Othello syndrome, also known as morbid jealousy, pathological jealousy, and conjugal paranoia, is a rare delusional disorder related to partner’s infidelity. There are no large scale or comprehensive studies on delusional jealousy, and only few case reports and cases series leave delusional disorder jealous type (DDJT) largely unknown. Herein, we report a case of DDJT, its possible etiology and describe its characteristics, comorbidities, and interventions.

A 65-year-old married, retired, and disabled Caucasian male with a history of closed traumatic brain injury and chronic pain presented for outpatient care accompanied by his wife with a chief complaint of paranoid delusions. The patient was a car racer when he sustained over 25% total body surface area burns after his motor vehicle crashed at the speed of almost 160 mph. The patient was in a coma for more than nine weeks, coded three times, and was resuscitated each time. Per imaging, the patient suffered subarachnoid hemorrhage to the right outer parietal and left front parietal lobes. The patient developed chronic pain from the extensive burns and has been on opioids for many years until he gradually tapered himself off about six years ago. For the last couple of years, the patient has experienced cognitive decline associated with disorientation and memory deficit. The patient has been perseverative on his wife’s trip two years ago during which the patient believed that she had an affair with one of their mutual acquaintances. The patient denied visual or auditory hallucinations and continued to express his love and affection toward his wife. Although his wife has continually provided reassurance, and multiple family members confirmed her faithfulness, the patient had minimal insight into his delusion and expressed disappointment in loss of sexual intimacy between him and his wife. The patient has been prescribed duloxetine 60mg and trazodone 150mg, and his mood, anxiety, and sleep have been stable. The patient has also started taking pimozide 1mg nightly since beginning of this year with good response.

The DSM estimates the prevalence of DDJT to be less than 1%. At least a third of cases show neurological basis involving frontal lobe dysfunction associated with strokes, Parkinson’s disease, brain trauma and tumors, neurodegenerative disorder, encephalitis, multiple sclerosis, and even normal pressure hydrocephalus. Association with alcohol, amphetamine, cocaine, and dopamine therapy (pergolide, ropinirole, levodopa, amantadine, and pramipexole) were reported. Finally, DDJT is known to be a risk factor of violent crimes including homicide. Treatment with pimozide shows the strongest evidence, and most patients show improvement with any antipsychotic medication along with CBT. Continued research and further clinical trials are warranted for DDJT considering patients’ positive response to interventions, and because DDJT can become a dangerous condition in forensic situations.

Dopaminergic mechanisms are involved in addiction but few effective drugs have been developed to treat it. Recent research has highlighted dopamine D2 receptor partial agonists, like aripiprazole, as a potential treatment for different types of substance dependence. In this study we investigate the use of both oral or long-acting injectable (LAI) aripiprazole in the treatment of dual disorders, specifically focusing on patients with psychotic disorder and comorbid substance use disorder.

Retrospective mirror-image study was conducted at an adult psychiatry inpatient unit from a tertiary care center (Ramon y Cajal University Hospital, Madrid, Spain). Patients included were those with a comorbid psychotic disorder and substance-related disorders (excluding tobacco and caffeine), according to DSM-5 criteria, who started aripiprazole in 2017. The number of psychiatric acute inpatient admissions and psychiatric emergency room visits, six months before and after aripiprazole initiation, were obtained from patients’ records. Sociodemographic factors, average length of stay, antipsychotic polypharmacy, type of substance and change on clinical global impression (GCI) scale during hospitalization were also obtained. Data was analyzed using the IBM SPSS, v21. The Wilcoxon signed-rank test was used in the analysis.

11 patients were included; 7 (63.6%) were males, the mean age was 40.37 (SD:13.23) years and the average length of stay was 11.27 (SD:7.53) days. LAI aripiprazole was prescribed in 7 (63.6%) patients (all of them receiving 400mg monthly) and oral aripiprazole was prescribed in 4 (36.4%) patients (mean daily dose= 16.25mg; SD:10.30). Antipsychotic polypharmacy was observed in 6 (54.5%) patients: 4 with quetiapine (mean daily dose=75mg; SD:61.23), 1 with clotiapine 20mg daily and 1 olanzapine 15mg daily. There were 6 (54.5%) polysubstance users and the substances used were cannabis (63.7%), alcohol (36.4%), stimulants (27.3%), opioids (9.1%), hallucinogens (9.1%) and sedative-hypnotics (9.1%).

The mean of inpatient admissions before and after aripiprazole initiation was 1.00 (SD:1.00) and 0.18 (SD:0.60) (p=0.047). The mean of emergency room visits before and after aripiprazole initiation was 1.64 (SD:1.85) and 0.36 (SD:0.67) (p=0.026). With respect to CGI scale, the severity of illness score was 5.09 (SD:0.94) and the global improvement score was 2.00 (SD:0.63) (p=0.004).

These results suggest that aripiprazole could be an effective treatment in psychotic patients with comorbid substance use disorders. However, the results should be taken with caution due to some limitations in our study: a small sample, the short period of time studied, the retrospective design and the inherent biases associated with this type of research. Preliminary investigations on the topic and the results of our study allow clinicians to be optimistic about the use of D2 receptor partial agonist in the treatment of dual disorders.

Hyperammonaemia (HA) is observed in decompensated liver disease. The picture of hyperammonemic encephalopathy in non-cirrhotic patients was reported mostly associated with valproic acid. There are few reports of hyperammonemia in people living with human immunodeficiency virus (PLHIV) and they are associated with other comorbidities and few with antiretrovirals (HAART), but not as adverse drug reactions associated with psychotropic drugs associated with the virus.

Report of cases of PLHIV in HARRT with hyperammonemia, its clinical impact and ammonium levels.

We report 67 PLHIV in treatment with HAART, negative viral loads, psychopharmacological treatment with valproic acid (n=45) or carbamazepine (n=22). Exclusion criteria were = HCV, HBV and alcohol consumption disorder (current or recent history) and decompensated liver pathology. We apply scales to evaluate side effects (UKU), subjective adherence (DAI), daily life activities (Barthel Index), liver severity (Child-Pugh Classification) and degrees of hepatic encephalopathy (West Haven Scale). The ethical-legal requirements were met. Results: 26.86% presented hyperammonemia, among which 38.88% was symptomatic. The clinical presentation was heterogeneous with a higher prevalence of gastrointestinal and cognitive alterations; the most severe cases presented alterations of the sensorium and 1 case of convulsions. We recorded a greater symptomatic severity with carbamazepine (average ammonia =104.4 pmol/L), but a higher prevalence of non-symptomatic hyperammonemia with valproic acid (62.3 pmol/L). The time of onset of symptoms was lower with carbamazepine, but the time until its decrease was higher with valproic acid.

We observed a higher prevalence of hyperammonemia and associated symptomatology in PLHIV with HAART medicated with carbamazepine. The significant percentage of this adverse drug reaction suggests a biochemical, perhaps preventive, control.

OCD is common among kindergarten teachers, and environmental space design is considered an intervention measure that can have a positive impact on OCD patients. The aim of this study is to explore the intervention effect of kindergarten environmental space design on preschool teachers with obsessive-compulsive disorder.

The study selected classrooms of preschool teachers with OCD in several kindergartens as the research subjects and divided them into an experimental group and a control group. The classrooms in the experimental group underwent interventions in environmental space design. The control group’s classroom was arranged in a conventional manner. The study collected OCD scores and mental health questionnaire survey data from preschool teachers with OCD as research indicators and used SPSS22.0 statistical software for data processing and analysis.

In the experimental results, the OCD scores of preschool teacher patients in the experimental group were significantly reduced. The OCD score of preschool teacher patients in the experimental group decreased from the initial 32.6 to 24.1, while the OCD score of preschool teacher patients in the control group decreased from the initial 31.9 to 30.5.

The research results indicate that the design of kindergarten environmental space has a positive intervention effect on OCD preschool teacher patients. By providing comfortable seating and soothing colors, and providing natural lighting, environmental design measures can significantly reduce the OCD score of preschool teachers’ patients, which can help improve their mental health status.