5 results
A clinical case of anosognosia in a CADASIL disease.
- E. Talaya Navarro, L. Gallardo Borge, E. Gómez Fernández, R. Fernández Díaz, L. Al Chaal Marcos, E. Rybak Koite
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1000-S1001
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Introduction
CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) is a cerebrovascular disease, tht appears in 1.98/100,000. It´s caused by a mutation of the Notch3 gene and is characterized by accumulation of granular osmiophilic material in the middle layer of the small and median sized cerebral arteries.
Sypmtoms are migraine, recurrent cerebral ischemic episodes, dementia, neuropsychiatric disorders (anosognosia, character disorders, apathy and cognitive impairment). It usually appears between 30-60 years, although there is an important variability. There is no curative treatment, only palliative.
ObjectivesClinical review of anosognosia and its presence in CADASIL disease.
MethodsClinical case and literatura review.
ResultsWe presented the clinical case of a 68-year-old man, who was diagnosed with CADASIL after a stroke 3 years earlier. In his family, his brother was diagnosed also with CADASIL. The patient had previously presented disturbances in impulse control (hyperorality) and important executive failures. He currently presented anosognosia, deficits in verbal memory, spatial perception and executive functions, in addition to behavioral alterations and apathy. Due to these deficits he was prohibited from certain activities (driving, hunting).
The patient was not aware of these deficits and becouse of his “no knowledge of his illness”, he disagreed with these prohibitions, so he showed rage and anger at the impotence of not understanding why certain actions are prohibited.
In the consultation, mnesic errors and in naming objects were also objectified, for which it was recommended to carry out cognitive stimulation on a daily basis. In addition, he presented failures of sphincter incontinence, especially of urine and occasionally also of the anal sphincter. He had previously had episodes of myoclonus or fasciculations.
A genetic study by massive sequencing confirmed the heterozygous presence of the pathogenic variant c.1819C>T p.(Arg607Cys) in the NOTCH3 gene, a CADASIL disease.
ConclusionsThe anosognosia that many patients with CADASIL disease present constitutes a problem because it contributes to the delay in consultation and, therefore, the delay in the adequate diagnostic approach, therapeutic possibilities and family genetic counseling. Due in part to anosognosia, CADASIL is considered an underdiagnosed entity. Due to the lack of awareness and the consequent lack of recognition of the deficit, these people are often seen as stubborn and difficult to deal with by people in their immediate environment.
In addition, there is general difficulty in the rehabilitation process, since patients do not think the neccesity to be treated. This can generate frustration and despair both in their relatives and in the health personnel.
For all these reasons, both in anosognosia and in CADASIL disease, adequate psychological support is needed for both those affected and their families.
Disclosure of InterestNone Declared
I am trapped in a wrong body
- R. Hernandez Anton, C. Noval Canga, E. Rybak Koite, H. De La Red Gallego, L. Gallardo Borge, A. Alonso Sanchez, I. Sevillano Benito, M.J. Garcia Cantalapiedra, P. Marques Cabezas, F. Uribe Ladron De Cegama, J.A. Espina Barrio, G. Isidro Garcia
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- Journal:
- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S590
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Introduction
Gender dysphoria is incoherence between the sex a person feels or expresses and the biological.
ObjectiveRevise the inclusion criteria for hormone therapy and sex reassignment surgery in gender dysphoria. Expose the multidisciplinary approach. Make differential diagnosis with other psychological disorders.
MethodologyA 45 years old male patient (biological female), who was sent from Endocrinology Unit for a psychiatric evaluation before restart a hormonal treatment. Since his childhood, he has presented dissatisfaction with his sexual characteristics; he has had fantasies and dreams, in which he belonged to the other sex. He has always chosen male activities and male stereotypes companies. He has presented preference for cross-dressing from 9 years. Always felt the sexual attraction for women. He first consulted for this reason in 1995.
ResultsIt reported favorably to start hormone treatment after completing the eligibility criteria: > 18 years old; knowledge of the effects of hormones; and more 3 months documented real-life experience. The hormone therapy caused the growth of microprolactinoma, which was treated with dopamine agonists until it disappeared and the cessation of galactorrhea. Testosterone treatment is restarted. Laboratory tests are done every 3 months during the first year and then, every 6 months.
ConclusionsIs the gender disphoria a pathology? The EU recommends a reclassification as no pathological disorders in ICD-11. The treatment of gender dysphoria is necessary, and there is no reason to postpone it. The main difficulty is the differential diagnosis; there may be comorbidity with others mental disorders which are not exclusive (psychotic disorder, OCD, personality disorders and other disorders of gender identity).
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.
Goodbye Eros. Hello Narciso
- R. Hernandez Anton, S. Gomez Sanchez, A. Alvarez Astorga, S. Cepedello Perez, E. Rybak Koite, M.J. Garcia Cantalapiedra, L. Rodriguez Andres, A.I. Segura Rodriguez, L.D.C. Uribe, G. Isidro Garcia
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S718
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Introduction
Love has been one of the topics most discussed by philosophy, literature, anthropology, religion, psychology and medicine. “The feelings of love and hate are present in the background of all psychiatric disorders; love has been associated, in one way or another, in all patients that I have had” Dr. Perez Lanzac Trujillo.
Objectives(1) Analyze the possible relationship between psychotic symptoms and breakup (stressor). (2) Review the neurotransmitters involved in psychotic episodes and in love. (3) Postmodern culture and sexuality (agony of Eros and liquid love).
MethodologyA 17-years-old female patient, who presented psychotic symptoms without psychiatric history. We hypothesize that the affair was the symptom and the stressful event was the breakup. We believe that early bond with the mother is a decisive factor in shaping the psychic structure of every human being factor. In this case, it seems that there is an insecure attachment: absent parent + overprotective mother.
True love draws three triangles: records (demand, drive and desire); dimensions (beliefs, significant and encounter) and emotions (pride, hope and desire).
ResultsMost psychiatric disorders are especially alterations in the way of experiencing emotions. Some neurotransmitters involved in her psychosis and addiction are key players in the neurobiology of love.
ConclusionsTrue love is the neurotic experience closer to psychosis.
Overexcitement in today's society is a trauma for the psychic apparatus and it has consequences on the internal world, psychosexuality and loving bond.
The crisis of art and literature can be attributed to the disappearance of the other, to the agony of Eros.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Rasagiline and venlafaxine: The serotonin syndrome
- A. Rodriguez Campos, L. Rodríguez Andrés, G. Medina Ojeda, L. Gallardo Borge, E. Rybak Koite
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S759
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Rasagiline is a highly potent irreversible monoamine oxidase (MAO)-B inhibitor, antiparkinsonian drug that may be used with caution in patients treated with antidepressant drugs because of the possible appearance of severe adverse effects. It is presented the case report of a woman treated with rasagiline and venlafaxine that presents confusion and a serotonin syndrome. Pathogenesis, physiopathology and treatment are discussed. Growing evidence suggests that Parkinson disease and depression are linked. Antidepressant drugs and PD treatment should be used with caution because of possible drug interaction.
Disclosure of interestThe authors have not supplied their declaration of competing interest.