“…I Just Wanted to Report Me, I Went Into the Subway Without Paying 9 Times…”

A clinical case is presented. The reason for admission was for behavioral disturbances and agitation piscomotriz episode in the street: she had gone to a library to “denounce” the police for entering the subway without paying several times. The patient was very distraught because she was heavily guarded (someone had tapped her phone, entered her house, changed objects place, she was chased down the street…). In the psychopathological examination revealed the sphere of language, her speech was fluid, with pressured speech, full of details, with loss of thread and highlighted the presence of neologisms and grammatical errors (changes of subject and predicate…) and changes some letters by others in the same word. She often used sayings incorrectly and, when you are exploring about this fact, objectively presenting alteration in abstract thinking. In addition, it presents self-references on television. The diagnostic impression was chronic psychotic process of years of evolution. In this case, it was decided to administer intramuscular antipsychotic treatment because she was not aware of the disease but presenting good tolerability profile because, otherwise, leave the track and also a good social functioning was sought. Currently, she continues in mental health, she has not reported new crisis and a progressive scan objective improvement in the organization of thought and speech, leaving the psychotic symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Changes in the cytokine profile in first episode, drug-naïve patients with psychosis after short-term antipsychotic treatment

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.382 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S371-S371

Author(s):

P. Petrikis ◽

P. Voulgari ◽

V. Boumba ◽

D. Archimandriti ◽

P. Skapinakis ◽

...

Keyword(s):

Antipsychotic Medication ◽

Transforming Growth Factor ◽

Serum Levels ◽

Psychotic Symptoms ◽

First Episode ◽

Enzyme Linked Immunosorbent Assay ◽

Antipsychotic Treatment ◽

Before And After ◽

Drug Naïve ◽

Competing Interest

IntroductionAn increasing body of evidence suggests that antipsychotic medication can cause immunological changes that could be attributed to the amelioration of psychotic symptoms or the metabolic side effects of the drugs. So far, the results of the studies remain controversial.ObjectiveOur aim was to compare the levels of interleukin (IL) IL-2, IL-6 and transforming growth factor-β2 (TGF-β2) in drug-naïve, first-episode patients with psychosis before and after six weeks of antipsychotic medication.MethodsThirty-nine first episode patients with psychosis were enrolled in the study. Serum levels of IL-2, IL-6 and TGF-β2 were measured by enzyme linked immunosorbent assay (ELISA) before and six weeks after the initiation of antipsychotic medication. In addition, clinical psychopathology was assessed using Positive and Negative Syndrome Scale (PANSS) before and after treatment.ResultsSerum levels of IL-2 were significantly higher in the study group six weeks after the initiation of antipsychotic treatment (P < 0.001) while TGF-β2 levels were decreased (P < 0.001) and IL-6 levels were slightly reduced (P < 0.004).ConclusionThe changes in cytokine levels may be attributed to the action of antipsychotic medication and the remission of psychopathology. The reduction in TGF-β2 levels is observed in all patients and with all antipsychotic medications used. TGF-β2 may be a marker of clinical efficacy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Pychiatrists and Legal Issues in Dementia Care

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.172 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S37-S37

Author(s):

M.M. Carrasco

Keyword(s):

Mental Disorders ◽

Social Problems ◽

Point Of View ◽

Psychotic Symptoms ◽

Theoretical Point ◽

Behavioral Disturbances ◽

The Family ◽

Competing Interest ◽

The Many

During more than half a century, Psychiatry has extensively accepted a biomedical model studying mental disorders (including schizophrenia, affective disorders and the large group of stress-related disorders, including anxiety disorder. Thus, the classical dichotomy between functional and organic psychiatric disorders is obsolete and from a theoretical point of view there should be no obstacle for Psychiatry to deal with the study of dementias from gene to clinical levels using empirical methods, including neurotransmitters and scanning techniques. However, in many European countries, the dementias have been claimed as belonging primarily to Neurology, leaving the role of psychiatrists to treat psychotic symptoms and bizarre behavioral disturbances.However, psychiatrists have a long tradition of detailed psychopathological description and great skill in coping with the many psychological, ethical and social problems that are such important features of mental disorders and particularly the dementias, and so, the specific skills of psychiatrists will certainly be warranted in managing the many significant psychological and social problems of the patient both within the family and in society. The discussion must overcome the sterile debate between specialties to focus on the skills needed to adequately address the needs of patients with dementia and their caregivers.Disclosure of interestThe author has not supplied his declaration of competing interest.

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Obsessive symptoms in schizophrenia: A case report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2122 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S573-S574 ◽

Cited By ~ 1

Author(s):

S. Benavente López ◽

N. Salgado Borrego ◽

M.I. de la Hera Cabero ◽

I. Oñoro Carrascal ◽

L. Flores ◽

...

Keyword(s):

Case Report ◽

Effective Dose ◽

Mood State ◽

Physical Restraint ◽

Psychotic Symptoms ◽

Minimum Effective Dose ◽

Obsessive Compulsive ◽

Behavioral Disturbances ◽

Compulsive Disorder ◽

Competing Interest

IntroductionSchizophrenia could be presented with obsessive thoughts or an obsessive-compulsive disorder. It is known that some antipsychotics like clozapine could cause obsessive symptoms or worsen them.Case ReportWe report the case of a 53-year-old male who was diagnosed of schizophrenia. The patient was admitted into a long-stay psychiatric unit due to the impossibility of outpatient treatment. He presented a chronic psychosis consisted in delusions of reference, grandiose religious delusions, and auditory pseudohallucinations. He often presented behavioral disturbances consisted in auto and heteroaggressive behavior, being needed the physical restraint. Various treatments were used, including clozapine, but obsessive and ruminative thoughts went worse. Because of that, clozapine dose was lowed, and it was prescribed sertraline and clomipramine. With this treatment the patient presented a considerable improvement of his symptoms, ceasing the auto and heteroaggressive behavior, presenting a better mood state, and being possible the coexistence with other patients. Psychotic symptoms did not disappeared, but the emotional and behavioral impact caused by them was lower.DiscussionThis case report shows how a patient with schizophrenia could present severe behavioral disturbances due to obsessive symptoms. If obsessive symptoms are presented, clozapine must be at the minimum effective dose and antidepressants with a good antiobsessive profile.ConclusionsObsessive symptoms could be presented as a part of schizophrenia. Clozapine could worsen this symptoms and it is necessary to adjust its dose to the minimum effective dose.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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A case of delusional disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1622 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s828-s828

Author(s):

O. Porta Olivares ◽

M. Juncal Ruiz ◽

B. Fernández Abascal Puente ◽

M. Gómez Revuelta ◽

M. Pérez Herrera ◽

...

Keyword(s):

Therapeutic Relationship ◽

Psychiatric Treatment ◽

Delusional Disorder ◽

Psychotic Symptoms ◽

First Line ◽

Behavioral Disturbances ◽

Competing Interest ◽

Long Acting ◽

The Right ◽

First Line Treatment

IntroductionFunctioning of patients with delusional disorder may be impaired, particularly if the delusional thinking is chronic rather than episodic. They refuse to characterize their beliefs as false and view opposing views with surprise, if not hostility and disdain, dismissing or ignoring them, and continuing their struggle to find resolution or restitution for the wrongs they have endured or the illnesses from which they suffer. They typically reject and often resent the suggestion that they are mentally compromised. They are a difficult group to engage clinically, often refusing to meet with a clinician about their delusions and/or to take medication. The first-line treatment of delusional disorder is antipsychotic medication rather than other clinical interventions. Patients with the disorder often reject psychiatric treatment, it is particularly important that medication be prescribed in the context of a therapeutic relationship that includes support, education, encouragement of healthier pursuits, and discouragement of damaging, delusion-inspired actions.MethodsWe describe a case of a 55-year-old woman with a delusional disorder that was diagnosed 4 years before. The supervision of the right take of the treatment was not possible and the intensity of behavioral disturbances increased. Then we started the treatment with long-acting injectable aripiprazole.ResultsWithin the 4 months following the start of treatment, her mental state improved by attenuation of psychotic symptoms.ConclusionsLong-acting aripiprazole could be an effective tool for treatment of psychotic symptoms in patients with no insight and difficulties to check the proper treatment take.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Four years follow-up in a naturalistic study of adults with ADHD treated with atomoxetine

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.743 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s278-s278

Author(s):

V. Richarte Fernández ◽

M. Corrales de la Cruz ◽

P. Ibáñez Jiménez ◽

M. Corominas Rosso ◽

R. Vidal Estrada ◽

...

Keyword(s):

Adult Adhd ◽

Clinical Profile ◽

Tolerability Profile ◽

Good Tolerability ◽

Psychopharmacological Treatment ◽

Chronic Disorder ◽

Adhd Treatment ◽

Competing Interest ◽

Monitoring Treatment ◽

Atomoxetine Treatment

IntroductionAttention-deficit/hyperactivity disorder (ADHD) is a psychiatric chronic disorder of childhood that persists into adolescence and adulthood in the most part of cases. There are various ways of treating ADHD.ObjectivesAssess the effectiveness and tolerability of atomoxetine long-term and routine clinical practice in adult ADHD treatment. Study the clinical profile of the patients who take atomoxetine.AimsThe aim of this is to study the treatment of ADHD in adults with a non-stimulant drug atomoxetine.MethodsWe obtain results from 126 patients recruited from July 2009 to May 2013 who have been prescribed Atomoxetine as a treatment for ADHD from the hospital pharmacy.ResultsComorbid disorders were presented in 57.1% of the patients included at the study (25.3% of which belong to the group of anxiety disorders). The use of other psychotropic drugs associated with atomoxetine was observed in 54.8% of patients. The 62.7% of the patients concerned continued treatment beyond 225 weeks (4 years 3 months) of observation. The Clinical Global Impression Improvement scale (CGI-I) and side effects determine monitoring treatment. A total of 61.9% of patients responded satisfactory to treatment with atomoxetine getting the CGI-I scale a score of 1-2. The duration of therapy and patient age are factors that influence the response. Furthermore, the clinical profile of patients treated with atomoxetine is characterized by different comorbidities, anxious symptomatology and personality disorders. Atomoxetine treatment with has also been shown its effectiveness and safe despite the presence of concomitant comorbidities and psychopharmacological treatment.ConclusionAtomoxetine treatment with has been effective and has proven good tolerability profile during treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Treatment patterns in schizophrenia: Clinical case of successful management with a series of long acting injectable antipsychotics

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1616 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s826-s826

Author(s):

M. Palomo Monge ◽

J.F. Calvo Mauri ◽

M.F. Tascon Guerra ◽

A. Duque Domínguez ◽

S. Díaz Conde ◽

...

Keyword(s):

Weight Gain ◽

Hospital Admissions ◽

Negative Impact ◽

Paranoid Schizophrenia ◽

Serum Prolactin ◽

Antipsychotic Treatment ◽

Tolerability Profile ◽

Successful Management ◽

Good Tolerability ◽

Fluphenazine Decanoate

IntroductionWe report the successful management of a 57-year-old woman with a 20 year diagnostic of paranoid schizophrenia (first visit November, 1995). She presented several comorbidities (arterial hypertension, diabetes mellitus and morbid obesity), with a history of five previous hospitalizations (1995, 2012, January and May 2014, and April 2016).Aims/methodsThe patient was always prescribed depot antipsychotics: she was treated for 14 years with Zuclopentixol depot (discontinued due to dermic adverse reactions and weight gain). After a period with oral paliperidone (from 2012 until 2013) and due to lack of adherence to oral therapy, in August 2013 she was prescribed paliperidone palmitate. The treatment was discontinued after nine months (May 2014) due to weight gain, a significant increase of serum prolactin levels and two psychotic relapses that led to hospital admissions.ResultsShe was then prescribed Fluphenazine decanoate depot for one year and 4 months, but she was switched to Aripiprazole once monthly (AOM) in September 2015 to avoid metabolic syndrome.ConclusionsNon-personalized antipsychotic treatment in a patient with a complicated comorbidity history can result in lack of compliance and a risk of relapse, and in a worsening of her medical conditions, with the consequential negative impact in her functioning and quality of life. Based on our results, the treatment with AOM resulted in a positive evolution of the patient, with a good tolerability profile, in an improvement of treatment-caused adverse events (weight loss, and prolactin serum levels normalization); all factors that enable treatment adherence and good clinical response.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Treatment of drug-resistant schizoaffective disorder with aripiprazol depot off-label: A case report

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1598 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s820-s820

Author(s):

L. Niell Galmés ◽

R.A. Baena Mures ◽

Í. Alberdi Páramo ◽

M.M. Tenorio Guadalupe ◽

G. Montero Hernández ◽

...

Keyword(s):

Schizoaffective Disorder ◽

Rating Scale ◽

Treatment Guidelines ◽

Safety Data ◽

Psychotic Symptoms ◽

Good Tolerability ◽

Off Label ◽

Competing Interest ◽

New Treatment ◽

Higher Doses

IntroductionWe expose a woman diagnosed with schizoaffective disorder 2 years ago, before she received several diagnostics. She was admitted to the psychiatry unit with hyperactivity, pressured speech without taking an appropriate turn, flight-of-ideas, irritability, expansiveness, emotional liability, ideas of reference and insomnia without diurnal tiredness. In addition, she admitted having abandoned the medication one month ago. She was diagnosed with maniac episode with psychotic symptoms and the medication was reintroduced. After two weeks, no response was observed so we decided to introduce ability depot 600 mg/3 weeks.ObjectivesWe want to show that is possible the use of ability depot off-label in patients with a special difficulty in handling. Also, we want to show that higher doses are not dangerous and it's possible to study new treatment guidelines for ability depot.MethodsWe use the Positive and Negative Syndrome Scale (PANSS) pre (the day of the introduction) and post (at two weeks) treatment with aripiprazol depot; the Clinical Global Impression rating scale (CGI), also pre and post.ResultsWe have obtained a punctuation of 180 in PANSS the day of the introduction of the aripiprazol depot and 45 at two weeks. In addition, we obtained 6 in CGI the day of the introduction and 3 at two weeks.ConclusionsIn this case, aripiprazol depot has shown good tolerability and efficacy for the acute phase of schizoaffective disorder at higher doses than recommended in clinical guidelines. The efficacy and safety data are consistent with short-term, placebo-controlled studies of aripiprazol depot conducted in similar populations.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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Olanzapine and zuclopenthixol combined therapy for the treatment of refractory schizophrenia: 2 case reports

European Psychiatry ◽

10.1016/s0924-9338(11)73142-x ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1437-1437

Author(s):

M. Manea ◽

V. Rusanu ◽

B.E. Patrichi ◽

M.G. Puiu ◽

R.M. Stoean ◽

...

Keyword(s):

Case Reports ◽

Combined Therapy ◽

Active Phase ◽

Full Blood Count ◽

Psychotic Symptoms ◽

Antipsychotic Treatment ◽

Good Tolerability ◽

High Affinity ◽

Schizophrenic Patients

IntroductionPatients who remain unresponsive to two different antipsychotics should be given clozapine. However, some of the schizophrenic patients had presented an unsatisfactory benefit under clozapine monotherapy or clozapine cannot be used because of toxicity or patient refusal. Finding an efficient therapy represents a tough challenge in this situation, other drugs or drug combinations can be tried.The aimTo choose a therapeutic scheme that improves acute psychotic symptoms and has a good tolerability. Olanzapine has antagonist activity at dopamine, serotonin, muscarinic, α1-adrenergic and histamine receptors. Zuclopenthixol has high affinity for both dopamine D1 and D2 receptors, high affinity for α1-adrenergic and 5-HT2 receptors, a weaker histamine H1 receptor blocking activity, and even lower affinity for muscarinic cholinergic and α2-adrenergic receptors.Methods2 schizophrenic females patients, hospitalized for an active phase episode. Both patient had perssistent hallucinations during the course of their illness despite the antipsychotic treatment and the good compliance. In the past they followed multiple therapeutic schemes. Antipsychotic medication was adjusted following the clinical outcome. Instruments: PANSS, CGI, weight, glycemia, lipide profile, blood pressure, heart rate, full blood count, hepatic enzymes, EKG, adverse events and relapse (follow-up 6 months).ResultsOlanzapine and zuclopenthixol combined therapy led to psychotic symptoms remission.ConclusionsIn this case olanzapine and zuclopenthixol may represent an option for treatment of refractory schizophrenia. No new side effects have been observed or any unfavorable drug interactions. These results have maintained untill the end of the follow-up period.

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Effect of Marriage on Pre-existing Psychoses: A Convenient or Futile Solution for Severe Mental Disorders?

Journal of Psychosexual Health ◽

10.1177/2631831820971738 ◽

2020 ◽

Vol 2 (3-4) ◽

pp. 273-276

Author(s):

Prakash B. Behere ◽

Aniruddh P. Behere ◽

Debolina Chowdhury ◽

Amit B. Nagdive ◽

Richa Yadav

Keyword(s):

Mental Disorders ◽

Age Of Onset ◽

Social Stigma ◽

Positive Family History ◽

Mental Illnesses ◽

Psychotic Symptoms ◽

Antipsychotic Treatment ◽

Contractual Relationship ◽

History Of ◽

Paranoid Type

Marriage can be defined as the state of being united as spouses in a consensual and contractual relationship recognized by law. The general population generally believes marriage to be a solution to mental illnesses. It can be agreed that mental disorders and marital issues have some relation. Parents of patients with psychoses expect that marriage is the solution to the illness and often approach doctors and seek validation about the success of the marriage of their mentally ill child, which is a guarantee no doctor can give in even normal circumstances. Evidence on sexual functioning in patients of psychosis is limited and needs further understanding. Studies show about 60%–70% women of the schizophrenia spectrum and illness to experience sexual difficulties. Based on available information, sexual dysfunction in population with psychosis can be attributed to a variety of psychosocial factors, ranging from the psychotic symptoms in itself to social stigma and institutionalization and also due to the antipsychotic treatment. Despite the decline in sexual activity and quality of life in general, it is very rarely addressed by both the treating doctor and by the patient themselves hence creating a lacuna in the patient’s care and availability of information regarding the illness’ pathophysiology. Patients become noncompliant with medications due to this undesirable effect and hence it requires to be given more attention during treatment. It was also found that paranoid type of schizophrenia patient had lower chances of separation than patients with other types of schizophrenia. The risk of relapse in cases with later age of onset of the disease, lower education, a positive family history of psychosis or a lower income increased more than other populations.

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