11 results
Clinician’s attitude towards clozapine prescription
- O. Brugue, M. Gonzalez, L. Moreno, C. Ivorra, R. Hernandez, S. Cepedello, J. Labad
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1013
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Introduction
Current clinical guidelines recommend the use of clozapine for the treatment of refractory schizophrenia, present in up to a third of patients with this disease. Despite the evidence, the data point to low prescription, underdosing, and delayed initiation.
ObjectivesThe objective of the study is to elucidate which factors may interfere in clozpine prescription.
MethodsThis is a cross-sectional observational study, carried out using a survey designed specifically for it.
It was answered online by seventy psychiatrists affiliated with the Catalan Society of Psychiatry.
ResultsMore than half admitted having prescribed two or more antipsychotics without having previously ruled out pseudorefractoriness through depot treatment. 70% recognized the need for monitoring as the main prescription barrier, while the main reason for withdrawal was its adverse effects. The most alarming was considered agranulocytosis, with drooling, drowsiness and weight gain being the most reported.
Statistically significant differences (p=0.031) were found in relation to the years of experience and the device where clozapine was preferred to be started: <10 years in hospital, 10-20 years in partial hospitalization and >20 years outpatient office.
Statistically significant differences were observed in the preference of the device for its initiation depending on the usual work device: hospitalization (p<0.000) and partial hospitalization (p=0.046) preferred to schedule it from their respective devices, without any preference in consultations.
The level of experience and the most reported side effect were statistically significant: for the newest psychiatrists it was weight gain (p=0.031), without presenting differences in the rest of the groups.
ConclusionsClozapine is the psychoactive drug of choice in refractory schizophrenia, so efforts should be devoted to reducing prescription barriers, offering training on its management and innovating forms of monitoring to promote its use.
Disclosure of InterestNone Declared
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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- 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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- 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.
Drawing in autistic spectrum disorder children
- S. Cepedello, A.S. Adrian, G.B. LAura, M.T. Eduardo, D.U.V. Nieves, D.L.R. Henar, Á.A. Aldara
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- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, pp. S433-S434
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Introduction
Drawing can be a tool to complete the psychodiagnose process, especially in children with expression and verbal problems.
The autistic spectrum disorder (ASD) children have problems to describe their feelings and emotions, they can provide us many information drawing their own world.
ObjectiveThe purpose of this study was to discover the psychopathology of children with ASD through their drawings.
MethodsA4-sized booklets were given for ASD children from 6 to 16 years to draw an imaginary family (L. Corman), a human figure (Buck) or a free drawing.
ResultsIn most of the drawings of ASD children, we could find at least one of the three criteria of ASD: social deficits, communication difficulties and restricted interests.
ConclusionsA projective technique as drawing could help us to discover additional information about our patients, specially children and mainly the ones who had problems with the expression of feelings like ASD children.
The act of drawing can be used to understand children's struggles, their internal world. Moreover, it could also help the children gain insight and review progress through drawing records.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Anorexia nervosa and attachment
- H. De la Red Gallego, A. Alonso Sánchez, A. Álvarez Astorga, S. Gómez Sánchez, L. Rodríguez Andrés, S. Cepedello Pérez, M. De Lorenzo Calzón, N. De Uribe Viloria, M. Gómez García, A. Rodríguez Campos, F. De Uribe Ladrón de Cegama
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- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S552
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Introduction
Attachment is an innate programming whereby a child seeks for security. There is scientific and empirical evidence that insecure attachment is usual in eating disorder patients [1].
ObjectivesTo highlight the relevance of attachment between child and caregivers, as well as its significance in therapeutic approach.
MethodsA 17-year-old girl hospitalized after attending to emergency department due to fainting. BMI: 12.89. She reports restrictive behavior since age 11 that her mother regards as “child issues”. Divorced parents, she grew up with her mother, diagnosed of hypochondria, who mentions not understanding why she is not the one who is hospitalized.
ResultsDuring hospitalization, she turned 18-years-old. Guardianship of her younger siblings was removed to her mother. She had a secure relationship with her 24-year-old sister, so she decided to move in with her. Later on, she had a positive progress, maintaining the gained weight and mood stability, although cognitive distortions persist.
ConclusionsAmong developmental and maintaining factors of eating disorders, impaired attachment is becoming increasingly interesting. Even though the main goal of treatment is weight restoration, exploring attachment patterns can facilitate to achieve that aim. This clinical case emphasizes the importance of attachment in eating disorders among child and young adults.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Body dysmorphic disorder: Classification challenges and variants
- N. De Uribe-Viloria, A. Alonso-Sanchez, S. Cepedello Perez, M. Gomez Garcia, M. De Lorenzo Calzon, H. De La Red Gallego, A. Alvarez Astorga, G. Medina Ojeda, F. De Uribe Ladron De Cegama
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- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S459
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Introduction
The main feature of body dysmorphic disorder (BDD) is impairing preoccupation with a physical defect that appears slight to others. Previously, its delusional and nondelusional variants were sorted in two separate categories, but owing to new data suggesting that there are more similitudes than differences between them, DSM-5 now classifies both as levels of insight of the same disorder.
ObjectivesTo enunciate the similarities and differences between the two variants of BDD.
AimsTo better understand the features and comorbidity of BDD, so as to improve its management and treatment.
MethodsTaking DSM-5 and DSM-IV-TR as a reference, we have made a bibliographic search in MEDLINE (PubMed), reviewing articles no older than 5 years that fit into the following keywords: body dysmorphic disorder, delusions, comorbidity, DSM-IV, DSM-5.
ResultsBoth the delusional and nondelusional form presented many similarities in different validators, which include family and personal history, pathophysiology, core symptoms, comorbidity, course and response to pharmacotherapy.
ConclusionsThe new classification of delusional and nondelusional forms of BDD as levels of insight of the same disorder, which places them closer to the obsessive-compulsive spectrum than to the psychotic one, not only improves treatment options, but also reinforces the theory that delusions are not exclusive of psychotic disorders, setting a precedent for the understanding and classification of other disorders with delusional/nondelusional symptoms.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
A bizarre love
- C. Noval Canga, R. Hernández Antón, S. Cepedello Pérez, S. Gómez Sánchez, L. Rodríguez Andrés, L. Gallardo Borge, G. Medina Ojeda, A. Alonso Sánchez, A. Álvarez Astorga, A. Portilla Fernández
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- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S355
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Introduction
Adoption constitutes a discontinuity in child care trajectory, that falls into a separation and a lost of reference figures, and therefore, the need to set up new attachment figures into a suitable familiar atmosphere.
ObjectivesThis case is a review of how a child adoption process, that can be something positive at first, can also produce many problems in the future, added to dificulties in order to regulate stressing situations and also solving problems.
MethodsThe clinical case consists in a 25-year-old woman, who suffers from anxiety and self-injure behaviour. She has a diagnosis of non-specified personality disorder with limit characteristics. The patient was adopted a few months after her birth. At the moment she's living with her adoptive father, her adoptive mother passed away when she was 4. At the age of 21, the patient meets her biological mother and since that moment she spends most of the weekends with her. After a few medical appointments, she admits that she has allowed sexual relationships with her biological mother since six months ago.
ResultsIt's important to appreciate the value of familiar atmosphere, and in addition, the attachment between child and his parental figures. The quality of the attachment is going to have influence in emotional regulation.
ConclusionsChildren who have suffered neglect from their biological parents and have been adopted develop attachment behaviours characterized by negative experiences. In spite of being in a good familiar environment, they feel vulnerable and insecure. Early and appropriate attachment experiences can improve relationships between children and their new family.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Psychosis and Creativity. Genetic and Structural Relation Between Them
- A. Alonso Sánchez, H. De la Red Gallego, A. Álvarez Astorga, M. Gómez García, N. De Uribe Viloria, M. De Lorenzo Calzón, S. Gómez Sánchez, S. Cepedello Pérez, J.A. Blanco Garrote
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- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. s801
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Introduction
Madness and creativity are thought to be related from ancient ages. Nowadays, thanks to new scientific developments and researches we are able to identify common genetic and brain patterns between creativity and psychosis.
ObjectivesTaking the inspiration of a psychotic patient with some shocking drawings, we want to get deep into the actual knowledge about the relation between creativity and psychosis.
MethodsCase report and bibliographic review.
ResultsA 19-year-old man was brought to the hospital after having been found making strange rituals in the public way. In the anamnese he showed to have experienced mystic delusions and hallucinations. He made some particularly creative drawings.
We made a review which showed that this patients may have a diminished latent inhibition, which could make them experiencing usual live irrelevant stimuli as something very exciting and creative at the same time. Genome wide association studies show also that people having creative jobs and psychotic patients share some genes, which could be linked to this abnormal latent inhibition.
ConclusionsLatent inhibition abnormalities could be related with psychosis and creativity. There are differences within the course of people having this oversensibility, which could be explained due to the presence of protective and risk factors.
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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- 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.
The psychotic patient at the General Hospital
- J.Á. Monforte Porto, A. San Román Uría, C. Llanes Álvarez, G. Humada Álvarez, I. Sevillano Benito, S. Cepedello Pérez, R. Hernández Antón, S. Gómez Sánchez
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- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, pp. S151-S152
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Background
Patients with schizophrenia have a higher prevalence of physical illness and a higher mortality from natural causes than the general population, which is a reason why they can be hospitalized for medical and surgical pathologies.
AimsTo determine the demand, the reason for consultation and the sociodemographic characteristics of the psychotic patient admitted at the general hospital.
MethodsSociodemographic variables (age, sex, marital status, education, place of residence, residential housing, with who they live, work status) and health care (service of origin, type of request and its relevance, complaints, days of delay between the request and assistance, number of visits, average length of stay).
Study designProspective epidemiological study of 80 psychotic patients (F.2 ICD-10), from the total of 906 consults solicited from 1 January 2012 until 31 December 2014. Bioethical considerations: compliance with these principles justice, non-maleficence, autonomy and beneficence.
ResultsThe average age is 58.34 years old, 60% were male, 73.8% single, 81.3% with primary education, 52.5% living in urban areas; and the 88.8% of cases were pensioners. The Departments that generate a greater demand are Internal Medicine (53.8%), Orthopaedic Surgery (10%), Pneumology (8.8%) and ICU (8.8%). The most frequent reasons for consultation are assessment/treatment setting (77.5%), abnormal behavior (30%), disorientation (18.8%) and psychotic symptoms (18.8%).
ConclusionsThe typical profile of psychotic patients hospitalized for medical-surgical diseases is a male, middle-aged, single, with primary education and pensioner; from whom it's sued consultation for adjusting of treatment, and secondly for abnormal behavior.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Belle De Jour: A Case of Hysteria
- C. Noval Canga, S. Gómez Sánchez, S. Cepedello Pérez, R. Hernández Antón, I. Sevillano Benito, L. Rodriguez Andrés, L. Gallardo Borge, G. Medina Ojeda, H. De la Red Gallego, A. Portilla Fernánadez
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- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S506
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Introduction
Histrionic Personality Disorder is one of the most common personality disorders diagnosed in Psychiatry. This disorder has been known to be present in more than 40% of patients. There is also a high tendency for those diagnosed with this disorder to be female.
ObjectivesThe case is to show all the difficulties caused by this pathology, differencial diagnosis with other personality disorders, groups of characteristics from different clusters and also, complications produced in daily routine.
MethodsThe purpose is to study a clinical case of a 27-year-old woman, with a degree in journalism, who began with a depressive episode after a failed relationship. After being diagnosed of infertility, she debuted with dissociative episodes and somatization symptoms. After that, she suffered several depressive episodes. At the moment, all the clinical symptoms support the diagnosis of histrionic personality disorder.
ResultsHistrionic Personality Disorder can be found in the cluster B group of personality disorders. They often present in an overly dramatic, erratic or emotional manner. They may fulfil their need for attention through speech and behaviour that draws one's focus of attention toward themselves, and also demanding and manipulative in interpersonal relationships. There are high comorbidity rates in those who suffer from HPD with other diagnoses.
ConclusionsHistrionic Personality Disorder appears to be one of the least threatening diagnosis among personality disorders as those affected are high functioning and do not seek relief for the disorder itself. There is also very little research on HPD which makes treatment options limitless.
Disclosure of interestThe authors have not supplied their declaration of competing interest.