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Overlapping Science in Radiation and Sulfur Mustard Exposures of Skin and Lung: Consideration of Models, Mechanisms, Organ Systems, and Medical Countermeasures: Overlapping science in radiation and sulfur mustard injuries to lung and skin
- Merriline M. Satyamitra, Devon K. Andres, Julie N. Bergmann, Corey M. Hoffman, Thomas Hogdahl, Mary J. Homer, Tom C. Hu, Carmen I. Rios, David T. Yeung, Andrea L. DiCarlo
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- Disaster Medicine and Public Health Preparedness / Volume 17 / 2023
- Published online by Cambridge University Press:
- 19 October 2023, e552
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Purpose:
To summarize presentations and discussions from the 2022 trans-agency workshop titled “Overlapping science in radiation and sulfur mustard (SM) exposures of skin and lung: Consideration of models, mechanisms, organ systems, and medical countermeasures.”
Methods:Summary on topics includes: (1) an overview of the radiation and chemical countermeasure development programs and missions; (2) regulatory and industry perspectives for drugs and devices; 3) pathophysiology of skin and lung following radiation or SM exposure; 4) mechanisms of action/targets, biomarkers of injury; and 5) animal models that simulate anticipated clinical responses.
Results:There are striking similarities between injuries caused by radiation and SM exposures. Primary outcomes from both types of exposure include acute injuries, while late complications comprise chronic inflammation, oxidative stress, and vascular dysfunction, which can culminate in fibrosis in both skin and lung organ systems. This workshop brought together academic and industrial researchers, medical practitioners, US Government program officials, and regulators to discuss lung-, and skin- specific animal models and biomarkers, novel pathways of injury and recovery, and paths to licensure for products to address radiation or SM injuries.
Conclusions:Regular communications between the radiological and chemical injury research communities can enhance the state-of-the-science, provide a unique perspective on novel therapeutic strategies, and improve overall US Government emergency preparedness.
Traumatic stress symptoms among Spanish healthcare workers during the COVID-19 pandemic: a prospective study
- Ana Portillo-Van Diest, Gemma Vilagut, Itxaso Alayo, Montse Ferrer, Franco Amigo, Benedikt L. Amann, Andrés Aragón-Peña, Enric Aragonès, Ángel Asúnsolo Del Barco, Mireia Campos, Isabel Del Cura-González, Meritxell Espuga, Ana González-Pinto, Josep M. Haro, Amparo Larrauri, Nieves López-Fresneña, Alma Martínez de Salázar, Juan D. Molina, Rafael M. Ortí-Lucas, Mara Parellada, José M. Pelayo-Terán, Aurora Pérez-Zapata, José I. Pijoan, Nieves Plana, Teresa Puig, Cristina Rius, Carmen Rodríguez-Blázquez, Ferran Sanz, Consol Serra, Iratxe Urreta-Barallobre, Ronald C. Kessler, Ronny Bruffaerts, Eduard Vieta, Víctor Pérez-Solá, Jordi Alonso, Philippe Mortier, MINDCOVID Working Group
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 32 / 2023
- Published online by Cambridge University Press:
- 09 August 2023, e50
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Aim
To investigate the occurrence of traumatic stress symptoms (TSS) among healthcare workers active during the COVID-19 pandemic and to obtain insight as to which pandemic-related stressful experiences are associated with onset and persistence of traumatic stress.
MethodsThis is a multicenter prospective cohort study. Spanish healthcare workers (N = 4,809) participated at an initial assessment (i.e., just after the first wave of the Spain COVID-19 pandemic) and at a 4-month follow-up assessment using web-based surveys. Logistic regression investigated associations of 19 pandemic-related stressful experiences across four domains (infection-related, work-related, health-related and financial) with TSS prevalence, incidence and persistence, including simulations of population attributable risk proportions (PARP).
ResultsThirty-day TSS prevalence at T1 was 22.1%. Four-month incidence and persistence were 11.6% and 54.2%, respectively. Auxiliary nurses had highest rates of TSS prevalence (35.1%) and incidence (16.1%). All 19 pandemic-related stressful experiences under study were associated with TSS prevalence or incidence, especially experiences from the domains of health-related (PARP range 88.4–95.6%) and work-related stressful experiences (PARP range 76.8–86.5%). Nine stressful experiences were also associated with TSS persistence, of which having patient(s) in care who died from COVID-19 had the strongest association. This association remained significant after adjusting for co-occurring depression and anxiety.
ConclusionsTSSs among Spanish healthcare workers active during the COVID-19 pandemic are common and associated with various pandemic-related stressful experiences. Future research should investigate if these stressful experiences represent truly traumatic experiences and carry risk for the development of post-traumatic stress disorder.
ARIPIPRAZOLE-INDUCED OCULOGYRIC CRISIS (ACUTE DYSTONIA)
- L. Rodriguez Andres, C. Vallecillo, L. Gallardo Borge, C. M. Capella Meseguer, G. Guerra Valera, C. Noval Canga
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1009-S1010
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Introduction
Aripiprazole is a third generation atypical antipsychotic and a dopamine serotonin system stabilizer, effective against positive and negative symptoms of schizophrenia. Within the group of atypical antipsychotics, aripiprazole shows a relatively benign safety profile (e.g. lower metabolic impact, mild effect on cardiovascular parameters), although the reported rate of extrapyramidal side effects is measurable.
Oculogyric crisis (OGC) is a rare movement disorder characterized by a prolongued involuntary upward deviation of the eyes, lasting minutes to hours. In most cases, OCG is a drug-induced adverse event with acute or tardive onset often attributable to a functional impairment of dopaminergic neurotransmission.
ObjectivesOGC is seldom reported in children and young adults during treatment with aripiprazole, althouh it is commonly used in youths.
MethodsWe report a case of an aripiprazole-induced oculogyric crisis in a 19 year old girl who diagnosed with schizophrenia (paranoid).
ResultsThere was a complete remission of the OGC’s following aripiprazole dose reduction, suggesting the clinical manifestation was a dose-dependent phenomenon.
ConclusionsThe present report should raise awarness among clinicians for this relevant possible adverse event, that can happen also with the use of aripiprazol, not only with typical or more antidopaminergic antipsychotics. Future research in the field should emphasize neurobiological dysfunctions as the basis of EPS/OGC in patients.
Disclosure of InterestNone Declared
DOCTOR, I’M PREGNANT. Psychopharmacological treatment of depression in pregnant women. A clinical case of a pregnant woman and major depressive disorder
- M. Queipo De Llano De La Viuda, G. Guerra Valera, C. Vallecillo Adame, C. De Andrés Lobo, T. Jiménez Aparicio, M. Fernández Lozano, I. D. L. M. Santos Carrasco, N. De Uribe Viloria
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1011
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Introduction
Depression during pregnancy can appear with a prevalence of up to 11% of pregnant women. Psychotherapeutic treatment in these cases is considered the first option, but treatment with antidepressants is sometimes required in these cases.
ObjectivesTo present a clinical case of a pregnant patient diagnosed with depression.
MethodsLiterature review of the psychopharmacological treatment of depression during pregnancy and possible complications.
ResultsA 25y Year old woman, 22 weeks pregnant, who lives with her partner. She has no background in mental health. Paternal aunt diagnosed with type I Bipolar Disorder. She goes to the Mental Health Center for evaluation, due to anxiety and depressive symptoms of 4 weeks of evolution, she refers sadness and apathy, continuous crying, somatic anxiety and obsessive ruminations in relation to childbirth and inability to care for your child. Suicidal ideation as a resolution of her discomfort. She presents with global insomnia and a significant loss of appetite, with a weight loss of 3 kg. Treatment with sertraline 50 mg/day was started, with good tolerance and clinical response
ConclusionsThe psychopharmacological treatment of antenatal depression is a challenge for the psychiatric professional. In all cases, an adequate balance must be made between the risks and complications for the fetus and the psychopathological stability of the pregnant woman. Among the main risks of untreated depression are: preterm delivery and low birth weight, an increased risk of suicide and alterations in the development during the baby’s infancy. The most used antidepressants are the SSRIs, with sertraline being a good option. Paroxetine has been associated with cardiac defects in the newborn. There are studies with tricyclics and duals but no specific teratogenic pattern has been seen. They are associated with an increased risk of spontaneous abortion. Exposure during the third trimester may be associated with obstetric complications.
Disclosure of InterestNone Declared
Efficacy of maintenance electroconvulsive therapy in recurrent depression: a case series
- G. Guerra Valera, Ó. Martín Santiago, M. Esperesate Pajares, Q. D. L. de la Viuda, A. A. Gonzaga Ramírez, C. Vallecillo Adame, C. de Andrés Lobo, T. Jiménez Aparicio, N. Navarro Barriga, B. Rodríguez Rodríguez, M. Fernández Lozano, M. J. Mateos Sexmero, A. Aparicio Parras, M. Calvo Valcárcel, M. A. Andreo Vidal, P. Martínez Gimeno, M. P. Pando Fernández, M. D. L. Á. Guillén Soto
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S832
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Introduction
Maintenance electroconvulsive therapy (mECT) is an option in the treatment of affective disorders which progress is not satisfactory. It is certainly neglected and underused during the clinical practice.
ObjectivesTo evaluate the efficacy of mECT in reducing recurrence and relapse in recurrent depression within a sample of three patients.
MethodsWe followed up these patients among two years since they received the first set of electroconvulsive sessions. We applied the Beck Depression Inventory (BDI) in the succesives consultations for evaluating the progress.
ResultsThe three patients were diagnosed with Recurrent Depressive Disorder (RDD). One of them is a 60 year old man that received initially a cycle of 12 sessions; since then he received 10 maintenance sessions. Other one is a 70 year old woman that received initially a cycle of 10 sessions; since then she received 6 maintenance sessions. The last one is a 55 year old woman that received initially a cycle of 14 sessions; since then she received 20 maintenance sessions.
All of them showed a significant reduction in depressive symptoms evaluated through BDI and clinical examination. In the first case, we found a reduction in the BDI from the first consultation to the last that goes from 60 to 12 points; in the second case, from 58 to 8 points; and in the last case, from 55 to 10 points. The main sections that improved were emotional, physical and delusional.
As side-effects of the treatment, we found anterograde amnesia, lack of concentration and loss of focus at all of them.
ConclusionsWe find mECT as a very useful treatment for resistant cases of affective disorders like RDD.
It should be considered as a real therapeutic option when the first option drugs have been proved without success.
Disclosure of InterestNone Declared
UNTIL IT BURSTS OR ALL OF US BURST. A SCHIZOTYPICAL CASE.
- B. Rodríguez Rodríguez, N. Navarro Barriga, M. Fernández Lozano, M. J. Mateos Sexmero, M. A. Andreo Vidal, M. Calvo Valcárcel, P. Martínez Gimeno, M. P. Pando Fernández, A. Aparicio Parras, M. D. L. Á. Guillén Soto, T. Jiménez Aparicio, M. D. C. Vallecillo Adame, C. de Andrés Lobo, A. A. Gonzaga Ramírez, G. Guerra Valera, M. Queipo de Llano de la Viuda, M. Esperesate Pajares
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S967
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Introduction
Schizotypal disorder is conceptualized as a stable personality pathology (Cluster A) and as a latent manifestation of schizophrenia. It can be understood as an attenuated form of psychosis or high-risk mental state, which may precede the onset of schizophrenia or represent a more stable form of psychopathology that doesn’t necessarily progress to psychosis.
ObjectivesTo exemplify the continuum of psychosis
MethodsReview of scientific literature based on a relevant clinical case.
Results39-year-old male living with his parents. He started studying philosophy. He is a regular cannabis user and has an aunt with schizophrenia. He’s admitted to psychiatry for behavioral disturbance in public. He refers to having been hearing a beeping noise in his street for months, what he interprets as a possible way of being watched due to his past ideology. Without specifying who and why, he sometimes shouts “until it bursts” to stop the noise and he thinks that his neighbours alerted the police about his behavior. During the interview he alludes to Milgram’s experiment, saying that throughout history there have been crimes against humanity and those who pointed them out were labeled “crazy”. His father refers that he has always been “strange” and with certain extravagant revolutionary ideas and thoughts. He doesn’t maintain social relationships and dedicates himself to reading and writing.
ConclusionsIt’s important to understand psychosis as a continuum to advance the understanding of etiology, pathophysiology and resilience of psychotic disorders and to develop strategies for prevention and early intervention
Disclosure of InterestNone Declared
Use of paliperidone palmitate half-yearly release in patients diagnosed with psychotic disorder: profile and satisfaction of use
- P. Andres-Olivera, A. Alvarez, M. D. L. A. Garzon, R. Gonzalez, C. Roncero, P. Jesús
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S638
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Introduction
The lack of insight can be present among patients with a diagnosis of schizophrenia, which often results in lack of adherence to pharmacological treatments1 and, subsequently, in treatment discontinuation and relapses2. This vicious pattern leads to further clinical deterioration, impaired functioning, and reduced quality of life 3. There is a plethora of evidence supporting the fact that long-acting injectable and depot antipsychotics can increase adherence to treatment, reduce the risk of discontinuation and hospital admissions4. It is also known that low fluctuations between peaks and lows in plasma drug levels could be related to a better tolerability profiles5. A new paliperidone palmitate prolonged release formulation, which is administered twice annually, has been approved as maintenance treatment for patients with schizophrenia who are already stable on the monthly or quarterly prolonged release paliperidone palmitate6.
ObjectivesWe aimed to evaluate the transition of monthly and quarterly paliperidone palmitate to the new six-monthly formulation and patients’ satisfaction with it in a real-world clinical setting.
MethodsWe collected a basic epidemiologic questionnaire, responses to a query about local pain after administration, and the Drugs Attitude Inventory (DAI).
ResultsA total of 21 patients from an outpatient clinic for severe mental disorders with a long evolution of their disease in Salamanca, Spain, were included. All of them had a DSM5-TR diagnosis of Schizophrenia. Sixteen were male and 5 female. The mean age was 42.6 years. 14 were receiving quartlery paliperidone palmitate (10 with high doses (525 mg) and 4 with moderate doses (350 mg)) and 7 were on monthly injections (6 with high doses (150 mg) and 1 with a moderate dose (100 mg)). Those receiving moderate doses of quarterly or monthly paliperidone palmitate were administered 700 mg of six-monthly paliperidone palmitate; 1000 mg were injected to those with higher doses. The mean score on the DAI scale was 8. Only one patient reported an increase in local pain after the injection, and another reported dissatisfaction with the administration in the gluteus instead of the deltoid muscle. The first administration of the new formulation in our site was on June 26th; to date none of these patients have required hospital admission due to relapse.
ConclusionsSix-monthly prolonged release paliperidone palmitate seems to be an effective maintenance treatment for schizophrenia. In addition, this new formulation is well received and tolerated by patients previously on monthly or quarterly formulations of the same drug.
Disclosure of InterestNone Declared
Delirious episode secondary to rotigotine: the psychotic patch
- M. A. Andreo Vidal, M. Calvo Valcárcel, P. Martínez Gimeno, P. Pando Fernández, B. Rodríguez Rodríguez, N. Navarro Barriga, M. Fernández Lozano, M. J. Mateos Sexmero, T. Jiménez Aparicio, M. D. C. Valdecillo Adame, C. de Andrés Lobo, G. Guerra Valera, M. Queipo de Llano de la Viuda, A. A. Gonzaga Ramirez, M. D. L. Á. Guillén Soto, A. Aparicio Parras, M. Esperesate Pajares
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S626
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Introduction
There is a fine line separating psychiatry and neurology. Most movement disorders can have psychiatric symptoms, not only those caused by the disease itself, but also those induced by the drugs used to treat them.
ObjectivesPresentation of a clinical case about a patient diagnosed with Parkinson’s disease presenting a several-month-long delirious episode due to dopaminergic drugs.
MethodsLiterature review on drug-induced psychosis episodes in Parkinson’s disease.
ResultsA 57-year-old patient with diagnosis of Parkinson’s disease for six years, who went to the emergency room accompanied by his wife due to delirious ideation. He was being treated with levodopa, carbidopa and rasagiline for years, and rotigotine patches whose dosage was being increased over the last few months.
His wife reported celotypical clinical manifestations and multiple interpretations of different circumstances occurring around her. He chased her on the street, had downloaded an app to look for a second cell phone because he believed she was cheating on him, and was obsessed with sex. He had no psychiatric background. It was decided to prescribe quetiapine.
The following day, he returned because he refused to take the medication since he thought he was going to be put to sleep or poisoned. It was decided to admit him to Psychiatry.
During the stay, rasagiline and rotigotine were suspended. Olanzapine and clozapine were introduced, with behavioral improvement and distancing from the psychotic symptoms which motivated the admission. The patient was also motorically stable. Although levodopa is best known for causing psychotic episodes, the symptons were attributed to rotigotine patches for temporally overlapping the dose increase.
ConclusionsPsychiatric symptoms are the third most frequent group of complications in Parkinson’s disease after gastrointestinal complications and abnormal movements. All medication used to control motor disorders can lead to psychosis, not only dopaminergics, but also selegiline, amantadine and anticholinergics.
Excessive stimulation of mesocortical and mesolimbic dopaminergic pathways can lead to psychosis, which is the most common psychiatric problem related to dopaminergic treatment.
In the face of a psychotic episode, antiparkinsonian drugs which are not strictly necessary for motor control should be withdrawn. If this is not sufficient, levodopa dose should be reduced, considering the side effects that may occur. When the adjustment of antiparkinsonian treatment is not effective, neuroleptics, especially quetiapine or clozapine, should be administered. In a recent study, pimavanserin, a serotonin 5-HT2 antagonist, was associated with approximately 35% lower mortality than atypical antipsychotic use during the first 180 days of treatment in community-dwelling patients.
Medication should always be tailor-made to suit each patient and we usually have to resort to lowering or withdrawing the dopaminergic medication.
Disclosure of InterestNone Declared
I don’t know where I’m going or where I come from. Self-disorders in schizophrenia.
- M. D. C. Vallecillo Adame, L. Rodríguez Andrés, C. de Andrés Lobo, T. Jimenez Aparicio, M. Queipo de Llano de la Viuda, G. Guerra Valera, A. A. Gonzaga Ramirez, M. Fernández Lozano, M. J. Mateos Sexmero, N. Navarro Barriga, B. Rodríguez Rodríguez, M. P. Pando Fernández, M. Calvo Valcárcel, P. Martínez Gimeno, M. A. Andreo Vidal, I. D. L. M. Santos Carrasco
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1069-S1070
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Introduction
In the early stages of schizophrenia the person experiences feelings of strangeness about themselves, difficulty in making sense of things and difficulty in interacting with their environment. Based on this, self-disorder assessment instruments have been developed and empirical studies have been conducted to assess people at risk of developing a schizophrenia spectrum disorder. These studies show that self-disorders are found in pre-psychotic stages and that their manifestation can predict the transition to schizophrenia spectrum disorders.
ObjectivesWe present the case of a patient with multiple diagnoses and mainly dissociative symptoms who, after years of evolution, was diagnosed with schizophrenia.
MethodsBibliographic review including the latest articles in Pubmed about self-disorders and schizophrenia.
ResultsWe present the clinical case of a 51-year-old woman with a long history of follow-up in mental health consultations and with multiple hospital admissions to the psychiatric unit, with several diagnoses including: dissociative disorder, histrionic personality disorder, adaptive disorder unspecified psychotic disorder and, finally, schizophrenia. The patient during the first hospital admissions showed a clinical picture of intense anxiety, disorientation and claiming to be a different person. The patient related these episodes to stressors she had experienced, and they improved markedly after a short period of hospital admission. Later, psychotic symptoms appeared in the form of auditory and visual hallucinations and delusional ideation, mainly of harm, so that after several years of follow-up and study in mental health consultations and in the psychiatric day hospital, she was diagnosed with schizophrenia and treatment with antipsychotics was introduced, with a marked clinical improvement being observed.
ConclusionsIt is important to take into account this type of symptoms (self-disorders), as they allow the identification of individuals in the early stages of the disorder and create the opportunity for early therapeutic interventions.
Disclosure of InterestNone Declared
Late diagnosis of attention deficit hyperactivity disorder and cocaine abuse
- C. De Andrés Lobo, C. Vallecillo Adame, T. Jiménez Aparicio, M. Queipo de Llano de la Viuda, G. Guerra Valera, A. A. Gonzaga Ramírez, M. Fernández Lozano, N. Navarro Barriga, M. J. Mateos Sexmero, B. Rodríguez Rodríguez, M. Calvo Valcárcel, M. Andreo Vidal, M. P. Pando Fernández, P. Martínez Gimeno, I. D. L. M. Santos Carrasco, J. I. Gonçalves Cerejeira, A. Rodríguez Campos
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S335-S336
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Introduction
Adult ADHD diagnosis sometimes represents a challenge for the clinician, due to the comorbid psychiatric diseases that are often associated and which complicate de recognition of the primary symptoms of ADHD. The prevalence of ADHD in adult populations is 2’5% and it is a relevant cause of functional impairment.
ObjectivesPresentation of a clinical case of a male cocaine user diagnosed with adult ADHD.
MethodsLiterature review on adult ADHD and comorbid substance abuse.
ResultsA 43-year-old male who consulted in the Emergency Department due to auditory hallucinosis in the context of an increase in his daily cocaine use. There were not delusional symptoms associated and judgment of reality was preserved. Treatment with olanzapine was started and the patient was referred for consultation. In psychiatry consultations, he did not refer sensory-perceptual alterations anymore, nor appeared any signals to suspect so, and he was willing to abandon cocaine use after a few appointments. He expressed some work concerns, highlighting that in recent months, in the context of a greater workload, he had been given several traffic tickets for “distractions.” His wife explained that he had always been a inattentive person (he forgets important dates or appointments) and impulsive, sometimes interrupting conversations. In the Barkley Adult ADHD Rating Scale he scored 32 points.
He was diagnosed with adult ADHD and treatment with extended-release methylphenidate was started with good tolerance and evolution, with improvement in adaptation to his job and social environment. Since then, the patient has moderately reduced the consumption of drugs, although he continues to use cocaine very sporadically.
ConclusionsEarly detection of ADHD and its comorbidities has the potential to change the course of the disorder and the morbidity that will occur later in adults. Comorbidity in adult ADHD is rather the norm than the exception, and it renders diagnosis more difficult. The most frequent comorbidities are usually mood disorders, substance use disorders, and personality disorders. Treatment of adult ADHD consists mainly of pharmacotherapy supported by behavioral interventions. When ADHD coexists with another disorder, the one that most compromises functionality will be treated first and they can be treated simultaneously. The individual characteristics of each patient must be taken into account to choose the optimal treatment.
Disclosure of InterestNone Declared
“The cat and the calcium”. A case of delirium secondary to hypercalcaemia.
- T. Jiménez Aparicio, C. Vallecillo Adame, C. de Andrés Lobo, G. Medina Ojeda, M. Queipo de Llano de la Viuda, A. A. Gonzaga Ramírez, G. Guerra Valera, M. Fernández Lozano, M. J. Mateos Sexmero, B. Rodríguez Rodríguez, N. Navarro Barriga, M. A. Andreo Vidal, M. Calvo Valcárcel, P. Martínez Gimeno, M. P. Pando Fernández, I. D. L. M. Santos Carrasco, J. I. Gonçalves Cerejeira
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S946-S947
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Introduction
Interconsultation with the psychiatry service is frequently requested from other specialties for the assessment and treatment of patients who present neuropsychiatric symptoms secondary to organic alterations. On the other hand (and in relation to this case), within the possible causes for the elevation of calcaemia figures, the most frequent are hyperparathyroidism and neoplasms, representing between these two entities 90% of cases (1).
Among the organic mental disorders, Delirium stands out, with an approximate prevalence between 1 and 2% (general population), which increases in hospitalized and elderly patients (2).
ObjectivesPresentation of a clinical case about a patient with delirium secondary to hypercalcemia, with hallucinations and behavioral disturbance.
MethodsBibliographic review including the latest articles in Pubmed about delirium (causes and treatment) and hypercalcaemia secondary to neoplasms.
ResultsWe present a 52-year-old male patient, who went to the emergency room accompanied by his wife, due to behavioral alteration. Two days before, he had been evaluated by Neurology, after a first epileptic crisis (with no previous history) that resolved spontaneously. At that time, it was decided not to start antiepileptic treatment.
The patient reported that he had left his house at midnight, looking for a cat. As he explained, this cat had appeared in his house and had left his entire bed full of insects. His wife denied that this had really happened, and when she told the patient to go to the emergency room, he had become very upset.
As background, the patient used to consume alcohol regularly, so the first hypothesis was that this was a withdrawal syndrome. However, although the consumption was daily, in recent months it was not very high, and at that time no other symptoms compatible with alcohol withdrawal were observed (tremor, tachycardia, sweating, hypertension…).
We requested a general blood test and a brain scan. The only relevant finding was hypercalcaemia 12.9mg/dL (which could also be the origin of the previous seizure). It was decided to start treatment with Diazepam and Tiapride in the emergency room, with serum perfusion, and keep under observation. After several hours, the patient felt better, the hallucinations disappeared, and calcium had dropped to 10.2mg/dL. A preferential consultation was scheduled, due to suspicion that the hypercalcaemia could be secondary to a tumor process.
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ConclusionsIt is important to rule out an organic alteration in those patients who present acute psychiatric symptoms. Hypercalcaemia is frequently associated with tumor processes (1) due to secretion of PTH-like peptide (4), so a complete study should be carried out in these cases.
Delirium has a prevalence between 1 and 2% in the general population (2).
Psychopharmacological treatment is used symptomatically, with antipsychotics (3). For the episode to fully resolve, the underlying cause must be treated.
Disclosure of InterestNone Declared
“Keeping an eye on amylase”. Side effects of antidepressants
- T. Jiménez Aparicio, G. Medina Ojeda, A. Rodríguez Campos, L. Rodríguez Andrés, C. Vallecillo Adame, C. De Andrés Lobo, M. Queipo de Llano de la Viuda, G. Guerra Valera, A. A. Gonzaga Ramírez, M. J. Mateos Sexmero, M. Fernández Lozano, B. Rodríguez Rodríguez, N. Navarro Barriga, M. P. Pando Fernández, P. Martínez Gimeno, M. Calvo Valcárcel, M. A. Andreo Vidal
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S831
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Introduction
Both in consultations with the general practitioner and with the psychiatrist, antidepressants are one of the most used drugs (1). These have multiple indications, and there are different groups according to their mechanism of action. In relation to this case, we are going to talk about Venlafaxine, a dual-type antidepressant, that is, it inhibits the reuptake of serotonin and norepinephrine. One of the most common side effects is digestive discomfort, which usually resolves after a few weeks (2). However, we should not ignore these symptoms, since they can hide something more serious.
ObjectivesPresentation of a clinical case on a patient who presented an increase in pancreatic amylase after starting treatment with Venlafaxine.
MethodsBibliographic review including the latest articles in Pubmed on side effects of antidepressant treatment, and more specifically at the gastrointestinal level (in this case we will talk about pancreatitis).
ResultsWe present the case of a 49-year-old woman, who was hospitalized 2 years ago, due to a first depressive episode. During this admission, psychopharmacological treatment was started for the first time, on that occasion with a selective serotonin reuptake inhibitor (SSRI), treatment of first choice (3). The patient had no side effects at that time, but the response was very modest, so it was decided to replace that antidepressant with Venlafaxine (with dual action), up to 150mg. The depressive symptoms improved markedly, however the patient began to feel digestive discomfort (which at first did not seem to be of great importance). A general analysis was performed, in which an increase in lipase (978 U/L) and amylase (528 U/L) was detected. An echoendoscopy, an abdominal scan, and a magnetic resonance cholangiography were performed; Pancreatitis secondary to drugs was suspected (a severe condition). Luckily, no significant lesions were found in the tests, and the levels of amylase and lipase decreased when Venlafaxine treatment was withdrawn (without reaching the normal range). The patient was discharged and continued to attend consultations. In the last control, amylase had dropped to 225 U/L. His abdominal pain disappeared. Treatment with Vortioxetine (a multimodal antidepressant) was started, however the amylase levels continue to be monitored, and the patient continues to see the gastroenterologist.
ConclusionsGastrointestinal side effects are very common when taking antidepressant treatment, and in most cases they do not usually represent a serious problem.
However, it is described in the scientific literature that in some cases, acute pancreatitis secondary to some drugs, including Venlafaxine, can occur (4). In order to detect it, it is necessary to perform a blood test and sometimes also other complementary tests.
For its treatment, the fundamental thing is to withdraw the causing drug, trying to find other alternatives, and carry out a control to monitor possible complications
Disclosure of InterestNone Declared
The P(4S) + NH(3Σ–) and N(4S) + PH(3Σ–)reactions as sources of interstellar phosphorus nitride
- Alexandre C. R. Gomes, André C. Souza, Ahren W. Jasper, Breno R. L. Galvão
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- Journal:
- Publications of the Astronomical Society of Australia / Volume 40 / 2023
- Published online by Cambridge University Press:
- 07 March 2023, e011
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Phosphorus nitride (PN) is believed to be one of the major reservoirs of phosphorus in the interstellar medium (ISM). For this reason, understanding which reactions produce PN in space and predicting their rate coefficients is important for modelling the relative abundances of P-bearing species and clarifying the role of phosphorus in astrochemistry. In this work, we explore the potential energy surfaces of the $\textrm{P}(^4\textrm{S}) + \textrm{NH}(^3\Sigma^-)$ and $\textrm{N}(^4\textrm{S}) + \textrm{PH}(^3\Sigma^-)$ reactions and the formation of $\textrm{H}(^2\textrm{S}) + \textrm{PN}(^1\Sigma^+)$ through high accuracy ab initio calculations and the variable reaction coordinate transition state theory (VRC-TST). We found that both reactions proceed without an activation barrier and with similar rate coefficients that can be described by a modified Arrhenius equation ($k(T)=\alpha\!\left( T/300 \right)^{\beta} \exp\!{(\!-\!\gamma/T)})$ with $\alpha=0.93\times 10^{-10}\rm cm^3\,s^{-1}$, $\beta=-0.18$ and $\gamma=0.24\, \rm K$ for the $\textrm{P} + \textrm{NH} \longrightarrow \textrm{H} + \textrm{PN}$ reaction and $\alpha=0.88\times 10^{-10}\rm cm^3\,s^{-1}$, $\beta=-0.18$ and $\gamma=1.01\, \rm K$ for the $\textrm{N} + \textrm{PH} \longrightarrow \textrm{H} + \textrm{PN}$ one. Both reactions are expected to be relevant for modelling PN abundances even in the cold environments of the ISM. Given the abundance of hydrogen in space, we have also predicted rate coefficients for the destruction of PN via H + PN collisions.
Confirmation and detection of novel acetolactate synthase- and protoporphyrinogen oxidase–inhibiting herbicide-resistant redroot pigweed (Amaranthus retroflexus) populations in North Carolina
- Eric A. L. Jones, Ryan J. Andres, Jeffrey C. Dunne, Ramon G. Leon, Wesley J. Everman
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- Journal:
- Weed Science / Volume 71 / Issue 2 / March 2023
- Published online by Cambridge University Press:
- 14 February 2023, pp. 84-94
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Complaints of control failures with acetolactate synthase (ALS)- and protoporphyrinogen oxidase (PPO)-inhibiting herbicides on redroot pigweed (Amaranthus retroflexus L.) were reported in conventional soybean [Glycine max (L.) Merr.] fields in North Carolina. Greenhouse dose–response assays confirmed that the Camden County and Pasquotank County populations were less sensitive to ALS- and PPO-inhibiting herbicides compared with susceptible A. retroflexus populations, suggesting the evolution of resistance to these herbicides. Sanger sequencing of target genes determined the Camden County population carried a Trp-574-Leu mutation in the ALS gene and an Arg-98-Gly mutation in the PPX2 gene, while the Pasquotank County population carried a His-197-Pro mutation in the ALS gene (first documentation of the mutation in the Amaranthus genus), but no mutation was detected in the PPX2 gene. Single-nucleotide polymorphism (SNP) genotyping assays were developed to enable efficient screening of future control failures in order to limit the spread of these herbicide-resistant populations. In addition, preliminary testing of these assays revealed the three mutations were ubiquitous in the respective populations. These two populations represent the first confirmed cases of PPO-inhibiting herbicide-resistant A. retroflexus in the United States, as well as the first confirmed cases of this particular herbicide-resistance profile in A. retroflexus inhabiting North America. While no mutation was found in the PPX2 gene of the Pasquotank County population, we suggest that this population has evolved resistance to PPO-inhibiting herbicides, but the mechanism of resistance is to be determined.
Mutism. What to expect?
- I. Santos Carrasco, J. Gonçalves Cerejeira, M. Fernández Lozano, A. Gonzaga Ramírez, M. Queipo De Llano De La Viuda, G. Guerra Valera, C. Vallecillo Adame, C. De Andrés Lobo, T. Jiménez Aparicio, B. Rodríguez Rodríguez, N. Navarro Barriga, M.J. Mateos Sexmero, E. Pérez, L. Gallardo Borge
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S588
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Introduction
Mutism is the inability or unwillingness to speak, resulting in an absence or marked paucity of verbal output. Mutism is a common manifestation of psychiatric, neurological, and drug-related illnesses. Psychiatric disorders associated with mutism include schizophrenia, affective disorders, conversion reactions, dissociative states, and dementias. Neurological disorders causing mutism affect the basal ganglia, frontal lobes, or the limbic system.
ObjectivesOutline the importance of setting a differential diagnosis of mutism in the Emergency Room.
MethodsReview of scientific literature based on a relevant clinical case.
ResultsMale, 58 years old. He has lived in a residence for 3 months due to voluntary refusal to ingest. Diagnosed with paranoid personality disorder. He is refered to the Emergency Service due to sudden mutism. During this day, he has been stable and suitable with a good functionality. For 3 hours he is mutist, oppositional attitude and stiff limbs, refusing to obey simple orders. Hyperalert and hyperproxia. Not staring. After ruling out organic pathology: normal blood tests, negative urine toxins and cranial CT without alterations, he was admitted to Psychiatry for observation and, finally, he was diagnosed with Psychotic Disorder NOS.
ConclusionsMutism most often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. The most common disorder of behavior occurring with mutism is catatonia. The differential diagnosis of mutism is complex. In some cases the diagnosis will be clarified only by careful observation and after a neurological evaluation. Published studies show neurological disorders presenting with mutism can be misdiagnosed as psychiatric.
DisclosureNo significant relationships.
Personality disorders and Juvenil Myoclonic Epilepsy
- I. Santos Carrasco, J. Gonçalves Cerejeira, M. Queipo De Llano De La Viuda, A. Gonzaga Ramírez, G. Guerra Valera, T. Jiménez Aparicio, C. De Andrés Lobo, C. Vallecillo Adame, M. Fernández Lozano, B. Rodríguez Rodríguez, N. Navarro Barriga, M.J. Mateos Sexmero, L. Gallardo Borge
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S668
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Introduction
There is a high comorbidity between psychiatric disorders and juvenile myoclonic epilepsy (JME), observed in up to 58% of these patients; specifically, mood disorders, anxiety and personality disorders (PD). In some patients with PD there are nonspecific alterations in the EEG, which nevertheless sometimes involve pathology. The presence of personality disorders along with JME has been repeatedly described. Previous studies have emphasized the difficulties in treating patients with JME, which have been attributed to some specific psychiatric, psychological and psychosocial characteristics.
ObjectivesDescribing distinctive personality traits in JME
MethodsReview of scientific literature based on a relevant clinical case.
Results19-year-old woman, single. Psychiatric history since she was 12 due to anxiety-depressive symptoms, after being diagnosed with JME. 4 admissions in Psychiatry, with a variety of diagnoses: eating disorder, attention deficit hyperactivity disorder and borderline personality disorder. The evolution of both disorders has been parallel, presenting epileptic seizures due to irregular therapeutic adherence together with pseudo-seizures, which made difficult their differential diagnosis. In addition, he has had frequent visits to the emergency room for suicide attempts and impulsive behaviors.
ConclusionsIn 1957, for the first time, distinctive personality traits were described in patients with JME: lack of control and perseverance, emotional instability, variable self-concept and reactive mood, which have been confirmed in subsequent studies. It is believed as epilepsy progresses, patients tend to develop symptoms of depression, anxiety, social problems, and attention deficit. Therefore, these patients have difficulty in following medical recommendations, especially precautions regarding precipitating factors for seizures.
DisclosureNo significant relationships.
Unplanned Pregnancy in women with mental disorder
- A. Roca Lecumberri, E. Gelabert, A. Torres Giménez, E. Solé, S. Andrés-Perpiñá, E. Roda, C. Lopez, C. Naranjo, L. Garcia-Esteve
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S331-S332
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Introduction
Few studies have investigated the level of planning of pregnancy among women with mental disorder and associated risk factors.
ObjectivesThe purpose of this study was to determine the associated factors to UP and psychopathological consequences.
MethodsA cross sectional study was conducted at the Perinatal Mental Health Unit of the Hospital Clínic in Barcelona. The total sample comprised 675 consecutive pregnant women with diagnosis of mental disorder (DSM-IV criteria), seen between January 2006 and December 2018. Clinical, psychometric and socio-demographic variables were collected at the first visit. Pregnancy planning was assessed by a question “Was this pregnancy planned?” with three possible answers: 1) Yes, it was planned and has been well received; 2) No, it was not planned but it has been well received; and 3) No, it was an accident. Response 1 was coded as “planned pregnancy” and responses 2 and 3 as “Unplanned Pregnancy”.
Results38.4% of the sample had an UP. Younger age, lower levels of education, Latin-American population, multiparity, financials problems and poor relationship with the partner were associated with UP in women with mental disorder. The mean EPDS and STAI scores and the presence of self-harming thoughts were significantly higher in women with UP.
ConclusionsUP was associated with more depressive and anxious symptoms and more self-harming thoughts. It is necessary to promote reproductive health care for women with mental disorders and to take into account their reproductive life plan, especially in those with risk factors described.
DisclosureNo significant relationships.
Acceptance and Commitment Therapy for Psychosis. What’s the evidence?
- F. Azevedo, R. André, L. Silva, R. Medinas, C. Almeida
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S744
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Introduction
Cognitive behavioural therapy for psychosis as an adjuvant to pharmacological treatment has been been shown to be one of the most effective interventions for schizophrenia with benefits noted in even treatment resistant schizophrenia. Benefits have been mostly registered in the positive symptoms domain of schizophrenia. Acceptance and commitment therapy is a third generation Cognitive-Behavioural Therapy, empirically supported for a range of symptoms and conditions, including psychosis, with quickly increasing data. It targets experiential avoidance, which seems to be closely related with psychopathology. Its ability to also target affective symptoms can be an important advantage in the adjuvant treatment of psychosis.
ObjectivesTo critically review the evidence of acceptance and commitment therapy in psychosis.
MethodsNon-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “schizophrenia”, “acceptance and commitment therapy”.
ResultsVery few studies have been published on ACT and psychosis, with even less controlled trials and systematic reviews. So far there is convincing evidence for ACT reducing the frequency of hallucinations, increasing the outcomes of traumatic events associated with psychosis and having measurable effects on anxiety and help seeking behaviour.
ConclusionsAs Acceptance and Commitment therapy evolves and more evidence arises a new kind of therapy with possible effects on both affective and positive symptoms in schizophrenia can emerge, allowing us to know what works for patients with psychosis and through what mechanisms and permitting the improvement of treatment strategies.
DisclosureNo significant relationships.
Voices change my name
- C. Vallecillo Adame, T. Jiménez Aparicio, C. De Andrés Lobo, A. Gonzaga Ramírez, M. Queipo De Llano De La Viuda, G. Guerra Valera, I. Santos Carrasco, J. Gonçalves Cerejeira, B. Rodríguez Rodríguez, M. Fernández Lozano, M.J. Mateos Sexmero, N. Navarro Barriga, N. De Uribe Viloria, G. Medina Ojeda, L. Rodriguez Andrés
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S801
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Introduction
We present the clinical case of a patient where the psychotic clinic coexists with gender dysphoria. This scenario can be the result of a change in gender identity derived from the psychotic process or appear independently of it.
ObjectivesWe want to explain the importance of knowing how to act with a patient in whom these two processes coexist.
Methods20-year-old woman, with no history of mental health. She comes to the emergency department for behavioral alteration. The family observes strange behaviors, unmotivated laughter, soliloquies and aggressive episodes. Abandonment of studies, hobbies and radical physical change. Delusions of prejudice and self-referential delusions. Possible phenomena of echo and diffusion of the thought. Auditory hallucinations talking to her in male gender, since then she presents doubts about her sexual identity and manifests her desire to change sex. Altered judgment of reality.
ResultsDuring admission, we started treatment with an antipsychotic with good tolerance and she was referred to mental health team, where psychopharmacological treatment was adjusted with good response. In the following medical appointments the psychotic clinic disappeared at the same time that sexual identification was completely restored and made a critique of the behavior and experiences.
ConclusionsThis case highlights the importance of assessing the chronology of symptoms, the patient’s criticality, the response to antipsychotic treatment and the need to exclude the psychotic background of the desire for gender reassignment before making a therapeutic decision.
DisclosureNo significant relationships.
Mother-Baby Day Hospital (MBDH): preliminary results of effectiveness of multidisciplinary intensive intervention for women with postpartum affective/anxiety disorder
- E. Gelabert, A. Torres Giménez, S. Andrés-Perpiñá, C. Naranjo, E. Roda, L. Garcia-Esteve, A. Roca Lecumberri
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S331
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Introduction
Women experiencing postpartum mental illness have unique needs. Psychiatric Mother Baby Units (MBUs) can provide specialist in-patient care for mothers without separation from their baby. Since 2018, an innovative Mother-Baby Day Hospital (MBDH) have been developed and implemented in a public hospital in Spain, directed at the intensive, integral, and multidisciplinary treatment.
ObjectivesThe aim of the present study was to obtain preliminary data regarding its effectiveness in postpartum women with affective and anxiety disorders.
MethodsThirty-three mothers and their babies with affective or anxiety disorders attended to MBDH CLINIC-BCN participated in the study. All women were assessed at admission, discharge, and 3 months follow-up. Primary outcomes were depression (EPDS) and anxiety symptoms (STAI-S), mother-infant bonding (PBQ) and functional impairment (HoNOs).
ResultsAt discharge, 100% of women no longer met the full criteria for the main diagnosis (PSR≥5). Significant improvements from admission to discharge were achieved in depression and anxiety symptoms, mother infant bonding and functional impairment. Clinical significance was also calculated. After treatment, mothers had greater autonomy for care their babies. Similar results were observed at 3 months follow-up. The MBDH was rated by mothers as an excellent quality program and they would recommend it.
ConclusionsThis study found that multidisciplinary intervention at MBDH for postpartum women with affective or anxiety disorders is effective, not only for maternal psychopathology but also for maternal care and bonding. It is imperative to develop specialized devices that integrate the care of the dyad by professionals specialized in perinatal mental health.
DisclosureNo significant relationships.