Manic episode associated with interferon alpha therapy: A case report

Interferon alpha is a cytokine with antiviral and antineoplastic action, which is commonly used for treatment of Hepatitis C and B, malignant melanoma, Kaposi's sarcoma, kidney cancer and certain hematologic diseases. It is well-known some of its neuropsychiatric symptoms such as depressive symptoms, cognitive impairment, chronic fatigue, dysphoria and anxiety, but there are also other less common like mania, psychotic symptoms and suicide risk that have been reported. These symptoms interfere in the quality of life very significantly, which at the end can affect treatment adherence.We report a case of a 33-year-old man who was taken to the emergency department by his family referring nervousness, irritability, verbose, and insomnia during the last 5 days. The patient had not psychiatric history. He was diagnosed with a malignant melanoma stage III A a year ago which required to start interferon alpha treatment.Patient and family tell that symptoms began after forgetting last interferon dose. In the psychopathology exploration, we could observe mood lability, delusion ideas of prosecution, which includes his entire family and autorreferentiality. In the emergency room the blood test, urine drug test and CT were normal.During the admission, and in collaboration with the Oncology service, it was agreed the reintroduction and maintenance of interferon combined with olanzapine up to 30 mg/day and clonazepam up to 6 mg/day, which resulted in the resolution of symptoms in two weeks.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Depot aripiprazole as maintenance treatment in bipolar disorder: Report of a case

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1154 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S332-S332

Author(s):

C. Gómez Sánchez-Lafuente ◽

R. Reina Gonzalez ◽

A. De Severac Cano ◽

I. Tilves Santiago ◽

F. Moreno De Lara ◽

...

Keyword(s):

Bipolar Disorder ◽

Maintenance Treatment ◽

Oral Treatment ◽

Manic Episode ◽

Mood Stabilizers ◽

Community Center ◽

Psychotic Symptoms ◽

Competing Interest ◽

Long Acting

IntroductionRecently, depot aripiprazole was approved as a maintenance treatment for schizophrenia. However, long-acting antipsychotics has not been established efficacy in manic episode or maintenance treatment of bipolar disorder.AimsDescribe a clinical case of multiresistant bipolar disorder.MethodsThirty-nine years old male, diagnosed since 8 years ago with bipolar disorder, current episode manic with psychotic symptoms, admitted to Acute Psychiatrist Unit. It was his seventh internment. He was dysphoric, had insomnia, and showed many psychotic symptoms like grandiose delusions and delusions of reference. He thought he was a famous painter from nineteenth century.His disorder was refractory to mood stabilizers monotherapy and to many neuroleptic and, like olanzapine 30 mg/day, depot risperidone, zuclopenthixol, haloperidol, palmitate paliperidone, He was on treatment with lithium 1200 mg/day (lithemia 0.62 prior to admission) and oral aripiprazole 15 mg/day that he was not taking regularly. Poor compliance to oral treatment. No awareness of illness.Resultsduring the patient admission, we started long-acting aripiprazole 400 mg per 28–30 days. First 3 days he persisted dysphoric, hostile, and showing delusions of mind being read. From the fourth day, delusions disappeared and later he was calmer and more friendly, He was discharged 9 days later fully euthymic.For 6 months follow-up, the patient came once a month to community center for aripiprazole injection and he was taking lithium regularly. Last lithemia 0.65 mEQ/L.ConclusionLong-acting antipsychotics, like depot aripiprazole could be a useful alternative to oral medication, specially when there is no awareness of illness and there is low adherence to oral treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Case Report: Three Years of Refractory Atypical Depression Successfully Treated With“Old School” Moclobemide (maoi-r)

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.006 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s239-s239

Author(s):

S. Latorre ◽

I. Moreno ◽

M.J. Gordillo

Keyword(s):

Rating Scale ◽

Manic Episode ◽

Psychotic Symptoms ◽

Specific Response ◽

Good Tolerability ◽

Atypical Depression ◽

Competing Interest ◽

Clinical Description ◽

One Year ◽

Amino Oxidase

BackgroundAtypical depression is linked to bipolarity and specific response to mono amino oxidase inhibitors (MAOI), treatments not commonly used due to their complex handling. We describe a successfully treated case.MethodologyClinical description. Depression severity is assessed with Montgomery Asberg depression rating scale (MADRS).Clinical caseFemale, 54-year-old. Major depression, since 2011, refractory to venlafaxine/aripiprazol and escitalopram 20 mg/day. Manic episode with psychotic symptoms after potentiation with duloxetine. Diagnose of schizoaffective disorder was made, treated with aripiprazol 10 mg/day, with established chronical depressive symptoms, despite addition of valproate and venlafaxine, and partial response to pramipexole up to 1 mg/day.– Decision of cleaning up aripiprazol during 8 days and switch to moclobemide monotherapy was made due to atypical features. Baseline MADRS: 31. At week 2, there is change in mood, expression, psychomotor features and speech formal and content alterations. At week 4, activity increases, and biorythms normalize. At week 8 (with 600 mg/day increased dose), full response is obtained, including drive, and anxiety, with MADRS 12.– After one year of treatment, she has kept stability with no manic or psychotic symptoms emergence. Reduction in dose are linked to depression relapses. She still struggles with psychosocial recovery.– Tolerance has been good in all moment, except for headache crisis, not linked to high blood pressure or diet.ConclusionsMAOI still has a role in affective disorders treatment, given its effectiveness, unique mechanism of action and good tolerability. Targeted psychopharmacological and phenomenology knowledge can be the key to a recovery.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Prevalence of Internet Addiction: A Pilot Study in a Group of Italian Students

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.030 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s248-s248

Author(s):

D. Marazziti ◽

F. Mucci ◽

F. Vanelli ◽

N. Renda ◽

S. Baroni ◽

...

Keyword(s):

High School ◽

High School Students ◽

Internet Addiction ◽

New Technologies ◽

Neuropsychiatric Symptoms ◽

Chronic Fatigue ◽

School Students ◽

Sport Activities ◽

Young Subjects ◽

Competing Interest

IntroductionInternet addiction (IA) is considered part of the so-called “new technologies addictions” group, that in turn belongs to a wider, novel group of abnormal behaviors defined “no-drug addictions” or “behavioral addictions”. Similarly to substance abuse, there is the risk either to arouse symptoms like craving, tolerance and habituation either to develop a full-fledged addiction to the Internet.AimThe aim of this study is to examine the current pattern of Internet use and eventually of IA, as well as their main characteristics, in a group of high-school students from Calabria, a Southern Italian region.MethodsFive hundred high-school students (42% boys, 58% girls, mean age SD ± 16.23 years) volunteered for this study. A specific questionnaire of 45 items with 5 possible answers ranging between “never” and “very often” on a Likert scale was developed.ResultsMost of the young subjects interviewed owned a smartphone with Internet, and claimed to spend more time online than at the beginning. Nearly everybody had an active account in a least one social network. A small withdrawal from social relationships and from sport activities emerged in this group.ConclusionsAlthough about 10% of examined students presented IA symptoms, our findings cannot be considered representative of the total high-school population, these results underline the need of further investigation and awareness. In fact, many underestimated, vague, and other unspecific neuropsychiatric symptoms, such as alterations of sleep-wake pattern, chronic fatigue, headache, visual problems, carpal tunnel syndrome and eventually anxiety or depression may be underlying to an unrecognized condition of IA.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Agenesis of the Corpus Callosum in A Patient With Bipolar Disorder

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1813 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S493-S493

Author(s):

J. Nogueira ◽

R. Ribeiro ◽

J. Vieira ◽

R. Sousa ◽

S. Mendes ◽

...

Keyword(s):

Bipolar Disorder ◽

Corpus Callosum ◽

Past History ◽

Case Reports ◽

Manic Episode ◽

Psychotic Symptoms ◽

Major Depressive ◽

Mixed Features ◽

Competing Interest ◽

The Brain

BackgroundThe corpus callosum (CC) is the largest white matter structure in the brain, which plays a crucial role in interhemispheric communication. Agenesis of the CC is a rare development anomaly, with unknown cause. It could be asymptomatic or associated with mental retardation and neurologic symptoms. Some case reports, post-mortem studies and image studies have linked thickness reduction and agenesis of CC with psychotic symptoms, mainly in schizophrenia patients. Lately, anatomical abnormalities in the CC have been reported in patients with Bipolar Disorder (BD).Case reportA 52-year-old woman was brought to the emergency room by the authorities after being physically aggressive to her 13-year-old daughter and inappropriate behavior in public. At the emergency department her mood was elevated with emotional lability, dispersible attention, slight increase of motor activity, pressured and difficult to interrupt speech, grandious and self-referent delusional ideas.Her past history revealed hippomaniac episodes characterized by periods of excessive shopping and hyperphagia. In 2008, she had a major depressive episode.Head CT-SCAN revealed agenesia of CC. She received the diagnosis of Manic Episode with mixed features and was treated with valproic acid, flurazepam and olanzapine.ConclusionThis case reinforces the fact that changes in CC, probably due to deficiency in myelination, could have a crucial importance in the pathophysiology of Bipolar Disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Psychotic symptoms in a patient diagnosed with temporal lobe epilepsy and schizoaffective disorder

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.269 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S150-S150

Author(s):

G. Martinez-Ales ◽

V. Baena ◽

I. Rubio ◽

B. Rodriguez-Vega ◽

V. Bonan ◽

...

Keyword(s):

Psychiatric Disorders ◽

Schizoaffective Disorder ◽

Neuropsychiatric Symptoms ◽

Clinical History ◽

Psychotic Symptoms ◽

Antiepileptic Medication ◽

Complex Motor ◽

History Of ◽

Competing Interest ◽

Symptomatic Remission

IntroductionEpilepsy is considered a complex neurological disorder, and its clinical picture can resemble many different cerebral dysfunctions, including those associated to major psychiatric disorders.Case reportWe report the case of a 52-year-old gentleman, with a 30-year history of schizoaffective disorder and of complex partial epilepsy with secondary generalization. He was admitted to an emergency room due to a voluntary overdose with 8 mg of clonazepam. The patient explained how he had recently experienced visual hallucinations and insomnia, symptoms that originally led to the psychotic diagnosis. He had previously presented these symptoms, along with stupor, delusions and lability, as a prodrome of complex motor epileptic decompensations. Thus, he took the overdose not to suffer seizures. After carefully reconstructing the clinical history, psychiatric admissions had shown seizures, and periods of clinical stability had been achieved by regulating antiepileptic medication. Eslicarbazepine and lamotrigine reintroduction, and quetiapine withdrawal, led to symptomatic remission.DiscussionEpilepsy and major psychiatric disorders show a high comorbidity. There has been an effort to even include epilepsy and psychosis in a unique diagnosis (alternant psychosis). Furthermore, polimorphism and restitutio ad integrum may resemble classic cycloid psychosis. In this case, chronological study showed all symptoms could be explained by one disorder.ConclusionEpilepsy includes a variety of neuropsychiatric symptoms. It can be difficult to withdraw psychiatric diagnoses from patients after years of follow-up. However, a carefully taken medical history clarifies temporal criteria.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Sun lupus and energy. Systemic lupus erythematosus presenting as mania

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.604 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s493-s493

Author(s):

M.J. Gordillo Montaño ◽

S. Ramos Perdigues ◽

M.A. Artacho Rodriguez ◽

S. Latorre ◽

C. Merino del Villar ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Psychiatric Symptoms ◽

Manic Episode ◽

Immunosuppressive Drugs ◽

Psychotic Symptoms ◽

Systemic Lupus ◽

Neuropsychiatric Manifestations ◽

Competing Interest ◽

High Doses

IntroductionSystemic lupus erythematosus is a chronic disease that can give neuropsychiatric episodes and systemic manifestations. About 57% of patients with SLE have neuropsychiatric manifestations in the course of their illness, however an initial presentation with neuropsychiatric clinic is rare.ObjectiveDescribe how patients receiving corticosteroids as part of their treatment can develop mental disorders but not only them.MethodIt will raise grounds with a case: 20-year-old woman recently diagnosed with SLE because of arthritis in his ankle. Treatment was initiated with prednisone 10 mg and chloroquine 200 MG. After 20 days the patient comes to the emergency after episode of turmoil at home with major affective clinical maniform. Presenting fever. The presence of fever downloads the possibility of a psychosis chloroquine or corticosteroids to be a small dose. Treatment was initiated with high doses of prednisone and immunosuppressants. In addition to associating specific anticonvulsant and antipsychotic drugs at usual doses for a manic episode.ResultsTreatment of psychosis in SLE is essentially empirical, and depends on the etiology. It usually responds to the use of high doses of corticosteroids combined with immunosuppressive drugs. Psychosis induced by corticosteroids requires lowering them. It is valid concomitant use of antipsychotics.ConclusionsThe presence of psychotic symptoms in a patient with systemic lupus erythematosus forces to distinguish between various etiological possibilities.Corticosteroids may cause a variety of psychiatric symptoms. And yet, in patients with SLE these syndromes are not always attributable to the use of corticosteroids.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Neuropsychiatric Symptoms and Antipsychotic Therapy in the Elderly Patients with Dementia

Psychiatry ◽

10.30629/2618-6667-2020-18-4-6-15 ◽

2020 ◽

Vol 18 (4) ◽

pp. 6-15

Author(s):

I. V. Kolykhalov

Keyword(s):

Neuropsychiatric Symptoms ◽

The Elderly ◽

Psychotic Symptoms ◽

Mixed Dementia ◽

Short Term ◽

Antipsychotic Therapy ◽

Dementia Patients ◽

Frequency Of Use ◽

Number Of Patients ◽

High Incidence

The objective of the study was to investigate syndromal-nosological specificities of neuropsychiatric symptoms (NPS) and the frequency of use of antipsychotics in patients with various types of dementias, institutionalized to geriatric units of mental hospitals.Patients and methods: a total of 106 in-patients of three psychogeriatric units were examined. The median age of patients is 75 years [69; 80].The diagnostic distribution of patients at the time of the examination was as follows: in 33 subjects (31.1%) Alzheimer’s disease (AD) was diagnosed, in 25 (23.6%) - mixed dementia (MD), in 32 (30.2%) - vascular dementia (VD) and in 16 (15.1%) patients had dementia of complex origin (DCO).Results: a high incidence (54.7%) of NPS was found in patients with dementia of various origins. The greatest number of patients with behavioral and psychotic symptoms was found in AD and MD. The proportion of dementia patients with such disorders in each of these types of dementia is about 70%, while in CGD and VD, the proportion of patients with NPS is noticeably smaller (30% and 40%, respectively). For the treatment of NPS, antipsychotics were most often prescribed, but their use caused adverse events (AEs) in 1/3 of cases. Patients with VD are most susceptible to the development of AE, and AD patients are the least susceptible.Conclusion: the study showed that NPS are one of the important components of dementia, regardless of the nosology and stage of the disease. The treatment of NPS in dementia is particularly challenging because, although the symptoms cause significant distress, there are currently no effective alternative therapies. The risk of AE can be minimized by carefully considering the indications for prescribing antipsychotics and their short-term use, regular monitoring of the patient’s condition, and educating caregivers.

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Delayed post-hypoxic leukoencephalopathy: Case report

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1654 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s839-s839 ◽

Cited By ~ 1

Author(s):

M. Solerdelcoll Arimany ◽

M. Garriga ◽

E. Parellada

Keyword(s):

Neuropsychiatric Symptoms ◽

Brain Mri ◽

Clinical History ◽

Good Prognosis ◽

Mri Findings ◽

The Mean ◽

Competing Interest ◽

Weighted Sequences ◽

Direct Toxicity ◽

Progressive Cognitive Impairment

IntroductionDelayed post-hypoxic leukoencephalopathy (DPHL) is an underrecognized syndrome of delayed demyelination, where patients manifest neuropsychiatric symptoms after a period of 2–40 days of apparent recovery from a cerebral hypo-oxygenation episode.ObjectivesWe report a case of a patient who successfully recovered from an overdose of heroin, but then suffered a delayed abrupt neurological deterioration.AimsTo improve assessment and recognition of DPHL.MethodsAn adequate retrospective collection of clinical data and nonsystematic review of the literature was performed.ResultsA 43-year-old male with schizoaffective disorder who attempted suicide with an overdose of heroin, was successfully revived and return to his previously mental status, but 3 weeks after, he abruptly developed progressive cognitive impairment with akinetic mutism and ataxia. He was admitted to our acute psychiatric unit after brain CT and chemistry analyses were unremarkable. Brain MRI showed diffusely symmetric hyperintensity in the white matter (WM), pronominally the periventricular WM, on FLAIR and T2 weighted sequences. At 16 weeks postoverdose, he presented improvement both cognitive and motor symptoms, lasting deficits in frontal-executive functions.DiscussionDPHL is characterized by similar clinical and neuroimaging features regardless of the initial insult. The mean lucid interval coincides with the replacement half-life for myelin related lipids and proteins. Prolonged mild-to-moderate hypo-oxygenation of WM is thought to disrupt myelin turnover. It appears probable that these were responsible for DPHL in our patient rather than a direct toxicity.ConclusionDPHL can be diagnosed when clinical history, laboratory assessments and MRI findings are concordant. DPHL requires extensive support care and carries a relatively good prognosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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405 - Music Therapy in the management of dementia

International Psychogeriatrics ◽

10.1017/s1041610220002586 ◽

2020 ◽

Vol 32 (S1) ◽

pp. 121-121

Author(s):

Catarina Pedro ◽

Beatriz Jorge ◽

Mariana Duarte

Keyword(s):

Cognitive Function ◽

Music Therapy ◽

Behavioral Problems ◽

Positive Impact ◽

Current Knowledge ◽

Neuropsychiatric Symptoms ◽

World Health ◽

Psychotic Symptoms ◽

The World ◽

Health Organization

Introduction:Dementia has become a worldwide concern. According to the World Health Organization, there are 50 million individuals suffering from dementia across the world and approximately 20 million new cases are diagnosed each year. The efficacy of medications in controlling agitation and psychotic symptoms is modest and may cause serious adverse effects, outlining the urge for new treatment methods for patients with dementia. Music therapy (MT) is a nonpharmacologic strategy that is used in patients with early-to-late stages of dementia with promising results.Objectives:The aim of this presentation is to evaluate the benefits of music therapy in cognitive functioning and neuropsychiatric symptoms in patients diagnosed with dementia. We also summarize the current knowledge about this topic.Methods:A non-systematic review of the literature was performed on PubMed, PsycINFO and Web of science using selected keywords.Results:MT sustains its benefit because musical memory regions in the brain are relatively spared compared to cognitive function. “Musical memories” can, thus, be stored longer than non-musical memories, allowing to recall associated life events and emotions. Systematic reviews suggest that MT seem to have a positive effect on symptoms such as depression, anxiety and behavioral problems while the findings concerning agitation/aggression are inconsistent. No large differences were found between studies using live or recorded music although the latter reported more of a consistently positive impact on behavioral and psychological outcomes. The studies using live music, however, reported specific benefits to relationships and interactions.Conclusions:The majority of the studies have methodological limitations, making it difficult to offer firm conclusions. Despite this, there were positive results on aspects of quality of life, cognitive function, behavioral, psychological, physiological and communication outcomes.

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A Prediction Model for Positive Infant Meconium and Urine Drug Tests

American Journal of Perinatology ◽

10.1055/s-0040-1721688 ◽

2020 ◽

Author(s):

Elizabeth A. Simpson ◽

David A. Skoglund ◽

Sarah E. Stone ◽

Ashley K. Sherman

Keyword(s):

Prediction Model ◽

Drug Testing ◽

Clinical Decision Making ◽

Drugs Of Abuse ◽

Clinical Decision ◽

P Value ◽

Test Characteristics ◽

Drug Test ◽

Urine Drug ◽

Urine Drug Test

Objective This study aimed to determine the factors associated with positive infant drug screen and create a shortened screen and a prediction model. Study Design This is a retrospective cohort study of all infants who were tested for drugs of abuse from May 2012 through May 2014. The primary outcome was positive infant urine or meconium drug test. Multivariable logistic regression was used to identify independent risk factors. A combined screen was created, and test characteristics were analyzed. Results Among the 3,861 live births, a total of 804 infants underwent drug tests. Variables associated with having a positive infant test were (1) positive maternal urine test, (2) substance use during pregnancy, (3) ≤ one prenatal visit, and (4) remote substance abuse; each p-value was less than 0.0001. A model with an indicator for having at least one of these four predictors had a sensitivity of 94% and a specificity of 69%. Application of this screen to our population would have decreased drug testing by 57%. No infants had a positive urine drug test when their mother's urine drug test was negative. Conclusion This simplified screen can guide clinical decision making for determining which infants should undergo drug testing. Infant urine drug tests may not be needed when a maternal drug test result is negative. Key Points

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