Introduction
Approximately 15% of pregnant women suffer from a mental illness, however only half of them accept psychopharmacological treatment. One of the reasons for refusing treatment is the ...stigma attached to it.An important part of functional recovery is defining identity. This identity is multifactorial and is defined by several variables, one of them being gender.Several studies on motherhood in women with mental illness define the importance of a mothering identity, providing meaning and values. We present the case of a 39-year-old woman, mother of a two-year-old child, undergoing follow-up at a psychiatric clinic for recurrent depressive episodes and a history of two suicide attempts ten years ago. Currently stable in treatment with escitalopram 10 mg and lorazepam 1 mg if necessary.The woman refers the desire to abandon treatment after realizing that she is pregnant again. Therapeutic accompaniment is decided. The social worker from the obstetric service communicates with the psychiatric service to question the woman’s ability to care for a child with her psychiatric history.
Objectives
Determine the stigma of mental illness, including among healthcare workers.
Methods
The woman makes her decision with full judgment. The patient is accompanied during pregnancy without incident, with clinical stability.
Results
After delivery, the patient decides to resume psychopharmacological treatment.
Conclusions
Having a mental illness does not determine a woman’s ability to be a mother. As long as it is agreed with the psychiatrist, patients have the right to make decisions about their treatment.
Disclosure
No significant relationships.
Introduction
Neuroleptic malignant syndrome (NMS) is a rare syndrome observed in around 0.2% of psychiatric patients. This syndrome consists of the presentation of muscular rigidity, tachycardia, ...hyperpyrexia, leukocytosis and elevated levels of CPK. Any antipsychotic drug, including atypical ones, can cause this syndrome. This being an idiosyncratic response to dopamine receptor antagonist medications.
The use of ECT in patients suffering from NMS is very effective, seeing the progressive resolution of the picture in the first sessions.
Objectives
The patient was a 43-year-old man, whose somatic history only highlights hypothyroidism, and according to his psychiatric history, he was diagnosed of mental retardation and paranoid schizophrenia. He was a resident of a group home. And he was recently admitted to a mid-stay psychiatric unit. During this admission, the responsible doctor added haloperidol to his medication regimen. His other medications at the time were; valproic acid, risperidone and trazodone. A few days later, the patient began to present a dysthermic sensation (presenting a temperature of 39ºC) and drowsiness. A laboratory tests and a chest X-ray was performed, highlighting: leukocytosis and an increase in elevated creatine phosphokinase (CPK).
Due to his recent exposure to 2 different antipsychotics, with fever, rigidity, and elevated CPK, we considered NMS. Antipsychotics were withdrawn and supportive measures were started. Within the next 2 days, his CPK level began to decline and the fever and leukocytosis resolved. But without resolving muscle rigidity. At the same time, he began to exhibit staring, negativism and prejudice delusions. Therefore, electroconvulsive therapy sessions were started.
Methods
.
Results
After the third session, his catatonic symptoms increased to better; he became more verbal, with less negativism and the psychotic symptomatology ceased. After the fifth session of ECT, he returned to his initial level and was able to walk to the bathroom without assistance and perform other activities of daily living.
Conclusions
It is extremely important that professionals specialized in psychiatry become familiar with ECT and consider this technique as treatment in cases of neuroleptic malignant syndrome.
Disclosure of Interest
None Declared
Introduction
The Roma population constitutes the largest ethnic minority in Spain (more than 2% of the population), with our country having the third largest total population of Roma in the world. ...The concept of health and disease varies with the sociocultural context. It is important to know the cultural characteristics to exercise good clinical practice. The stigma surrounding mental illness is widely known, and is even stronger in the Roma community, leading to marginalization and shame.
Objectives
We present a case of a gypsy woman misdiagnosed from the age of 8 with hebephrenic schizophrenia.
Methods
Patient frequents the emergency department with symptoms of predominantly anxiety, including episodes of psychomotor agitation, self-harm, verbalization of visual hallucinations of a mystical-religious nature. In treatment with antipsychotics since diagnosis, with no therapeutic adherence. It is observed during all the episodes how the anxiolytic treatment, even, sometimes, the verbal restraint, make the symptoms subside. Psychotic symptoms over the years are ruled out.
Results
Due to the diagnosis, this patient has been relegated from the gypsy community, she has not married or had children (an important milestone in gypsy culture), this has generated an exponential increase in anxiety symptoms and home problems.
Conclusions
It is important to know the cultural traits to which the patients we treat in consultation belong, and how the disease can affect their lives, and a simple diagnosis can be a source of greater anxiety.
Disclosure of Interest
None Declared
IntroductionWe present the case of a 34-year-old female patient, 35 weeks pregnant and previously diagnosed with delusional disorder.ObjectivesSomatic personal history: NAMC. intrinsic asthma. ...Cutaneous psoriasis.Personal psychiatric history: In psychiatric follow-up since childhood, due to eating problems. Subsequently by adaptive pictures, with anxiety and dysfunctional personality traits intermittently. She resumes contact again in February 2017 presenting frank delusional clinic. Father diagnosed with schizophrenia.Personal data: 34-year-old woman, married, with a 6-year-old son.MethodsCurrent illness: The patient presents active delusional symptoms of about 3 years of evolution, she reports that she knows that there are people in her neighborhood who want to harm her and have guns with which they are constantly shooting to kill her "I hear the shots every day, I have the windows covered with metal plates and I cannot go out with my son, nor to the park, nor to do the shopping”. When she began the delusional symptoms, she was prescribed treatment with olanzapine without response, later with paliperidone palmitate, without response, and then with oral aripiprazole and depot 400mg once a month, with partial response. Prior to the current pregnancy, treatment with clozapine was considered, which the patient accepted but did not tolerate and had to be withdrawn.ResultsEvolution: The patient then remains in treatment with depot aripiprazole, with a partial response and less behavioral repercussion of the delusional content, but with a torpid evolution and tending to chronicity. During this course the patient accidentally becomes pregnant again. The doses of benzodiazepines that she was previously taking to control anxiety and sleep were lowered, maintaining treatment with depot aripiprazole, reducing the dose to 300mg monthly. The pregnancy has proceeded normally to date, with close controls by the gynecology service and monthly visits to psychiatry clinics.ConclusionsClinical judgment: Persistent delusional disorder.In this case, the need arises to maintain depot antipsychotic treatment in a patient with a severe mental disorder during pregnancy, given the serious consequences of delusional content on the patient’s functioning and thus be able to preserve stability at this level during pregnancy.Disclosure of InterestNone Declared
Introduction
Regarding the diagnosis of schizophrenia, a peak of onset of symptoms is considered at 25 years. The debut after 60 years is considered late onset and is rare, generating controversies ...in the diagnosis
Objectives
We present the case of a 58-year-old patient with no personal or family history of mental health, who came to the emergency room for the first time, reporting feeling in danger. He comments itching on his skin, verbalizing seeing bugs running through it, relating this phenomenon to “witchcraft by my brothers”, he also refers to feeling like “they watch my thoughts and block it through a mobile application, they enter through my eye right and this gives me less vision and a headache. He also refers to having the ability to listen to how his brothers talk about how they are going to “hurt me.” Psychopathologically, we highlight that she is oriented in the three spheres, presenting delusional ideation with an experience of harm, a phenomenon of thought theft and auditory and tactile hallucinations.
Methods
Analytical and imaging tests, as well as toxins in urine, were negative.
Results
Diagnosis of psychotic episode is made to see evolution. The clinic partially yields to treatment with atypical antipsychotics. At this time, the patient has no awareness of the disease.
Conclusions
Despite being a diagnosis that is scarcely prevalent, once organic disease has been ruled out.
Disclosure of Interest
None Declared
Introduction
Numerous studies establish clear connections between traumatic childhood experiences and the risk of developing psychosis. According to the study carried out by Filippo Varese, childhood ...traumas, understanding by; physical, psychological or sexual abuse, abandonment, death of the parent and “bullying”, increase up to three times the risk of suffering from psychosis.
Objectives
-
Determine the prevalence of traumatic events in the sample studied.
-
Determine which traumatic event has a greater relationship with the risk of presenting a psychotic episode.
-
To determine whether traumatic events may be more strongly associated or not with gender differences, age at onset and family story.
Methods
A descriptive study is carried out in which the traumatic events are evaluated (through the CAVE questionnaire) of 98 patients who have been treated for a psychotic episode in the last two years in the Early Intervention Unit for Psychosis (ITPCan).
The stressful life history questionnaire (CAVE) consists of 52 questions divided into blocks: school stage, work, partner, family, health and other stressful events. All of them focused on those stressful events prior to the onset of psychotic symptoms. Stressful events have been considered to be those events in which the patients studied have scored 10 (maximum score) on the anxiety scale.
Inclusion criteria:
-
Older than 18 years-old
-
Having presented a first psychotic episode.
Exclusion criteria:
-
Intellectual disabilities
Results
For now, the data studied in this sample are similar to those described in most of the studies reviewed: more than half of the patients present at least one traumatic event before the onset of psychotic symptoms and a third of these have had any traumatic experience before the age of 18.
The percentage of the presence of at least one traumatic event within the categories of the CAVE questionnaire would be:
14.2% in the school stage
26.7% in the workplace
26% in relationships
24.3% in family relationships
12.1% in events related to the patient’s own health problems
Conclusions
We continue to increase the sample to have a more significant result.
Disclosure of Interest
None Declared
Introduction
We present the case of a 69-year-old patient who went to the emergency department due to an episode of aggressiveness and behavioral alteration, presenting irritability and nervousness, ...of about 2 days of evolution according to her family member. Given that the patient had previously presented chronic behavioral disorders and had previously been followed up in psychiatric consultations, psychiatry was notified after an initial evaluation by the emergency physician.
Objectives
Somatic personal history: NAMC. HTA. Not DM, not DL. Former smoker of 20 cigarettes/day. Recurrent intracranial hemorrhage secondary to amyloid angiopathy and suspected amyloid vasculitis. Last admission to the neurology service in June 2022, also presenting symptomatic epileptic seizures and secondary behavioral alterations. Mastocytosis. Post-traumatic vertebral fracture. Non-anticoagulated paroxysmal atrial fibrillation. Surgical: Left ear surgery. appendectomy. Hysterectomy + oophorectomy.
Personal psychiatric history: In follow-up since May 2021 referred from neurology for emotional lability, episodes of anger and fear. Diagnosed with anxiety-depressive disorder secondary to a medical illness.
Current psychiatric treatment: Oxcarbazepine 800mg 0-0-1, trazodone 100mg 0-0-1, aripiprazole 10mg 1-0-0.
Methods
Current illness: The patient goes to the emergency room brought by her husband. During the interview she minimizes her aggressive behaviors or even does not remember them. She is disoriented in time, with very striking memory failures. Her husband comments verbal aggressiveness if he contradicts her in something, sometimes even presenting physical aggressiveness with her relatives. They report that in the last psychiatric consultation a little over 1 month ago, aripiprazole was withdrawn due to an increased risk of cardiovascular events.
After the examination of the patient, she was referred back to the emergency department for a new assessment and to rule out the organicity of the current condition, given that the patient had cardiovascular risk factors, due to the suspicion of a new episode of intracranial hemorrhage.
Results
sychopathological examination: Vigil, conscious, disoriented in time, partially in space. Collaborative, calm during the interview. Coherent, structured speech, with obvious memory failures. Labile, irritable mood. Verbal and physical heteroaggressiveness at home, not during the interview. No structured or planned autolytic ideation at this time. Appetite and sleep preserved.
Conclusions
An urgent head CT was requested, with the result of a small intraparenchymal bleeding in the left frontal location, and she was admitted to the neurology department, with a diagnosis at discharge of: small left frontal haematoma, suspected amyloid vasculitis, and secondary behavioral alteration (vascular dementia).
Disclosure of Interest
None Declared
Folie à deux, about a case Palomo Monge, M.; Tascón Guerra, M.F.; Pérez Fominaya, M. ...
European psychiatry,
06/2022, Letnik:
65, Številka:
S1
Journal Article
Recenzirano
Odprti dostop
Introduction
First described in France by Lasègue and Falret as the presence of the same psychiatric symptom in 2 individuals. It involves the transference of delusional ideas from a “primary” ...affected individual to one or more “secondaries,” in close association.
Objectives
We present the case of a patient, diagnosed with schizophrenia, who, after several years of evolution, and after a relapse, comes accompanied by his mother, who recently began to present the same delusional symptoms that the patient reported previously.
Methods
After several pharmacological adjustments, control of the patient’s symptoms is achieved and it is he himself who is able to identify the symptoms that his mother presents, allowing her to also attend and be treated.
Results
Induced delusional disorder F.24
Conclusions
Among the variants that the folie a deux encompasses (folie imposée, folie communiquée, folie simultenée, folie induite) in this case we are probably talking about a folie communiquée, given the resistance over time of the patient’s mother until the symptoms develop. It is important to know these syndromes to be able to make a clear diagnosis, and depending on the way of onset and evolution, to be able to distinguish between the different subtypes, in order to avoid future complications and guide the corresponding treatment.
Disclosure
No significant relationships.
Introduction
Patients with severe mental disease have a considerably shorter lifespan than the general population. The majority of psychiatric drugs are metabolized by the liver. Cytochromes play a ...central role, interactions between drugs are expected. Neuroleptics are frequently associated with weight gain, steatosis development, elevation of liver enzymes and rare acute cytolytic hepatitis, particularly with clozapine and olanzapine. Mood stabilizers, like Valproate classically gives mitochondrial steatosis with potentially important damages, and also possible acute liver failure.
Objectives
This case presents a 56-year-old patient, previously diagnosed of schizoaffective disorder, with chronic psychotic symptoms that showed high drug resistance. She had been treated in the past with most common antipsychotic drugs with no clinical response. While being in treatment with valproate and olanzapine, she was started on clozapine while olanzapine removed. Two weeks later she developed Acute Pharmacologic Hepatitis with mild liver failure.
Methods
Physical examination was normal. Mental exam revealed presence of delusion. Blood tests showed: hyperbilirubinemia and mil coagulopathy. Clozapine dose was reduced and valproate was suspended.
Results
The patient showed a substantial improvement of hepatic damage. Delusions are active after 12 weeks of treatment with clozapine.
Conclusions
Psychiatric disorders and liver illnesses are entangled in multiple ways. Screening for liver diseases is essential in order to prevent liver complications in patients receiving psychotropic medications. Further investigation of combinations of agents such as mood stabilizers and atypical antipsychotics may yield valuable insights into the potential of combination therapies to enhance clinical outcomes in patients with Severe Mental Disease.
Disclosure
No significant relationships.
Introduction
Despite the efficacy of antipsychotics, up to about 30% of schizophrenia patients do not respond adequately to treatment and are called treatment-resistant schizophrenia (TRS) patients. ...The treatment of choice in these patients is clozapine, which is used last due to the adverse effects it can cause. However, it has been shown that half of TRSs are also resistant to clozapine, leading to ultra-resistant schizophrenia.
Objectives
We present a clinical case corresponding to a 33-year-old man, single, residing in a community residence, undergoing psychiatric follow-up from the age of 7, receiving during this period the diagnoses of schizotypal personality disorder and paranoid schizophrenia.
Methods
As of 2015, he began to make autolytic attempts, the last being this year, 2021. Moment in which he manifests for the first time presenting imperative, sporadic auditory pseudo-hallucinations, which incite self-harm. These sensory-perceptual alterations appeared from 2015, together with the worsening of the negative symptoms.
Results
The patient has been treated with numerous antipsychotics, without complete remission, so since 2019 treatment with Clozapine 200mg was started. As the symptoms did not subside, the dose was increased to 400mg, at which point some of its side effects began to appear; urinary incontinence, sedation, sexual impotence … so the patient abandoned the treatment, suffering a relapse of his mental pathology.
Conclusions
Despite the arrival of atypical antipsychotics, it remains a challenge that there is a complete remission of symptoms in some patients with schizophrenia, for which we consider that psychopharmacological research in this group of patients is of the utmost importance.
Disclosure
No significant relationships.
