Lisdexamfetamine in combination with guanfacine as an effective treatment in the management of behavioral disturbances in patients with Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). Case report

Introduction We often find it challenging to manage hyperactivity, low frustration tolerance and angry outbursts in patients with ASD and comorbid ADHD. Fewer drugs are approved for these disorders and these patients are more likely to develop adverse effects. Objectives The aim of this case is to show how the combination of lisdexamfetamine together with guanfacine has very positive effects on anger outbursts and boundary heteroaggressiveness in patients with ASD and ADHD. Methods Case report and literature review Results This is a 14-year-old minor admitted to the psychiatric unit after physical aggression against his family due to anger after removal of video games, requiring police intervention. He has been diagnosed since he was 11 years old with ADHD and Autism Spectrum Disorder. He was being treated with methylphenidate 54 mg and aripiprazole 10 mg. Since the beginning of the admission, the following pharmacological adjustment has been made: Methylphenidate is substituted by lisdexamfetamine up to 50 mg per day. Guanfacine has been started up to 4 mg per day and the dose of aripiprazole has been maintained. The patient had no adverse effects with adequate tolerance without sedation, hyporexia or hypotension. With this adjustment, improvement was found in the levels of restlessness and hyperactivity. The patient expressed a subjective improvement in the levels of restlessness and with a notable improvement in attention in the hospital classroom. An improvement in emotional regulation was also observed, with more tolerance to the imposition of limits, without an explosion of anger in the face of any rule during admission Conclusions The management of hyperactivity and episodes of low frustration tolerance in patients with ASD and ADHD is complex. Many studies point out the time-limited use of some antipsychotics such as risperidone or aripiprazole. This work aims to show guanfacine in combination with lisdexamfetamine as an excellent combination for the management of agitation and rage explosion in these patients. In addition, the profile of adverse effects at metabolic level is much better than that of atypical antipsychotics. Reference Extended-Release Guanfacine for Hyperactivity in Children With Autism Spectrum Disorder. Lawrence Scahill et al. Am J Psychiatry. 2015 Dec. Disclosure of Interest None Declared

Introduction: Impulsivity in adolescents has been largely studied as it is frequently observed in that phase.However, the relationship between impulsivity and emotion regulation has been rarely explored.
Objectives: Our study aimed to assess impulsivity and emotional regulation in medical students as well as to explore the link between them.Methods: This was a descriptive and analytical cross-sectional study conducted from September to December 2017, among first and second year students of the medical school of Sfax who were aged between 18 and 19 years.We collected sociodemographic as well as clinical data of the participants."Barratt Impulsivity Scale" (BIS) and "Difficulties in Emotion Regulation Scale" (DERS) were used to assess impulsivity and emotion regulation respectively.Results: One hundred students were included in our study, with a mean age of 18 years and a sex ratio of 0.81.Among them, 62% were smokers with an average consumption of 19.6 packets year.Alcohol and cannabis use was reported by 9% and 5% of the students respectively.The mean impulsivity score on the Barratt scale was 66.78 AE 9.44 with scores ranging from 40 to 112.Among our participants, 25% had a high level of impulsivity (score > 72).Unplanned impulsivity was the dimension with the highest mean score (23.74AE4.64).Our results showed that impulsivity was significantly associated with the male gender (p=0.002) and smoking (p<10-3).As for emotion regulation, the mean score on the DERS scale was 78.8 AE17.The majority of the students (64%) had a moderate difficulty in regulating emotions.Our results showed a positive correlation between impulsivity and emotional regulation with a moderate link (p=10-3; r= 0.57).The high emotion dysregulation group had a significantly higher score on the two dimensions of impulsivity: attentional impulsivity (p=10-3) and unplanned impulsivity (p=0.047).Conclusions: Our study highlights the relationship between emotion dysregulation and impulsivity, suggesting that emotion regulation may be an important factor to consider when assessing impulsive adolescents.

EPV0202
Use of cariprazine as an impulsivity regulator in an adolescent with non suicidal self-injury and suicidal attempts.Case report Introduction: Adolescents with emotional dysregulation are at risk for self-injury.Antipsychotics are often used to manage these symptoms.
Objectives: The aim of the present case is to show the use of cariprazine as an effective drug for emotional dysregulation and impulsivity in a 17-year-old adolescent girl Methods: Case report Results: The patient was a 17-year-old female admitted to in patient psychiatric unit for a self-harm attempt due to sertraline overdose.She was being followed up for self-injury, anxiety and eating disorder symptoms.Her treatment was sertraline 200 mg, diazepam 20 mg per day and olanzapine 15 mg per day.With this medication she had gained up to 7 kgs in 4 months.A progressive change was made with cariprazine up to 3 mg and olanzapine was reduced to 2.5 mg at night.With this adjustment the patient did not present worsening in anxiety levels, with adequate impulse control and being able to perform emotional regulation strategies.Conclusions: Although it has no indication in patients under 18 years of age, it shows a case of good tolerance and efficacy for the management of impulsivity by improving emotional regulation.Cariprazine is an atypical antipsychotic that works through partial agonism on dopaminergic receptors, serotonin 5-HT 1A receptors and an antagonist at the 5-HT 2B receptors, with moderate affinity for adrenergic, histaminergic, and cholinergic receptors reducing the likelihood of side effects Disclosure of Interest: None Declared

EPV0203
Lisdexamfetamine in combination with guanfacine as an effective treatment in the management of behavioral disturbances in patients with Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD).Case report Introduction: We often find it challenging to manage hyperactivity, low frustration tolerance and angry outbursts in patients with ASD and comorbid ADHD.Fewer drugs are approved for these disorders and these patients are more likely to develop adverse effects.
Objectives: The aim of this case is to show how the combination of lisdexamfetamine together with guanfacine has very positive effects on anger outbursts and boundary heteroaggressiveness in patients with ASD and ADHD.Methods: Case report and literature review Results: This is a 14-year-old minor admitted to the psychiatric unit after physical aggression against his family due to anger after removal of video games, requiring police intervention.He has been diagnosed since he was 11 years old with ADHD and Autism Spectrum Disorder.He was being treated with methylphenidate 54 mg and aripiprazole 10 mg.Since the beginning of the admission, the following pharmacological adjustment has been made: Methylphenidate is substituted by lisdexamfetamine up to 50 mg per day.Guanfacine has been started up to 4 mg per day and the dose of aripiprazole has been maintained.The patient had no adverse effects with adequate tolerance without sedation, hyporexia or hypotension.With this adjustment, improvement was found in the levels of restlessness and hyperactivity.The patient expressed a subjective improvement in the levels of restlessness and with a notable improvement in attention in the hospital classroom.An improvement in emotional regulation was also observed, with more tolerance to the imposition of limits, without an explosion of anger in the face of any rule during admission Conclusions: The management of hyperactivity and episodes of low frustration tolerance in patients with ASD and ADHD is complex.Many studies point out the time-limited use of some antipsychotics such as risperidone or aripiprazole.This work aims to show guanfacine in combination with lisdexamfetamine as an excellent combination for the management of agitation and rage explosion in these patients.In addition, the profile of adverse effects at metabolic level is much better than that of atypical antipsychotics.Hesitancy of parents choosing not to vaccinate their children is studied here.Also studied is the effect of a brief motivational interviewing intervention on the parent's decision to vaccine their child, or not.What was found was a myriad of beliefs and values in the parents, and varied reactions and outcomes in response to the motivational interviewing.
Objectives: The aim of our study is to determine whether motivational interviewing techniques can be used as an effective tool to educate patients and their families about the benefits of vaccination against COVID-19 and increase vaccinations rates.In our urban community hospital-based child and adolescent psychiatry outpatient clinic, we found a high level of vaccine hesitancy among our patient population.As motivational interviewing is an evidence-based approach to addressing ambivalence and behavior change, we sought to engage parents with this approach.Methods: This is a quality improvement project where chart review of all pediatric patients currently enrolled in our clinic was performed to determine which patients are unvaccinated for COVID-19.Telephone contact was made to reach parents to obtain verbal consent and to deliver the intervention consisting of standardized motivational interview techniques followed by brief educational points about the vaccines.Follow up calls were made one week later to determine whether there was any change in readiness to consider vaccination on a scale from 1-10.We reached a total of 29 parents on initial outreach, and 11 parents during the follow up phase.Many were lost to follow up due to unavailability or refusal to participate further.
Results: Parents (N = 11, 5-African American, 6-Hispanic) reported on their decision to have their child (mean age=12.2,55% Female) receive the covid-19 vaccine.Preliminary findings show an increase in readiness on a scale from 1-10 to receive the vaccine following a one week interval post intervention (t(10) =2.096, p=.06), with the most common barriers that subjects endorsed being fear of side effects, skepticism regarding the speed at which the vaccines were developed, and wanting to allow their children to decide for themselves.Conclusions: We found that there was an overall improvement in vaccine hesitancy following our intervention, though it did not cross the threshold of statistical significance.We also identified common reasons given for hesitancy within our community.Motivational interviewing is a promising intervention to address vaccine hesitancy.Further study is warranted as expanding the reach of such interventions could lead to more robust data as well as broader vaccine acceptance.

Disclosure of
Reference: -Extended-Release Guanfacine for Hyperactivity in Children With Autism Spectrum Disorder.Lawrence Scahill et al.Am J Psychiatry. 2015 Dec. Disclosure of Interest: None Declared EPV0204 Motivational Interviewing Technique As a Means of Decreasing Vaccine Hesitancy in Children and Adolescents During the COVID-19 Pandemic Introduction: Vaccine hesitancy is a known phenomenon predating the COVID-19 pandemic.Vaccine hesitancy is a significant factor effecting the control and spread of the COVID-19 Virus.
Adolescence presents itself as a phase of life marked by rapid changes produced by different social contexts and in many cases, it can be configured in a stressful situation.The development of a psychosocial support network is of fundamental importance for Introduction: