan, N., Kutney, A., Clarke, S. P., Reis, B. F., & Riegel, B. (2007). Psychiatric comorbidity and greater hospitalization risk, longer length of stay, and higher hospitalization costs in older adults with heart failure. Journal of the American Geriatrics Society.
Tan, X. W., Lee, E. S., Toh, M., Lum, A., Seah, D., Leong, K. P., Chan, C., Fung, D., & Tor, P. C. (2021). Comparison of mental-physical comorbidity, risk of death and mortality among patients with mental disorders - A retrospective cohort study. Journal of psychiatric research.
Disclosure of InterestNone Declared
Neuropsychiatric symptoms related to agenesis of the corpus callosum. A case report
- A. Izquierdo De La Puente, P. del Sol Calderón, M. García Moreno, R. Blanco Fernandez, M. Vizcaino Da Silva
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S892
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
We present the case of a 41-year-old male patient with multiple psychiatric diagnoses, he was diagnosed with agenesis of the corpus callosum, which explains his clinical presentation.
ObjectivesThe objective is to carry out a brief review of the symptoms associated with the agenesis of the corpus callosum.
MethodsThe patient has been diagnosed with ADHD, cyclothymia, depressive anxiety disorder and social phobia. He has been treated with a multitude of drugs such as antidepressants, anxiolytics, stimulants and even low-dose antipsychotics. Despite the pharmacological treatments received, as well as the therapies, the patient’s functionality has progressively worsened, to the point of restricting going out of the home or maintaining a stable job.
Biographical data were collected, including psychomotor retardation and inappropriate laughter. He showed mannerisms such as fluttering and low frustration tolerance. He was slow to respond to his name and showed little affective resonance with his sister and parents. Restrictive interests, especially with English culture, for which he later studied English philology. On the other hand, his mother explains that he had no symbolic play and that, from early childhood, he had difficulties in relationships with peers.
Due to the aforementioned clinical manifestations, the functional worsening and the examination carried out in the consultation room, it was decided to extend the study with a brain MRI, where an agenesis of the corpus callosum was observed.
ResultsAgenesis of the corpus callosum is a malformation of the central nervous system, which affects one in every 4000 births. It can be partial or complete, and occurs between the 7th-20th week of gestation.
Agenesis of the corpus callosum presents with a triad of symptoms:
- Reduced interhemispheric communication of sensory-motor information.
- Increased information processing time
- Difficulty in abstract thinking.
This triad causes difficulties not only cognitively, but also socially. There is difficulty in integrating and learning new verbal and visual information. Tendency to literalism, with difficulty in understanding double meanings. They also have difficulty understanding non-verbal language and reading emotions, which makes interaction with peers difficult. All these symptoms can sometimes be confused with symptoms compatible with Autism Spectrum Disorder.
ConclusionsAfter the diagnosis and after focusing the patient’s treatment on the most limiting symptoms of his daily life, an integrated approach was initiated, not only at a pharmacological level, with the use of antidepressants and anxiolytics, but also from a psychotherapeutic point of view, working on those areas in which the patient is most dysfunctional. He was accompanied in the disability application process, as well as helped in the search for associations for adults with ASD, finding there the answer to his symptoms and difficulties.
Disclosure of InterestNone Declared
Assessing a PSP (primary care support programme) from the point of view of the professionals involved: A joint-effort between primary care and psychiatric ward
- S.F. Contaldo, D. Carbonell Simeon, B. Rodriguez Ferraz, E. Blanco García, R. Fernandez Vergel, M. Iglesias Gonzalez, M. Rubio Valera, M. Gil Girbau, M.T. Peñarrubia Maria
-
- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S402
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
The PSP has been implemented in Catalonia in 2006 in an attempt to improve the Primary Care treatment of the most common mental disorders and addictions. It’s based on a collaborative model, made up between Primary Care and Mental Health professionals.
ObjectivesTo identify the strengths and limitations of the PSP from the perspective of Primary Care and Mental Health professionals.
MethodsQualitative, exploratory and interpretive study based on Grounded Theory, made between 2018 and 2019 with Primary Care and Mental Health professionals. Group interviews were conducted with triangulated analysis. The study got the approval from the Research Ethics Committee of the Sant Joan de Deu’s foundation.
Results11 group interviews were conducted in 6 primary care centers and 5 mental health centers in Barcelona. Intrinsic and extrinsic factors impacting the programme functioning were detected. Within the extrinsic factors, elements related to professionals, patients and public health system have been observed. All the professionals agree that the PCSP has a favorable impact on inter-professional relationships and patients, facilitating the management of cases. In contrast the heterogeneity implementation, the lack of training, and the health care burden in is considered to negatively influence an optimal development of the programme. Professionals suggest communication and inter-professional collaboration would be improved by creating more a horizontal structure that eliminates vertical lines of command and disagreements in clinical judgement, thus facilitating shared decisions.
ConclusionsPrimaryCare and MentalHealth professionals value the PSP positively, but conclude there are communication and organizative barriers that should be addressed in order to improve the overall programme’s efficiency.
EPA-0768 – Validation of the Personality and Life Event (PLE) Scale in a Spanish Population
- P. Artieda-Urrutia, J.M. Garcia-Vega, N. Berenguer-Elias, C. Rodriguez-Lomas, M. Fernandez-Rodriguez, I. Gonzalez-Villalobos, M. Martin-Garcia, R. Blanco-Fernández, D. Delgado-Gomez, H. Blasco-Fontecilla
-
- Journal:
- European Psychiatry / Volume 29 / Issue S1 / 2014
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
-
- Article
-
- You have access Access
- Export citation
-
Introduction:
There is a lack of accurate screening tools for suicide risk in the patients presenting to emergency departments. The Personality and Life Event (PLE) Scale, a set of the 27 most discriminative items from a collection of questionnaires usually employed in the assessment of suicidal behavior, demostrated an elevated accuracy, sensibility, and specificity in classifying suicide attempters.
Objectives:To validate the self-administered PLE Scale.
Material and methods:In order to examine its psychometric properties, the PLE scale was administered to 59 suicide attempters, 48 psychiatric controls, and 69 medical patients attending the Puerta de Hierro emergency department. To examine its reliability, we used: 1) Cronbach's coefficient α to evaluate the internal consistency; 2) test-retest reliability to assess if the scale is stable over time. Interrater reliability is not relevant as the PLE is a self-report. To assess its construct validity, we used some of Beck's Suicide Intent Scale (SIS). All analyses were carried out using SPSS v.20 (Macintosh).
Results:The most frequent criteria for suicide attempters were item 4 (‘I often feel empty inside’; 88.1%) and 20 (‘I act on impulse’; 79,7%). Mean (± SD) of the PLE Scale in suicide attempters, psychiatric controls, and medical controls was 74.49 (± 32.44), 57.19 (± 29.63), and 17.48 (± 21.15), respectively. The PLE had an acceptable internal consistency (Cronbach's alpha =0,674).
Conclusions:Our preliminary findings support the reliability, construct validity, and ussefulness of the PLE to identify suicide attempters to those attending to emergency departments.
Effect of Long-acting Injectable Aripiprazole in Glucose and Lipids: A 1 Year Study
- M. Juncal Ruiz, O. Porta Olivares, B. Fernández-Abascal Puente, M. Gómez Revuelta, R. Landera Rodríguez, G. Pardo de Santayana Jenaro, L. Sánchez Blanco, M. Pérez Herrera, D. Abejas Díez, J.L. García Egea
-
- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S268
-
- Article
-
- You have access Access
- Export citation
-
Introduction
Atypical anti-psychotics are associated with an impaired in glucose and lipids homeostasis.
AimsTo evaluate, the effect in lipids and glucose levels after switching to long-acting injectable (LAI) aripiprazole.
MethodsThis was a prospective, observational, 1 year study carried out in 125 outpatients with schizophrenia who were clinically stabilized but a switching to another anti-psychotic was indicated. We measured basal levels of glucose and lipids at the time to start the study and 1 year after switching to LAI-aripiprazole.
ResultsIn basal analytic we observed these abnormalities: hyperglycemia (16.7%), high-levels of LDL-cholesterol (33.3%), low-levels of HDL-cholesterol (39%) and hypertrygliceridemia (22.2%). One year after switching to LAI-aripiprazole we found: glucose levels were normalized in all patients; levels of LDL-cholesterol were lower in 66.7% (in 33.3% levels were normalized) and they were higher in 16.7% (in 11% marked a change from normal to abnormal parameters); levels of HDL-cholesterol were lower in 23.3% and higher in 32.2% (in 11% levels were normalized); and finally, levels of tryglicerides were higher in 66.7% (in 8% marked a change from normal to abnormal parameters) and in 16.7% they were lower (in 7.3% levels were normalized).
ConclusionsLAI-aripiprazole has a beneficial effect in glucose and cholesterol levels. Although, it usually increases tryglicerides levels, only in seven cases there was a change from normal to abnormal parameters. Our study suggests that LAI-aripiprazol could be an alternative in patients with schizophrenia who have high levels of glucose and lipids related with atypical anti-psychotics treatment.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
A mixed approach: Posttraumatic obsessive compulsive disorder
- R. Landera Rodríguez, M. Gómez Revuelta, M. Juncal Ruíz, O. Porta Olivares, R. Martín Gutiérrez, L. Sánchez Blanco, D. Abejas Díez, G. Pardo de Santayana Jenaro, M. Fernández Rodríguez, L.A. Giraldo Vegas
-
- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S411
-
- Article
-
- You have access Access
- Export citation
-
Introduction
Several studies along the last two decades provide information indicating the relationship between posttraumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD). The particular features described in patients who developed OCD symptoms closely after the onset of PTSD, may suggest the existence of a specific subtype of OCD more likely to be suffered after a traumatic event. The few studies focused on evaluating treatment efficacy for the association between OCD and PTSD seem to predict poor response to pharmacologic or behavioral cognitive (BCT) monotherapy.
ObjectivesDespite the evidence, most widely used guidelines propose the employment of either a psychotherapeutic or psychopharmacologic approach. We propose to combine intensive BCT and serotonin profile antidepressants in order to optimize PTSD-OCD subtype.
Material and methodsWe present two detailed case reports offering the results of combining intensive BCT and serotonin profile antidepressants as soon as the comorbid diagnosis for both disorders was established. These two patients were recruited from outpatient care centers.
ResultsOur limited experience supplied promising outcome results. Significant improvement regarding to functional impairment appeared from early stages of the treatment in both patients.
DiscussionDespite logistic difficulties, an intensive and coordinated psychopharmacologic and psychotherapeutic approach might constitute another treatment choice which may be taken into account in those cases monotherapy fails to reduce PTSD-OCD subtype patients’ impairment.
ConclusionsA mixed treatment approach might be taken into account as a first line treatment in PTSD-OCD disorder.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Anticipating Outcome: Predictors of First and Subsequent Relapses in Schizoprenia. A 3-year Follow-up
- M. Gomez Revuelta, V. Gajardo Galan, M. Juncal Ruiz, O. Porta Olivares, R. Landera Rodriguez, G. Pardo De Santayana Jenaro, L. Garcia Ayala, L. Sanchez Blanco, M. Fernandez Rodriguez, B. Crespo Facorro
-
- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S97
-
- Article
-
- You have access Access
- Export citation
-
Introduction
Relapse prevention during early stages after psychosis onset is a key factor for long term outcome. While factors associated with first relapse have been widely studied, factors associated with subsequent relapses are poorly described.
ObjectivesTo determine predictive factors of first and subsequent relapses among patients recruited from a cohort of PAFIP Early Intervention Program.
Material and methodsWe analyzed socio-demographic and clinical data of a cohort of 393 first episode psychosis (FEP) patients that were recruited since February 2001 to May 2011. Of these, 341 achieved clinical remission and were, therefore, considered to be at risk of relapse. They were followed-up for 3 years. A wide range of potential factors were included as possible predictors of relapse. Test univariate, analysis logistics of regression, regression of Cox and analysis of survival of Kaplan-Meier were carried out.
ResultsPoor adherence to medication was the main predictor associated to first relapse (ExpB: 2.979; P < 0.001). After the first relapse, only 56 patients (33.9%) underwent a second relapse, being the diagnosis (ExpB: 1.975; P = 0.074), the age of onset, (ExpB: 1.078; P = 0.003) and a low level of positive symptomatology (ExpB: 0.863; P = 0.03) the predictors of associated with a second relapse.
ConclusionsAfter a FEP, non-adherence to medication is the main predictor of first relapse. Second and subsequent relapses relate with non-modifiable factors such as age of onset or schizophrenia diagnosis. This subgroup of patients could have greater predisposition to relapse related with the severity of the disease itself.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
A case of pharmacologic extrapyramidal syndrome
- O. Porta Olivares, M. Juncal Ruiz, B. Fernández Abascal Puente, M. Gómez Revuelta, G. Pardo de Santayana Jenaro, L. Sánchez Blanco, R. Landera Rodriguez, A.B. Pérez Santos, F. Arnaiz de las Revillas Almajano
-
- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, pp. s828-s829
-
- Article
-
- You have access Access
- Export citation
-
Introduction
More than 60% of patients receiving intensive treatment with first generation antipsychotic manifest some type of clinically significant extrapyramidal side effects. Parkinsonian syndrome is the most common and is characterized by rigidity, tremors, akinesia and bradykinesia and usually improves with discontinuation of antipsychotic drug or anticholinergic association.
MethodsIt is a 60-year-old man, married with two children. Initiates contact with mental health in 2013 with a diagnosis of adjustment disorder. In February 2014 he requires hospitalisation, establishing the diagnosis of delusional disorder and starting treatment with long-acting injectable paliperidone palmitate (100 mg/month) with remission of psychotic symptoms in a few days. When we receive the patient in our clinic, he presents parkinsonian extrapyramidal symptoms (UKU subscale: 18), with significant functional limitation. We decrease the dose to 75 mg/month and an anticholinergic was added without improvement of Parkinsonian clinic, so we decided to switch to long-acting injectable aripiprazole 400 mg/month, objectifying complete remission of extrapyramidal syndrome (UKU subscale: 0).
ConclusionsThe mechanism of action of aripiprazole m LAI (partial agonist of D2 receptors in the brain) without decreases in the nigrostriatal dopamine pathway, of improving extrapyramidal effects associated one other antipsychotics.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Neuroleptic malignant syndrome: Case report and literature review
- R. Martín Gutierrez, R. Medina Blanco, P. Suarez Pinilla, R. Landera Rodriguez, M. Juncal Ruiz, I. Madrazo del Río Hortega, M. Gómez Revuelta, O. Porta Olivares, J. González Gómez, J. Vázquez Bourgon, R. Hernando Fernández
-
- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S564
-
- Article
-
- You have access Access
- Export citation
-
Introduction
Neuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal adverse effect of neuroleptic, both classic and atypical drugs.
ObjectiveTo review the incidence, clinical characteristics, diagnosis and treatment of NMS.
AimWe have described the case of a man of 32 years of age diagnosed with bipolar disorder treated with lithium. He precised high-dose corticosteroids after having tonsillitis. Then, he presented manic decompensation requiring neuroleptic treatment (oral risperidone). After 72 hours, he presented an episode characterized by muscular rigidity, fever, altered mental status and autonomic dysfunction. Life support measures and suspension of neuroleptic treatment were required.
MethodsA literature review of the NMS was performed using the PubMed database.
ResultsThe frequency of NMS ranges from 0.02 to 2.4%. The pathophysiology is not clearly understood but the blockade of dopamine receptors seems to be the central mechanism. Some of the main risk factors described are: being a young adult, the concomitant use of lithium and metabolic causes, among others. NMS occurs most often during the first week of treatment or after increasing the dosage of the neuroleptic medication. Some issues of NMS are those related with diagnosis, treatment and reintroduction of antipsychotic treatment or not.
ConclusionsNMS can be difficult to diagnose due to the variability in the clinical symptoms and presentation. Because of it diagnosis is of exclusion, clinicians should always take it into consideration when a patient is treating with neuroleptic, especially when the dosage has been recently increased. NMS is a clinical emergency.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Steroid-induced psychiatric syndromes: A case report and a review of the literature
- R. Martín Gutierrez, P. Suarez Pinilla, R. Medina Blanco, R. Landera Rodriguez, M. Juncal Ruiz, M. Gómez Revuelta, I. Madrazo del Río Hortega, O. Porta Olivares, J. González Gómez, R. Hernando Fernández
-
- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S694
-
- Article
-
- You have access Access
- Export citation
-
Introduction
Glucocorticoids are widely prescribed for a variety of diseases and are known to cause neuropsychiatric as well as somatic side effects.
ObjectiveTo review the incidence, clinical characteristics, course and treatment of neuropsychiatric effects of glucocorticoids.
AimWe have described the case of a 86-year-old woman. She had no personal and no psychiatric medical history in her family. She presented wrist arthritis requiring high doses of an oral corticoid treatment (prednisona 20 mg/d). After a week, she started with symptoms characterised by persecutory and surveillance delusions. Organicity was ruled out. The patient got a progressive recovery after starting anti-psychotic medication and progressive reduction of the steroid drugs.
MethodsWe have performed a literature review of the neuropsychiatric complications of glucocorticoids using the PubMed database.
ResultsNeuropsychiatric effects of glucocorticoids involve affective, behavioural, and cognitive manifestations. The incidence is variable, between 2 and 60% of patients who receive steroids. Although the effects of glucocorticoids are unpredictable, the administered dose is the most significant risk factor for the development of neuropsychiatric symptoms. Dosage reduction typically results in clinical recovery. Although the limited data on this subject, it is a problem that clinicians face on their regular basis. The administration of anti-psychotics or mood stabilizers may be beneficial in the prevention and treatment of this syndrome.
ConclusionThe neuropsychiatric effects of glucocorticoids are unpredictable and non-specific. More controlled trials are needed in order to perform evidence-based clinical guidelines for the treatment with glucocorticoids and for the prevention of neuropsychiatric manifestations.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Cognitive symptoms in mayor depression: A study with vortioxetina
- O. Porta Olivares, M. Juncal Ruiz, B. Fernández Abascal Puente, M. Gómez Revuelta, M. Pérez Herrera, G. Pardo de Santayana Jenaro, L. Sánchez Blanco, A.B. Pérez Santos, F. Arnaiz de las Revillas Almajano, R. Martín Gutiérrez, R. Landera Rodríguez
-
- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S538
-
- Article
-
- You have access Access
- Export citation
-
Introduction
The major depression is associated with decreased cognitive functions in a range of areas, including attention, memory and executive functions. The cognitive symptoms of depression can have a profound effect on the ability of patients to keep out the tasks of daily living, and are significant factors that affect the ability to function both interpersonal and occupational level.
AimsVortioxetina have a multimodal action acting on various serotonin receptors in addition to inhibiting serotonin reuptake. Vortioxetina, is a new therapeutic tool seems to have shown efficacy in the treatment of cognitive symptoms of depression.
MethodsTo evaluate this action we have evaluated the cognitive decline in patients with major depression before receiving treatment vortioxetina (whether state or not previously treated with other antidepressants) and at 2, 6 and 12 months after starting treatment with the drug. For that, we’ve used the Verbal Hearing Test King (RAVLT), which evaluates the auditory verbal short-term memory, the learning rate, the retention of information, and the differences between learning and recovery, and testing Digit substitution by symbols (DSST) that perform quick detection of brain dysfunctions by a conventional task.
ResultsThe results of this study are still under analysis.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Cognitive Symptoms: The Border Between Dementia and Depression, a Report of One Case
- M. Juncal Ruiz, O. Porta Olivares, L. Blanco Sánchez, R. Landera Rodríguez, M. Gómez Revuelta, G. Pardo de Santayana Jenaro, N.I. Núñez Morales, R. Martín Gutiérrez, A.B. Pérez Santos, B. Fernández-Abascal Puente
-
- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, pp. S654-S655
-
- Article
-
- You have access Access
- Export citation
-
Introduction
Twenty percent of people aged over 80 have a serious dementia. Cognition disturbances are present both in depressive disorder and dementia. Vortioxetine is a new antidepressant with a multi-modal mechanism of action, being one of the antidepressant with more procholinergic action.
Aimsto know the efficacy of vortioxetine in elder people with cognitive disturbances due to both pathologies: depression and dementia.
MethodsIt is described the result of using vortioxetine in one elder woman with dementia and affective symptoms with no clinical improvement after using two classical antidepressants.
ResultsWoman aged 82 without psychiatric history came to our consultation in April 2016. She had been diagnosed with dementia last year by a neurologist and she had started treatment with Donepezile 10 mg/d. Six months after this diagnosis she complained of depressive mood and faster deterioration of her previous cognition disturbances in terms of functionality level and autonomy, so her neurologist prescribed escitalopram until 10 mg/d and mirtazapine until 30 mg/d without clinical improvement. After first exploration, we decided starting treatment with vortioxetine 10 mg/d and withdraw previous antidepressants. Next week she complained of nausea and vomiting so we reduced the dose to 5 mg/d with good tolerance after that moment. Six months later her depressive mood had improved and her family remarked she had a little more autonomy and more desire to do things.
ConclusionsVortioixetine might be an effective and safe option in elder people who have cognitive disturbances due to mood disorder and/or dementia, probably because of its procholinergic action.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Effect in antipsychotic-induced hyperprolactinemia after switching to long-acting injectable aripiprazole: A 1-year study
- M. Juncal Ruiz, B. Fernández-Abascal Puente, O. Porta Olivares, M. Gómez Revuelta, R. Landera Rodríguez, L. Sánchez Blanco, G. Pardo de Santayana Jenaro, M. Pérez Herrera, J. Mayoral Van Son
-
- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, pp. s815-s816
-
- Article
-
- You have access Access
- Export citation
-
Introduction
Antipsychotic-induced hyperprolactinemia is associated with relevant side effects: short-term as hypogonadism, gynecomastia, amenorrhoea, sexual dysfunction and galactorrhoea; long-term as cardiovascular disease, bone demineralization and breast and prostate tumors.
AimsTo evaluate the effect of switching to long-acting injectable aripiprazole on long-lasting antypsychotic-induced hyperprolactinemia.
MethodsThis was a prospective observational 1-year study carried out in 125 outpatients with schizophrenia who were clinically stabilized but a switching to another antipsychotic was indicated. We measured the basal prolactine at the start of the study and 1 year after switching to long acting injecatable (LAI) aripiprazole.
ResultsIn basal analytic, 48% had hyperprolactinemia (21.8–306.2 ng/mL) and 66.5% of them described side effects: 78% sexual dysfunction (72% men), 11% galactorrhoea (100% women), 5.5% amenorrhoea and 5.5% bone pain (100% women). In 48% of patients with hyperprolactinemia, the previous antipsychotics comprised: LAI-paliperidone (65,7%), oral-risperidone (7%), oral-olanzapine (6.1%), oral-paliperidone (5.2%), LAI-risperidone (4%) and others (12%). One year after switching to LAI-aripiprazole, prolactine levels were lower in all patients and in 85% prolactine levels were normalized. Overall, 72% described a clinical improvement, especially in terms of sexual dysfunction.
ConclusionsSeveral studies have described an improvement of drug-induced hyperprolactinemia after switching to or adding oral aripiprazole. In our study, we observed that levels of prolactine were normalized in 85% of patients with a clinical improvement in almost all of cases. These findings suggest that switching to LAI aripiprazole may be an effective alternative for managing antipsychotic-induced hyperprolactinemia due to its partial agonism in D2 brain receptors, especially in tuberoinfundibular pathway.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
A case of delusional disorder
- O. Porta Olivares, M. Juncal Ruiz, B. Fernández Abascal Puente, M. Gómez Revuelta, M. Pérez Herrera, J.L. Garcia Egea, L. Garcia Ayala, N.I. Nuñez Morales, R. Landera Rodríguez, G. Pardo de Santayana Jenaro, L. Sánchez Blanco
-
- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. s828
-
- Article
-
- You have access Access
- Export citation
-
Introduction
Functioning of patients with delusional disorder may be impaired, particularly if the delusional thinking is chronic rather than episodic. They refuse to characterize their beliefs as false and view opposing views with surprise, if not hostility and disdain, dismissing or ignoring them, and continuing their struggle to find resolution or restitution for the wrongs they have endured or the illnesses from which they suffer. They typically reject and often resent the suggestion that they are mentally compromised. They are a difficult group to engage clinically, often refusing to meet with a clinician about their delusions and/or to take medication. The first-line treatment of delusional disorder is antipsychotic medication rather than other clinical interventions. Patients with the disorder often reject psychiatric treatment, it is particularly important that medication be prescribed in the context of a therapeutic relationship that includes support, education, encouragement of healthier pursuits, and discouragement of damaging, delusion-inspired actions.
MethodsWe describe a case of a 55-year-old woman with a delusional disorder that was diagnosed 4 years before. The supervision of the right take of the treatment was not possible and the intensity of behavioral disturbances increased. Then we started the treatment with long-acting injectable aripiprazole.
ResultsWithin the 4 months following the start of treatment, her mental state improved by attenuation of psychotic symptoms.
ConclusionsLong-acting aripiprazole could be an effective tool for treatment of psychotic symptoms in patients with no insight and difficulties to check the proper treatment take.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Vintage mode: Expansive paraphrenia
- R. Landera Rodríguez, M. Gómez Revuelta, M. Juncal Ruíz, G. Pardo de Santayanda Jenaro, L. Sánchez Blanco, O. Porta Olivares, M. Fernández Rodríguez, E. López García, R. Medina Blanco, R. Martín Gutiérrez
-
- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, pp. S460-S461
-
- Article
-
- You have access Access
- Export citation
-
Introduction
Paraphrenia is a poorly defined process whose uncertain origins date back to the German psychiatry mid-nineteenth century. Paraphrenia would be a subtype of schizophrenia characterized by a more benign clinical course in terms of volitional and emotional involvement. Certain types of serious sensoperceptive distortions and paranoid symptoms are characteristics of this clinical variant. Despite its diverse presentation, its chronic development and its presence in the daily lives of the patient, the overall functionality is not deeply affected.
ObjectivesTo discuss the validity of this and other clinical processes based on classical clinical descriptions for diagnostic approach of our current patients, in contrast to the common use simplified concept (forgetting in ICD-10 or disappeared in American manuals).
Materials and methodsClinical case a middle-aged woman diagnosed with longstanding paranoid schizophrenia who suffered from a highly systemized delusional and hallucinatory syndrome with chronic evolution after a first relapse due to abandonment of treatment, but keeping high functional performance even during phases of partial remission.
ConclusionsSchizophrenia presents multiple symptomatic and prognostic paths. Classical authors named these different subtypes. Revisiting these subtypes could be useful as a complementary tool for predicting clinical outcome based on their descriptions, especially in the absence of reliable material instruments.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
The cannabis profile: A high-risk subtype
- R. Landera Rodríguez, M. Gómez Revuelta, J.L. García Egea, O. Porta Olivares, M. Juncal Ruíz, M. Pérez Herrera, L. Sánchez Blanco, D. Abejas Díez, G. Pardo de Santayana Jenaro, M. Fernández Rodríguez
-
- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, pp. S310-S311
-
- Article
-
- You have access Access
- Export citation
-
Introduction
The first phase following the diagnosis of a first psychotic episode (FEP), is crucial to determine clinical and functional long-term outcome. Cannabis exerts a mediating action on the debut of the disease and determines a poor prognosis.
ObjectivesThe description of a specific population profile of increased vulnerability to maintain cannabis use after a FEP could help to identify this high risk subtype of patients and speed up the implementation of specific interventions.
Materials and methodsOne hundred and seventy-eight patients were recruited from PAFIP (early intervention program on FEP), obtaining detailed socio-demographic assessment. They were followed-up for a year during which cannabis consumption was assessed by Drake scale every three months. We divided the sample into two groups:
– those patients who neither smoked cannabis before the FEP nor during follow-up period (nn);
– consumers group: cannabis users before the FEP who kept on smoking during the follow-up period (ss) and those who smoked before the FEP and gave up consumption during follow-up (sn).
ResultsStatistically significant differences between groups were observed. The consumers group (ss + sn) had an earlier age of onset, most were male, unemployed, single, prone to loneliness and they were concomitant users of alcohol and tobacco.
ConclusionsThe use of cannabis has a detrimental effect on the outcome of schizophrenia. A specific and early intervention could contribute to prognostic improvements. Identifying cannabis consumption subtypes could be useful for this purpose.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Antidepressants and sexual dysfunction: study with vortioxetina
- O. Porta Olivares, M. Juncal Ruiz, B. Fernández Abascal Puente, M. Gómez Revuelta, M. Pérez Herrera, L. Garcia Ayala, R. Landera Rodríguez, N.I. Nuñez Morales, G. Pardo de Santayana Jenaro, L. Sánchez Blanco
-
- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S538
-
- Article
-
- You have access Access
- Export citation
-
Introduction
Antidepressant treatment, although it is effective to improve the manifestations of major depression, may also induce or exacerbate some symptoms of sexual dysfunction. Symptoms such as decreased libido, anorgasmia, delayed ejaculation, erection difficulty or dyspareunia, affect the quality of life of the subject who suffers and the self-esteem, can lead to lack of adherence to treatment and in accordingly, the relapse of depressive symptoms. Serotonergic antidepressants are frequently associated with the onset of sexual dysfunction in sexually active patients exceeding 70%. Clinicians underestimate the actual incidence of dysfunction as the technical specifications of drugs show lower levels than 25% and spontaneous reports of patients do not exceed 20-40%.
AimsVortioxetina is a reuptake inhibitor of serotonin (5-HT) and is also an agonist of the 5-HT1A partial agonist 5-HT1B and an antagonist of 5-HT3, 5-HT1D and 5-HT7. Apparently, this molecule at doses of between 5 and 15 mg is safe and effective and does not cause sexual dysfunction. It is a well-tolerated and safe, with low incidence of sexual dysfunction.
MethodsTo evaluate the action we have evaluated sexual dysfunction in patients with major depression before receiving treatment vortioxetina (whether state or not previously treated with other antidepressants) and at 2, 6 and 12 months after starting treatment with the drug. So we’ve used the SALSex scale (Scale for measuring sexual dysfunction secondary to psychotropic drugs).
ResultsThe results of this study are still being analyzed.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Case Report Klinefelter Syndrome and Multiple Sclerosis as the Cause of Psychosis
- A. Rodriguez Rodriguez, R. Blanco Fernández, M. Vizcaino da Silva, R. Fernández Fernández, O. Mendez Gonzalez
-
- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S638
-
- Article
-
- You have access Access
- Export citation
-
Introduction and goals
Forty-three-year-old male diagnosed with Klinefelter syndrome and showing radiological findings suggesting a demyelinating pathology who presents several psychiatric manifestations including megalomaniacal ideation, delusion, lack of impulse control and behavioral alterations.
Clinical caseForty-three-year-old male diagnosed with Klinefelter syndrome at the age of 31, presenting several psychiatric pathologies since adolescence: delusions, megalomania, mood fluctuation, and high impulsiveness. The patient had a poor therapeutic response to anti-psychotic drugs and ECT. He was hospitalized up to 9 times, but the full control of the symptomatology was not achieved. During his last hospitalization, a MRI revealed lesions compatible with a demyelinating pathology.
DiscussionA higher prevalence of schizophrenia spectrum disorders has been described among patients suffering from Klinefelter syndrome, which might explain the role of the X chromosome in the susceptibility to psychiatric disorders, particularly to psychosis. Furthermore, the brain structure alterations presented by patients suffering from Klinefelter syndrome are similar to those described among schizophrenic patients: small brain volume, lateral cerebral ventricular enlargement and reduced temporal gyrus, amygdala, insula and cingulate cortex. Patients suffering from multiple sclerosis are more prone to psychiatric disorders, such as mood swing, aggressiveness or psychosis, which are not concurrent with the physical progression of the disease, sometimes being its first manifestation. Even when being patchy and multifocal, demyelination seems to be concentrated in the frontal lobes, related to the cognitive and affective functions and the personality.
ConclusionsBoth multiple sclerosis and Klinefelder syndrome may alter the brain structure, mainly in the frontal lobe, and predispose to psychiatric disorders.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
The impact of Cannabis in Schizophrenia: Pafip Three-year Longitudinal Study on Outcome and Functionality After a First Episode of Psychosis
- M. Gomez Revuelta, M. Juncal Ruiz, O. Porta Olivares, M. Fernández Rodríguez, D. Abejas Díez, L. Sánchez Blanco, R. Landera Rodríguez, R. Medina Blanco, B. Crespo Facorro, I. Madrazo Del Río Hortega, R. Gutierrez Martin
-
- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, pp. S136-S137
-
- Article
-
- You have access Access
- Export citation
-
Introduction
The association between cannabis and psychosis makes crucial the intervention on cannabis use disorder at first episodes of psychosis (FEP), especially among young population. In this group of patients, the harmful potential of cannabis is more evident by its influence on neurodevelopment. However, the nature of the association cannabis-psychosis is not clearly described. It seems to represent a mediating factor for an increased risk of psychosis in healthy and high-risk populations, determining an earlier age of onset and worsening long term outcome.
ObjectivesTo assess the impact of cannabis in terms of functional and clinical prognosis in patients recruited after a FEP.
Material and methodsPAFIP is an early intervention program for early stages of psychosis. One hundred and sixty-three were included, followed-up at regular intervals of six months for three years with administration of clinical and functional scales (BPRS, SAPS, SANS, CDRS, GAF and Drake). Patients were divided into three groups: (1) those non-users neither before the onset nor during follow-up (nn) PEP, (2) consumers before the FEP and during follow-up (ss) and (3) consumers before the FEP that gave up consumption during follow-up (sn).
ResultsNo statistically significant differences were observed in terms of functionality at three-year follow-up endpoint but a trend to a better-preserved functionality in the sn group. The sn group presented lower scores in scales for positive symptoms with respect to the comparison groups.
ConclusionsThe interruption in cannabis use may have a beneficial effect on short-term clinical prognosis and functionality on long term.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
The Impact of Cannabis in the Early Stages of Schizophrenia: A 3-Year Longitudinal Study on Cannabis Influence on Relapse Rates
- M. Gomez Revuelta, M. Juncal Ruiz, O. Porta Olivares, V. Gajardo Galan, G. Pardo de Santayana Jenaro, L. Sanchez Blanco, D. Abejas Diez, R. Landera Rodriguez, L. Garcia Ayala, N.I. Nuñez Morales, M. Fernandez Rodriguez
-
- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, pp. S196-S197
-
- Article
-
- You have access Access
- Export citation
-
Introduction
The first five years after the onset of a first episode of psychosis (FEP) are crucial for long term outcome. In this period, the risk of relapse is particularly high. Consequences of relapse include an increased risk of neurotoxicity, chronicity, hospitalization, decreased response to treatment, increased economic burden and functional impairment.
ObjectivesTo discern the influence of cannabis on relapse as it may contribute to adopt specific measures in patients during early stages of the illness.
Material and methodsPAFIP is an early intervention program for patients with a FEP. Between January 2005 and January 2011, 163 patients were recruited for this study. They were followed-up during 3 years at intervals of three months. The sample was divided into three groups: (1) those non-cannabis users neither before the FEP nor during follow-up (nn), (2) consumers before the FEP and during follow-up (ss) and (3) consumers before the FEP that gave up consumption during follow-up (sn).
ResultsNo statistically significant differences between the three groups were observed but a trend (P = 0.057) towards a more enduring survival in Group 3 (sn). (Kaplan–Meier curve and detailed Log Rank Test results will be included in the final poster).
ConclusionsCannabis has a detrimental effect on schizophrenia. The interruption of its use could contribute to improve the outcome of the disease, as the results of our study suggest.
Disclosure of interestThe authors have not supplied their declaration of competing interest.