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Nematocide activity of 6,7-diarylpteridines in three experimental models
- C. Ochoa, M. Rodríguez, L. Domínguez, J. Saldaña, R. Di Maio, P. Alonso-Villalobos, M.M. Martínez Grueiro
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- Journal:
- Journal of Helminthology / Volume 73 / Issue 4 / April 1999
- Published online by Cambridge University Press:
- 11 April 2024, pp. 333-336
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The in vitro nematocide activity of seventeen 6,7-diarylpteridines has been tested using three different experimental models, Caenorhabditis elegans, Nippostrongylus brasiliensis and Heligmosomoides polygyrus. The method of evaluation of inhibition in the secretion of acetylcholinesterase by H. polygyrus seems to be the most indicated to avoid false positives. The in vivo activities, against Trichinella spiralis, of the most in vitro active pteridines have been assayed. All pteridine derivatives bearing 6,7-di-p-bromophenyl substituents have shown in vitronematocide activites in the three experimental models used. Amongst all the pteridines tested in vivo, only 2,4-pteridinedithione derivatives exhibited moderate activity.
Strategies to promote language inclusion at 17 CTSA hubs
- Linda Sprague Martinez, Cristina Araujo Brinkerhoff, Riana C. Howard, James A. Feldman, Erin Kobetz, J. Tommy White, Laurene Tumiel Berhalter, Alicia Bilheimer, Megan Hoffman, Carmen R. Isasi, Cynthia Killough, Julia Martinez, Johanna Chesley, Arshiya A. Baig, Capri Foy, Nadia Islam, Antonia Petruse, Carolina Rosales, Michele D. Kipke, Lourdes Baezconde-Garbanati, Tracy A. Battaglia, Rebecca Lobb
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- Journal:
- Journal of Clinical and Translational Science / Volume 8 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 25 March 2024, e67
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The prioritization of English language in clinical research is a barrier to translational science. We explored promising practices to advance the inclusion of people who speak languages other than English in research conducted within and supported by NIH Clinical Translational Science Award (CTSA) hubs. Key informant interviews were conducted with representatives (n = 24) from CTSA hubs (n = 17). Purposive sampling was used to identify CTSA hubs focused on language inclusion. Hubs electing to participate were interviewed via Zoom. Thematic analysis was performed to analyze interview transcripts. We report on strategies employed by hubs to advance linguistic inclusion and influence institutional change that were identified. Strategies ranged from translations, development of culturally relevant materials and consultations to policies and procedural changes and workforce initiatives. An existing framework was adapted to conceptualize hub strategies. Language justice is paramount to bringing more effective treatments to all people more quickly. Inclusion will require institutional transformation and CTSA hubs are well positioned to catalyze change.
Floquet stability analysis of a two-layer oscillatory flow near a flexible wall
- Antonio J. Bárcenas-Luque, W. Coenen, C. Gutiérrez-Montes, C. Martínez-Bazán
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- Journal:
- Journal of Fluid Mechanics / Volume 978 / 10 January 2024
- Published online by Cambridge University Press:
- 05 January 2024, A24
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We investigate the linear Floquet stability of two fluid layers undergoing oscillations in the direction parallel to the flexible wall that separates them. This canonical configuration is inspired by the cerebrospinal fluid flow in the spinal canal of subjects with hydromyelia/syringomyelia. The analysis focuses on the marginal conditions for the onset of instability, and how these depend on the spatial wavelength of the perturbation, and on the values of the control parameters, which are the two channel widths, the Reynolds number and the wall stiffness. Unstable perturbations are found to oscillate synchronous with the base flow. The wavelength of the most unstable perturbation, of the order of the stroke length of the basic oscillatory motion, depends strongly on the wall stiffness, but is only weakly influenced by the channel widths and the Reynolds number. In general, around criticality, it was found that increasing the Reynolds number has a destabilizing effect, and that decreasing the canal widths stabilizes the instability. The wall stiffness on the other hand has a non-monotonic effect, exhibiting an intermediate value for which the instability is maximally amplified. The present analysis is a first step towards a better understanding of the physical mechanisms that govern many (bio)fluid mechanical problems that involve oscillatory flows near compliant walls.
68 Preliminary Evidence of a Therapeutic Effect of Electrical Neuromodulation on Cognitive Deficits in Patients with Mild Cognitive Impairment
- Christian LoBue, Didehbani Nyaz, Hsueh-Sheng Chiang, John Hart, Jessica Helphrey, Michael Conley, Eric Smernoff, Laura Lacritz, Caitlin Reese, C M Cullum, Cindy Marshall, Trung Nguyen, Brendan J Kelley, Alka Khera, Alex Frolov, Natalie Martinez, Rebecca Logan
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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, p. 475
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Objective:
Episodic memory functioning is distributed across two brain circuits, one of which courses through the dorsal anterior cingulate cortex (dACC). Thus, delivering non-invasive neuromodulation technology to the dACC may improve episodic memory functioning in patients with memory problems such as in amnestic mild cognitive impairment (aMCI). This preliminary study is a randomized, double-blinded, sham-controlled clinical trial to examine if high definition transcranial direct current stimulation (HD-tDCS) can be a viable treatment in aMCI.
Participants and Methods:Eleven aMCI participants, of whom 9 had multidomain deficits, were randomized to receive 1 mA HD-tDCS (N=7) or sham (N=4) stimulation. HD-tDCS was applied over ten 20-minute sessions targeting the dACC. Neuropsychological measures of episodic memory, verbal fluency, and executive function were completed at baseline and after the last HD-tDCS session. Changes in composite scores for memory and language/executive function tests were compared between groups (one-tailed t-tests with a = 0.10 for significance). Clinically significant change, defined as > 1 SD improvement on at least one test in the memory and non-memory domains, was compared between active and sham stimulation based on the frequency of participants in each.
Results:No statistical or clinically significant change (N-1 X2; p = 0.62) was seen in episodic memory for the active HD-tDCS (MDiff = 4.4; SD = 17.1) or sham groups (MDiff = -0.5; SD = 9.7). However, the language and executive function composite showed statistically significant improvement (p = 0.04; MDiff = -15.3; SD = 18.4) for the active HD-tDCS group only (Sham MDiff = -5.8; SD = 10.7). Multiple participants (N=4) in the active group had clinically significant enhancement in language and executive functioning tests, while nobody in the sham group did (p = 0.04).
Conclusions:HD-tDCS targeting the dACC had no direct benefit for episodic memory deficits in aMCI based on preliminary findings for this ongoing clinical trial. However, significant improvement in language and executive function skills occurred in response to HD-tDCS, suggesting HD-tDCS in this configuration has promising potential as an intervention for language and executive function deficits in MCI.
TRANVIA: A program for continuum mental health assistance in transition period
- L. Pérez Gómez, A. González Álvarez, M. A. Reyes Cortina, E. Lanza Quintana, N. Álvarez Alvargonzález, C. Rodríguez Turiel, E. Lago Machado, J. J. Martínez Jambrina
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S728
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Introduction
Transition between adolescence and adulthood represents the most important challenge for personal development and involves several transformations: physical, psychological and social. It is a complex age bracket, concurring the transition from youth psychiatric units to adult ones, with an increased risk for the appearance of mental disorders and risky behaviours. TRANVIA program, developed in Avilés, provides psychiatric assistance to patients between 15 and 25 years old, diagnosed with a severe psychiatric disorder or with an increased risk of having one.
ObjectivesOur objectives are: ensuring clinical continuity assistance, promoting communication among professionals and the empowerment of our patients to improve their functionality and quality of life.
MethodsDescriptive study including patients involved in TRANVIA program from November 2019 to November 2021.
ResultsDuring this two-years period there have been 44 referrals to the program, 11 of them were rejected for failure to comply with diagnostic criteria. In November 2021 there were 33 patients included in the TRANVIA program with an average age of 17 years old (range: 15-22). 70% of them were men and 30% women. All of them had psychiatric assistance from different sources: youth mental health units, neuropediatrics… About 75% of the patients were diagnosed with autistic spectrum disorder and approximately three-quarters of the sample needed pharmacological treatment. Risperidone was the most prescribed drug. We have also developed other assistance alternatives as home-based care, relaxation sessions, social worker interventions and coordination with schools.
ConclusionsTRANVIA program has allowed us to provide continual attention to vulnerable patients that shift from youth psychiatric units to adult ones. Patients that meet inclusion criteria were enrolled independently the type of assistance they have previously received. Accessibility and flexibility were our priority. During the described period there was only one dropout, three patients required psychiatric hospitalization and two others visited the emergency department. There have been no cases of completed suicide.
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
Efficacy of maintenance electroconvulsive therapy in recurrent depression: a case series
- G. Guerra Valera, Ó. Martín Santiago, M. Esperesate Pajares, Q. D. L. de la Viuda, A. A. Gonzaga Ramírez, C. Vallecillo Adame, C. de Andrés Lobo, T. Jiménez Aparicio, N. Navarro Barriga, B. Rodríguez Rodríguez, M. Fernández Lozano, M. J. Mateos Sexmero, A. Aparicio Parras, M. Calvo Valcárcel, M. A. Andreo Vidal, P. Martínez Gimeno, M. P. Pando Fernández, M. D. L. Á. Guillén Soto
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S832
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Introduction
Maintenance electroconvulsive therapy (mECT) is an option in the treatment of affective disorders which progress is not satisfactory. It is certainly neglected and underused during the clinical practice.
ObjectivesTo evaluate the efficacy of mECT in reducing recurrence and relapse in recurrent depression within a sample of three patients.
MethodsWe followed up these patients among two years since they received the first set of electroconvulsive sessions. We applied the Beck Depression Inventory (BDI) in the succesives consultations for evaluating the progress.
ResultsThe three patients were diagnosed with Recurrent Depressive Disorder (RDD). One of them is a 60 year old man that received initially a cycle of 12 sessions; since then he received 10 maintenance sessions. Other one is a 70 year old woman that received initially a cycle of 10 sessions; since then she received 6 maintenance sessions. The last one is a 55 year old woman that received initially a cycle of 14 sessions; since then she received 20 maintenance sessions.
All of them showed a significant reduction in depressive symptoms evaluated through BDI and clinical examination. In the first case, we found a reduction in the BDI from the first consultation to the last that goes from 60 to 12 points; in the second case, from 58 to 8 points; and in the last case, from 55 to 10 points. The main sections that improved were emotional, physical and delusional.
As side-effects of the treatment, we found anterograde amnesia, lack of concentration and loss of focus at all of them.
ConclusionsWe find mECT as a very useful treatment for resistant cases of affective disorders like RDD.
It should be considered as a real therapeutic option when the first option drugs have been proved without success.
Disclosure of InterestNone Declared
Gut permeability and low-grade inflammation in bipolar disorder
- M. Couce, G. Paniagua, L. González-Blanco, A. García-Fernández, C. Martínez-Cao, P. Sáiz, J. Bobes, M. P. García-Portilla
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S385-S386
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Introduction
Systemic inflammation has been increasingly related to bipolar disorder -BD- (Tanaka et al. Neurosci Res 2017;115 59-63). Intestinal bacterial translocation has been postulated as one of the causes of this inflammation (Nguyen et al. J Psychiatr Res 2018;99 50-61). A possible pathway is through the lipopolysaccharide, which is presented to CD14 through lipopolysaccharide binding protein (LBP) leading to a release of systemic inflammatory markers like C-reactive protein (CPR) (Funda et al. Infect Immun 2001;69 3772-81).
Objectives1) Describe gut permeability in patients with BD through the determination of intestinal inflammatory markers (LBP, sCD14) in plasma; 2) Analyze variables associated with intestinal inflammation.
MethodsCross-sectional study of 38 patients with BD [mean age=45.50 (SD=10.93; range 23-68); males=15 (39.5%)], recruited from mental health outpatient clinics in Oviedo (Spain).
Assessment: Pro-inflammation biomarkers [CRP (mg/dL), Erythrocyte Sedimentation Rate (ESR) (mm/h), Neutrophil/Lymphocyte, Monocyte/Lymphocyte, Platelet/Lymphocyte and Systemic Immune Inflammation Indexes]. Indirect markers of intestinal bacterial translocation [LBP, soluble CD14 (sCD14)]. Dichotomous variables were created for LBP, considering LBP ≥15 μg/dL as increased gut permeability; and for CPR, considering CRP≥0.3 as systemic inflammation. Metabolic syndrome [ATPIII criteria: glucose, HDL, triglycerides (mg/dl), arterial pressure (mmHg), abdominal circumference (cm)], body mass index (BMI) (kg/m2), smoking, cannabis or alcohol use.
Statistical analyses: t-Student test, multiple linear regression analyses.
ResultsAverage LBP was 14.60 μg/dL (SD=6.4) and 15 patients (39.5%) had increased gut permeability. Moreover, average CPR was 0.40 mg/dL (SD=0.58) and 16 patients (47.1%) showed systemic inflammation. There were no patients with increased levels of sCD14.
Associations were found between LBP and CPR (r=0.357; p=0.032), cannabis use in the last month (t=-2.293; p=0.029), BMI (r=0.433; p=0.008) and abdominal obesity (t=3.006; p=0.005); but no with age or sex.
Subsequently, a multiple linear regression model for LBP was calculated with variables previously mentioned, and age (based on expert criteria). The overall regression was statistically significant (R2=0.49, F=9.273, p<0.001). It was found that CPR, abdominal obesity, and cannabis use in the last month significantly predicted LBP levels (table 1).
Table 1. Multiple linear regression analyses to LBP B SE β t p CPR 4.842 1.529 0.439 3.167 0.004 Abdominal obesity 4.810 1.849 0.362 2.601 0.014 Cannabis use -5.048 2.273 -0.296 -2.221 0.034 ConclusionsMore than one third of patients with BD had increased gut permeability. Almost 50% had systemic inflammation. Intestinal permeability was directly related to abdominal obesity and systemic inflammation, but inversely related to cannabis use.
Disclosure of InterestNone Declared
UNTIL IT BURSTS OR ALL OF US BURST. A SCHIZOTYPICAL CASE.
- B. Rodríguez Rodríguez, N. Navarro Barriga, M. Fernández Lozano, M. J. Mateos Sexmero, M. A. Andreo Vidal, M. Calvo Valcárcel, P. Martínez Gimeno, M. P. Pando Fernández, A. Aparicio Parras, M. D. L. Á. Guillén Soto, T. Jiménez Aparicio, M. D. C. Vallecillo Adame, C. de Andrés Lobo, A. A. Gonzaga Ramírez, G. Guerra Valera, M. Queipo de Llano de la Viuda, M. Esperesate Pajares
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S967
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Introduction
Schizotypal disorder is conceptualized as a stable personality pathology (Cluster A) and as a latent manifestation of schizophrenia. It can be understood as an attenuated form of psychosis or high-risk mental state, which may precede the onset of schizophrenia or represent a more stable form of psychopathology that doesn’t necessarily progress to psychosis.
ObjectivesTo exemplify the continuum of psychosis
MethodsReview of scientific literature based on a relevant clinical case.
Results39-year-old male living with his parents. He started studying philosophy. He is a regular cannabis user and has an aunt with schizophrenia. He’s admitted to psychiatry for behavioral disturbance in public. He refers to having been hearing a beeping noise in his street for months, what he interprets as a possible way of being watched due to his past ideology. Without specifying who and why, he sometimes shouts “until it bursts” to stop the noise and he thinks that his neighbours alerted the police about his behavior. During the interview he alludes to Milgram’s experiment, saying that throughout history there have been crimes against humanity and those who pointed them out were labeled “crazy”. His father refers that he has always been “strange” and with certain extravagant revolutionary ideas and thoughts. He doesn’t maintain social relationships and dedicates himself to reading and writing.
ConclusionsIt’s important to understand psychosis as a continuum to advance the understanding of etiology, pathophysiology and resilience of psychotic disorders and to develop strategies for prevention and early intervention
Disclosure of InterestNone Declared
Delirious episode secondary to rotigotine: the psychotic patch
- M. A. Andreo Vidal, M. Calvo Valcárcel, P. Martínez Gimeno, P. Pando Fernández, B. Rodríguez Rodríguez, N. Navarro Barriga, M. Fernández Lozano, M. J. Mateos Sexmero, T. Jiménez Aparicio, M. D. C. Valdecillo Adame, C. de Andrés Lobo, G. Guerra Valera, M. Queipo de Llano de la Viuda, A. A. Gonzaga Ramirez, M. D. L. Á. Guillén Soto, A. Aparicio Parras, M. Esperesate Pajares
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S626
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Introduction
There is a fine line separating psychiatry and neurology. Most movement disorders can have psychiatric symptoms, not only those caused by the disease itself, but also those induced by the drugs used to treat them.
ObjectivesPresentation of a clinical case about a patient diagnosed with Parkinson’s disease presenting a several-month-long delirious episode due to dopaminergic drugs.
MethodsLiterature review on drug-induced psychosis episodes in Parkinson’s disease.
ResultsA 57-year-old patient with diagnosis of Parkinson’s disease for six years, who went to the emergency room accompanied by his wife due to delirious ideation. He was being treated with levodopa, carbidopa and rasagiline for years, and rotigotine patches whose dosage was being increased over the last few months.
His wife reported celotypical clinical manifestations and multiple interpretations of different circumstances occurring around her. He chased her on the street, had downloaded an app to look for a second cell phone because he believed she was cheating on him, and was obsessed with sex. He had no psychiatric background. It was decided to prescribe quetiapine.
The following day, he returned because he refused to take the medication since he thought he was going to be put to sleep or poisoned. It was decided to admit him to Psychiatry.
During the stay, rasagiline and rotigotine were suspended. Olanzapine and clozapine were introduced, with behavioral improvement and distancing from the psychotic symptoms which motivated the admission. The patient was also motorically stable. Although levodopa is best known for causing psychotic episodes, the symptons were attributed to rotigotine patches for temporally overlapping the dose increase.
ConclusionsPsychiatric symptoms are the third most frequent group of complications in Parkinson’s disease after gastrointestinal complications and abnormal movements. All medication used to control motor disorders can lead to psychosis, not only dopaminergics, but also selegiline, amantadine and anticholinergics.
Excessive stimulation of mesocortical and mesolimbic dopaminergic pathways can lead to psychosis, which is the most common psychiatric problem related to dopaminergic treatment.
In the face of a psychotic episode, antiparkinsonian drugs which are not strictly necessary for motor control should be withdrawn. If this is not sufficient, levodopa dose should be reduced, considering the side effects that may occur. When the adjustment of antiparkinsonian treatment is not effective, neuroleptics, especially quetiapine or clozapine, should be administered. In a recent study, pimavanserin, a serotonin 5-HT2 antagonist, was associated with approximately 35% lower mortality than atypical antipsychotic use during the first 180 days of treatment in community-dwelling patients.
Medication should always be tailor-made to suit each patient and we usually have to resort to lowering or withdrawing the dopaminergic medication.
Disclosure of InterestNone Declared
Bipolar disorder and substance use: Risk factors and prognosis
- M. Fernández Lozano, B. Rodríguez Rodríguez, M. J. Mateos Sexmero, N. Navarro Barriga, C. Vallecillo Adame, C. de Andrés Lobo, T. Jimenez Aparicio, M. Queipo de Llano de la Viuda, G. Guerra Valera, A. A. Gonzaga Ramírez, M. P. Pando Fernández, M. Calvo Valcárcel, M. A. Andreo Vidal, P. Martínez Gimeno
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S704
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Introduction
Bipolar disorder comorbidity rates are the highest among the major mental disorders. In addition to other intoxicants, alcohol is the most abused substance because it is socially accepted and can be legally bought and consumed. Estimates are between 40-70% with male predominance, which further influences the severity with a more complicated course of both disorders.
ObjectivesThe objective of this article is to highlight the impact of substance use on the course and prognosis of bipolar disorder, as well as to make a differential diagnosis of a manic episode in this context.
MethodsBibliographic review of scientific literature based on a relevant clinical case.
ResultsWe present the case of a 45-year-old male patient. Single with no children. Unemployed. History of drug use since he was young: alcohol, cannabis and amphetamines. Diagnosed with bipolar disorder in 2012 after a manic episode that required hospital admission. During his evolution he presented two depressive episodes that required psychopharmacological treatment and follow-up by his psychiatrist of reference. Since then, he has been consuming alcohol and amphetamines occasionally, with a gradual increase until it became daily in the last month. He went to the emergency department for psychomotor agitation after being found in the street. He reported feeling threatened by a racial group presenting accelerated speech, insomnia and increased activity.
ConclusionsThe presence of substance abuse complicates the clinical presentation, treatment and development of bipolar disorder. It is associated with a worse prognosis with multiple negative consequences including worsening symptom severity, increased risk of suicide and hospitalization, increased medical morbidity and complication of social problems. In addition, this comorbidity delays both the diagnosis and treatment, by masking the symptoms, and making more difficult an adequate differential diagnosis.
Disclosure of InterestNone Declared
Cross-sectional study on anxiety in confinement due to covid-19 in a sub-acute and long-stay mental health unit
- A. Llimona González, J. Mayans Henares, E. Pechuan Martínez, O. Orejas Pérez, C. Masferrer Herrera, C. Muro Celma, L. Vargas Puertolas, J. Peñalver Aguilar
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S151-S152
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Introduction
Chronic psychiatric patients admitted to subacute and long-stay hospital units are especially vulnerable to the situation of confinement due to the pandemic. Throughout 2020 and 2021 they have suffered the consequences of multiple strict confinements given the differences in isolation protocols in hospitalized patients compared to the general population. This has repercussions on the increase in anxious symptomatology, which influences a more torpid and prolonged evolution of mental disorders in this subpopulation.
ObjectivesThe objective of this study is to study the anxiety levels of patients admitted to a sub-acute and long-stay mental health unit in a situation of confinement due to covid-19.
MethodsWe have carried out a cross-sectional descriptive observational study in 25 patients admitted to the subacute and long-stay unit of the Barcelona Forum Center between December 8 and 23, 2021 in the context of confinement due to a covid-19 outbreak. Sociodemographic and clinical variables are collected. We have used the self-administered STAI scale to assess clinical anxiety.
ResultsThe mean age is 47.7 years; women 60%. 80% with single marital status. 90% of the patients presented active tobacco consumption, with an average of 21.2 cigarettes/day. The mean score on the STAI scale was 58.8 for state anxiety and 46.7 for trait anxiety, both levels above the 75th percentile for adults, both men (state anxiety 28, trait anxiety 25) and women (state anxiety 31, trait anxiety 32).
ConclusionsThe state and trait anxiety scores of the STAI scale of hospitalized patients are higher than the average of the general population, which could be due to the situation of confinement due to the covid pandemic.
Disclosure of InterestNone Declared
I don’t know where I’m going or where I come from. Self-disorders in schizophrenia.
- M. D. C. Vallecillo Adame, L. Rodríguez Andrés, C. de Andrés Lobo, T. Jimenez Aparicio, M. Queipo de Llano de la Viuda, G. Guerra Valera, A. A. Gonzaga Ramirez, M. Fernández Lozano, M. J. Mateos Sexmero, N. Navarro Barriga, B. Rodríguez Rodríguez, M. P. Pando Fernández, M. Calvo Valcárcel, P. Martínez Gimeno, M. A. Andreo Vidal, I. D. L. M. Santos Carrasco
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1069-S1070
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Introduction
In the early stages of schizophrenia the person experiences feelings of strangeness about themselves, difficulty in making sense of things and difficulty in interacting with their environment. Based on this, self-disorder assessment instruments have been developed and empirical studies have been conducted to assess people at risk of developing a schizophrenia spectrum disorder. These studies show that self-disorders are found in pre-psychotic stages and that their manifestation can predict the transition to schizophrenia spectrum disorders.
ObjectivesWe present the case of a patient with multiple diagnoses and mainly dissociative symptoms who, after years of evolution, was diagnosed with schizophrenia.
MethodsBibliographic review including the latest articles in Pubmed about self-disorders and schizophrenia.
ResultsWe present the clinical case of a 51-year-old woman with a long history of follow-up in mental health consultations and with multiple hospital admissions to the psychiatric unit, with several diagnoses including: dissociative disorder, histrionic personality disorder, adaptive disorder unspecified psychotic disorder and, finally, schizophrenia. The patient during the first hospital admissions showed a clinical picture of intense anxiety, disorientation and claiming to be a different person. The patient related these episodes to stressors she had experienced, and they improved markedly after a short period of hospital admission. Later, psychotic symptoms appeared in the form of auditory and visual hallucinations and delusional ideation, mainly of harm, so that after several years of follow-up and study in mental health consultations and in the psychiatric day hospital, she was diagnosed with schizophrenia and treatment with antipsychotics was introduced, with a marked clinical improvement being observed.
ConclusionsIt is important to take into account this type of symptoms (self-disorders), as they allow the identification of individuals in the early stages of the disorder and create the opportunity for early therapeutic interventions.
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
PEAKS AND VALLEYS: BIPOLAR DISORDER, RAPID CYCLERS AND ENERGY DRINKS CONSUMPTION
- M. Calvo Valcárcel, M. A. Andreo Vidal, P. Martinez Gimeno, P. Pando Fernández, B. Rodriguez Rodriguez, N. Navarro Barriga, M. Fernández Lozano, M. J. Mateos Sexmero, M. D. C. Vallecillo Adame, T. Jimenez Aparicio, C. de Andres Lobo, M. Queipo de Llano de la Viuda, A. A. Gonzaga Ramirez, G. Guerra Valera
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S702-S703
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Introduction
Bipolar Disorder (BD) is considered a serious mental disorder characterized by a changing mood that fluctuates between two completely opposite poles. It causes pathological and recurrent mood swings, alternating periods of exaltation and grandiosity with periods of depression. We talk about rapid cyclers when four or more manic, hypomanic or depressive episodes have occurred within a twelve-month period. Mood swings can appear rapidly. Approximately half of the people with bipolar disorder may develop rapid cycling at some point.
ObjectivesPresentation of a clinical case about a patient with Bipolar Disorder with rapid cycling and poor response to treatment.
MethodsReview of the scientific literature based on a clinical case.
Results33-year-old male, single, living with his mother, under follow-up by mental health team since 2012. First debut of manic episode in 2010. The patient has filed multiple decompensations related to consumption of toxics (alcohol and cannabis). Currently unemployed. He attended to the emergency service in June 2022 accompanied by his mother, who reported that he was restless. The patient refers that he has interrupted the treatment during the vacations, having sleep rhythm disorder with abuse of caffeine drinks. Currently the patient does not recognize any consumption.The patient reports that during the village festivals he felt very energetic, occasionally consuming drinks rich in taurine and sugars, even having conflicts with people of the village. Finally, the patient was stabilized with Lithium 400 mg and Olanzapine. In September, the patient returned to the emergency service on the recommendation of his referral psychiatrist due to therapeutic failure. The only relevant finding we observed in the analytical determinations were low lithium levels (0.4 mEq/L). The transgression of sleep rhythms and the abuse of psychoactive substances required the admission of the patient to optimize the treatment (Clozapine, Lithium, Valproic Acid). At discharge, he is euthymic, has not presented behavioral alterations and is resting well. Finally, it was decided that the patient should go to the Convalescent Center to continue treatment and achieve psychopathological stability.
ConclusionsBipolar disorder is an important mental illness, having an incidence of 1.2%, being responsible for 20% of all mood disorders. Therefore, it is important to perform an adequate and individualized follow-up of each patient. Treatment with mood stabilizers tries to improve and prevent manic and depressive episodes, improving chronicity and trying to make the long-term evolution as good as possible, being important psychoeducation and psychotherapy.
Disclosure of InterestNone Declared
Late diagnosis of attention deficit hyperactivity disorder and cocaine abuse
- C. De Andrés Lobo, C. Vallecillo Adame, T. Jiménez Aparicio, M. Queipo de Llano de la Viuda, G. Guerra Valera, A. A. Gonzaga Ramírez, M. Fernández Lozano, N. Navarro Barriga, M. J. Mateos Sexmero, B. Rodríguez Rodríguez, M. Calvo Valcárcel, M. Andreo Vidal, M. P. Pando Fernández, P. Martínez Gimeno, I. D. L. M. Santos Carrasco, J. I. Gonçalves Cerejeira, A. Rodríguez Campos
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S335-S336
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Introduction
Adult ADHD diagnosis sometimes represents a challenge for the clinician, due to the comorbid psychiatric diseases that are often associated and which complicate de recognition of the primary symptoms of ADHD. The prevalence of ADHD in adult populations is 2’5% and it is a relevant cause of functional impairment.
ObjectivesPresentation of a clinical case of a male cocaine user diagnosed with adult ADHD.
MethodsLiterature review on adult ADHD and comorbid substance abuse.
ResultsA 43-year-old male who consulted in the Emergency Department due to auditory hallucinosis in the context of an increase in his daily cocaine use. There were not delusional symptoms associated and judgment of reality was preserved. Treatment with olanzapine was started and the patient was referred for consultation. In psychiatry consultations, he did not refer sensory-perceptual alterations anymore, nor appeared any signals to suspect so, and he was willing to abandon cocaine use after a few appointments. He expressed some work concerns, highlighting that in recent months, in the context of a greater workload, he had been given several traffic tickets for “distractions.” His wife explained that he had always been a inattentive person (he forgets important dates or appointments) and impulsive, sometimes interrupting conversations. In the Barkley Adult ADHD Rating Scale he scored 32 points.
He was diagnosed with adult ADHD and treatment with extended-release methylphenidate was started with good tolerance and evolution, with improvement in adaptation to his job and social environment. Since then, the patient has moderately reduced the consumption of drugs, although he continues to use cocaine very sporadically.
ConclusionsEarly detection of ADHD and its comorbidities has the potential to change the course of the disorder and the morbidity that will occur later in adults. Comorbidity in adult ADHD is rather the norm than the exception, and it renders diagnosis more difficult. The most frequent comorbidities are usually mood disorders, substance use disorders, and personality disorders. Treatment of adult ADHD consists mainly of pharmacotherapy supported by behavioral interventions. When ADHD coexists with another disorder, the one that most compromises functionality will be treated first and they can be treated simultaneously. The individual characteristics of each patient must be taken into account to choose the optimal treatment.
Disclosure of InterestNone Declared
Memory complaints and quality of life in a patient with mild cognitive impairment
- M. P. Pando Fernández, M. A. Andro Vidal, M. Calvo Valcarcel, P. Martinez Gimeno, M. Queipo de Llano de la Viuda, G. Guerra Valera, A. A. Gonzaga Ramírez, C. De Andrés Lobo, T. Jimenez Aparicio, C. Vilella Martin, M. Fernández Lozano, B. Rodríguez Rodríguez, M. J. Mateos Sexmero, N. Navarro Barriga
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S937-S938
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Introduction
Subjective memory complaints remain a relevant aspect to be considered in patients with mild cognitive impairment. Likewise, their association with depressive symptoms, quality of life and cognitive performance is also an objective to be studied in such patients.
ObjectivesOur clinical case represents just one opportunity to study how memory complaints are related to depressive states and how they affect the quality of life of patients with mild cognitive impairment.
MethodsWe conducted a bibliographical review by searching for articles in Pubmed.
ResultsPERSONAL HISTORY: Male, 73 years old, separated, residing alone in Valladolid. He has home help, a person comes to help him with the household chores. Little social and family circle.
History in Mental HealthHe has a history of an admission in 2013 to this Short Hospitalization Unit for ethanol detoxification. Since then, he has been followed up in the Mental Health Unit. According to the reports, he has been diagnosed with depressive disorder and cluster B personality disorder.
Current psychopharmacological treatment: diazepam, olanzapine, duloxetine 60 mg, quetiapine.
Toxic habits: history of chronic ethanol consumption. Smoker. He denies other toxic habits.
Current EpisodeThe patient presents a worsening of his mood of 15 days of evolution, coinciding with a voluntary decrease of his psychopharmacological treatment that the patient has carried out on his own. He walks with the aid of a crutch. Hypomimic facies. Slowed language, circumstantial, with speech focused on current discomfort.
On assessment, he reports initial improvement after reducing his medication, but in recent days he has experienced a decrease in initiative accompanied by feelings of emptiness, sadness and loneliness. He refers to memory complaints for which he is awaiting evaluation by Neurology. The patient explains that at other times in his life he has presented self-harming ideas that he has been controlling. At this time he expresses desire for improvement and adequate future plans, and accepts plans to attend a memory workshop. He also reports visual hallucinations with no affective repercussions and preserved judgment of reality.
Therapeutic PlanTreatment adjustment: Duloxetine 60 mg, 2cp/day. The patient is recommended to lead an active lifestyle and attend a day center or memory workshop.
ConclusionsIn numerous patients with mild cognitive impairment, we have observed that memory complaints are closely related to depressive symptoms and to the patient’s functioning in daily life.
In one study memory complaints were a negative predictor of quality of life in these patients.
Therefore, in addition to considering the importance of treating depressive symptoms, it is also important to address quality of life in patients with mild cognitive impairment.
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
“The cat and the calcium”. A case of delirium secondary to hypercalcaemia.
- T. Jiménez Aparicio, C. Vallecillo Adame, C. de Andrés Lobo, G. Medina Ojeda, M. Queipo de Llano de la Viuda, A. A. Gonzaga Ramírez, G. Guerra Valera, M. Fernández Lozano, M. J. Mateos Sexmero, B. Rodríguez Rodríguez, N. Navarro Barriga, M. A. Andreo Vidal, M. Calvo Valcárcel, P. Martínez Gimeno, M. P. Pando Fernández, I. D. L. M. Santos Carrasco, J. I. Gonçalves Cerejeira
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S946-S947
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Introduction
Interconsultation with the psychiatry service is frequently requested from other specialties for the assessment and treatment of patients who present neuropsychiatric symptoms secondary to organic alterations. On the other hand (and in relation to this case), within the possible causes for the elevation of calcaemia figures, the most frequent are hyperparathyroidism and neoplasms, representing between these two entities 90% of cases (1).
Among the organic mental disorders, Delirium stands out, with an approximate prevalence between 1 and 2% (general population), which increases in hospitalized and elderly patients (2).
ObjectivesPresentation of a clinical case about a patient with delirium secondary to hypercalcemia, with hallucinations and behavioral disturbance.
MethodsBibliographic review including the latest articles in Pubmed about delirium (causes and treatment) and hypercalcaemia secondary to neoplasms.
ResultsWe present a 52-year-old male patient, who went to the emergency room accompanied by his wife, due to behavioral alteration. Two days before, he had been evaluated by Neurology, after a first epileptic crisis (with no previous history) that resolved spontaneously. At that time, it was decided not to start antiepileptic treatment.
The patient reported that he had left his house at midnight, looking for a cat. As he explained, this cat had appeared in his house and had left his entire bed full of insects. His wife denied that this had really happened, and when she told the patient to go to the emergency room, he had become very upset.
As background, the patient used to consume alcohol regularly, so the first hypothesis was that this was a withdrawal syndrome. However, although the consumption was daily, in recent months it was not very high, and at that time no other symptoms compatible with alcohol withdrawal were observed (tremor, tachycardia, sweating, hypertension…).
We requested a general blood test and a brain scan. The only relevant finding was hypercalcaemia 12.9mg/dL (which could also be the origin of the previous seizure). It was decided to start treatment with Diazepam and Tiapride in the emergency room, with serum perfusion, and keep under observation. After several hours, the patient felt better, the hallucinations disappeared, and calcium had dropped to 10.2mg/dL. A preferential consultation was scheduled, due to suspicion that the hypercalcaemia could be secondary to a tumor process.
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ConclusionsIt is important to rule out an organic alteration in those patients who present acute psychiatric symptoms. Hypercalcaemia is frequently associated with tumor processes (1) due to secretion of PTH-like peptide (4), so a complete study should be carried out in these cases.
Delirium has a prevalence between 1 and 2% in the general population (2).
Psychopharmacological treatment is used symptomatically, with antipsychotics (3). For the episode to fully resolve, the underlying cause must be treated.
Disclosure of InterestNone Declared
High genetic diagnostic yield in children and adolescents with psychiatric disorders
- C. Manso-Bazús, N. Spataro, L. Torrent, L. Plans, M. Casadesús, M. Tomás, N. Baena, J. P. Trujillo, N. Capdevila, A. Brunet, V. Martínez-Glez, M. Pàmias, A. Ruiz Nel·lo
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S104
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Introduction
Psychiatric disorders are more prevalent in children with mild (MID) to borderline intellectual functioning (BIF). Rare pathogenic variants in neurodevelopmental genes increase the risk for psychiatric disorders and may explain the comorbidity. Despite these patients represent up to 35% of those attended at mental health services, genetic diagnosis is usually not offered. The identification of mentioned variants could lead to improved clinical care.
ObjectivesTo identify pathogenic variants responsible of the psychiatric disorders in mild and borderline intellectual functioning.
To correlate phenotypic and genetic profiles to personalize diagnostic, clinical care and support to clinicians and families.
MethodsWhole exome sequencing (WES) was performed on 99 enrolled children/adolescent (6-18 yo) affected by a psychiatric condition diagnosed following DSM-5 criteria, and either MID (IQ 55-69) or BIF (IQ 70-85). Severity and interference of IQ and psychiatric comorbidity was evaluated using several psychometric tests (Conners, CDI, STAIC, CAARMS, CBCL and hONOSCA). Inheritance pattern was assessed through Sanger sequencing. ACMG/AMP guidelines were used for variant classification.
ResultsIn our cohort, 64% patients presented BIF and 36% MID. 45% of the patients had 2 or more psychiatric diagnoses, the most prevalent (87%) being attention deficit hyperactivity disorder and, in second place, autism spectrum disorder (51%).
WES identified pathogenic/likely pathogenic variants in 30% of analyzed patients (30/99), 80% of the variants were de novo. There is no significant difference in patient severity between those with a genetic diagnosis and those without.
ConclusionsRare deleterious and de novo variants in neurodevelopmental genes are responsible for the comorbidity that exists between psychiatric disorders and mild/borderline intellectual disability.
The high diagnostic yield obtained from our exome sequencing approach demonstrates the need to offer genetic testing in children with psychiatric disorders and comorbid mild to borderline intellectual functioning.
Finally, patients being identified with a genetic diagnosis are subsequently attended in a specialised unit for rare disorders to receive personalised clinical management.
Disclosure of InterestNone Declared