Ekbom syndrome in a visually impaired patient with alcohol abuse and OCD: A case report

This is a case report of a 63-year-old patient with no previous attentions in mental health. He is referred by his general practitioner because he presents wounds all over his body. He reports that there is a plague of bugs at his place that bite him everywhere. Therefore, he scratches continuously, trying to remove the stingers, and injuring himself all over. The family ensures there are no bugs at all, but the patient threatens to set fire to the house in order to extinguish the plague or even kill himself. An OCD with cleaning compulsive behavior was also present since many years, as well as an alcohol abuse. The patient required hospitalization in the psychiatry service. Organic cause for the disorder was discarded. Long-acting injectable aripiprazol was introduced and the patient stopped drinking. Progressively, the delusional symptoms began to subside. Now he maintains no awareness of illness but he says the bugs are disappearing and, at least, they do not bite him anymore.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Cerebellar atrophy supporting diagnosis of alcohol dependence: A case report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1063 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S311-S311

Author(s):

F. Pavez Reyes ◽

M. Sánchez ◽

E. Moral ◽

M. Terradillos ◽

N. López ◽

...

Keyword(s):

Case Report ◽

Alcohol Dependence ◽

Cerebellar Atrophy ◽

Clinical Suspicion ◽

Gamma Glutamyl Transferase ◽

The Family ◽

Other Information ◽

Diagnostic Hypothesis ◽

Competing Interest ◽

Glutamyl Transferase

Chronic use of alcohol is a known cause of cerebellar atrophy. This finding could be a valuable diagnosis support when there are not other information sources. In this case report, we describe a 65-year-old male patient who was referred from primary care to specialized consultation because a depressive syndrome it was unresponsive to treatment with desvenlafaxine and lorazepam. In psychopathological exploration we found overvalued ideas of suffering some kind of injury and damage by the family, which oriented the diagnostic hypothesis of delusional disorder with secondary mood symptoms, although the clinical suspicion of abuse of alcohol was proposed as a differential diagnosis. The continuing minimization and denial of consumption by the patient as well as their reluctance to incorporate an external informant made that the workup was a key element to elucidate the diagnosis. We found a discrete increase in transaminases, gamma glutamyl transferase and alkaline phosphatase. Magnetic resonance imaging showed cerebellar atrophy (vermian and, in a lesser extent, in both hemispheres). Once the patient was confronted with these results, he agreed to disclose his problem, which fulfilled alcohol dependence criteria. After that, he accepted to initiate treatment and detoxification in a specialized unity.ConclusionsAlthough psychiatric diagnosis is based on the clinical features and the exclusion of associated medical conditions, in this case the workup provided support to our clinical suspicion, favouring recognition of the problem and willingness to treatment by the patient.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Folie à Deux: Shared or “Infected” Madness? About a Case Report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1959 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S529-S530

Author(s):

M.Á. Soriano ◽

C. Garcia

Keyword(s):

Mental Health ◽

Mental Health Center ◽

Psychiatric Condition ◽

Psychotic Experience ◽

Environmental Features ◽

The Family ◽

Folie À Deux ◽

Delusional System ◽

Competing Interest ◽

Folie A Deux

The shared madness or Folie à deux was described in France in the nineteenth century by Charles Lasage and Pierre Falret, as a condition where a person (the primary) builds a delusional system, sharing it with another (the secondary), who must be very close to the first affected, becoming delirious with the same subject. Several theories attempt to explain the phenomenon that challenges theories of personality structures, rooted in relational and/or environmental features of psychosis. Theoretically, there are many attempts to classify this psychotic experien in some manuals they distinguish various types of partners: the simultaneous psychosis, where the two people start to became delirious at once; imposed psychosis, in which the disorder arises first with one, then going on to “healthy” individual and symptomatology disappears after being separated; and communicated psychosis, where the first transmitted the psychotic experience to the second, and he or she develops his or her own delusion not interrupted even while separated. Other classifications about shared madness not only between two people, but three, and four, even a whole family show us how complicated the delirium systems can become. In our paper, we will discuss the different theories explaining this rare psychiatric condition based on a case about two brothers of 35 and 37, who live together with the rest of the family, and also come together to the same mental health center, although with different psychiatrists.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Paliperidone palmitate: Experience in a community mental health unit

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1556 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s804-s805

Author(s):

L. Carrión Expósito ◽

G.M. Chauca Chauca ◽

E.L. Guadalupe

Keyword(s):

Mental Health ◽

Retrospective Study ◽

Maintenance Dose ◽

Lower Number ◽

Paliperidone Palmitate ◽

Health Unit ◽

Dose Number ◽

Competing Interest ◽

Long Acting ◽

Mental Health Unit

IntroductionThere are many jobs that offer advantages of treatment with long-acting injectable in psychosis.ObjectiveTo know the changes in the different variables after the start of paliperidone palmitate (PP).Material and methodWe performed a descriptive and retrospective study. Were evaluated patients who received maintenance therapy with PP during 48 months.ResultsThe sample was composed of 29 patients: 72.4% men and 27.6% women. Average age of 46.21 years. In Figures 1, 2 and 3 show data obtained in relation to compliance with treatment, relapse, maintenance dose, number of admissions and visits to emergency departments respectively.ConclusionsThe administration of PP is associated with a higher level of compliance with treatment. The patients presented a lower number of relapses, hospitalizations and visits to the emergency room. The maintenance dose more used is 150 mg.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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A mirror image study of the utility of long acting aripiprazole

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.640 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s252-s252

Author(s):

R. Hodgson ◽

C. Aladakatti ◽

N. Kataria ◽

T. Saravanappa ◽

D. Brittany

Keyword(s):

Mental Health ◽

First Generation ◽

Time Frame ◽

Blood Parameters ◽

Mirror Image ◽

Image Study ◽

Intention To Treat ◽

Competing Interest ◽

Long Acting ◽

The Uk

Aims and backgroundAblify Maintena (AM) is a long acting injection of aripiprazole that received marketing authorisation in the UK in January 2014. It is costly compared to first generation antipsychotics (FGAs) LAIs and there are no robust trials comparing AM with FGAs. We examined the effectiveness and use of AM in a mental health trust.MethodsWe identified all patients prescribed AM in North Staffordshire (population: 470,000) since launch and examined records for demography, diagnosis, bed and medication use. We examined the effectiveness of AM using a mirror image design.ResultsThirty patients received AM in a time frame allowing a 1-year follow-up. Sixty-nine percent were male and the mean age was 39 years. Over half were detained under the 1983 Mental Health Act and 30% were inpatients on a psychiatric intensive care unit when AM was started. Twenty-eight patients had a psychotic diagnosis. There was a significant reduction in bed occupancy (63 v 6 days, P = 0.0001) and admissions (1.6 v 0.5, P = 0.0001). The median dose was 400 mg. Lack of effectiveness/poor adherence with prior treatments were the main reason for starting AM in 84%. Eighty-six percent of patients clinically improved on AM. Blood parameters were in the normal range.DiscussionWithin the limitations of the methodology, our results show a reduction in psychiatric bed use in the year following AM initiation on an intention to treat basis. The reduction in bed use equates to a minimum annual saving of £14,250 per patient. AM at the median study dose costs £2645 per year.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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A pharmacologic option to reduce hospital admissions and relapses of patients with severe mental illness

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1404 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S753-S753

Author(s):

N. Gomez-Coronado ◽

P. Blanco ◽

I. Martinez

Keyword(s):

Mental Health ◽

Hospital Admissions ◽

Descriptive Analysis ◽

Psychotic Episode ◽

Anti Psychotic ◽

Before And After ◽

Previously Treated ◽

Competing Interest ◽

One Year ◽

Long Acting

IntroductionSome diseases relapses involve functional impairment that sometimes takes years to recover. We present our experience using long-acting aripiprazole as maintenance therapy in patients diagnosed with psychotic episode, acute mania (bipolar disorder) or personality disorder, who were previously treated with another anti-psychotic.AimsAnalyze what treatment were they taking before aripiprazole depot. Determine the number of hospital admissions and relapses before and after long-acting aripiprazole treatment.MethodsDescriptive analysis based on a sample of 37 patients, aged 18–65 years, treated during one year with anti-psychotics at two community mental health units.ResultsReduction of hospitalization average: 0.59/year with non-long-acting-aripiprazol anti-psychotic, 0.18/year with long-acting aripiprazol (66.6%).ConclusionLong-acting aripiprazole appears to reduce the number of hospitalizations and relapses compared to other anti-psychotics. However, the sample size is small and more studies are needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Long-acting injectable aripiprazole. Clinical experience in a case series

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2296 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S614-S614

Author(s):

J.M. Hernández Sánchez ◽

M.C. Cancino Botello ◽

M.F. Molina López ◽

D. Peña Serrano ◽

M. Machado Vera

Keyword(s):

Mental Health ◽

Health Center ◽

Mental Health Center ◽

Case Series ◽

Antipsychotic Agent ◽

Clinical History ◽

Concomitant Treatment ◽

Patient Profile ◽

Competing Interest ◽

Long Acting

IntroductionThe use of long-acting injectable antipsychotics is useful in patients with low therapeutic compliance.ObjectiveTo present the demographic and clinical data of a case series in which long-acting injectable aripiprazole has been prescribed in an ambulatory Mental Health Center.MethodsSystematic review of the related literature and clinical history of patients in which long-acting injectable aripiprazole had been prescribed from January to March 2015 in a Mental Health Center.ResultsWe found 10 patients, whose diagnosis were schizophrenia (4), non-specified psychosis (2), personality disorder (1), bipolar disorder (1), schizoaffective disorder (2), of whom 7 were men and 3 women, with a mean age of 43.8 years old. The mean of years since diagnosis was 15.1 years. In 7 patients, we found concomitant treatment with another antipsychotic agent (low dose quetiapine in all of them); antidepressants in 1 patient, benzodiazepines in 6; mood stabiliser in 5 and biperidene in 1. In relation to previous antipsychotic drugs, we found: aripiprazole 15 mg/day oral (4); long-acting injectable paliperdidone 150 mg/28 days (2) paliperdone 6 mg/day oral (1); combination of paliperidone 6 mg/day oral plus olanzapine 5 mg/day oral (1). Only 4 patients had used long-acting injectable drugs previously in their lifetime. The reason of having initiated treatment with long-acting injectable aripiprazole was sexual disturbance (3); lack of compliance (4); clinical inestability (2) and motor side effects (1).ConclusionsIn our series, we can observe a chronic patient profile, predominantly men with diagnosis of psychotic spectrum.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Early Signs of Crisis in the Perception of Users and their Family

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1518 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s791-s792

Author(s):

G. Fucci ◽

N. Ratti ◽

R. Ignarra

Keyword(s):

Mental Health ◽

Health Center ◽

Management Practice ◽

Mental Health Center ◽

Educational Activity ◽

Early Signs ◽

The Family ◽

Competing Interest ◽

The Individual ◽

The City

The identification of the early signs of crisis is globally considered one of the fundamental elements in the illness management practice of the psychiatric user. For this reason the mental health center of the city of Ravenna wanted to offer a personalized questionnaire to a 15 random-selected users and their families, with the aim of evaluating and analyzing the alarm signals in the participant's perception. The questionnaire has been created on the basis of other tests in the literature. It is divided in two parts, a “symptomatic”, related to the early signs of crisis, and an “environmental”, focalized on the potentially stressing situations for the individual. The administration took place within the individual and the family talks at the center. This project was implemented not only as a psycho-educational activity for the users and their family's, but also to amplify the knowledge of the staff on these signs. The results have shown how often there are points of difference in the perceptions of the early signs of crisis of the users and their families and it is believed this could turn out to be an important factor to be worked on within the projects of psycho-education of the mental health center.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Effective doses of paliperidone palmitate (PAP): Retrospective analysis from three years of treatment

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1996 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S540-S540

Author(s):

S. Galiano Rus ◽

A. Soler Iborte ◽

C. Quesada González

Keyword(s):

Mental Health ◽

Clinical Practice ◽

Hospital Admissions ◽

Average Length ◽

Average Hospital ◽

Icd 10 ◽

Effective Doses ◽

Technical Specifications ◽

Competing Interest ◽

Long Acting

IntroductionThe use of PAP is already much extended in general. The recommended doses in the technical specifications of the drugs, as the result of trial studies, differ from the doses administered in habitual clinical practice. Therefore, the justification of this study is to monitor the average doses prescribed, to be able to reach an agreement on the best doses. To retrospectively analyze the first 32 patients in our area of healthcare, who were prescribed PAP, the doses used at the start of treatment and after 3 years.Materials and methodsTwo initial doses of PAP were analyzed, maximum and current (outpatient) in 32 patients attended in the area of mental health of North Jaen, who started the treatment with PAP between 2012 and 2013, with an average length of time of 2.55 years (SD 2.02). We evaluated the diagnosis (schizophrenia and related disorders, ICD-10 F20), the number of hospital admissions previous and posterior to the start of the treatment and change in weight.ResultsAverage doses: initial: 110.15 mg (SD 32.83), maximum: 165.51 mg (SD 29.76) and maintenance: 146.81 mg (SD 29.59). Average hospital admissions: prior and posterior to the start of treatment: 1.5 and 0.83. An average reduction of 44.06% in admissions was observed.ConclusionsThe data obtained suggests that a dose of 75–200 mg could be effective in the maintenance of patients with schizophrenia and for decreasing the number of new hospital admissions. Fifty percent of the cases can be compensated with long acting peliperidone as a monotherapy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Effects of switching antipsychotics in 80 outpatients: A descriptive analysis from a mental health community

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.275 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S332-S332

Author(s):

R. Medina Blanco ◽

R. Martín Gutiérrez ◽

M.J. Cuesta Nuñez ◽

D. Sierra Biddle ◽

P. Suárez Pinilla

Keyword(s):

Mental Health ◽

Gender Differences ◽

Behavioral Disorders ◽

Descriptive Analysis ◽

Health Clinic ◽

Final Treatment ◽

Before And After ◽

Competing Interest ◽

Long Acting ◽

Gender Groups

IntroductionIn the general practice, psychiatrists widely prescribe antipsychotics for several conditions as schizophrenia, bipolar disorder and behavioral disorders among others.Aim and objectivesThe aim of this study is to describe the clinical and sociodemographic features of typical patients receiving antipsychotics and their effects after switching to long-acting treatment.MethodsA descriptive analysis of 80 outpatients collected from a mental health clinic in Santander (Spain) was performed. All patients were taking antipsychotics at baseline, both oral and intramuscular, and were switched to a different long-acting antipsychotic drug.ResultsAt baseline, 24 patients were taking oral medication and 56 intramuscular. There were 37 females and 43 males. There were no gender differences in the final treatment, but Palmitate Paliperidone (71.3%) was the most prescribed drug, followed by intramuscular risperidone (16.3%) and long-acting aripiprazole (11.3%). We found gender differences regarding cannabis (P = 0.002), alcohol (P = 0.004) and tobacco (P = 0.043) consumption, being their use more common in males. In regard to diagnosis, schizophrenia was predominant in both gender groups, whereas delusional and behavioral disorders were more frequent in females. There were no significant differences in the reason of switching, but the inefficacy was more common in males and the side effects in females. At the switching, females were significantly older than males (P = 0.003). We found significant differences before and after switching regarding the number of admissions, emergency visits and length of stay.ConclusionsAntipsychotic benefits are individual and unpredictable. When switching, some other different factors should be taking in account, not only regarding medication.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Drug prescriptions associated with long acting. Pharmaco-economic aspects

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1422 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S759-S759

Author(s):

A. Riolo ◽

F. Babici ◽

F. Tassi

Keyword(s):

Mental Health ◽

Mental Health Center ◽

Unit Price ◽

Economic Aspects ◽

Adherence To Treatment ◽

Controversial Subject ◽

Economic Profile ◽

Competing Interest ◽

Long Acting ◽

Interaction Between Drugs

IntroductionThe polypharmacy is a very controversial subject; it brings together problems of interaction between drugs, side effects, and rationality of co-prescriptions, pharmaco-economic aspects. The long acting is useful to solve adherence to treatment but they are often prescribed in polytherapy.MethodThe aim of this studies is to compare long-acting haloperidol, fluphenazine, risperidone and paliperidone regard to prescribing associations and pharmaco-economy. Also we want to consider for each long-acting which and how many drugs are associated and the implications in terms of pharmaco-economics. We examined all prescriptions (126 patients) over a period of 12 months in a mental health center, identifying which long acting had the best pharmaco-economic profile.ResultsDespite being the less prescribed and not being associated with other psychiatric drugs, paliperidone palmitate shows the best pharmaco-economic profile.ConclusionsThe costs of a drug are in relationship not only with unit price but also with the question of safety in order to oppose the overmedication.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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