Asenapine in the treatment of trichotillomania with comorbid bipolar disorder: A case report

Trichotillomania has been found to be associated with mood disorders, particularly bipolar disorder. Trichotillomania has shared similarities with bipolar disorder by virtue of phenomenology, co-morbidity, and psychopharmacologic observations. In the past, trichotillomania with comorbid bipolar disorder was treated with lithium and sodium valproate. There has been little, if any, literature on using asenapine to augment treatment in patients with trichotillomania with comorbid bipolar disorder. A patient presented with hair-pulling episodes for a year, resulting in bald scalp patches. She had no mood symptoms prior to this. She developed low mood, anhedonia, poor sleep and poor appetite subsequently as she could not stop pulling her hair. She was started on escitalopram 10 mg daily for he depressive symptoms. Three years later, she developed hypomanic symptoms such as irritability and spending sprees. Her hair pulling behaviour worsened at this time. At this point, a diagnosis of bipolar disorder type 2 was considered and she was started on lithium 300 mg daily. Her escitalopram was discontinued. As her mood was still labile 10 months later, asenapine was added to augment lithium in the treatment of the bipolar disorder. With asenapine, her hair pulling frequency started to decrease rapidly. Asenapine was increased to 10 mg daily and her hair pulling ceased. Her mood also stabilized and she no longer had erratic periods of mood lability. In conclusion, asenapine augmentation of lithium has potential to be used in patients who have trichotillomania with comorbid bipolar disorder due to its unique receptor profile.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The importance of establishing a good differential diagnosis in bipolar disorder

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1182 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S338-S338

Author(s):

I. Peñuelas Calvo ◽

J. Sevilla Llewellyn-Jones ◽

C. Cervesi ◽

A. Sareen ◽

A. González Moreno

Keyword(s):

Mental Health ◽

Bipolar Disorder ◽

Personality Disorder ◽

Correct Diagnosis ◽

Unipolar Depression ◽

Health Condition ◽

Diagnostic Process ◽

Negative Consequences ◽

Competing Interest ◽

Disorder Type

Diagnosis plays a key role in identification of a disease, learn about its course, management and predicting prognosis. In mental health, diseases are often complex and coalesce of different symptoms. Diagnosing a mental health condition requires careful evaluation of the symptoms and excluding other differential disorders that may share common symptoms. Diagnose hastily can lead to misdiagnosis. A premature diagnosis or misdiagnosis has clear negative consequences. This is one of the problems related to mental health and one needs to optimize the diagnostic process to achieve a balance between sensitivity and specificity. Currently, the diagnosis of bipolar disorder (BD) is one of the major mental health conditions that is often misdiagnosed.To differentiate BD from unipolar depression with recurrent episodes or with personality disorder (PD), especially type Cluster B – with features shared with mania/hypomania like mental instability or impulsivity, it is important to differentiate between a diagnosis and its comorbidity. BD is often misdiagnosed as personality disorder and vice versa specially when both are coexisting (almost 20% of patients with bipolar disorder type II are misdiagnosed as personality disorders). This is common especially with borderline PD, although in some cases the histrionic PD may also be misdiagnosed as mania.Due to the inconsistency in patient care involving different psychiatrists combined with difficulty in obtaining a precise patient history and family history leads to loss of key information which in turn leads to misdiagnosis of the condition. The time delay in making the correct diagnosis cause by such inconsistencies may worsen the prognosis of the disease in the patient.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Gender differences in dual bipolar disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.558 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S477-S478

Author(s):

G. Mateu-Codina ◽

R. Sauras-Quetcuti ◽

A. Farre-Martinez ◽

L. Galindo-Guarín ◽

J. Marti-Bonany ◽

...

Keyword(s):

Bipolar Disorder ◽

Borderline Personality ◽

Dually Diagnosed ◽

Sociodemographic Differences ◽

Co Morbidity ◽

Severity Scores ◽

Substance Abuse Disorders ◽

Dsm Iv ◽

Competing Interest ◽

Image Position

IntroductionWomen with bipolar disorder are more prone to psychiatric co-morbidity as anxiety, substance use disorders, eating disorders and borderline personality disorder. Nevertheless, substance abuse disorders as co-morbidity in bipolarity are higher in males than females.ObjectivesTo describe differential characteristics of patients admitted to a psychiatric unit referring to gender in a group of patients with bipolar disorder co-morbid with substances disorders (dually diagnosed patients).MethodsSociodemographic, clinical and administrative data of all patients diagnosed with bipolar admitted to a dual diagnosis during a 3-year period were collected. The psychiatric diagnosis was made according to DSM-IV-R criteria.ResultsFrom the whole sample (n = 66), males (84.8%) were prevalent. Mean age were 37.71 ± 11.7 and mean length of admission was 24.94 ± 17.9 days. Cannabis (34.8%) and cocaine (33.3%) were the most frequent SUD diagnosis and main reasons for admittance were conduct disorder (33.3%) and mania (25.8%).Women showed higher length of admission, higher severity scores at admission and greater reduction in severity scores along hospitalisation. No other clinical or sociodemographic differences were found comparing both groups of patients (Tables 1–4).ConclusionsWomen affected by dual bipolar disorder showed higher severity scores at admission but achieved better remission rates during hospitalisation.Table 1Demographic characteristics of both groups.Table 2Clinical and functional variables at admission in both groups.Table 3Historical data about age of drug use in both groups.Table 4Severity Scores for both groups of study.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Impulsivity and Brain Volume in Patients with Bipolar Disorder type I and Bipolar Disorder Type II

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.241 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S75-S75

Author(s):

D. Janiri ◽

G. Giuseppin ◽

E. Spinazzola ◽

M. Maggiora ◽

G. Sani

Keyword(s):

Bipolar Disorder ◽

Negative Relationship ◽

Statistical Parametric Mapping ◽

Angular Gyrus ◽

Type I ◽

Type Ii ◽

Brain Volumes ◽

Competing Interest ◽

The Right ◽

Disorder Type

IntroductionImpulsivity is a key feature of both bipolar disorder (BD) type I (BDI) and type II (BDII).ObjectiveStructural neuroimaging studies help clarifying brain mechanisms underpinning the regulation of impulsivity in BDI and BDII.AimsTo address the question whether grey matter (GM) alterations relate differently with impulsivity in BDI and BDII.MethodsWe assessed 54 euthymic outpatients, diagnosed with BDI (n = 28) or BDII (n = 26) according to DSM-IV-TR criteria. They underwent a 3 T magnetic resonance imaging (MRI) investigation. GM brain volumes were analyzed on a voxel-by-voxel basis using Statistical Parametric Mapping 8. The Barratt Impulsiveness Scale (BIS), version 11A, was used to assess trait impulsivity.ResultsBDI and BDII patients present an inverse relationship between impulsivity and GM volume in two cerebral areas: the right cerebellum (right crus I) and the interface between the left angular gyrus and the left inferior parietal cortex (Brodmann Area 39, 7, 40). More specifically, a negative relationship for BPI and a positive relationship for BPII were found in both areas.ConclusionsResults suggest that the different diagnosis between BDI and BDII could have a significant effect on GM changes according to impulsivity severity and point up the importance of considering the BP subtype distinction in neuroimaging studies on this topic.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Psychiatry 2017: Acknowledging Complexity While Avoiding Defeatism

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.014 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S1-S1

Author(s):

M. Maj

Keyword(s):

Bipolar Disorder ◽

Mental Disorders ◽

Psychiatric Research ◽

Psychiatric Diagnoses ◽

The Past ◽

Current Period ◽

Competing Interest ◽

Main Components

In the past few years, it has become a sort of cliché to state that psychiatry is in a crisis. In particular, it has been repeatedly argued that: (a) psychiatric diagnoses are invalid; (b) psychiatric research has not progressed significantly (in particular, it has not been able to identify “the cause” of schizophrenia, depression or bipolar disorder); (c) psychiatric treatments are of limited value, and their widespread use has not been able to reduce the incidence of mental disorders. This perception of crisis has been at least in part generated by an identification of mainstream psychiatry with the neo-kraepelinian paradigm, so that the crisis of confidence in that paradigm has expanded into a crisis of confidence in the psychiatric discipline. According to Kuhn, the crisis of confidence in a paradigm is accompanied by a period of “extraordinary science”, marked by a proliferation of competing methodologies, the proposition of a variety of divergent solutions for the problem defining the crisis, and the recourse to philosophy and to debate over fundamentals of the discipline. The crisis of confidence in the neo-kraepelinian paradigm has generated such a period, in which we are all now immersed. In this presentation, I will summarize the main components of the neo-kraepelinian paradigm; I will illustrate why that paradigm has failed, or at least has lost people's confidence; and will summarize the main elements which are emerging in the current period of “extraordinary science”.Disclosure of interestThe author has not supplied his declaration of competing interest.

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Severe behavioral disturbances in bipolar disorder: A case report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1141 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S329-S329

Author(s):

S. Benavente López ◽

N. Salgado Borrego ◽

M.I. de la Hera Cabero ◽

I. Oñoro Carrascal ◽

L. Flores ◽

...

Keyword(s):

Bipolar Disorder ◽

Case Report ◽

Psychiatric Patients ◽

Clinical Status ◽

Behavioral Disturbances ◽

Correct Treatment ◽

Affective Symptoms ◽

Competing Interest ◽

Disorder Type

IntroductionBehavioral disturbances are common in psychiatric patients. This symptom may be caused by several disorders and clinical status.Case reportWe report the case of a 40 year-old male who was diagnosed of nonspecific psychotic disorder, alcohol dependence, cannabis abuse and intellectual disability. The patient was admitted into a long-stay psychiatric unit because of behavioral disturbances consisted in aggressive in the context of a chronic psychosis consisted in delusions of reference and auditory pseudohallucinations. During his admission the patient received the diagnosis of bipolar disorder type 1, presenting more severe behavioral disturbances during these mood episodes. It was necessary to make diverse pharmacological changes to stabilize the mood of the patient. Finally, the treatment was modified and it was prescribed clozapine (25 mg/24 h), clotiapine (40 mg/8 h), levomepromazine (200 mg/24 h), topiramate (125 mg/12 h), clomipramine (150 mg/24 h) and clorazepate dipotassium (50 mg/24 h). With this treatment, the patient showed a considerable improvement of symptoms, presenting euthymic and without behavioral disturbances.DiscussionIn this case report, we present a patient with severe behavioral disturbances. The inclusion of bipolar disorder in the diagnosis of the patient was very important for the correct treatment and management, because of depressive and manic mood episodes the behavioral disturbances were exacerbated.ConclusionsPatients with behavioral disturbances could present psychotic and affective symptoms as cause of them. It is necessary to explore these symptoms and try different treatments to improve them.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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What about the hidden face of Akathisia?

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1203 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S688-S688 ◽

Cited By ~ 1

Author(s):

L. Jouin ◽

U. Ouali ◽

S. Ouanes ◽

R. Zaouche ◽

R. Jomli ◽

...

Keyword(s):

Bipolar Disorder ◽

Suicidal Ideation ◽

Social Impact ◽

Psychiatric Symptoms ◽

Total Dosage ◽

Drug Compliance ◽

Suicidal Attempts ◽

Mood Lability ◽

Competing Interest ◽

Barnes Akathisia Scale

IntroductionAkathisia is commonly known for its objective components such as rocking while standing or sitting and lifting feet. However, little is known about its psychiatric impact that can even lead to suicidal attempts.ObjectivesThe aim of this study is to investigate the main psychiatric symptoms associated with akathisia in a Tunisian sample of patients under treatment for Schizophrenia, Schizoaffective or Bipolar Disorder.MethodsFifteen patients were diagnosed with akathisia using the Barnes Akathisia Scale. Psychiatric symptoms related to akathisia such as mood lability, sadness, anxiety, aggressivity, suicidal ideation, insomnia and social and professional impairment were assessed.ResultsThe average age of the sample was 47 years. The average antipsychotic chlorpromazine-equivalent total dosage was 1756 mg. All patients reported at least one psychiatric symptom imputed to akathisia. These were: mood lability (n = 11), inner restlessness (n = 10), anxiety (n = 10), sadness (n = 10), aggressivity (n = 6), and insomnia (n = 12). Eight patients described suicidal ideation and five confessed having committed a suicide attempt. Four and ten said akathisia had professional and social impact respectively. The prevalence of psychiatric symptoms did not differ according to sex, age, diagnosis, illness duration, presence of a comorbid anxiety disorder, the number and types of antipsychotics used, the antipsychotic chlorpromazine-equivalent total dosage or the reported drug compliance.ConclusionsPsychiatric symptoms resulting from Akathisia remain frequently undetected. Special interest by the clinician is required to elicit these symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Temporal tumor as a cause of bipolar-like disorder?

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.538 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S471-S471

Author(s):

S. Domingues ◽

M. Cotter ◽

I. Amado ◽

R. Massano

Keyword(s):

Bipolar Disorder ◽

Psychiatric Symptoms ◽

Sudden Onset ◽

Psychomotor Agitation ◽

Temporal Epilepsy ◽

Co Morbidity ◽

History Of ◽

Competing Interest ◽

History Of Epilepsy ◽

Clinical Records

IntroductionThe relationship between brain tumours, temporal epilepsy and psychiatric symptoms are historically known.ObjectivesTo report a case of mania in a patient with previous diagnosis of bipolar disorder, temporal tumour and temporal epilepsy.MethodsClinical records. Research on PubMed, using “lateral temporal epilepsy” or “brain tumour” and “mania”.ResultsA 52 years old man was conducted to the emergency department by the police. He was found with psychomotor agitation at the Sanctuary of Fátima. He was apparently hyperthimic with flight of ideas. He had a history of epilepsy and temporal tumour and two previous manic episodes. It was assumed as a maniac episode.During inpatient evaluation, patient had memory for the occurrence. He described a sudden onset on the day before, after drinking wine. He described delirant atmosphere, persecutory and mystic delusional beliefs “this is the third secret of Fátima being revealed”, followed by ecstasy and psychomotor agitation. Remission was obtained in one week on psychotropics. MRI documented the lesion. Electroencephalography performed one month later revealed “slow waves.”ConclusionsOrganic causes should be excluded before consider a psychiatric disorder. The hypothesis of epilepsy-related psychosis or mania and other effects of a temporal tumour should be considered in etiology. However, co morbidity with bipolar disorder cannot be excluded.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Methamphetamine-induced choreoathetosis: A case report

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1780 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s881-s882 ◽

Cited By ~ 1

Author(s):

M.L. Turk ◽

J. Smith

Keyword(s):

Daily Basis ◽

Psychiatric Evaluation ◽

Poor Sleep ◽

Urine Drug Screen ◽

Compulsive Disorder ◽

The Past ◽

Normal Limits ◽

Patient Reported ◽

History Of ◽

Competing Interest

We describe the case of a 23-year-old male with a past psychiatric history of Obsessive Compulsive disorder, Generalized Anxiety Disorder, Cannabis Use Disorder, and a reported history of Bipolar II Disorder and ADHD, and no past medical history, who presented to the hospital for a psychiatric evaluation of erractic behavior. Per his family's report, the patient has not been attending to his activities of daily living and has had poor sleep and significant weight loss for the past month. In the days preceding his presentation, he has experienced worsening irritability and rapid speech, and has been responding to internal stimuli and displaying odd repetitive movements of his extremities. On interview, the patient reported non-compliance to his prescribed Lithium and Paroxetine for the past three months. He also noted recently smoking methamphtamine on a daily basis for the past month and intermittently abusing cannabis, benzodiazepines and cocaine. His urine drug screen was positive for cannabinoids and amphetamines and the rest of his medical workup was within normal limits. On physical exam, he exhibited involuntary writhing and twisting movements of his extremities. An atypical antipschotic was prescribed, after which his choreoathetotic movements resolved within 24 hours. The purpose of this poster is to highlight the possibility of developing chorea as a result of methamphetamine use, given the rarity of such cases, and to discuss whether the resolution of his neurological symptoms were a result of antipsychotic administration or were simply due to the natural course of methamphetamine discontinuation during hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Case study: Bipolar disease in treatment with asenapine

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1139 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S328-S329 ◽

Cited By ~ 1

Author(s):

A.M. Alvarez Montoya ◽

C. Diago Labrador ◽

T. Ruano Hernandez

Keyword(s):

Bipolar Disorder ◽

Adverse Effects ◽

Lithium Treatment ◽

Type I ◽

Toxic Substances ◽

Benign Intracranial Hypertension ◽

Adherence To Treatment ◽

Competing Interest ◽

Treatment Alternatives ◽

Disorder Type

ObjectivesAnalysis of the treatment alternatives for patients diagnosed with a bipolar disorder of torpid evolution. Revision of the possible adverse effects of lithium and its impact on the adherence to treatment.MethodsWe revise the clinical evolution of a patient diagnosed with Bipolar disorder type I, with the following characteristics: at least two maniac episodes per year, consumption of toxic substances and high sensibility to antipsychotics and euthymics.ResultsWe will describe the case of a 23-years-old patient diagnosed with bipolar disorder type I. During the course of the illness, benign intracranial hypertension is diagnosed and the treatment with lithium must be stopped. We replace lithium treatment by Asenapine monotherapy. The evolution of the patient was very positive. Taking account of the adverse effects of lithium and reducing them can facilitate the adherence to treatment and also benefit early remission and less deterioration in each episode.ConclusionsIt is fundamental to promote a comprehensive approach to each patient, including psychotherapy, psychoeducation as well as appropriate medication. The knowledge of the described effects helps us to determinate the appropriate medication for each patient.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Comparison of insight in bipolar disorder with and without co-morbid substance use disorders

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.523 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S466-S466

Author(s):

S. Ben Mustapha ◽

W. Homri ◽

L. Jouini ◽

R. Labbane

Keyword(s):

Bipolar Disorder ◽

Substance Use ◽

Substance Use Disorders ◽

Type I ◽

Need For Treatment ◽

Co Morbidity ◽

Significant Difference ◽

Competing Interest ◽

Bipolar Patients

AimsCompare the level of insight in bipolar disorder (BD) with and without substance use disorders (SUD).MethodsCase-control study during a period of six months from July 2015 to December 2015. One hundred euthymic patients with BD (type I, II or unspecified) were recruited in the department of psychiatry C Razi Hospital, during their follow-up. Two groups were individualized by the presence or not of SUD co-morbidity. We evaluated and compared insight with Birchwood IS scale (with its three sub-scales),ResultsThe mean age was 40.6 years (±16.4). The sex ratio was 2. Sixty-six percent of patients were diagnosed with bipolar disorder type 1 and type 2 bipolar disorder remains.There is no statistically significant difference between bipolar with and without SUD in terms of quality of insight.As for the subscales, bipolar patients with comorbid SUD had lower scores of awareness of any symptoms, whereas there was no significant difference regarding the awareness of illness and the need for treatment between the two populations.ConclusionsCo-morbid SUD can affect the quality of insight in individuals with BD. Patients with this co-morbidity should be targeted for intensive psycho-educational measures and psychotherapeutic interventions focused on the improvement of insight.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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