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Additive effects of a family history of schizophrenia spectrum disorders and an environmental risk score for the outcome of patients with non-affective first-episode psychosis
- Manuel J. Cuesta, Elena García de Jalón, Ana M. Sánchez-Torres, Gustavo J. Gil-Berrozpe, Lidia Aranguren, Gerardo Gutierrez, Asier Corrales, Amalia Zarzuela, Berta Ibañez, Víctor Peralta, PEPsNa Group
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- Journal:
- Psychological Medicine , First View
- Published online by Cambridge University Press:
- 20 March 2024, pp. 1-9
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Background:
First-episode psychotic disorders comprise a heterogeneous phenotype with a complex etiology involving numerous common small-effect genetic variations and a wide range of environmental exposures. We examined whether a family of schizophrenia spectrum disorder (FH-Sz) interacts with an environmental risk score (ERS-Sz) regarding the outcome of patients with non-affective first episode psychosis (NAFEP).
Methods:We included 288 patients with NAFEP who were evaluated after discharge from an intensive 2-year program. We evaluated three outcome measures: symptomatic remission, psychosocial functioning, and personal recovery. We analyzed the main and joint associations of a FH-Sz and the ERS-Sz on the outcomes by using the relative excess risk due to interaction (RERI) approach.
Results:A FH-Sz showed a significant association with poor symptomatic remission and psychosocial functioning outcomes, although there was no significant interaction between a FH-Sz and the ERS-Sz on these outcomes. The ERS-Sz did not show a significant association with poor symptomatic remission and psychosocial functioning outcomes, even though the magnitude of the interaction between ERS-Sz and FH-Sz with the later outcome was moderate (RERI = 6.89, 95% confidence interval −16.03 to 29.81). There was no association between a FH-Sz and the ERS-Sz and personal recovery.
Conclusions:Our results provide further empirical support regarding the contribution of FH-Sz to poor symptomatic remission and poor psychosocial functioning outcomes in patients with NAFEP.
A multi-shot target wheel assembly for high-repetition-rate, laser-driven proton acceleration
- J. Peñas, A. Bembibre, D. Cortina-Gil, L. Martín, A. Reija, C. Ruiz, M. Seimetz, A. Alejo, J. Benlliure
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- Journal:
- High Power Laser Science and Engineering / Volume 12 / 2024
- Published online by Cambridge University Press:
- 12 March 2024, e22
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A multi-shot target assembly and automatic alignment procedure for laser–plasma proton acceleration at high repetition rate are introduced. The assembly is based on a multi-target rotating wheel capable of hosting more than 5000 targets, mounted on a 3D motorized stage to allow rapid replenishment and alignment of the target material between laser irradiations. The automatic alignment procedure consists of a detailed mapping of the impact positions at the target surface prior to the irradiation that ensures stable operation of the target, which alongside the purpose-built design of the target wheel, enables operation at rates up to 10 Hz. Stable and continuous laser-driven proton acceleration at 10 Hz is demonstrated, with observed cut-off energy stability about 15%.
64 Neuroimaging Evidence of Neurodegenerative Disease in Former Professional American Football Players Who “Fail” Validity Testing: A Case Series
- Ranjani Shankar, Julia Culhane, Leonardo Iaccarino, Chris Nowinski, Nidhi Mundada, Karen Smith, Jeremy Tanner, Charles Windon, Yorghos Tripodis, Gustavo Mercier, Thor D Stein, Anne C McKee, Robert A Stern, Neil Kowall, Bruce L Miller, Jesse Mez, Ron Killiany, Gil D Rabinovici, Michael L Alosco, Breton M Asken
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 574-575
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Objective:
Former professional American football players have a high relative risk for neurodegenerative diseases like chronic traumatic encephalopathy (CTE). Interpreting low cognitive test scores in this population occasionally is complicated by performance on validity testing. Neuroimaging biomarkers may help inform whether a neurodegenerative disease is present in these situations. We report three cases of retired professional American football players who completed comprehensive neuropsychological testing, but “failed” performance validity tests, and underwent multimodal neuroimaging (structural MRI, Aß-PET, and tau-PET).
Participants and Methods:Three cases were identified from the Focused Neuroimaging for the Neurodegenerative Disease Chronic Traumatic Encephalopathy (FIND-CTE) study, an ongoing multimodal imaging study of retired National Football League players with complaints of progressive cognitive decline conducted at Boston University and the UCSF Memory and Aging Center. Participants were relatively young (age range 55-65), had 16 or more years of education, and two identified as Black/African American. Raw neuropsychological test scores were converted to demographically-adjusted z-scores. Testing included standalone (Test of Memory Malingering; TOMM) and embedded (reliable digit span, RDS) performance validity measures. Validity cutoffs were TOMM Trial 2 < 45 and RDS < 7. Structural MRIs were interpreted by trained neurologists. Aß-PET with Florbetapir was used to quantify cortical Aß deposition as global Centiloids (0 = mean cortical signal for a young, cognitively normal, Aß negative individual in their 20s, 100 = mean cortical signal for a patient with mild-to-moderate Alzheimer’s disease dementia). Tau-PET was performed with MK-6240 and first quantified as standardized uptake value ratio (SUVR) map. The SUVR map was then converted to a w-score map representing signal intensity relative to a sample of demographically-matched healthy controls.
Results:All performed in the average range on a word reading-based estimate of premorbid intellect. Contribution of Alzheimer’s disease pathology was ruled out in each case based on Centiloids quantifications < 0. All cases scored below cutoff on TOMM Trial 2 (Case #1=43, Case #2=42, Case #3=19) and Case #3 also scored well below RDS cutoff (2). Each case had multiple cognitive scores below expectations (z < -2.0) most consistently in memory, executive function, processing speed domains. For Case #1, MRI revealed mild atrophy in dorsal fronto-parietal and medial temporal lobe (MTL) regions and mild periventricular white matter disease. Tau-PET showed MTL tau burden modestly elevated relative to controls (regional w-score=0.59, 72nd%ile). For Case #2, MRI revealed cortical atrophy, mild hippocampal atrophy, and a microhemorrhage, with no evidence of meaningful tau-PET signal. For Case #3, MRI showed cortical atrophy and severe white matter disease, and tau-PET revealed significantly elevated MTL tau burden relative to controls (w-score=1.90, 97th%ile) as well as focal high signal in the dorsal frontal lobe (overall frontal region w-score=0.64, 74th%ile).
Conclusions:Low scores on performance validity tests complicate the interpretation of the severity of cognitive deficits, but do not negate the presence of true cognitive impairment or an underlying neurodegenerative disease. In the rapidly developing era of biomarkers, neuroimaging tools can supplement neuropsychological testing to help inform whether cognitive or behavioral changes are related to a neurodegenerative disease.
Introduction
- Edited by Gil Raz, Dartmouth College, New Hampshire, Anna Shields, Princeton University, New Jersey
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- Book:
- Religion and Poetry in Medieval China
- Published by:
- Amsterdam University Press
- Published online:
- 20 February 2024
- Print publication:
- 19 December 2023, pp 9-18
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Summary
Studies of the ancient Chinese classics, medieval Chinese history, Buddhism, Daoism, poetry, and prose have all too often been constrained within traditional disciplinary silos, such as literature, politics, philosophy, art, and religion. As a consequence, historians have infrequently read religious texts, scholars of Tang poetry have rarely engaged with archeological and epigraphic materials, while scholars of Buddhism have not often explored Daoist materials. Authors and readers in medieval China were of course not constrained by such boundaries. On the contrary, government and military officials, historians, poets, Buddhists, Daoists, and authors of tomb epitaphs and of imperial inscriptions shared cultural interests, and medieval authors read and found inspiration in each other’s diverse works. Our contemporary disciplinary labels tend to simplify the identities of medieval Chinese people—as adherents to a particular religion, or writers of a specific literary form—and thereby occlude the reality of their intertwined, multiple cultural practices. Indeed, people were rarely restricted to a single social identity or narrow set of cultural interests. But the blind spots in our understanding of medieval Chinese culture are not merely a result of contemporary disciplinary views: they are also shaped by the contours and gaps in the textual archive as it was transmitted and refashioned by centuries of readers. The surviving textual record from early and medieval China represents only a minute portion of the cultural productions of this era. In order to create a richer understanding of lived medieval culture, including the intersections of religious and literary practices, we need to not only read across the grain of modern disciplinary categories but also to expand our source base to include epigraphic and artistic materials, among others that have survived outside orthodox compilations of literary and scriptural traditions.
The subtitle of this volume, “The Way and the Words,” points to a fundamental critique of our very project. The Dao, the Way, is formless and nameless; it is the “teaching without words.” However, as humans we are forced to use words to communicate, and we are constrained within specific language and script communities. People in medieval China sought to attain the Way, and they realized that their words were mere traces of the ineffable. And yet, as the poems, inscriptions, scriptures, and commentaries explored in this volume demonstrate, medieval people continually sought to use words to trace the ineffable, and their ceaseless efforts to do so require our careful, attentive reading.
Assessing evidence supporting cannabis harm reduction practices for adolescents at clinical high-risk for psychosis: a review and clinical implementation tool
- Simon Kapler, Laura Adery, Gil D. Hoftman, Carolyn M. Amir, Vardui Grigoryan, Ziva D. Cooper, Carrie E. Bearden
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- Journal:
- Psychological Medicine / Volume 54 / Issue 2 / January 2024
- Published online by Cambridge University Press:
- 26 October 2023, pp. 245-255
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Cannabis use is consistently associated with both increased incidence of frank psychotic disorders and acute exacerbations of psychotic symptoms in healthy individuals and people with psychosis spectrum disorders. Although there is uncertainty around causality, cannabis use may be one of a few modifiable risk factors for conversion to psychotic disorders in individuals with Clinical High Risk for Psychosis (CHR-P) syndromes, characterized by functionally impairing and distressing subthreshold psychotic symptoms. To date, few recommendations beyond abstinence to reduce adverse psychiatric events associated with cannabis use have been made. This narrative review synthesizes existing scientific literature on cannabis' acute psychotomimetic effects and epidemiological associations with psychotic disorders in both CHR-P and healthy individuals to bridge the gap between scientific knowledge and practical mental health intervention. There is compelling evidence for cannabis acutely exacerbating psychotic symptoms in CHR-P, but its impact on conversion to psychotic disorder is unclear. Current evidence supports a harm reduction approach in reducing frequency of acute psychotic-like experiences, though whether such interventions decrease CHR-P individuals' risk of conversion to psychotic disorder remains unknown. Specific recommendations include reducing frequency of use, lowering delta-9-tetrahydrocannabinol content in favor of cannabidiol-only products, avoiding products with inconsistent potency like edibles, enhancing patient-provider communication about cannabis use and psychotic-like experiences, and utilizing a collaborative and individualized therapeutic approach. Despite uncertainty surrounding cannabis' causal association with psychotic disorders, cautious attempts to reduce acute psychosis risk may benefit CHR-P individuals uninterested in abstinence. Further research is needed to clarify practices associated with minimization of cannabis-related psychosis risk.
La conexión entre ambientes de tierras bajas y altas en el límite Cuyo Patagonia (Argentina): Un análisis sobre el transporte y uso de obsidiana Laguna del Maule
- María Laura Salgán, M. Paz Pompei, Adolfo Gil, Gustavo Neme, Patricia Sruoga, Michael D. Glascock
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- Latin American Antiquity , First View
- Published online by Cambridge University Press:
- 20 September 2023, pp. 1-17
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Este trabajo busca conocer las estrategias tecnológicas, los rangos de acción y la conectividad en las estrategias humanas de ambientes marginales. Se discute, para el caso del sur de Mendoza, el modelo clásico de trashumancia cazadora recolectora entre tierras bajas y altas. El estudio se centra específicamente en El Payén y en el uso de la obsidiana andina Laguna del Maule. En El Payén, esta obsidiana ocupa el primer lugar entre las variedades conocidas y su uso se vinculó a circuitos de movilidad estacional que involucraban tierras bajas y altas. La obsidiana Laguna del Maule posee dos subtipos geoquímicos, el Subtipo 1 registrado en cordillera, y el Subtipo 2 localizado en depósitos fluviales distales. En este trabajo modelamos las estrategias de interacción de tierras altas con tierras bajas, enfocándonos en modelos propuestos para La Payunia, que ponen énfasis en la tecnología lítica y se articulan con análisis geoquímicos y geoarqueológicos. Los resultados sostienen que las poblaciones de El Payén obtenían este recurso mediante distintas estrategias tecnológicas: un aprovisionamiento serial del Subtipo 2, con circuitos de movilidad centrados en tierras bajas; diferente al Subtipo 1 de aprovisionamiento cíclico, que habría involucrado la interacción entre tierras altas y tierras bajas.
THE COMPLEXITY OF DUAL PATHOLOGY: REGARDING A CASE REPORT OF SEIZURES
- M. F. De Andrade, M. Magalhães, L. Gil, V. Viveiros, C. Moreira
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S760-S761
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Introduction
Wernicke’s encephalopathy (WE) is a potentially reversible neuropsychiatric emergency caused by thiamine deficiency, whose classical triad consists of acute onset of confusion, gait ataxia, and oculomotor dysfunction. The diagnosis is missed in 75-80% of cases and approximately 80% of untreated patients develop Korsakoff Syndrome, which is characterized by memory impairment associated with confabulation. Early recognition of nutritional deficiency or any portion of the triad is critical and should prompt treatment, since WE is readily reversible if treated with adequate doses of parenteral thiamine.
ObjectivesStarting from a case report of suspected WE, we pretend to discuss the differential diagnosis of seizures in dual pathology.
MethodsNon-systematic review of the literature was performed in PubMed database using the keywords “Wernicke’s Encephalopathy”, “Seizures”, “Alcohol” and “Benzodiazepines”. The articles were selected according to their relevance. A patient´s clinical record was reviewed and presented.
ResultsWe present a case of a 44-year-old Ukrainian man with suspected background of chronic alcohol abuse and psychiatric history of schizoaffective disorder, who presented with acute onset of confusion, psychomotor agitation, gait ataxia and nystagmus. Anamnesis was hampered by the language barrier and absence of past medical history and patient’s alcoholic habits remained unclear. After suspicion of WE it was introduced thiamine and diazepam, with significant improvement. After discontinuation of diazepam, the patient presented with several episodes of tonic-clonic seizures. He was medicated for seizures with clinical stabilization. At time of discharge the diagnostic discussion prevailed.
Seizures are a common presentation of various conditions associated with alcohol use, whose differential diagnosis is difficult, especially in patients with dubious alcohol consumption. Alcohol abuse is a major precipitant of status epilepticus as seizure threshold is raised by alcohol drinking. Seizures may also occur during alcohol withdrawal, for which treatment with benzodiazepines is recommended, however carefully, since both abrupt cessation and high-dose use are critical for the appearance of seizures. Although very rare, WE may also present with seizures, whereby overdiagnosis and overtreatment are preferred to prevent persistent neurocognitive impairments.
ConclusionsThis case illustrates the complexity of neuropsychiatric diagnoses in dual pathology. It requires a longitudinal assessment for a better understanding of clinical conditions and establishment of the best therapeutic approach.
Disclosure of InterestNone Declared
An interesting clinical case. New therapies in Dissociative Identity Disorder.
- P. García Vázquez, E. Seijo Zazo, C. Vilellla Martin, A. Serrano García, C. M. Franch Pato, E. Martína Gil, C. Alvarez Vazquez
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S970-S971
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Introduction
Dissociative identity disorder (DID) also referred as multiple personality disorder is a chronic post-traumatic condition. It is characterized according to DSM-5 by “disruption of identity characterized by two or more distinct personality states”, with “marked discontinuity in sense of self… accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning.”
ObjectivesHere, we present a case of a 33-year-old Caucasian female with no psychiatric history until 2 years ago, privately. The patient is admitted to the Psychiatry Service due to worsening. During admission, consultations are made to the Neurology Service and the Neurophysiology Service, who request an electroencephalogram, an MRI and a brain scan, resulting in normality.
After discharge, she returns home with her parents, and the crisis become more frequent and of longer duration. She acknowledges that during these periods she is dominated by her alternate personality, which she is unaware of until her family informs her. This personality is a demon, who verbally assaults and even physically threatens her surroundings, and can hardly be controlled by the prayers of her family.
MethodsDespite psychopharmacological treatment, as well as the cognitive-behavioral therapy carried out by the patient for more than two years, there was no improvement. Once she comes to the consultation, it is decided to carry out a therapy guided by the central Rogerian attitudes, originating a process of empathic resonance of the therapist, which influences the experience of the patient. Three main interventions are carried out, the awareness of the disease, the regulation of the intensity of this experience, to maintain the attention and the exploration of what guides the change. After carrying out this intervention, the patient is currently asymptomatic.
ResultsCurrently, there are not evidence-based treatment guidelines. The most common approach is individual psychodynamic psychotherapy according to practice-based guidelines initiated by the International Society for the Study of Trauma and Dissociation.
To handle the present case, we used a model with two pillars, the patient’s commitment and the investigation of microprocesses within a process of experiential exploration, in which the therapist is a facilitator of reflective attention and experimental awareness.
ConclusionsThe torpid evolution suffered by the patient, with little clinical improvement to the interventions carried out, and the absence of evidence on the treatment, led to a therapeutic approach focused on the empathic resonance process of the therapist, with good results.
Disclosure of InterestNone Declared
Acute mutism in a young female. A case report of a 20-year-old female who presents a 3-month mutism
- A. Gonzalez-Mota, A. Gonzalez-Gil, C. Martin-Gomez, J. A. Benito-Sanchez, I. M. Peso-Navarro, L. Fernandez-Alonso
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S177-S178
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Introduction
A 20-year-old female presents with a progressive 3-month mutism, hyporexia (20kg weight loss), abulia, anhedonia, apathy, social isolation,seeking company of her parents even at night, bradypsychia, sialorrhea, psychomotor slowdown and hypomimia. She is hospitalized in the Psychiatric Brief Hospitalization Unit (PBHU).Her parents relate the beginning of this symptomatology to a breakup and gender violence,which the patient confirms during the interview by eye/cephalic movements and single words jotted down.
ObjectivesThe objective of this study is to describe the evolution of the patient during her hospitalization in the PBHU of Salamanca and to look into the available bibliography about mutism related to stress and sialorrhea.
MethodsWe carried out a follow-up of the hospitalization of the patient and a structured search in PubMed with the keywords “mutism”,“sialorrhea” and “stress” in the last 10 years in English,Spanish and French.
ResultsFew or no articles where found.Therefore, the articles about mutism and stress were analyzed, which focused mostly in selective mutism. Regarding fear,the response to cope with the threat(fight, flight, freeze) is mediated by the autonomic system. The “Polyvagal Theory” speaks about the vagus nerve participating in emotion regulation (social communication and mobilization). Dissociation, in this context,has adaptive and defensive purposes and its threshold can be reduced by repeated stress situations.Long-term alteration of the autonomic nervous system has been described in selective mutism.This malfunction can be related to an elevated production of saliva due to the activation of the parasympathetic in the salivary glands, causing sialorrhea in our patient.
The patient began treatment with sertraline 100mg and risperidone 2mg with the aim of its antidepressive and major tranquilizer effects, she also began individual and family psychotherapy, we assured her sleep and intakes and she began to progressively recover her speech and mobility,identifying a possible trigger for the symptomatology: a physical beating of gender violence after her breakup.
ConclusionsDissociation and “freeze” response can be a maladaptative mechanism to fear.The malfunction of the autonomic nervous system can explain the disconnection,poor gaze,low facial and body expression and inability to speak.
Disclosure of InterestNone Declared
Non-convulsive epiletic seizure after electroconvulsive therapy session
- L. Llovera García, L. Veiga Gil, L. Lopez Unzue, A. Corrales Rodriguez, A. Ballesteros Prados, J. Yoldi Murillo, J. M. Lopez Ilundain
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1021-S1022
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Introduction
Electroconvulsive therapy (ECT) is a procedure performed under general anaesthesia involving triggering an intentional brief seizure through small electrical currents through the brain. The anaesthetic depth should be adequate prior to shock and measured with BIS, a processed electroencephalogram (EEG) monitor. Adjusting the hypnotic dose allows to decrease the ictal threshold and thus improve the response to treatment and decrease side effects.
ObjectivesOur goal is detecting elements such as spontaneous epileptiform activity after ECT without tonic-clonic activity with the spectral density matrix (SDM).
MethodsOur patient: an 87-year-old woman, diagnosed with F20.2 catatonic schizophrenia and under antipsychotic treatment since her youth. She has required multiple hospital admissions due to psychopathological decompensations until starting monthly maintenance ECT sessions in 2014. Since then she no new hospital admissions have been required.
ResultsImages 1D and 1E shows the SDM, a spectrogram of the EEG. The X axis show time (minutes), the Y axis shows the frequency (Hz) and the Z axis shows the energy or intensity of that electrical activity in the frequency bands replaced by colors: warm colors (red) reflecting high intensity electroencephalographic activity and cool colors (yellow, blue and green), low activity. Images 2 and 3’s EDM shows spontaneous epileptiform activity after electroconvulsive therapy without tonic-clonic activity. We observed an initial EDM of an awake patient, with warm colours in practically all frequency bands, including the beta band (13-30 Hz), characteristic of waking states. Around 9:50 anaesthetic induction occurs, activity increases in slow frequencies (red colours in alpha, theta and delta), plus an increase of cold colours in beta, reflecting the disappearance of brain activity in that frequency. The asterisk reflects the EEG response to the electrical discharge, followed by a postcritical state with brain activity exclusively in slow waves and high amplitude (delta and some theta) and absence of activity in other frequencies (blue colour in the beta and alpha bands) around 9:57. At about 10:00 there is an abrupt appearance of high intensity brain activity (warm colours) in beta and alpha and delta, mainly, reflecting spontaneous epileptiform activity after treatment and clinically reflected as a patient absent and disconnected from the environment, but without tonic-clonic activity. New postcritical state in which blue colour predominates, reflecting little brain activity, and warmer colours reappear in all frequency bands, including beta, reflecting the progressive recovery of wakefulness.
Image:
Image 2:
Image 3:
ConclusionsPsychiatric pathology can be reflected in the SDM, which allows to observe changes in the EEG, correcting the electrical stimulus of the shock and the dose of anesthetic appropriate to the patient to trigger an intentional brief seizure under general anesthesia.
Disclosure of InterestNone Declared
Catatonia in a case of major depression resistant to pharmacotherapy. A case report
- C. M. Gil Sánchez, P. Casado de la Torre, M. V. Taillefer Aguanell
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S827
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Introduction
Catatonia is a clinical syndrome characterized by behavioral alterations, which may include motor immobility or excitation. As a symptom, catatonia may be present in several mental disorders, primarily schizophrenia and mood disorders. Symptoms can be severe and can lead to dangerous and lethal conditions if not diagnosed and treated properly.
ObjectivesTo describe the complicated evolution of a case of major depression with psychotic symptoms, which developed catatonic status. We discuss the psychopharmacological approach and non-pharmacological therapies (ECT).
MethodsCase summary. We have conducted a systematic review of the descriptions published to date, regarding this case.
ResultsWe present a case of extreme severity, in a 55-year-old male, with a broad differential diagnosis with organic pathology, which required multidisciplinary management in conjunction with other specialties and multiple complementary tests.
Eventually diagnosed with major depression with psychotic symptoms evolving into a catatonic state. During more than one year of follow-up, multiple drugs have been tested sequentially: SSRI antidepressants, dual action, low-dose antipsychotics (caripracin, lurasidone, aripiprazole, olanzapine).
Finally, a good response was obtained in the treatment with lorazepam 1mg /6h and 12 sessions of ECT administered concomitantly.
In this case, the patient presented a refusal to eat and weight loss with a BMI of malnutrition. We had to be coordinated with the endocrinology service for a nutritional restitution strategy through dietary supplements. Once nutritional restitution was achieved, we started treatment with clomipramine, with good results on affective symptoms.
ConclusionsNowadays, the origin and treatment of catatonia are still unclear.
We present the case of a man with melancholic depression with psychotic symptoms, who evolved into a catatonic syndrome. A good response was achieved with the combination of ECT and benzodiazepines.
We want to highlight nutritional recovery as an important point to achieve good absorption of antidepressant drugs. Once achieved, we started treatment with clomipramine with good results.
During the treatment, he has presented multiple difficulties and finally, he was able to leave after five months of hospitalization in the acute mental health unit.
Disclosure of InterestNone Declared
Use and experience with six-monthly paliperidone in the Campo de Gibraltar area. Descriptive study.
- C. M. Gil Sánchez, J. A. Salomón Martínez, E. Corbacho Navarro
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1005-S1006
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Introduction
Long-acting injectable antipsychotics have demonstrated advantages over therapeutic adherence and can reduce the rates of relapses and due to treatment discontinuation. The novel presentation of paliperidone palmitate six-month (PP6M) can simplify the treatment to two injections per year.
ObjectivesThe purpose of the present research is to describe the profile of patients receiving this novel treatment in our area. For this, a descriptive study has been carried out.
MethodsWe have collected and analyzed data from a total of 8 patients from the global long-acting injectable nursing registry in our area. The data collection was from May 2022 to October 2022.
ResultsID Patient Age Gender Medical comorbidities Social support Adherence to previous LAI EP001AGC 52 M No - Yes EP002EGA 53 M No Low No EP003ESL 45 F Yes HIV, HCV, dyslipidemia, Enough Yes EP004ACG 60 M Yes Hypertension, dyslipidemia Good Yes EP005DCP 52 M Yes COPD Enough Yes EP006ATT 47 M No Enough / Low Yes EP007AH 40 F Yes Tension headache Enough Yes EP008IAR 66 F Yes Type 2 diabetes mellitus, hypertension, hyperuricemia Enough Yes ID Patient Diagnosis Refractory positive symptoms Last H. Polypharmacy Previous injection Injection date / Dose H. / Side Effects EP001AGC Paranoid schizophrenia - 08/03/2014 No PP3M 525mg 17/05/22 1.000 mg No EP002EGA Schizoaffective disorder Yes 19/08/2022 Yes Valproic acid 1.000mg PP1M 150mg (once) 13/09/22 1.000mg No EP003ESL Paranoid schizophrenia No 17/04/2019 Yes Olanzapine 10mg BZD PP3M 525mg 10/08/22 1.000mg Sedation (low) EP004ACG Paranoid schizophrenia No - Yes Quetiapine 50mg PP3M 525mg 16/09/22 1.000mg No EP005DCP Paranoid schizophrenia No 16/01/2004 Yes Olanzapine 20mg BZD PP3M 525mg 11/10/22 1.000mg No EP006ATT Persistent delusional disorder Yes - No PP3M 525mg 19/09/22 1.000mg No EP007AH Paranoid schizophrenia No 2017 No PP3M 525mg 03/08/22 1.000mg No EP008IAR Persistent delusional disorder Yes - Yes BZD Paliperidone oral 9mg and later PP3M 350mg (twice) 18/10/22 1.000mg No Fig. 1: Sociodemographic characteristics and Fig. 2: Clinical characteristics.
ConclusionsNone of the patients required hospitalization at the time of the study, although this work team considers that it is early to make conclusions in this regard. No serious or minor adverse effects were reported in any of the cases during the time of the investigation, apart from one case of mild sedation.
The clinical characteristics of most patients were psychopathological stability and good adherence to previous treatment. Although this study shows that the drug was also used in patients who did not meet these characteristics, specially one case of poor social support. The data collected show that the profile of the patient in whom the drug has been prescribed can be varied and broad.
Disclosure of InterestNone Declared
Advances in the field of genetics and difficulties in the diagnosis of di george syndrome.
- I. E. Menendez Gil, M. L. Maria Del Carmen
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S983-S984
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Introduction
The spectacular progress of the last decade in the field of genetics is allowing a new development of medicine and the ability to make a better diagnosis. A great example of this is the diagnosis of chromosome 22q11 deletion, which occurs in 1:4000 live births.
ObjectivesThis case wants to illustrate the difficulties in the diagnosis, despite technological advances.
MethodsExhaustive review of the literature
ResultsThis is a 38-year-old male patient diagnosed with chromosome 22q11 deletion in adulthood.
Family history of medical problems: mother with genetic diagnosis of chromosome 22q11 deletion, in adulthood, after the diagnosis of her own son.
Personal history of medical problems:
- Psychiatry: he has been followed up intermittently in psychology since he was 6 years old, due to cognitive difficulties and behavioral alterations. He has had several hospital admissions in psychiatry during adolescence for behavioral disorders and intellectual disability, with possible psychotic symptoms. In treatment with antiepileptics and antipsychotics.
- Cardiology: aortic aneurysm and bicuspid aortic valve were detected. The patient underwent surgery in 2018.
- Genetics: he is diagnosed with chromosome 22q11 deletion in 2019. This is an inherited mutation of maternal origin that is detected later.
- Rheumatology: seropositive rheumatoid arthritis, non-erosive.
- Rehabilitation: treatment to improve psychomotor skills, from 6-12 years of age.
It is important to emphasize that the diagnosis was made at the age of 35 years, after a more deep study which had been carried out after the debut of the cardiac pathology. In addition, it is very striking that the diagnosis of his mother was made later than the one of the patient himself.
Currently, the patient presents serious difficulties in respecting the rules of coexistence at home and in understanding social norms, so that he has not been able to integrate in any environment and remains isolated at home. Serious behavioral alterations with tendency to physical and verbal heteroaggressiveness, difficulty in accepting limits and sexualized and uninhibited behaviors.
Clinical judgment: chromosome 22q11 deletion.
ConclusionsEarly diagnosis is essential to be able to treat and, above all, prevent the possible complications that this syndrome may present. However, diagnosis is sometimes very complex, despite advances in molecular diagnostic techniques. Therefore, an integrative approach is very valuable, looking at the individual as a whole and not only by systems or medical subspecialties. In addition, it would be very interesting to establish a means of communication between specialties. Finally, it would be a real step forward to integrate all the medical information of each person in a single medical record, an apparently simple aspect, but so far from being possible.
Disclosure of InterestNone Declared
Impact of COVID-19 pandemic on psychiatric emergency care in a general hospital
- J. M. Rodríguez Capilla, A. Rubio Carramiñana, S. Vega Castellote, S. López Fernández, I. Arilla Herrera, J. M. Almenara Galdeano, A. Mora Prat, M. Campillo Benito, J. Albero Garcia, A. Valderrey Ratia, A. Grau Peñas, C. Pastor Fernández, M. Moreno Monzó, J. Guitart Gil, J. Martínez Raga, C. Knecht
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S405-S406
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Introduction
The SARS-CoV-2 pandemic has produced an unprecedented clinical situation, causing a direct and indirect impact on the physical and mental health of the population. In Spain, between March 15 and June 21 of 2020, it was decreed a home confinement that caused the interruption of the daily life of millions of people. However, there are few studies that analyze the changes produced in psychiatric care in the Emergency Department (ED).
ObjectivesTo analyze the changes produced in psychiatric emergencies, subanalysing paediatric population, during the first year of the pandemic (COV1/Y-COV1) compared to the previous year (NOCOV/Y-NOCOV1). To analyze the clinical features of patients attended during the lockdown period of the pandemic (LOCK) and compare it to the period of the pandemic after the lockdown (NOLOCK).
MethodsThrough the registry of computerized medical records, patients who attended the psychiatric hospital emergency department between 03/01/2019 and 02/28/2021 were identified. We also identified all attendances from 15/03 to 21/06 in 2019 and in 2020 to obtain variables from the lockdown period.
ResultsDuring period of this study, 2694 psychiatric visits made in the ED (1744 patients - 54.3% women, and 69.5% were between 25 and 64 years-), 1537 in NOCOV and 1157 in COV1. Significant differences were found between COV1 and NOCOV in sociodemographic variables, such as employment status and number of offspring. At a clinical level, in COV1, we observed an increase in attendance due to heteroaggressive behaviors, mania, insomnia and problems due to substance use. An increase in the prescription and/or modification of treatment was observed (59.3% vs 54.3%). During COV1, in terms of discharge follow-up in the month following the ED visit, telematic assistance increased (11.4% vs. 5.3%). During the period of study, 282 ED attendances were performed, 153 in Y-NOCOV and 129 in Y-COV1. At a clinical level, during Y-COV1, a decrease in attendances related to substance use was found significant. The sub-analysis carried out for LOCK and NOLOCK yields similar data to those obtained in the COV1 vs. NOCOV1 comparison. During lockdown, the face-to-face follow-up in the month following the ED was significantly lower (39,5% vs 57,1%) regarding telematic follow-up (24,4% vs 5,8%) In this period, an increase of adolescents without previous mental health follow-up was observed (44% LOCK vs. 22% NOLOCK).
ConclusionsOur work supports the hypothesis that the COVID-19 pandemic caused a change in psychiatric care in the ED. It also shows how lockdown changed the attendance in psychiatric emergencies, and also in the later community care attendance. Changes are detected in emergency care for adolescents during the pandemic compared to the previous year. Strikingly, our study does not reflect a quantitative increase in the demand. It would be of interest to continue collecting data after the time of the present project.
Disclosure of InterestNone Declared
Mental health and post-traumatic growth in multiple sclerosis
- I. Gil-González, M. Á. Pérez-San-Gregorio, A. Martín-Rodríguez
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S302-S303
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Introduction
people suffering from multiple sclerosis (MS) can experience post-traumatic growth (PTG), a sense of personal growth and benefit gain. Patients mental health can play an important role in PTG development.
Objectivesto explore possible differences in mental health according to PTG levels.
Methodsthe sample was composed of 392 outpatients with MS from Virgen de la Macarena University Hospital (268 women; 124 (31.6 %) men, ages 19-78 years old (mean 45.61 years, SD=11.16 years). Expanded Disability Status Scale (EDSS) mean score was 3.38 (SD=2.06). Relapsing remittent (n=327) and progressive (n=65) MS type were reported. Post-traumatic Growth Inventory (PGI-21) measured patients perception of personal benefit gain after MS experience. General Health Questionnaire-28 (GHQ-28) evaluated Mental Health distress symptoms. Unpaired t-test was used to identify differences in mental health distress between “low PTG ≤49 score” and “high PTG ≥50 score” groups.
ResultsSignificant differences were found in social dysfunction (t=2.521, p=0.012) and severe depression (t=2.442, p=0.015), “high PTG group” (n=194) presented lower scores compare to “low PTG group” (n=198). No significant difference was detected in somatic symptoms (t=0.185, p=0.087) and anxiety and insomnia (t=0.859, p=0.391).
Conclusionspatients with higher PTG reported a better mental health. This suggests the relevance of mental health status in positive outcomes development after an adverse life event. Particularly, social dysfunction and depressive symptoms should be considered in interventions aimed to promote positive outcomes as personal gain and benefit finding in MS population.
Disclosure of InterestNone Declared
Delusions of body control: Psychopathological description of a case.
- C. M. Gil Sánchez, J. A. Salomón Martínez, E. Fernández García
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S999-S1000
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Introduction
A considerable number of patients with schizophrenia suffer from somatic passivity or delusions of control. So much so, that Schneider considered them as part of the first-rank symptoms.
In these cases, patients can think that feelings, impulses, thoughts, or actions are controlled or imposed by an external force.
ObjectivesThe objective is to make a psychopathological description of this symptomatology, based on a case report with Anomalous bodily experiences.
MethodsIn this study, we describe the case of a patient with disorder of self-experience. We have conducted a systematic review of the descriptions published to date, regarding this case.
ResultsWe present the case of a 21-year-old patient who had gone to the emergency services three times for somatic pathology (described as dysesthetic and algic sensations in the throat, stomach and testicles).
In the psychopathological exploration, a delusional narrative is observed, as he refers that these sensations are being provoked by external people, with the aim of harming him.
The patient reports that these people are causing an increase in salivation in his salivary glands, for which he spits repeatedly.
He explains that these people can control his organs using an influencing machine, which in this case consists of a microchip implanted at the retroauricular area, from which they give orders and insult him at the same time.
In this case, a good symptom response was achieved with intramuscular Aripiprazole.
ConclusionsIn the experiences of passivity, the patient experiences one event as if it were not his, but inserted into his self from the outside.
In the case of somatic passivity, there is a belief that there are external influences acting on the body. In this case, there was probably a kinesthetic hallucination coupled with an experience of passivity.
Similar to other published cases, this patient complained of being controlled and impaired by some form of contemporary technology. Delusions of control are often associated with delusional explanations about how thought or body can be controlled, in this case, through a microchip.
Disclosure of InterestNone Declared
A case of outpatient treatment in a 58-year-old woman with hoarding disorder and hallucinations.
- A. Gonzalez-Mota, A. Gonzalez-Gil, M. T. Basanta-Patiño, M. Colomer-Sagaste
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S224-S225
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Introduction
In hoarding disorder the patient has a strong tendency to collect and accumulate objects with or without value and great difficulty in destroying them.
In this case, a 58-year-old woman diagnosed with a hoarding disorder 5 years ago, came to a psychiatry clinic due to frequent auditory hallucinations related to episodes of acute stress. She received treatment in an outpatient mental health unit which consisted of psychopharmaceuticals and cognitive behavioural therapy. The patient achieved a partial remission of the hallucinations and a clinical improvement of the accumulation symptoms.
ObjectivesThe main objective of this study is to describe the psychiatric and psychological treatment of this patient. We also performed a review of the available literature on comorbidity of the symptoms of Diogenes syndrome and psychotic symptoms.
MethodsA close follow-up of the psychopathology of this patient was carried out and we did a database search in PubMed to document the case, with the keywords: “hoarding disorder”, “psychotic disorder”, “comorbidity”, “hallucination”, with the inclusion criteria: In the last ten years, Spanish and English language.
ResultsThe patient, who was being treated with sertraline 100 mg, started treatment with olanzapine 10 mg and with a psychotherapeutic plan with different objectives: stabilization of symptoms, reduction of hoarding behaviours, letting go of objects, as well as coping with stressful situations. Cognitive behavioural techniques such as psychoeducation, exposure with response prevention and cognitive therapy were included in the psychological treatment.
After one year of treatment the hallucinatory symptoms have remitted and the patient’s daily functioning has improved. The most resistant symptoms are those of accumulation that are slowly decreasing but the patient has stopped collecting objects from the street.
ConclusionsMore studies of the treatment of hoarding disorder and more investigation of its possible comorbidities are needed.
Disclosure of InterestNone Declared
Effect of polygenic risk score, family load of schizophrenia and exposome risk score, and their interactions, on the long-term outcome of first-episode psychosis
- M. J. Cuesta, S. Papiol, B. Ibañez, E. García de Jalón, A. M. Sánchez-Torres, G. J. Gil-Berrozpe, L. Moreno-Izco, A. Zarzuela, L. Fañanás, V. Peralta, SEGPEPs Group
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- Journal:
- Psychological Medicine / Volume 53 / Issue 14 / October 2023
- Published online by Cambridge University Press:
- 06 March 2023, pp. 6838-6847
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Background
Consistent evidence supports the involvement of genetic and environmental factors, and their interactions, in the etiology of psychosis. First-episode psychosis (FEP) comprises a group of disorders that show great clinical and long-term outcome heterogeneity, and the extent to which genetic, familial and environmental factors account for predicting the long-term outcome in FEP patients remains scarcely known.
MethodsThe SEGPEPs is an inception cohort study of 243 first-admission patients with FEP who were followed-up for a mean of 20.9 years. FEP patients were thoroughly evaluated by standardized instruments, with 164 patients providing DNA. Aggregate scores estimated in large populations for polygenic risk score (PRS-Sz), exposome risk score (ERS-Sz) and familial load score for schizophrenia (FLS-Sz) were ascertained. Long-term functioning was assessed by means of the Social and Occupational Functioning Assessment Scale (SOFAS). The relative excess risk due to interaction (RERI) was used as a standard method to estimate the effect of interaction of risk factors.
ResultsOur results showed that a high FLS-Sz gave greater explanatory capacity for long-term outcome, followed by the ERS-Sz and then the PRS-Sz. The PRS-Sz did not discriminate significantly between recovered and non-recovered FEP patients in the long term. No significant interaction between the PRS-Sz, ERS-Sz or FLS-Sz regarding the long-term functioning of FEP patients was found.
ConclusionsOur results support an additive model of familial antecedents of schizophrenia, environmental risk factors and polygenic risk factors as contributors to a poor long-term functional outcome for FEP patients.
Parental food consumption and diet quality and its association with children’s food consumption in families at high risk of type 2 diabetes: the Feel4Diabetes-study
- Lubna Mahmood, Luis A Moreno, Paloma Flores-Barrantes, Christina Mavrogianni, Peter Schwarz, Konstantinos Makrilakis, Stavros Liatis, Greet Cardon, Ruben Willems, Imre Rurik, Sándorné Radó, Tsvetalina Tankova, Violeta Iotova, Natalya Usheva, Yannis Manios, Esther M Gonzalez-Gil
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- Journal:
- Public Health Nutrition / Volume 25 / Issue 12 / December 2022
- Published online by Cambridge University Press:
- 11 October 2022, pp. 3344-3355
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Objective:
To examine the parental food consumption and diet quality and its associations with children’s consumption in families at high risk for developing type 2 diabetes mellitus across Europe. Also, to compare food frequency consumption among parents and children from high-risk families to the European Dietary guidelines/recommendations.
Design:Cross-sectional study using Feel4diabetes FFQ.
Setting:Families completed FFQ and anthropometric measures were obtained. Linear regression analyses were applied to investigate the relations between parental food consumption and diet quality and their children’s food consumption after consideration of potential confounders.
Participants:2095 European families (74·6 % mothers, 50·9 % girls). The participants included parent and one child, aged 6–8 years.
Results:Parental food consumption was significantly associated with children’s intake from the same food groups among boys and girls. Most parents and children showed under-consumption of healthy foods according to the European Dietary Guidelines. Parental diet quality was positively associated with children’s intake of ‘fruit’ (boys: β = 0·233, P < 0·001; girls: β = 0·134, P < 0·05) and ‘vegetables’ (boys: β = 0·177, P < 0·01; girls: β = 0·234, P < 0·001) and inversely associated with their ‘snacks’ consumption (boys: β = –0·143, P < 0·05; girls: β = –0·186, P < 0·01).
Conclusion:The present study suggests an association between parental food consumption and diet quality and children’s food intake. More in-depth studies and lifestyle interventions that include both parents and children are therefore recommended for future research.
Bilateral Ménière's disease according to its form of debut: synchronous and metachronous disease
- T Pérez-Carbonell, M Orts-Alborch, I Pla-Gil, V Pérez-Guilén, J M Tenías-Burrillo, J Marco-Algarra, H Pérez-Garrigues
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- Journal:
- The Journal of Laryngology & Otology / Volume 137 / Issue 7 / July 2023
- Published online by Cambridge University Press:
- 06 October 2022, pp. 782-788
- Print publication:
- July 2023
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Objective
Bilateral Ménière's disease is classified according to the time of appearance of symptoms in each ear into synchronous and metachronous types. A descriptive longitudinal study, involving 59 bilateral Ménière's disease patients, was carried out to assess the two forms of bilateral Ménière's disease.
MethodData on symptomatic chronology in each ear, auditory evolution and evolution of vertiginous crisis, among other aspects, were obtained, analysed and compared. Possible risk factors for Ménière's disease becoming bilateral were analysed after conducting nested case–control studies in a cohort.
ResultsThe metachronous form was seen in 76.3 per cent of cases, and the time it took for the disease to become bilateral took a median time of seven years. The symptomatic triad was the most frequent symptomatic debut for the first ear in both forms. Synchronous debut presented a greater average hearing loss. Suffering from migraine and a symptomatic onset with a greater number of symptoms appear to be possible predictors of conversion to bilateral Ménière's disease.
ConclusionBilateral Ménière's disease temporal models presented differences. The study of them helps to better understand, prevent and predict the behaviour of these patients.