Challenges in Treating Schizophrenia with LAIs – Analysis of Own Results

Introduction Schizophrenia is a multifactorial and multifarious disorder with an unidentified etiology and pathogenesis, various clinical symptoms, unpredictable course and definite social significance. It’s social significance manifests in the long inability to work, the decrement of qualification and the burdening of family and social services. Patients find following therapy difficult; they often stop it altogether, which leads to new exacerbations and maintaining a vicious cycle. Objectives To present an analysis of the results of the treatment of patients with LAIs – Trevicta and Xeplion in General Psychiatry Ward of UMBAL "Dr. Georgi Stranski” - Pleven for the period October 2016 – October 2022. Methods Our retrospective research includes 17 patients treated in General Psychiatry Ward of UMBAL “Dr. Georgi Stranski”- Pleven. A treatment with LAI’s – Trevicta and Xeplion (Paliperidone palmitate) had been initiated in these patients. In consideration of the correct applications of the medication, they are always made by qualified personnel who received training for that purpose in the Ward. For assessment of the patients’ condition are used: Positive and Negative Syndrome Scale (PANSS) and Personal Social Performance (PSP). Standard statistic methods are used for processing results. Results Our research includes 17 female patients as the Ward’s profile is such, with the average age of 38.65 years at the initiation of the treatment with Xeplion. Some were later introduced to Trevicta. Of all who participated in the research, 12 patients continue their treatment with regular applications, 2 have changed their address and by unreliable data still continue their treatment and for the other 3 we have no information of their status of treatment. The average count of admissions in the Ward before the initiation of treatment with LAI’s is 3.88 against 0.88 after the initiation. Regarding the PANSS scale – all score in the interval 75-100 points before initiation as opposed to the scores marked after the initiation of the medication that vary in the interval 34-48 points with definite distinctions in P and G items. Regarding the PSP scale – all participants score between 50 and 70 points before the initiation of the treatment as opposed to the scores of 89-95 points after the initiation. During the regular check-ups the patients report of subjective improvement, coupled with reports of objective and positive improvement by family. Conclusions Treatment with LAIs – Xeplion and Trevicta has an unquestionable positive and lasting effect in the treatment of schizophrenia. Proof of that is the definite improvement of the symptoms, the increased social engagement and interpersonal communication. Everything mentioned is a valid reason to direct the treatment of schizophrenia in the direction of preservation of the personality of the patients. Disclosure of Interest None Declared


Introduction:
The occurrence of psychotic symptoms induced by dopaminergic drugs marks a new phase in the course of Parkinson's disease (PD).The term drug induced psychosis may be used when other significant psychiatric diseases are excluded in patients with no history of psychosis.The prevalence of dopaminomimetic psychosis varies from 5% to 20%.Therefore, knowledge of the psychopharmacological management of this condition is essential.Objectives: The purpose of this case report and literature review is to to learn the psychopharmacological management of this not uncommon medical complication.Methods: Descriptive case study and review of literature Results: We present the case of a 71-year-old man with a medical history of Parkinson's disease with partial response to treatment with high doses of levodopa and carbidopa.He was brought to the emergency department by his family due to the presence of behavioural alterations at home.The patient reported seeing men in foam trying to harm his family.In a disjointed way in his speech, he links this idea with the delusional belief that he is being watched by electronic devices placed throughout the house.In a variegated manner he links this with a coelotypical type of discourse, however the delusional ideation remains unstructured throughout.
With no previous personal or family history of mental health and ruling out underlying organic conditions, a diagnosis of psychosis secondary to pharmacological treatment for Parkinson's disease is presumed.Considering the risks and benefits, it was decided to maintain the anti-Parkinson's dose in order to avoid worsening the patient's motor function.Therefore, after reviewing the literature, the best option was to introduce clozapine at low doses, up to 50 mg at night, with the respective analytical control.After a week's admission, the patient began to improve psychopathologically, achieving an ad integrum resolution of the psychotic symptoms.Conclusions: Despite the availability of other antipsychotic treatments such as quetiapine or the more recent pimavanserin, clozapine remains the treatment of choice for drug-induced psychosis in Parkinson's disease.

EPV0910
Challenges in Treating Schizophrenia with LAIs -

Analysis of Own Results
Introduction: Schizophrenia is a multifactorial and multifarious disorder with an unidentified etiology and pathogenesis, various clinical symptoms, unpredictable course and definite social significance.It's social significance manifests in the long inability to work, the decrement of qualification and the burdening of family and social services.Patients find following therapy difficult; they often stop it altogether, which leads to new exacerbations and maintaining a vicious cycle.Objectives: To present an analysis of the results of the treatment of patients with LAIs -Trevicta and Xeplion in General Psychiatry Ward of UMBAL "Dr.Georgi Stranski" -Pleven for the period October 2016 -October 2022.Methods: Our retrospective research includes 17 patients treated in General Psychiatry Ward of UMBAL "Dr.Georgi Stranski"-Pleven.A treatment with LAI's -Trevicta and Xeplion (Paliperidone palmitate) had been initiated in these patients.In consideration of the correct applications of the medication, they are always made by qualified personnel who received training for that purpose in the Ward.For assessment of the patients' condition are used: Positive and Negative Syndrome Scale (PANSS) and Personal Social Performance (PSP).Standard statistic methods are used for processing results.
Results: Our research includes 17 female patients as the Ward's profile is such, with the average age of 38.65 years at the initiation of the treatment with Xeplion.Some were later introduced to Trevicta.Of all who participated in the research, 12 patients continue their treatment with regular applications, 2 have changed their address and by unreliable data still continue their treatment and for the other 3 we have no information of their status of treatment.The average count of admissions in the Ward before the initiation of treatment with LAI's is 3.88 against 0.88 after the initiation.
Introduction: CT of the endocranium is an indispensable step in the differential-diagnostic evaluation of a patient with the first episode of psychotic disorder.In this context, the main goal of this diagnostic procedure is to "exclude" the so-called organic disorders of the brain tissue, which could be manifested by psychotic phenomenology.However, during the past decades, pathological changes in the brain parenchyma have been found during neuroimaging studies of psychiatric patients.With the group of schizophrenic psychoses, the following are most often associated: Expansion of the ventricular system, cortical reductive changes, agenesis of the corpus callosum, a higher frequency of some congenital anomalies of the brain, such as cavum septum pellucidum and cavum verga.Objectives: Consequently, the main goal of our study is to demonstrate the possibility of diagnosing these changes and examine the frequency of cases of so-called secondary psychotic syndromes, where psychotic phenomenology arose on the basis of some other illness.Methods: Data were collected for 145 patients from the Acute Male Department, who were treated in the period 2011-2019.CT scan of the endocranium was performed as part of the diagnostic evaluation during the first psychiatric hospitalization.Results: Out of the total number of examinations (145), 20.7% of patients had a pathological finding, with the following structure: In 6.9% of the age group up to 45 years, moderately expressed (disproportionate for the age) cortical reductive changes were found.Concomitant occurrence of cavum septi pellucid et cavum vergae was observed in 3.4% and isolated septum pellucidum cyst in 1.3% of patients.Post-stroke changes, post-contusion foci, and benign congenital brain tumors were found with a frequency of 1.3%, pronounced cortical reductive changes and pathological calcifications with a frequency of 3%, while in individual cases (0.68%) the presence of a subarachnoid cyst and atrophy of the cerebellar cortex was recorded Conclusions: CT of the endocranium represents a significant aid in the evaluation of a patient with the first episode of psychotic disorder.However, its use in order to analyze more complex changes in psychiatric patients is significantly limited compared to more modern neuroimaging modalities.

EPV0912
GnRh agonists as precipitating components of psychiatric pathology.A case report.
Introduction: GnRh agonists are drugs used in various gynecological pathologies, among which is endometriosis.They act by stimulating GnRh receptors in the pituitary gland.This sustained and continuous stimulation of GnRh, will initially generate an increase in the release of luteinizing hormones and folliclestimulating hormones, subsequently losing sensitivity to the receptors, internalizing them, and thus suppressing the release of these hormones, which would entail an ovarian suppression, thereby inhibiting the release of estrogens and progesterone.Psychiatric adverse effects have been described.Gonzalez-Rodriguez et al (Front Psychiatry 2020;11:479), described this association with changes in mood, and the presence of a series of cases where the link between GnRh agonist and the possibility of presenting psychotic symptoms is observed.Wieck (Curr Top Behav Neurosci 2011;8:173-87), Frokjaer (J Neurosci Res 2020;98(7):1283-1292), Brzezinski-Sinai et al (Front Psychiatry 2020;11:693) reported that this association could be related with the relationship of the hypothalamic-pituitary-gonadal axis, hormonal fluctuation and its relationship with the dopaminergic regulation, a genetic component that would increase the predisposition to trigger psychiatric pathology in patients with greater sensitivity to hormonal fluctuations, and the loss of neuroprotection generated by the decrease of estrogens in the central nervous system.All of this in the context of multiple environmental and genetic factors that participate together in the appearance of the disease.Objectives: To describe the importance of detecting the risk factors that can precipitate a psychotic episode, including the use of certain drugs, such as GnRh agonists.Methods: We describe a case of a 45 year old patient with endometriosis with multiple organ involvement who went to the emergency room due to behavioral changes in the context of a brief psychotic disorder with "ad-integrum" recovery.Results: A retrospective analysis of the case is conducted, observing an association between the introduction of GnRh agonists and the presentation of a first psychotic episode.Conclusions: The importance of this case lies in the limited evidence of this association in the literature, and the implication of