11 results
Conversion or inflammation?
- L. Rodriguez Rodriguez, M.J. Gordillo Montaño, S.V. Boned Torres
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S702
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Introduction
Autoimmune encephalitis are inflammatory diseases of the CNS mediated by antibodies that attack neurotransmitter receptors or proteins on the surface of neurons, usually in the limbic system. The clinic is different according to the antineuronal Ac involved.
ObjectivesTo make a correct differential diagnosis between autoimmune encephalitis and primary psychiatric pathologies that may be similar in symptoms through a complete study of the patient including anamnesis, physical examination, imaging tests, cerebrospinal fluid and serum studies.
MethodsDescription of a clinical case. A 31-year-old female patient, with no previous history of interest, was brought to the emergency department for a suspected seizure. The previous days she had presented emotional lability, difficulty in concentration and reading, blurred vision, confusion and hemicranial headache. Two days later she returned to the emergency room for insomnia, dysarthria, difficulty in reading, comprehension, naming, and excessive rumination of her problems. Incoherent and repetitive language. The Emergency service requested to rule out a conversive disorder.
ResultsNeuropsychiatric manifestations (anxiety, depression, behavioral disturbances, insomnia, memory deficits, psychomotor agitation, mania, auditory and visual hallucinations, delusions) are the first symptom in 70% of autoimmune encephalitis due to anti-NMDA antibodies and usually respond poorly to psychiatric treatment, making the treatment of the primary cause necessary for the remission of these symptoms.
ConclusionsGiven their increasing recognition and prevalence, autoimmune causes should always be taken into account in behavioral changes, cognitive or consciousness impairment of subacute installation, especially in young patients and once infectious, metabolic and vascular causes have been ruled out with an appropriate complementary study.
DisclosureNo significant relationships.
Psycho-Covid
- M.J. Gordillo Montaño, S.V. Boned Torres, L. Rodriguez
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S530
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Introduction
The COVID-19 pandemic generated a health emergency and led to the adoption of different measures, including home quarantine and social isolation, which, as we have seen, has had an impact on the mental health of the majority of citizens, with the possibility of psychiatric disorders appearing. in people without prior mental illness, such as acute decompensations in patients with known disorders, more vulnerable to environmental stressors.
ObjectivesLearn and rethink alarm signals in extreme situations such as the one experienced in recent months, as well as observe the impact, negative in many cases, but positive in others, of the patients we treat daily.
MethodsDescription through brief clinical cases of the impact of the COVID-19 pandemic on psychotic patients and the decompensation that it has entailed, including due to confinement measures and social isolation, associated with over-information through the media, chaos initial and the uncertainty that it caused and the associated fear.
ResultsRestrictions as a result of COVID-19 have played a very relevant role as an external stressor for the appearance of psychopathological alterations, including psychotic symptoms. In addition, people who suffer from psychosis or at risk of psychotic disorder can be especially affected and trigger acute psychopathology with social isolation, loss of daily routines, unemployment, homelessness.
ConclusionsThese cases are an example that shows the need for an early and effective approach to the rise in mental illnesses in circumstances of this caliber.
DisclosureNo significant relationships.
Paranoia
- M.J. Gordillo Montaño, L. Rodriguez Rodriguez, S.V. Boned Torres
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S776
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Introduction
Paranoid ideas occur very often in humans (prevalence of 0.2%). According to several studies, the origin could be found in a genetic predisposition to a selective hyperdopaminergia related to the D2 receptor and dopamine neurotransmitter dysfunction.
ObjectivesTo delve into this pathology, including origin and development, epidemiology, diagnostic criteria, clinical aspects, differential diagnosis, treatment, evolution and prognosis.
MethodsWe conducted a literature review of delusional disorder.
ResultsThe disease appears in middle age, between ages 35 and 55, being slightly more frequent in women. It seems to affect more economically and educationally disadvantaged social strata, and it is more frequent in immigrants. The onset is usually progressive and insidious. Correct perception but delusional interpretation: the objectivity of what is perceived is disturbed by the subjectivity of what is registered. The delirium is usually logical, contagious, and frequently credible. Patients retain their lucidity. It is very important to make a correct differential diagnosis with schizophrenia. With regard to treatment, the therapeutic relationship with the patient will be basic. If possible, psychotherapy should be combined with pharmacological treatment (second generation antipsychotics being the treatment of choice). In general, their evolution is compatible with out-of-hospital life, being considered “odd guys”.
ConclusionsThe risk of suffering from Delusional Disorder during the lifetime is between 0.05 and 0.1%. This pathology constitutes 1-4% of all psychiatric admissions. Therefore, it is essential to know it in depth in order to be able to manage it properly.
DisclosureNo significant relationships.
Natsukashii
- M.J. Gordillo Montaño, S.V. Boned Torres, L. Rodriguez Rodriguez, M. De Amuedo Rincon
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S403
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Introduction
NATSUKASHII: Japanese word that means happy nostalgia, it is the moment in which memory transports you to a beautiful memory that fills you with sweetness. NOSTALGY: (from the classical Greek [nóstos], “return”, and [algos], “pain”) feeling of sadness, suffering of thinking about something that has been had or lived in a stage and now not. In bipolar disorder, patients are more likely to complain of dysphoria than euphoria. Hypomanic periods often provide pleasant relief from depression. Patients experience this situation as pleasant, positive and longing once it has remitted, since they feel more creative, active and sociable.
ObjectivesWe intend to draw attention to the blurred limits of the state of euthymia, even when stable there is a sustained emotional hypersensitivity, which must be learned to identify and coexist. Behind the desire to be euthymic, in certain patients there is a desire to remain hypomanic and / or manic due to the fact that they have tasted absolute happiness.
MethodsAfter several interviews with stable patients, we have realized that a great majority want to re-experience the sensations of a hypomanic episode.
ResultsAfter a bibliographic search we have realized that in the West there is no term in psychopathology that describes that longing that they verbalize as “maniac lives happier”
ConclusionsSpecial attention must be paid to these patients since they have less adherence to treatment and risk of abandoning it.
DisclosureNo significant relationships.
Polydipsia and intermittent hyponatremia
- S. Ramos-Perdigues, M.J. Gordillo, C. Caballero, S. Latorre, S.V. Boned, G. Miriam, P. Torres, M. De Almuedo, M.T. Sanchez, E. Contreras, E. Gomez, E. Sanchez, M. Segura, C. Torres, G. Gemma, M. Tur, A. Fernandez, C. Merino
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- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. s502
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Introduction
Hyponatraemia occurs in 4% of schizophrenic patients. Dilutional hyponatraemia, due to inappropriate retention of water and excretion of sodium, occurs with different psychotropic medications and could lead to hippocampal dysfunction. This complication is usually asymptomatic but can cause severe problems, as lethargy and confusion, difficult to diagnose in mentally ill patients.
ObjectivesTo describe a case of a patient with psychotropic poli-therapy, admitted three times due to hyponatremia and the pharmacological changes that improved his condition.
AimsTo broadcast the intermittent hyponatraemia and polydipsia (PIP), a not rare condition, suffered by treated schizophrenic patients and discuss its physiopathology and treatment thorough a case report.
MethodsA 56-year schizophrenic male was admitted for presenting disorganized behavior, agitation, auditory hallucinations, disorientation, ataxia, vomits and urinary retention. He was on clomipramine, haloperidol and clotiapine (recently added), quetiapine, fluphenazine and clonazepam. After water restriction his symptoms improved and he was discharged. Twenty-five days later, he was readmitted for presenting the same symptoms and after water restriction, he was discharged. Five days later, he was again admitted and transferred to the psychiatric ward.
ResultsHaloperidol, fluphenazine and clomipramine were replaced by clozapine. These changes lead him to normalize the hypoosmolality and reduce his water-voracity. Endocrinology team did not label this episode of SIADH due to its borderline blood and urine parameters.
ConclusionsHyponatremia is frequent in schizophrenic patients and may have severe consequences. Therefore, a prompt recognition and treatment is warranted.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Sun lupus and energy. Systemic lupus erythematosus presenting as mania
- M.J. Gordillo Montaño, S. Ramos Perdigues, M.A. Artacho Rodriguez, S. Latorre, C. Merino del Villar, C. Caballero Roy, S.V. Boned Torres, M. de Amuedo Rincon, P. Torres Llorens, M. Segura Valencia
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. s493
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Introduction
Systemic lupus erythematosus is a chronic disease that can give neuropsychiatric episodes and systemic manifestations. About 57% of patients with SLE have neuropsychiatric manifestations in the course of their illness, however an initial presentation with neuropsychiatric clinic is rare.
ObjectiveDescribe how patients receiving corticosteroids as part of their treatment can develop mental disorders but not only them.
MethodIt will raise grounds with a case: 20-year-old woman recently diagnosed with SLE because of arthritis in his ankle. Treatment was initiated with prednisone 10 mg and chloroquine 200 MG. After 20 days the patient comes to the emergency after episode of turmoil at home with major affective clinical maniform. Presenting fever. The presence of fever downloads the possibility of a psychosis chloroquine or corticosteroids to be a small dose. Treatment was initiated with high doses of prednisone and immunosuppressants. In addition to associating specific anticonvulsant and antipsychotic drugs at usual doses for a manic episode.
ResultsTreatment of psychosis in SLE is essentially empirical, and depends on the etiology. It usually responds to the use of high doses of corticosteroids combined with immunosuppressive drugs. Psychosis induced by corticosteroids requires lowering them. It is valid concomitant use of antipsychotics.
ConclusionsThe presence of psychotic symptoms in a patient with systemic lupus erythematosus forces to distinguish between various etiological possibilities.
Corticosteroids may cause a variety of psychiatric symptoms. And yet, in patients with SLE these syndromes are not always attributable to the use of corticosteroids.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Confusion between symptom and disease. Parkinson vs meningioma
- M.J. Gordillo Montaño, S. Ramos Perdigues, C. Merino del Villar, C. Caballero Roy, S. Latorre, M. Guisado Rico, A. Bravo Romero, S.V. Boned Torres, M. de Amuedo Rincon
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. s493
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Introduction
Parkinson's disease is caused by decreased dopaminergic neurons of the substantia nigra. Psychosis occurs between 20 and 40% of patients with Parkinson's disease. Dopaminergic drugs act as aggravating or precipitating factor. Before the introduction of levodopa patients had described visual hallucinations but the frequency was below 5%.
ObjectiveIllustrated importance of treatment, reassessment after its introduction and refractoriness to answer; as well as the importance of a differential diagnosis at the onset of psychotic symptoms later in life.
MethodClinical case: female patient 75 years tracking Neurology by parkinsonism in relation to possible early Parkinson disease. She was prescribed rasagiline treatment. Begins to present visual and auditory hallucinations, delusional self-referential and injury. She had no previous psychiatric history. She went on several occasions to the emergency room, where the anti-Parkinson treatment is decreased to the withdrawal point and scheduled antipsychotics did not answer. Doses of antipsychotics are increased despite which symptoms persist and even increase psychotic symptoms. In this situation it is agreed to extend the study. Subsequently an NMR of the skull where the image is suggestive of a right occipital meningioma appears.
Results/conclusionsWith the emergence of psychotic symptoms later in life it will be important to ask a broad differential diagnosis, since in a large number of cases will be secondary to somatic or to drug therapies.
Parkinsonism can be a symptom of occipital meningioma, presenting in the psychotic clinic. Refractoriness, on one hand to the suspension of treatment for Parkinson's disease, such as poor response to antipsychotics, did extend the study, which ultimately gave us the diagnosis.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
A broken heart
- M.J. Gordillo Montaño, S. Ramos Perdigues, S. Latorre, M. de Amuedo Rincon, P. Torres Llorens, S.V. Boned Torres, M. Segura Valencia, M. Guisado Rico, C. Merino del Villar
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, pp. S422-S423
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Introduction
Within the various cultures and throughout the centuries has observed the relationship between emotional states and heart function, colloquially calling him “heartbroken”. Also in the medical literature are references to cardiac alterations induced by stress.
ObjectiveTakotsubo is a rare cardiac syndrome that occurs most frequently in postmenopausal women after an acute episode of severe physical or emotional stress. In the text that concerns us, we describe a case related to an exacerbation of psychiatric illness, an episode maniform.
MethodWoman 71 years old with a history of bipolar I disorder diagnosed at age 20. Throughout her life, she suffered several depressive episodes as both manic episodes with psychotic symptoms. Carbamazepine treatment performed and venlafaxine. He previously performed treatment with lithium, which had to be suspended due to the impact on thyroid hormones and renal function, and is currently in pre-dialysis situation.
She requires significant adjustment treatment, not only removal of antidepressants, but introduction of high doses of antipsychotic and mood stabilizer change of partial responders. In the transcurso income, abrupt change in the physical condition of the patient suffers loss of consciousness, respiratory distress, drop in blood pressure, confusion, making involving several specialists. EEG was performed with abnormal activity, cranial CT, where no changes were observed, and after finally being Echocardiography and coronary angiography performed when diagnosed Takotsubo.
Results/conclusionsIn this case and with the available literature, we can conclude that the state of acute mania should be added to the list of psychosocial/stressors that can trigger this condition.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
I was not so
- M.J. Gordillo Montaño, S. Ramos Perdigues, E. Guillén Guillén, O. Lopez Berastegui, M. Guisado Rico, S.V. Boned Torres, M. De Amuedo Rincon, C. Merino del Villar, S. Latorre
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, pp. S668-S669
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Introduction
The frontal lobes are the brain structures of latest development and evolution in the human brain. It is considered that the frontal lobes represent the “executive center of the brain”. The frontal tumors represent 16% of all supratentorial tumors. Symptoms are easily confused as psychiatric rather than neurological.
ObjectivesCan see the alterations of the executive functions in a case of frontal affectation, for future cases know where to focus our attention and develop concepts associated with frontal lobe.
MethodThirty-year-old patient without relevant medical history. Go to the emergency department with major episode of agitation. After performing cranial CT abnormality, it is detected in the front area. Sign up study. It presents amnesia episode before admission, whereupon shown stunned and worried. The patient describes a change in your life 12 months ago, when it begins to be more nervous, increasing their impulsiveness, she has episodes of binge eating, purging behavior with subsequent occasional alcohol abuse. Jealousy. The patient is informed as much as your family of the possible impact of the injury on the behavioral sphere and impulse control when it is still unknown origin.
ConclusionsFrom a neuropsychological point of view the frontal lobes represent a system of planning, regulation and control of psychological processes; coordination and allow selection of multiple processes and various behavioral options and strategies available to the human being. Tumour research is important as it provides enough information we cognitive impairment. These patients exhibit symptoms that are easily confused as psychiatric rather than neurological.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Clozapine induced diarrhea
- S. Ramos-Perdigues, M.J. Gordillo, C. Caballero, S. Latorre, S.V. Boned, M.T. Sanchez, P. Torres, M. Guisado, E. Contreras, M. De Almuedo, E. Esmeralda, E. Sanchez, M. Segura, A. Fernandez, C. Torres, G. Herrero, M. Tur, C. Merino
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. s502
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Introduction
Clozapine (CZP) is the only antipsychotic approved for resistant schizophrenia 1. Due to its side effects, CZP is not the first therapeutic option in a psychotic episode. Its anticholinergic effects often cause constipation, however, diarrhea have also been described in literature.
ObjectivesWe describe a patient with two episodes of severe diarrhea after clozapine initiation, which lead to CZP discontinuation.
AimsDiscuss about the differential diagnosis of diarrhea in CZP patients and the needing of a further studies for clarify the more appropriate management in CZP induced diarrhea.
MethodsWe present a case report of a 46 years man diagnosed with schizoaffective disorder who presented two episodes of severe diarrhea with fever, which forced his transfer to internal medicine and UCI after CZP initiation.
ResultsAt the first episode analytical, radiological and histological findings led to Crohn's disease diagnosis, which required budesonide and mesalazine treatment. In the second episode, the digestive team concluded that the episode was due to clozapine toxicity despite the controversial findings (clostridium toxin and Crohn's compatible biopsies)
ConclusionsDiarrhea caused by CZP has been controversial in the literature. However due to the severity of digestive episodes and the paucity of alternative treatments further studies for a better understanding of its physiopathology are warranted.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Cannabinoid hyperemesis syndrome, a treatment discussion
- S. Ramos-perdigues, M.J. Gordillo, C. Caballero, S. Latorre, S.V. Boned, M. Guisado, M. De Almuedo, P. Torres, M.T. Sanchez, E. Contreras, A. Fernandez, G. Esmeralda, E. Sanchez, M. Segura, C. Torres, G. Herrero, M. Tur, C. Merino
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- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S318
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Introduction
Cannabinoid hyperemesis syndrome (CHS), is characterized by recurrent episodes of severe nausea and intractable vomiting, preceded by chronic use of cannabis. A pathognomonic characteristic is compulsive bathing in hot water. The resolution of the problem occurs when cannabis use is stopped. However, patients are often reluctant to discontinue cannabis. Treatment with anti-emetic medication is ineffective. Case series suggested haloperidol as a potential treatment. Other antipsychotics as olanzapine has been used as anti-emetic treatment in chemotherapy.
ObjectivesTo describe three cases of patients with CHS whom showed a successful response to olanzapine, even when, haloperidol had failed.
AimsTo present an alternative treatment for CHS which can offer benefits over haloperidol.
MethodsWe present three cases of patients who suffered from CHS and were admitted to emergency department. All patients were treated with olanzapine after conventional anti-hemetic treatment failure. One patient was also unsuccessfully treated with haloperidol.
ResultsAll three patients showed a good response to olanzapine treatment. Different presentations were effective: velotab and intramuscular. Their nausea, vomits and agitation were ameliorated. They could be discharge after maintained remission of symptoms.
ConclusionsOlanzapine should be considered as an adequate treatment for CHS. Its suitable receptorial profile, its availability in different routes of administration and its side effects profile could offer some benefits over haloperidol.
Disclosure of interestThe authors have not supplied their declaration of competing interest.