Patients with Polycystic ovary syndrome (PCOS) have increased vulnerability to psychiatric disorders, particularly a tendency to depression and anxiety, as well as schizophrenia. The association between PCOS and psychiatric disorders is a topic of research given the possibility of common potential mechanisms as well as the clinical similarity between the adverse effects of atypical antipsychotics and the symptoms of PCOS.

We proposed to investigate the etiopathogenic relationship between schizophrenia and PCOS as well as the therapeutic particularities.

We report a case of schizophrenia occurring in a patient with PCOS. Then, we conducted a literature review using “PubMed” database and keywords “psychosis”, “schizophrenia”, “Polycystic ovary syndrome” and “antipsychotic drugs”.

She was an 18-year-old patient, diagnosed with PCOS since 2018. She has been followed in the psychiatry outpatient department since 8 months for psychotic symptoms (hallucinatory syndrome with thoughts of self-aggressiveness, delusional syndrome with mental automatism…). She was prescribed olanzapine (5 then 10 mg/day). However, after a weight gain (4 kg per month), this drug was switched by Risperidone (2 then 4 mg/day). The evolution was marked by the appearance of galactorrhea. Thus, the Risperidone was switched to Aripiprazole. Then, we noted a significant improvement on the psychiatric features and a better clinical tolerance.

For women with PCOS and psychosis, treatment with antipsychotic drugs can worsen PCOS symptomatology and lead to negative consequences for a woman’s reproductive potential and her quality of life. Therefore, the psychosis management must take these particularities into account, in order to improve the prognosis of both diseases.

No significant relationships.

The authors presents an overview of the schools of learning in the area of modern psychosomatic medicine.

The author presents different variants for the concept of disease in psychosomatics.

Groddeck was of the opinion that illness was a “creative endeavour”. Adler speaks of the will to be ill. Schulz Henke found that there are “gaps” where one would expect “normal life coping”. Heraclitus said the character of the human is his fate. In psychosomatic medicine, we must focus attention on the character failings. Viktor von Weizäcker spoke of the revolving door principle. Gebsattel concentrated on the inhibition in becoming. Arthur Jores described psychosomatic disorders as human illnesses. Humans become sick when they find themselves in a “dead-end-street of destiny”. They lose their core of being. Günther Ammon describes the psychosomatic reaction as the expression of a disturbed interaction process and advocates the psychoanalytical group therapy in the treatment of psychosomatic illnesses.

In psychosomatics one looks for a special personality type or for a special trigger situation. One asks about the childhood anamnesis and the biography, about the characteristic drives and the character problems for the respective illness.Those who have lost their core of being can regain it through self-education and self-reflection. However, a “core of being” must be present.

Depending on the illness, character and social environment, it can happen that a patient “learns to express his wishes and fantasies, needs and sensitivities through his respective physical symptoms and complaints.

No significant relationships.

Numerous clinical and epidemiological studies show an increased prevalence of anxiety disorders, including obsessive-compulsive disorder, in subjects followed for bipolar disorder. This comorbidity is not without consequence on the evolutionary course of the mood disorder, with frequent relapse, a lower pharmacological sensitivity and an increased risk of suicide.

We aim to analyze through a clinical observation and according to the data of the literature the place of ECT in the management of a bipolar disorder with comorbid OCD.

In this work, we reported a case of a patient in which depressive episodes of bipolar disorder and OCD comorbidity were present and the symptoms were resolved using ECT.

Mrs. TN with family history of suicide had experienced her first depressive episode in 2005 in post-partum, when she had 31 years old. The diagnosis of bipolar disorder II with comorbid OCD was retained after she has had several depressive relapses with few hypomanic ones and reported obsessive suicidal ideation with many religious compulsions. Despite several pharmacotherapeutic combinations (Teralithe, Olanzapine and Venlafaxine) a remission of the symptoms could only be obtained after 15 sessions of ECT that she has had in 2017.

ECT can be a very good substitute for the treatment of mood disorders with comorbid OCD resistant to pharmacotherapy.

No significant relationships.

The only available genome-wide study (Minelli et al., 2018) indicated an association between the neglect CT and MED22, a transcriptional factor gene.

To verify how the dysregulation of MED22 could be affected by environmental and genetic factors, we carried out an analysis on these components and a longitudinal study concerning the effect of trauma-focused psychotherapy in MDD patients that experienced CT.

On a large mRNA sequencing dataset including 368 MDD patients we computed the genetic (GReX) and the environmental (EReX) components affecting gene expression in relation to CT. Furthermore, we measured the expression of MED22 in 22 MDD patients treated with trauma-focused psychotherapy.

The dissection of MED22 expression profiles revealed an association of neglect with environmental and genetic components (p=6x10-3 p=2.6x10-4). Furthermore, in an independent cohort of 177 controls, we also observed a significant association between cis-eSNPs of MED22 and higher neuroticism scores (best p-value: 0.00848) that are usually associated with a decreased amount of resilience to stress events. Finally, the results of psychotherapy revealed a reduction of depressive symptomatology (p<0.001) and 73% of patients resulted responders at the follow-up visit. MED22 expression during psychotherapy showed a change trend (p=0.057) with an interaction effect with response (p=0.035). Responder and non-responder patients showed MED22 expression differences at different trauma-focused psychotherapy timepoints (p=0.15; p=0.012) and at the follow-up (p=0.021).

Our results provide insights suggesting that some biological and clinical consequences of CT depend on genetic background and environmental factors that could induce vulnerability or resilience to stressful life events.

No significant relationships.

Acute and chronic exposure to cannabis have been associated with neurocognitive deficits in executive function, including inhibitory control processes.

To research memory deficiency in the young consumers of cannabis in Tunisia.

this is a transversal descriptive study conducted during two months (January and February 2020). The research involved about 137 participants in the emergency department at the university hospital of Mahdia

In our study population, there was a noticeable male predominance of 71%. Hence, the age structure ranged between 18 years old and 35 years old. Among the latters, 65.9% were single, and 29.7% experienced school failure. In this sample, 23.2% had a psychiatric history. The average age of the first use of cannabis was between 18 and 25 years old in 70% of cases. Besides, a high percentage of association of other substances was found among cannabis users as follows: use of tobacco 74.6%, alcohol 72.5% ecstasy 41.3%, and cocaine 25.4%. The use of cannabis was considered as a means of indulgence for 66.7% of the study population, as an anxiolytic for 26.8%, and as a sedative for 23.9%. Additionally, the effect of cannabis use on working memory deficiency according to the functional impact assessment scale was: no deficiency in 19% of cannabis users, minimal in 34%, mild in 32%, moderate in 9%, fairly severe in 4%, very severe in 1%, and extreme in1% of cases.

The assumption of the effect of cannabis on memory and cognitive deficiency remains controversial and leads us to suggest further in-depth study of this subject.

No significant relationships.

At present, the mental health of members in international Buddhist organizations is often damaged by decontextualized concepts and misleading meditation training. As the treatment of resulting mental diseases presents therapeutic challenges, currently diagnostic and related therapeutic considerations are crucial.

Since subjects predominantly reported having received several diagnoses, with depression, anxiety disorder, and post-traumatic stress disorder being the most frequently assigned, a diagnostic assessment device was employed for further differentiation.

The questionnaire SCL-90 was used to evaluate the nine dimensions: interpersonal sensitivity, depression, anxiety, paranoid ideation, psychoticism, somatization, obsessive-compulsive disorder, hostility and phobic anxiety.

In a pilot group of eight German-speaking subjects of different Buddhist groups the general psychological burden (GSI) was significantly elevated in six of them. However, the intensity of responses in precisely those two individuals in whom it was not increased was far below the norm (PSDI). Furthermore, seven of the subjects had an above-average number of symptoms indicating burden (PST). All of them showed a heightened level of interpersonal sensitivity and for most of the subjects anxiety, depression, paranoid ideation and psychoticism were above the mean value of the norm group.

As for psychiatric treatment and psychotherapy, extended research with a larger group of such subjects and at the beginning of their treatment is crucial. Particularly, hypotheses on the causes of their social insecurity, depressivity, paranoid thinking as well as psychoticism based on the distorted concepts and neologisms these persons were exposed to (e.g. ‘karma-purification’) as well as their ways of ‘meditation-training’ seems to hold core relevance.

This research was funded by the German Federal Ministry of Education and Research, funding reference number: 01UL1823X.

Compared to the general population, people living with schizophrenia spectrum disorders (SSD) are more likely to perpetrate acts of violence. When this happens, family members (informal carers) are most commonly the victims. However, family violence by people with SSD is often a taboo topic and largely neglected within public discourse, research, and clinical domains. Consequently, our understanding of families’ experiences and support needs are limited.

To develop a detailed understanding of the subjective experiences, and impact, of patient violence towards family carers.

Individual semi-structured interviews were held with family carers of adults with SSD and a history of violence perpetration towards their family carer. Interview data were subject to thematic analyses using NVivo software.

Twenty-one UK based carers that were predominately White British (90%) and female (81%) were interviewed. Key themes highlight the range of physical and mental injuries endured by carers following patient violence, and speak to carers’ experiences of suffering, living in a constant state of hypervigilance, as well as social isolation in the context of shame, stigma, and an absence of professional and informal support.

Family violence by people living with SSD can and does happen. Yet, too often, carers are left with no option but to continue supporting their relative in the absence of support, even in contexts where this compromises their own safety. The devastating impact of violence is far-reaching, across all levels of the family-system. The findings highlight the danger of neglecting family violence by people with SSD in research and clinical fields.

No significant relationships.

We present the case of a 21 year-old male, with history of a psychotic episode, currently with monthly follow-up in an outpatient facility, with a favorable clinical evolution after one year of intensive follow-up. In the context of abandonment of his medication and a problematic family situation, the patient starts to show suspicious, with insomnia and a progressive social isolation. Despite an attempt of ambulatory treatment with oral aripiprazole, showing good tolerance, the patient refuses such treatment, showing active clinical psychotic with great distress and behavioral repercussion, finally requiring hospital admission.

To perform a literature review about the treatment initiation with two vials of aripiprazole long-acting injection.

Literature review of scientific articles using Pubmed as search engine. We considered articles published both in English and Spanish.

During hospital stay, treatment with 2 intramuscular injections of 400mg of aripiprazole is started, combined with a single dose of oral aripiprazole 20mg on day 1, assuring correct dosing, with good tolerance and favoring therapeutic adherence. Progressively, the patient starts to feel calmer, adequate, collaborative and emotionally stable, recuperating chronobiological rhythms, with remission of the hallucinations and appearing more distant from delusions.

According to the currently available studies, the use of this posology could avoid the potential impact that lack of adherence to oral treatment could have in the therapeutic outcome, assuring a correct dosing and favoring adherence from day 1. Furthermore, this would help simplify the medication regiment for patients, physicians and caregivers.

No significant relationships.

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis commonly begins with a prodromal phase characterized by flu-like symptoms, subsequently the patients experience a rapid deterioration with psychiatric symptoms that may include anxiety, irritability, insomnia, paranoia, aggression, auditory or visual hallucinations, sexual disinhibition, mania, cognitive disorder, and psychosis; seizures; motor and autonomic dysfunction. The triggers of the disorder comprise viral infections, tumors, and other unknown factors. Taking in count the prominence of psychiatric symptoms, it is relevant to rise the question whether patients with anti-NMDA receptor encephalitis are being misdiagnosed with psychiatric disorders.

Non-systematic literature review of the relationship between anti-NMDA receptor encephalitis and psychiatric disorders.

From the review performed, 2 studies stand out: In one study, 459 serum samples for NMDA receptor antibodies were evaluated. The analysis compared samples from patients diagnosed with schizophrenia, major depressive disorder, and borderline personality disorder with nonpsychiatric controls. In another study, serum was obtained prospectively from a cohort (n = 46) of patients at first presentation of psychosis and NMDA receptor antibodies were measured.

In the first study, the authors found that 9.9%, 2.8%, and 0% of patients with schizophrenia, major depressive disorder, and borderline personality disorder, respectively, were antibody positive. In the second study, it was found that 7% of the patients were serum NMDA receptor antibody positive.

It is unclear yet if patients with primary psychotic disorders have higher rates of pathogenic NMDA receptor antibodies. More evidence is needed to study this relationship.

No significant relationships.

Ziprasidone is an atypical antipsychotic that has demonstrated efficacy for the treatment of bipolar disorder and schizophrenia. There is some preliminary evidence for Ziprasidone use in children and adolescents with several open label studies and some randomized control trials, therefore it is advantageous to understand where Ziprasidone lies in the treatment algorithm of children and adolescents.

The aim of our study is to examine the efficacy and tolerability of Ziprasidone in children and adolescents.

We conducted a literature search consisting of open label or randomized control trials (RCT) that report on Ziprasidone use in children on the PubMed database. We found 13 studies (11 open label and 2 RCT) that met our inclusion criteria. Our outcome measures included efficacy measures such as BPRS, YMRS, CGI-S and adverse effects such as weight gain, increase in BMI, QTc prolongation, sedation, dizziness and EPS.

Data from thirteen studies was meta-analyzed (Total n= 560, mean age=13.16 years, male= 70.35% that reported the use of Ziprasidone in children and adolescents. We found that Ziprasidone was efficacious in children and adolescents in measures of BPRS (-13.493, p<0.05), YMRS (-14.225, p<0.05), CGI-S (-1.430, p<0.05). In measures of adverse effects, Ziprasidone was not found to cause any significant weight gain (0.164, p>0.05) or change in BMI (-0.159, p>0.05). QTc prolongation was found to be significant (13.122, p<0.05).

Ziprasidone is an efficacious in children and adolescent population. It does not cause significant weight gain, however QTc prolongation and sedation were found to be the most significant side effects .

No significant relationships.

The exponential increase of the older segment of the population (1) is coinciding with the growing challenges of a digital society in different socio-cultural contexts (2).

This exploratory study aims to analyze older adult perspectives of how smart technology influenced their meaning in life during the Covid-19 Public Health Emergency period, using qualitative research at a cross-national level.

Three hundred and fifty one community-dwelling older participants aged 65-87 years were included in the study. Participants were Italian, Mexican, Portuguese and Spanish. All the narratives went through a process of content analysis.

Findings of content analysis produced six themes: Meaningful relations, rewarding activities, spirituality, health and safety-related support, self-growth, and physical activity. Smart technology was important in promoting significant relations for Mexican older adults (71.3%), rewarding activities for Portuguese older adults (57.1%), spirituality for Spanish older participants (71.6%), and physical activity for Italian older adults (29.5%).

This study indicated that smart technology during the Health Emergency period was important for the meaning in life of older populations, mostly by facilitating meaningful relations, rewarding activities and spirituality. Future interventions with older adults during pandemic periods should consider the diversity of themes associated with increasing older adult well-being, from a cross-cultural perspective. 1. von Humboldt S & Leal I. The old and the oldest old: Do they have different perspectives on adjustment to aging?. Int J Gerontol; 9:156-160. 2. von Humboldt S et al. Does spirituality really matter? - A study on the potential of spirituality to older adult’s adjustment to aging. Jpn Psychol Res, 56;114-125.

No significant relationships.

Cancer survivors frequently report suffering from neurocognitive impairment, that persists after physical recovery from their disease. Cognitive impairment is associated with important emotional disturbances, socio-professional consequences and diminished quality of life.

This observational study aims to assess the effectives of an integrative neurocognitive remediation therapy (iNRCT), offered as a 12-week program (1day/week), organized within our Cognitive Remediation Clinic. The iNCRT combines personalized computerized cognitive training and neurocognitive strategy training, with group sessions of physical exercise, mindfulness, and cognitive behavior therapy (CBT).

The assessment before and after NCRT includes neuropsychological testing (10 subtests), assessment of daily functioning and subjective neurocognitive function (NCF).

Out of 16 eligible cancer survivors, 12 patients were recruited and 11 completed the iNCRT; median age 53 years [range, 41-71]; 3 patients had a prior history of a central nervous system tumor, 5 patients of breast cancer, 2 patients of stage-IV melanoma, and 1 patient of gastric cancer. After iNCRT subjective NCF did not improve significantly (p=0.13) according to the Cognitive Failure Questionnaire. However neuropsychological assessment revealed an improvement on ≥ 1 impaired subtest in all patients; 6 patients improved on ≥ 4 impaired subtests. Improvement was most prominent in long-term verbal and visual memory, working memory and executive function. All patients reported a clinical benefit in their daily function after completion of iNCRT.

Our iNRCT, which combines personalized neurocognitive training with physical exercise, mindfulness and CBT can be an effective therapeutic model for treating neurocognitive impairment in cancer survivors, with a clinically relevant impact on their daily function.

No significant relationships.

No significant relationships.

For older adults, feeling subjectively younger is associated with improvements in cognition, subjective well-being and depressive symptoms. Positive psychiatry is the field that focuses on patient strengths and the promotion of positive outcomes, rather than just mitigation of illness. Younger subjective age may be a useful measure of successful aging, but little is known about how subjective age is associated with positive psychosocial characteristics.

Our objective is to characterize how subjective age is related validated positive psychosocial measures, with the goal of better understanding the determinants of successful aging.

The Successful Aging Evaluation (SAGE) longitudinal study recruited over 1,300 community-dwelling residents of San Diego County, CA, from age 21 to over 100. A single-item question asked “How old/young do you feel?” We used spearman correlations to assess the relationship between subjective age and validated positive psychosocial scales such as the Self-Rated Successful Aging, Life Orientation Test, Personal Mastery Scale, Connor-Davidson Resilience Scale, Satisfaction with Life Scale, Adult Hope Scale, and Social Support Index.

Mean chronological age was 65.5, and mean subjective age was 53.6. Mean age discrepancy was 11.5 years. Younger subjective age was positively associated with most of the positive psychosocial characteristics measured, including self-rated successful aging, optimism, personal mastery, resilience, curiosity, hope, and social support.

There is a growing movement within psychiatry to understand the positive characteristics that lead to successful aging. This is one of the first studies demonstrating younger age identities are associated with positive psychosocial characteristics and successful aging.

No significant relationships.

Esketamine is a novel antidepressant approved by the FDA in 2019 in the form of an intranasal spray, recommended for Treatment-Resistant Depression (TRD). The intranasal spray system appears to be more manageable than intravenous ketamine infusion. It contains ketamine’s S- isomer which is four-fold more potent for the NMDA receptor.

The aim of this case series is to describe our clinical experience in the use of Esketamine.

6 TRD patients (3 men; 3 women) were recruited in San Raffaele Turro Hospital from March 2021. All patients (2 bipolar and 4 unipolar) were diagnosed with a Major Depressive Episode according to DSM-5 criteria, resistant to at least two antidepressants. Initially, Esketamine was administrated twice weekly for one month; afterward, it was administrated once weekly for a month; finally, it was administrated once weekly or every two weeks for a month. Clinical scales (HAM-D, YMRS, SSI, HAM-A, MADRS, CADSS) were administrated to assess symptoms and sides effects before and after each administration on a weekly basis.

Three patients out of six showed an improvement in depressive symptoms: two patients had remission (final HAM-D score < 8); one patient had a clinical response (final HAM-D score < 50 % respect baseline value). Three patients withdrew the treatment: two for perceived inefficacy, after 16 and 19 administrations, one for personal reasons.

The use of Esketamine in our TRD patients showed good effectiveness and tolerability but randomized controlled clinical trials are needed to confirm our findings.

No significant relationships.

Depression is associated with a high risk of suicidal thoughts (ST) and behaviour (SB). Suicidality and depression have partially shared genetic underpinnings and family history of mood disorders (FH) can reflect genetic impact on specific features of depression. Thus, in depressed patients, FH may affect suicidality and its associations with other risk factors, such as personality traits.

We conducted a cross-sectional study to test the impact of FH on the association between suicidality and personality traits in depressed patients.

200 depression in- and outpatients (64% (n=128) women, mean age (M(SD):36,21(15,09)) were enrolled. 28% (n=56) reported FH (“FH+” cohort), other patients comprised the “FH-” cohort. Columbia-Suicide Severity Rating Scale (C-SSRS) was used to assess ST and SB during the most suicidal period of life. Personality traits were assessed by Cloninger Temperament and Character Inventory (TCI-125). Information about FH and history of suicide attempts (SA) was obtained during the clinical interview.

Personality traits and suicidality characteristics (ST, SB, SA) did not differ between FH+ and FH- patients. In FH+, no differences in TCI-125 scores between suicide attempters and non-attempters were found, while in FH-, attempters had higher scores of TCI-125 “Novelty seeking” (p=0.002) and “Self-transcendence” (p=0.031) subscales. Multiple correlations between ST, SB and TCI-125 subscales were found only in FH-, In FH+, only one correlation (between ST and TCI-125 “Persistence” subscale (r=-0.288, p=0.038) was found.

Our results showed a weakened association between personality traits and suicidality in depressed patients with FH of mood disorders, although more data on larger samples are needed.

The study was supported by RSF grant # 20-15-00132

The infection caused by the SARS-CoV-2 virus called COVID-19 may affect not only the respiratory system but also the central nervous system (CNS). Delirium is a frequent and serious condition in COVID-19 patients and may be caused by the direct invasion of the CNS or the induction of CNS inflammatory mediators or by indirect effects due to the systemic inflammatory status, other organ failure, prolonged mechanical ventilation time, immobilization but also social isolation. We aim to critically review literature reporting this syndrome in patients infected by the SARS-CoV-2 virus with a particular emphasis on reported clinical, laboratorial and neuroimaging findings. Methods: A state-of-the-art literature review was performed using PubMed, Embase and Web of Knowledge using the following keywords: delirium, COVID-19, SARS-Cov-2, neuroimaging, laboratorial findings. Results: More than 50% of patients with COVID-19 may present with delirium and in about 20% of the cases this is the primary presentation of the disorder. Previous data suggests that these patients may show a higher frequency of certain symptoms such as agitation, myoclonus, abulia, and alogia. Some distinct neuroinflammatory syndromes have been identified in patients presenting with delirium associated with the virus, namely, autoimmune encephalitis, Acute Disseminated Encephalomyelitis (ADEM) and stroke showing its potential for CNS involvement. Many of these patients present normal brain imaging, EEG and CSF findings but others have more specific laboratorial changes such as elevated creatinine kinase, elevated D-dimer levels, abnormal coagulation parameters and positive SARS-Cov-2 PCR in CSF or meningeal enhancement, ischemic stroke and perfusion changes in MRI imaging.

No significant relationships.

It is important to determine those clinical factors that imply a greater risk of rehospitalization in psychotic patients

To determine the rate and predictors of rehospitalization in psychotic patients after their first hospitalization

We include all Psychotic patients admitted for first time in their life in our Psychiatric Unit between 2009 and 2019 (N=359) , including all diagnosed according DSM-IV of Schizophrenia or other Psychotic disorders -Multiple clinical, sociodemographic and biological variables of the basal hospitalization were recorded With the SPSS program we compared the variables between patients who needed any hospitalization in the follow-up until 31th December 2019 and those who do not. We use the Chi square ( qualitative variables) and the Student T ( quantitative variables)

109 psychotic inpatients had at least one rehospitalizations (30,4%). The qualitative variables significantly associated with rehospitalization were : cannabis in urine at admission (P<0.03), and treatment with risperidone (P<0.014). Instead treatment with long acting paliperidone was associated with absence of rehospitalization (P<0.005) .The quantitative variables relationed significantly with multiple rehospitalization were : lower age (P<0,015) lower HDL cholesterol levels (P<0.02) and higher years of follow-up after discharge (P<0.000)

1-More of 30% of psychotic patients need rehospitalization after their first hospitalization in a mean of follow up of 5,8 years 2-Lower age, longer follow-up period and treatment with risperidone are significantly associated with rehospitalization , instead treatment with long acting paliperidone are significantly associated with absence of rehospitalization

No significant relationships.

Autoimmune encephalitis are inflammatory diseases of the CNS mediated by antibodies that attack neurotransmitter receptors or proteins on the surface of neurons, usually in the limbic system. The clinic is different according to the antineuronal Ac involved.

To make a correct differential diagnosis between autoimmune encephalitis and primary psychiatric pathologies that may be similar in symptoms through a complete study of the patient including anamnesis, physical examination, imaging tests, cerebrospinal fluid and serum studies.

Description of a clinical case. A 31-year-old female patient, with no previous history of interest, was brought to the emergency department for a suspected seizure. The previous days she had presented emotional lability, difficulty in concentration and reading, blurred vision, confusion and hemicranial headache. Two days later she returned to the emergency room for insomnia, dysarthria, difficulty in reading, comprehension, naming, and excessive rumination of her problems. Incoherent and repetitive language. The Emergency service requested to rule out a conversive disorder.

Neuropsychiatric manifestations (anxiety, depression, behavioral disturbances, insomnia, memory deficits, psychomotor agitation, mania, auditory and visual hallucinations, delusions) are the first symptom in 70% of autoimmune encephalitis due to anti-NMDA antibodies and usually respond poorly to psychiatric treatment, making the treatment of the primary cause necessary for the remission of these symptoms.

Given their increasing recognition and prevalence, autoimmune causes should always be taken into account in behavioral changes, cognitive or consciousness impairment of subacute installation, especially in young patients and once infectious, metabolic and vascular causes have been ruled out with an appropriate complementary study.

No significant relationships.

Acute mania can have behavioral effects such as agitation, being a frequent cause of presentation in the emergency department. Pharmacological treatments include mood stabilizers and atypical antipsychotics. Valproate is an effective drug. However, the intravenous formulation is relegated to other pathologies, such as epilepsy.

The objective was to review the use of intravenous valproate in acute mania in the literature and present its use through a clinical case.

A clinical case using intravenous valproate to treat an episode of acute mania is described and the scientific literature of the last 5 years is reviewed.

A 43-year-old patient attended the emergency department with a diagnosis of bipolar disorder type I in manic episode with agitation, rejection of oral medication, brought in by the police due to risk of aggression against family members, who reported that the patient had stopped taking her usual medication with valproate 500 mg / 24h and quetiapine 200 mg / 24h threemonths ago. Due to the possibility of having intravenous valproate, it was decided to administer 300 mg intravenously, as well as haloperidol 5 mg intravenously, and hospitalization was decided. The patient had a favorable evolution, with no side effects to the medication, and oral treatment was started after 8 hours, with a good response. In the literature there are few studies in this regard, although the most of them approved the use of valproate as a loading dose in acute mania.

Intravenous valproate is an effective, safe, and tolerated treatment in acute mania. More studies are needed to collect precise information.

No significant relationships.