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Anxiety, Depression and Suicidal Behavior Among Medical Students from the University of Valladolid
- A. Alvarez Astorga, M.H. De la Red Gallego, A. Alonso Sánchez, S. De la Fuente Ballesteros, T. Delgado Santillana, R. Hernandez Anton, M. Gómez García, M.M. De Lorenzo Calzón, E. Mayor Toranzo, J.A. Blanco Garrote
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S290
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Introduction
Suicide is a major public health problem, especially in young people. It is one of the most significant causes of mortality and potential years of life lost. Medical students are a vulnerable group presenting mental health problems.
ObjectivesTo study the prevalence of common mental illnesses among medical students from the university of Valladolid in order to assess the need for intervention programs.
MethodsCross-sectional study in which, 584 students participated during the academic year 2015–2016 by completing an online self-administered questionnaire. Mental health outcomes were measured by different batteries of depression, anxiety and suicide (BDI, GAD-7 and MINI). Information about possible related risk factors was also obtained. Statistical Chi2 and Student t-tests were applied to estimate associations between socio-demographic, socioeconomic data and clinical results.
ResultsWe found a prevalence of 15.8% for depression, 11.6% for ideation suicide and 38.5% for anxiety, with gender differences in the latter case. Prevalence rates were higher than those described in general population. Compared to other international studies, prevalence estimates were also higher among our sample.
ConclusionsThis study shows for the first time data of these three psychiatric disorders among medical students in Spain. It suggests the urge to implementing preventive activities to alleviate maladaptive behaviors, academic stress, improve the quality of life and adaptation of students to college life. Larger, prospective, multicentre studies are needed to draw conclusions about the causes and consequences of students’ stress, since evidence shows that mental health problems are perpetuated throughout professional performance.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Emerging treatments options for narcolepsy throughout a case
- A. Alvarez Astorga, L. Gallardo Borge, H. de la Red Gallego, A. Alonso Sánchez, S. Gómez Sánchez, C. Noval Canga, E. Mayor Toranzo, S. Cepedello Pérez, L. Rodriguez Andrés, T. Ballesta Casanova
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- Journal:
- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S594
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Background
Narcolepsy is a neurological disorder characterized by disturbances in REM sleep. The symptoms that the patient could present are excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations and disrupted nocturnal sleep. Its etiology is unknown. Currently, there is established pharmacotherapy for symptomatic treatment, which are often unsatisfactory.
ObjectiveReview of new treatments for narcolepsy based on recent advances about its ethiopathogenesis.
MethodSeventy-five year-old female with a personal history of arterial hypertension and obstructive sleep apnea syndrome. The patient presented several episodes of abrupt muscular weakness, nightmares, sleep paralysis and excessive daytime sleepiness. Diagnosed of narcolepsy and treated with methylphenidate immediate-release (IR) 10 mg, alprazolam 1 mg, and trazodone 100 mg with good response.
ResultsDue to persistent symptoms, treatment was modified to osmotic-release oral system (OROS) – methylphenidate resulting on a substantial weight loss (12 kg) and persistence of symptoms. Another methylphenidate preparations were unsuccessfully tested. Currently she continues treatment based on methylphenidate release-release and she improved significantly though she sometimes presented daytime sleepiness.
DiscussionRecent studies have shown that a loss of the hypothalamic neuropeptide hypocretin causes Narcolepsy with cataplexy and that an autoimmune mechanism may be responsible for this loss (related to HLA DQB*0602). Pathophysiology of narcolepsy without cataplexy is less understood.
Although amphetamines and its derivatives are the mainstay of management, therapies that involve hypocretine seems to be hopeful (intranasal, peripherical or hipocretin cell transplantation). Monotherapy with GHB, H3 antagonist receptors, TRH analogs and immunotherapy are also being studied.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Charles-bonnet Syndrome: Hallucinations are in the Eye of the Beholder
- N. De Uribe-viloria, E. Mayor Toranzo, S. Cepedello Perez, I. Sevillano Benito, M. De Lorenzo Calzon, M. Gomez Garcia, G. Medina Ojeda, F. De Uribe Ladron De Cegama
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S631
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Introduction
Charles-Bonnet Syndrome (CBS) is a clinical entity characterized for visual hallucinations in patients with severe vision impairment and preserved cognitive state. Its pathogeny is still unknown, limiting management options. For diagnosis neurological and psychiatric disorders must be discarded. Treatment is based in three pillars: explaining to the patient the origin and nature of the symptoms, treating the visual deficit when possible, and pharmacotherapy with anti-psychotics.
Objectives and aimsTo outline the main characteristics and etiopathogenic theories of the CBS, so as to improve diagnosis and treatment.
MethodsBasing on a case followed in mental health consults, we made a systematic review of the articles published in Medline (PubMed) in the last 5 years, with the following keywords, Charles-Bonnet Syndrome, hallucinations, deafferentation, visual impairment.
ResultsWe found that all our case and the reported ones had in common the nature and characteristics of the hallucinations, the presence of a trigger, usually a new medicament, and the functional MRI patrons of activity; those patrons located the loss of input prior to the association cortex, which appeared hyper-excitable in functional MRI.
ConclusionsAlthough the aetiology and pathogeny of CBS is still unclear, present data suggests that the key mechanism may be a dysregulation in the homeostatic adaptation of the neural pathway when it is left without external input, traducing a hyper-function of a physiological process, probably mediated by acetylcholine, as opposed with other neuropsychiatric pathologies, in which the cortex is the primary affected area.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Traumatic Brain Injury as Psychosis Development Factor
- A. Alonso Sánchez, A. Álvarez Astorga, H. De la Red Gallego, M. De Lorenzo Calzón, N. De Uribe Viloria, M. Gómez García, C. Noval Canga, E. Mayor Toranzo, J.A. Blanco Garrote
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. s801
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Introduction
The pathophysiology of psychosis is not fully discovered yet. However, during the last years many different risk factors are shown to prove to have a strong influence within the development of this pathology. Traumatic brain injury (TBI) is one of them.
ObjectivesShow TBI as a psychosis development risk factor.
MethodsCase report. A clinical vignette is presented followed by the results obtained in a bibliographic review.
ResultsA young 19-year old immigrant man, who lives with his parents in a social exclusion situation is brought to the hospital after having been observed making estrange religious rituals within a local river. During the anamnese he declares that God is “getting in touch with him” while he shows to be changed, with suspicion about being pursued. He also reveals to have suffered a mild-severe TBI with 8 years, having right ear audition problems since then. During the hospitalization some medical test were done, such as MRI, showing the lack of the inner right ear, as well as white matter abnormalities in his right hemisphere, which could be consequence of the TBI. Those findings make us think that this pathology might have been influenced, within other factors, by the traumatic brain injury.
ConclusionsThis bibliographic review shows that traumatic brain injury may increase the risk of developing psychosis up to 65% from healthy controls, with a medium gap of 3.3 years between the TBI and the appearance of psychotic pathology.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Recurrent hypersomnia: Kleine-Levin syndrome
- L. Rodríguez Andrés, A. Rodríguez Campos, L. Gallardo Borge, G. Isidro García, E. Mayor Toranzo
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- Journal:
- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S595
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Introduction
Kleine-Levin syndrome was first described by Kleine in 1925 and elaborated on by Levi in 1936. It is an infrequent syndrome that predominantly affects to teenagers, and boys are four times more likely to be affected than girls. It is rare for patients over 30 years although some cases have been reported. Kleine-Levin syndrome is a recurrent hypersomnia characterized by episodes of hypersomnia lasting for 2 days to 4 weeks associated with symptoms of hyperphagia, hypersexuality and cognitive impairment. It can be accompanied by other abnormal behavior such as aggression, personality changes and irritability. Deficits are resolved between episodes.
Case reportIt is presented the case report of a patient that suffers from recurrent episodes of hypersomnia associated with hyperphagia and abnormal behavior.
ElectroencephalographyEEG demonstrates slowing of drowsiness and a decrease in REM sleep. The test of multiple sleep latency is abnormal and the rest of complementary test are normal.
DiagnosisF51.1 Recurrent hypersomnia (Kleine-Levin syndrome) [307.44].
DiscussionKleine-Levin syndrome is an intriguing, severe and homogenous disease with no obvious cause or treatment. Treatment is generally supportive. It should be considered in any teenager presenting with recurrent episodes of hypersomnia concurrent with cognitive changes or disinhibition.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Suicide: A major public health problem
- R. Hernandez Anton, E. Dominguez Alvarez, A. Alvarez Astorga, E. Rybak Koite, S. Gomez Sanchez, L. Rodriguez Andres, E. Mayor Toranzo, M. Hernandez Garcia, J.M. Blanco Garrote, J.M. Maderuelo, M.V. Garcia Santos, H. De La Red Gallego, F. Uribe Ladron De Cegama
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- Journal:
- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, pp. S601-S602
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Introduction
Suicide is the deliberate act of take off life to itself. According to WHO, more than one million people commit suicide every year.
GoalsCompare data of suicide attempts between 1996 and 2014 in the University Hospital of Valladolid. Influence of the economic crisis on suicide data. Expose the risk factors. Provide prevention strategies.
Material and methodsWe have performed a study of epidemiological surveillance collecting descriptive data of suicide attempts; using the same methodology as in 1996. The variables studied were: sex, age, day, month, residence, method, personal status, education, employment status, religious believes, family history of suicide, psychiatric history and family and personal psychiatric history.
ResultsIncrease in the rate of suicide attempts 27%. Distribution by sex is similar, but in 2014, a higher proportion was observed in males. The percentage of women is significantly higher than that of men in the group of teenagers (10–19 years old) (20% women vs. 4.5% of men; P = 0.005); 83.5% have a psychiatric diagnosis (54.2% of them have a depressive disorder). Unemployment and economic problems stand out as environmental stressors in 2014. The main suicide method used in Valladolid is the hanging, and the second method used is the precipitation.
ConclusionsThe primary, secondary and tertiary prevention strategies are very important. Suicide is the major cause of mortality in the young age group (15–24 years old). Mortality in the general population has been on a downward trend; but suicide rates per 100,000 population has remained stable over the last decade.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Is 22q11.2 deletion syndrome a genetic subtype of schizophrenia?
- R. Hernandez Anton, H. De La Red Gallego, M. Gomez Garcia, A. Alonso Sanchez, E. Mayor Toranzo, J.A. Blanco Garrote, M. De Lorenzo Calzon, M. Hernandez Garcia, E. Dominguez, F. Uribe Ladron De Cegama, V. Molina Rodriguez
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S596
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Introduction
22q11.2 deletion syndrome is a primary immunodeficiency due to micro-deletion on the large arm of chromosome 22. Patients suffer from several anomalies, including metal illness, that such the case we present, mean a warning sign for further study.
MethodsTwenty-one years-old male, with psychotic symptoms, typical of schizophrenia, behavioral disorders and mental confusion, plus epileptic episodes and psychomotor agitation. Two previous incomes with the diagnosis of psychotic disorder not otherwise specified. Treated with anti-psychotics at low doses with inter-episode stability.
BackgroundPrematurity, low birth weight, neonatal asphyxia, generalized seizures, otitis and recurrent urinary tract infections, hypernasal voice, poor academic performance, difficulty relating. Physical examination: hypernasal voice, furred tongue, dysmorphic faces, scoliosis, hipotanía, stereotypes, delusions, auditory hallucinationsd negative symptoms.
ResultsWe considered the possibility of a neurodevelopmental disorder, with a multidisciplinary approach, resulting in the diagnosis of paranoid schizophrenia and velocardiofacial syndrome, which had gone unnoticed. Mean doses of clozapine, haloperidol and topiramate were used. He accepted psychiatry and other specialties follow-up, since it requires a complex and multidisciplinary approach.
ConclusionsDefinition of velocardiofacial Syndrome and lack of consensus on terminology:
– syndrome 22q11.2 DS as genetic subtype of schizophrenia? Opportunity to study the pathogenesis of schizophrenia;
– the importance of a comprehensive approach to early diagnosis, clinical improvement and preventing complications.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Immunity and eating disorders. Clinical description of a case
- M.D.H. Gallego, A. Álvarez Astorga, A. Alonso Sánchez, R. Hernández Antón, E. Mayor Toranzo, I. Sevillano Benito, M.S. Hernández García, M.S. Geijo Uribe, F. De Uribe Ladrón de Cegama
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, pp. S552-S553
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Introduction
Recently, there is an increasing interest in the link between anorexia nervosa and autoimmune diseases. Studies show significant association between anorexia nervosa, diabetes mellitus, autoimmune thyroid disease and Crohn's disease [1]. The findings of significantly elevated autoantibodies (anti α-MSH, anti ACTH) and cytokines (IL-1, IL-6, IFN-γ, TNF-α) support this relationship.
ObjectivesTo illustrate with a clinical case the connection between eating disorders and Crohn's disease.
MethodsFourteen years-old boy with moderate depression syndrome after his grandfather's decease. Since overweight diagnosis by his pediatrician, he begins to restrict food intake with an important weight loss (19 kg in 9 months) and over exercising. Blood test reveals microcytic and hypochromic anaemia, rest of the examination shows no other disorder. Psychometric assessment EDI-3 suggests Anorexia Nervosa restricting type.
ResultsTwo months after clinical stabilization, he is hospitalized due to abdominal pain. Exploration including blood test, serology, coproculture, sonography and colonoscopy reveals severe Crohn's disease.
ConclusionsThis case is about a patient diagnosed of moderate depressive syndrome, who develops anorexia nervosa and Crohn's disease during his follow up. It exemplifies the link between stress, immunity and eating disorders. Recent findings suggest that immune diseases are involved in onset and maintenance of eating disorders. More studies are required in order to inference its consequences in evaluation, prognostic, treatment and identification of subgroups of patients.
Disclosure of interestThe authors have not supplied their declaration of competing interest.