Psychotic disorder is defined as a loss of contact with reality. Those who suffer from it perceive an altered reality, assuming it to be true.This feeling of unreality generates nervousness, anguish, hypervigilance and even social and emotional isolation.

We present the case of a 18-year-old woman who attended the Emergency Department accompanied by the director of her college due to behavioral alterations. The patient reports that since she has moved to Salamanca to study,she has the feeling that her father has hired spies, one of them being her classmate, being able to hear sounds and voices, which she defines as motivating her to go on with her life. She reports that she is in a lower mood in this context and that there have been some days when she has not been able to attend class.

The objectives are to study the severity of the psychotic disorder in a young patient subjected to an episode of stress and to observe the reaction of the patient when it has been properly treated.

We carry out a review of the clinical history of a 18-year-old female patient with psychotic disorder, admitted to the Psychiatric Brief Hospitalization Unit (PBHU) in Salamanca.

The patient was treated with Risperidone 2mg/24h. After a few days in the PBHU, total disappearance of the psychotic symptoms was observed and the patient is completely self-critical. Once she was discharged, it was decided that she should return home with her parents for several months and continue treatment with Aripiprazole and Sertraline.

Occasionaly, there are ethical dilemmas about beginning to treat young patients with psychotic ideas derived from external situations. Optimal treatment including drugs, psychotherapy and family support are essential. According to the scientific literature,a greater involvement in diagnosis,treatment and follow-up is recommended in patients with psychotic symptomatology derived from stress.

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The occurrence of psychotic symptoms induced by dopaminergic drugs marks a new phase in the course of Parkinson’s disease (PD). The term drug induced psychosis may be used when other significant psychiatric diseases are excluded in patients with no history of psychosis. The prevalence of dopaminomimetic psychosis varies from 5% to 20%. Therefore, knowledge of the psychopharmacological management of this condition is essential.

The purpose of this case report and literature review is to to learn the psychopharmacological management of this not uncommon medical complication.

Descriptive case study and review of literature

We present the case of a 71-year-old man with a medical history of Parkinson’s disease with partial response to treatment with high doses of levodopa and carbidopa.

He was brought to the emergency department by his family due to the presence of behavioural alterations at home.

The patient reported seeing men in foam trying to harm his family. In a disjointed way in his speech, he links this idea with the delusional belief that he is being watched by electronic devices placed throughout the house. In a variegated manner he links this with a coelotypical type of discourse, however the delusional ideation remains unstructured throughout.

With no previous personal or family history of mental health and ruling out underlying organic conditions, a diagnosis of psychosis secondary to pharmacological treatment for Parkinson’s disease is presumed.

Considering the risks and benefits, it was decided to maintain the anti-Parkinson’s dose in order to avoid worsening the patient’s motor function. Therefore, after reviewing the literature, the best option was to introduce clozapine at low doses, up to 50 mg at night, with the respective analytical control. After a week’s admission, the patient began to improve psychopathologically, achieving an ad integrum resolution of the psychotic symptoms.

Despite the availability of other antipsychotic treatments such as quetiapine or the more recent pimavanserin, clozapine remains the treatment of choice for drug-induced psychosis in Parkinson’s disease.

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Schizophrenia is a multifactorial and multifarious disorder with an unidentified etiology and pathogenesis, various clinical symptoms, unpredictable course and definite social significance. It’s social significance manifests in the long inability to work, the decrement of qualification and the burdening of family and social services. Patients find following therapy difficult; they often stop it altogether, which leads to new exacerbations and maintaining a vicious cycle.

To present an analysis of the results of the treatment of patients with LAIs – Trevicta and Xeplion in General Psychiatry Ward of UMBAL "Dr. Georgi Stranski” - Pleven for the period October 2016 – October 2022.

Our retrospective research includes 17 patients treated in General Psychiatry Ward of UMBAL “Dr. Georgi Stranski”- Pleven. A treatment with LAI’s – Trevicta and Xeplion (Paliperidone palmitate) had been initiated in these patients. In consideration of the correct applications of the medication, they are always made by qualified personnel who received training for that purpose in the Ward. For assessment of the patients’ condition are used: Positive and Negative Syndrome Scale (PANSS) and Personal Social Performance (PSP). Standard statistic methods are used for processing results.

Our research includes 17 female patients as the Ward’s profile is such, with the average age of 38.65 years at the initiation of the treatment with Xeplion. Some were later introduced to Trevicta. Of all who participated in the research, 12 patients continue their treatment with regular applications, 2 have changed their address and by unreliable data still continue their treatment and for the other 3 we have no information of their status of treatment. The average count of admissions in the Ward before the initiation of treatment with LAI’s is 3.88 against 0.88 after the initiation. Regarding the PANSS scale – all score in the interval 75-100 points before initiation as opposed to the scores marked after the initiation of the medication that vary in the interval 34-48 points with definite distinctions in P and G items. Regarding the PSP scale – all participants score between 50 and 70 points before the initiation of the treatment as opposed to the scores of 89-95 points after the initiation. During the regular check-ups the patients report of subjective improvement, coupled with reports of objective and positive improvement by family.

Treatment with LAIs – Xeplion and Trevicta has an unquestionable positive and lasting effect in the treatment of schizophrenia. Proof of that is the definite improvement of the symptoms, the increased social engagement and interpersonal communication. Everything mentioned is a valid reason to direct the treatment of schizophrenia in the direction of preservation of the personality of the patients.

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CT of the endocranium is an indispensable step in the differential-diagnostic evaluation of a patient with the first episode of psychotic disorder. In this context, the main goal of this diagnostic procedure is to “exclude” the so-called organic disorders of the brain tissue, which could be manifested by psychotic phenomenology. However, during the past decades, pathological changes in the brain parenchyma have been found during neuroimaging studies of psychiatric patients.

With the group of schizophrenic psychoses, the following are most often associated: Expansion of the ventricular system, cortical reductive changes, agenesis of the corpus callosum, a higher frequency of some congenital anomalies of the brain, such as cavum septum pellucidum and cavum verga.

Consequently, the main goal of our study is to demonstrate the possibility of diagnosing these changes and examine the frequency of cases of so-called secondary psychotic syndromes, where psychotic phenomenology arose on the basis of some other illness.

Data were collected for 145 patients from the Acute Male Department, who were treated in the period 2011-2019. CT scan of the endocranium was performed as part of the diagnostic evaluation during the first psychiatric hospitalization.

Out of the total number of examinations (145), 20.7% of patients had a pathological finding, with the following structure: In 6.9% of the age group up to 45 years, moderately expressed (disproportionate for the age) cortical reductive changes were found. Concomitant occurrence of cavum septi pellucid et cavum vergae was observed in 3.4% and isolated septum pellucidum cyst in 1.3% of patients. Post-stroke changes, post-contusion foci, and benign congenital brain tumors were found with a frequency of 1.3%, pronounced cortical reductive changes and pathological calcifications with a frequency of 3%, while in individual cases (0.68%) the presence of a subarachnoid cyst and atrophy of the cerebellar cortex was recorded

CT of the endocranium represents a significant aid in the evaluation of a patient with the first episode of psychotic disorder. However, its use in order to analyze more complex changes in psychiatric patients is significantly limited compared to more modern neuroimaging modalities.

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GnRh agonists are drugs used in various gynecological pathologies, among which is endometriosis. They act by stimulating GnRh receptors in the pituitary gland. This sustained and continuous stimulation of GnRh, will initially generate an increase in the release of luteinizing hormones and follicle-stimulating hormones, subsequently losing sensitivity to the receptors, internalizing them, and thus suppressing the release of these hormones, which would entail an ovarian suppression, thereby inhibiting the release of estrogens and progesterone. Psychiatric adverse effects have been described. Gonzalez-Rodriguez et al (Front Psychiatry 2020; 11:479), described this association with changes in mood, and the presence of a series of cases where the link between GnRh agonist and the possibility of presenting psychotic symptoms is observed. Wieck (Curr Top Behav Neurosci 2011;8:173-87), Frokjaer (J Neurosci Res 2020;98(7):1283-1292), Brzezinski-Sinai et al (Front Psychiatry 2020;11:693) reported that this association could be related with the relationship of the hypothalamic-pituitary-gonadal axis, hormonal fluctuation and its relationship with the dopaminergic regulation, a genetic component that would increase the predisposition to trigger psychiatric pathology in patients with greater sensitivity to hormonal fluctuations, and the loss of neuroprotection generated by the decrease of estrogens in the central nervous system. All of this in the context of multiple environmental and genetic factors that participate together in the appearance of the disease.

To describe the importance of detecting the risk factors that can precipitate a psychotic episode, including the use of certain drugs, such as GnRh agonists.

We describe a case of a 45 year old patient with endometriosis with multiple organ involvement who went to the emergency room due to behavioral changes in the context of a brief psychotic disorder with “ad-integrum” recovery.

A retrospective analysis of the case is conducted, observing an association between the introduction of GnRh agonists and the presentation of a first psychotic episode.

The importance of this case lies in the limited evidence of this association in the literature, and the implication of these drugs in the triggering of psychiatric pathology, being an aspect to be considered by psychiatrists in their patient’s follow-up.

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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.

• - 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.

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

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

We continue to increase the sample to have a more significant result.

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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.

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.

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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.

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.

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The association between insight, stigma and self-concept has been considered as a potential predictor of poor clinical outcomes and global functioning in psychosis. In patients with delusional disorder (DD), the effects of stigma and self-stigma have been poorly explored.

Our main goal was to systematically review studies addressing stigma and self-stigma in DD to assess whether these phenomena have an impact on clinical symptoms.

A systematic review was conducted through PubMed and Google Scholar databases from inception to 2022 (PRISMA guidelines). Search terms: (Stigma OR self-stigma) AND (“delusional disorder” OR psychosis OR paranoia). Studies were considered eligible if they included patients with DD.

A total of 875 records were retrieved, from which 18 were included.

Stigma: (1) Stigma is associated with poor quality of life, poor adherence to medications and acceptation of diagnosis. (2) Support at workplaces would improve stigma and discrimination in DD. (3) Poor interpersonal competence may increase stigma experience in DD.

Self-stigma: (1) Women show higher level of self-stigma than men. (2) Higher rates of psychiatric hospitalizations and higher severity of symptoms associated with greater degree of self-stigma. (3) Suicidal ideation was associated with negative self-schema but not self-stigma, particularly in patients with persecutory delusions. (4) Self-stigmatization negatively associated with quality of life. (5) Depressive symptoms associated with higher levels of self-stigma. (6) Promotion interventions should address self-stigma content.

Further longitudinal studies are needed to test the influence of stigma and self-stigma on adherence to follow-up and specific interventions to improve them.

None Declared

Improving outcomes in schizophrenia generally involves an improvement in drug adherence. Aripiprazole two-injection start (TIS) is the newest option of available on the market, with limited data on its effects.

It was our goal to evaluate whether TIS has an effect on hospitalization rates, persistence and adverse events in patients with schizophrenia.

This 12-months cross-sectional study included 32 patients suffering from schizophrenia (mean age 33.6 years; 22 males). We collected sociodemographic data on all individuals, hospitalization rates, persistence, use of neuroleptic drugs as well as adverse events.

Before starting TIS, the mean in terms of number of hospitalizations was 5.6, emergency department visits 8.7 and hospitalization days 12. After TIS, hospitalization rates was 22%, persistence 81%, adverse events were present in 3% of the patients and only 9% needed concomitant treatment with neuroleptic drugs.

The findings imply that TIS should be considered a first-line treatment choice for schizophrenic patients. It results in a decrease in the use of hospital services, which might ease the socioeconomic healthcare burden.

None Declared

The First Episode Psychosis (FEP) Inpatient Unit is specialized in early assessment/intervention in patients with Psychotic Disorders. Duration of Untreated Psychosis/DUP has a key role in the prognosis of those patients. Longer DUP is associated with poorer treatment response and greater risk of relapse. Some studies also suggest an association between DUP and the severity of negative symptoms, but further research is needed.

The objectives of this study were to analyze the relationship between DUP and psychotic symptoms, duration of admission, medication, and quality of life, after inpatient intervention.

This is a retrospective study of a cohort (N=25) admitted to the unit. Sociodemographic and clinical variables (number of days of hospitalization, DUP, and Defined Daily Dose/DDD of antipsychotics) were evaluated. Psychometric instruments (PANSS/Positive and Negative Syndrome Scale and WHOQOL-BREF/World Health Organization Quality Of Life) were applied at admission and at discharge. We used a Spearman correlation test to measure the degree of association between the variables.

Longer DUP correlated with more days of hospitalization, higher negative PANSS scores, and poorer social relationships domain of the WHOQOL at admission (p<0.05). At discharge, DUP presented positive and significant correlations with all subscales of the PANSS (positive, negative, and general; p<0.05) and DDD (p<0.01).

Our results are in line with the current literature on DUP, showing it leads to a worse prognosis, with a more severe clinical course, with the need for extended hospitalizations, a worsening of social relationships, and a higher dosage of medication.

Thus, DUP may be a potentially modifiable prognostic factor. It is possible that FEP patients with negative symptoms dominance may have a more insidious onset and, therefore, the search for treatment may be delayed. Conversely, if there is a mechanism by which DUP influences the symptom profile, its knowledge may lead to a better understanding of psychosis and improved treatment options.

Importantly, DUP showed stronger correlations with the severity of the clinical picture at discharge than at admission, suggesting that longer untreated psychosis may also predict poorer treatment response.

None Declared

Brief psychotic disorder according to the DSM-5 is a condition of sudden onset lasting less than 1 month followed by complete remission with possible future relapses, characterized by the development of psychotic conditions. The duration of the illness is a differentiating factor from other disorders such as schizophreniform psychosis or schizophrenia. When there is a stressful event at the origin of the psychotic symptomatology, it is also called brief reactive psychosis. The pathophysiology of BPD is not known, especially given the extremely low incidence of the disorder. This condition most often affects people in their 20s, 30s, and 40s, and its higher prevalence among patients with personality or mood disorders may suggest an underlying biological or psychological susceptibility that may have some genetic influence.

To describe the main diagnostic considerations, clinical manifestations, treatment, prognosis and prevention of brief reactive psychosis through the description of a clinical case that developed two episodes of brief reactive psychosis in a period of 1 year and to emphasize the importance of maintaining treatment for a period of suitable time.

Case report and literature search with the terms: brief reactive psychosis, psychosis, neuroleptic, stressor event.

We describe the clinical case of a 29-year-old woman, born in S. Tomé and Príncipe, previously healthy, with no personal or family history of mental illness, who had her first brief reactive episode after coming to Portugal. With the introduction of the 2nd generation antipsychotic, paliperidone, there was a substantial improvement in the condition, however, with the development of side effects having subsequently abandoned the treatment. About 1 year after starting work in Portugal, she develops a new event, a new psychotic episode, with characteristics of a brief psychotic disorder.

It is extremely important to alert patients to the possible side effects of drugs, as well as those who experience a brief psychotic episode, which are the risk factors and the need to comply with treatment in order to avoid a new relapse.

None Declared

Evidence from contemporary research has highlighted abnormal subjective pre-psychotic experiences as an expression of schizotropic vulnerability, for which trajectories up to First Rank Symptoms have been described. Embodiment is crucial to the conceptualisation of these experiences as the distinctive feature of schizophrenic phenomena. In fact, these are embedded in precise experiential frameworks such as Diminished Self-Affection and Hyperreflexivity, which constitute in nuce the experience of Dis-Embodiment. The latter responds poorly to conventional therapies, thereby affecting considerably the prognosis quoad valetudinem of Schizophrenia.

This study is intended to explore the use of specific psychomotor therapy protocols aimed at fostering Embodiment in patients with Schizophrenia, especially by investigating its efficacy and specificity on self-perceived body disorders, on characteristic motor abnormalities and on psychopathological dimensions.

The study involves the participation of 20 patients throughout 10 weekly 90-minute meetings of Embodied Psychomotor Therapy (EPT) in groups of approximately 5 participants. Despite being partially inspired by current approaches, EPT is conceived as a specific activity intended for patients with schizophrenia: each meeting combines intersubjective coordination activities (complex motor sequences, harmonious control of voluntary movement and movement in space, body-awareness), intra-subjective coordination (mirroring, demarcation and identification of one’s own boundaries, single-group dynamics), and exercises aimed at developing motor skills (proprioception, balance, posture, rhythm and speed). At the beginning of the activity (T0) and after 10 meetings (T1) participants will carry out self-administered and externally administered assessments, for the evaluation of motor (BMS, LOFOPT, BBS, AIMS, SRRS), psychopathological (PANSS, FBF, ABP), social functioning (SOFAS) and daily physical activity level (IPAQ) dimensions.

The study is still ongoing, due to limitations dictated by the Sars-CoV-2 pandemic. Preliminary results at T0 indicate a positive correlation between low levels of daily physical activity (IPAQ) and poor functioning (SOFAS). Significantly higher motor impairment with respect to the general population is also confirmed in all motor scales used. Moreover, a positive correlation between low levels of motor coordination (BMS_MC) and balance (BSS_TOT) was found together with basic symptoms related to loss of control or self-agency (FCQ_KO). Furthermore, the first results suggest an overall improvement in motor performance at T1.

The longitudinal analysis will enable the extent of the impact of EPT on functioning, motor and psychopathological dimensions of the patients to be determined, providing useful elements for planning specific rehabilitation interventions for schizophrenia.

None Declared

The use of diagnostic categories, although useful, fails in capturing the psychopathological complexity of the individual case. As for schizophrenia spectrum disorders, positive symptoms are not always included in the presentation, so further dimensions should be considered for a correct diagnosis.

To describe the importance of dimensional diagnosis in schizophrenia spectrum disorder based on a clinical experience

We report the case of a late-onset schizophrenia spectrum disorder with an affective presentation

I. is a 44-year-old woman who accessed the Community Mental Health Center due to subjective memory complains. After clinical evaluation, depressive symptoms and circadian rhythm disturbances emerged. The patient also reported dissociative experiences, which emerged after her brother’s death. She underwent a neurological visit that excluded the possible early manifestation of a neurodegenerative disorder. Quetiapine was at first prescribed, due to the possible action on both insomnia and mood symptoms, with insufficient response. After a few visits, a deeper mental state examination revealed the presence of delusions. The patient also reported having experienced hallucinations. Psychotic symptoms appeared to be persistent and pervasive. We changed the antipsychotic to full-dose olanzapine, with good response. After a six-month observation, the patient was diagnosed with schizophrenia.

The diagnosis of late-onset schizophrenia should take into account clinical history, drugs response, and the evaluation of different psychopathological dimensions

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In patients with schizophrenia, numerous studies have shown a relationship between negative symptoms and cognitive deficits (both neurocognition and social cognition deficits) and a similar impact of these domains on different clinical features such as onset, course and prognostic relevance. However, this relationship is still today subject of scientific debate.

The aim of the present study is to conduct a systematic review of the literature on data concerning the relationships between neurocognition and social cognition deficits and the two different domains of negative symptoms ̶ avolition-apathy and expressive deficit.

A systematic review of the literature was carried out following PRISMA guidelines and examining articles in English published in the last fifteen years (2007 - March 2022) using three different databases (Pubmed, Scopus and PsychINFO). The included studies involved subjects with one of the following diagnoses: high risk of psychosis, first episode of psychosis, or chronic schizophrenia. Other inclusion criteria of the reviewed studies included: evaluation of at least one neurocognitive or social cognition domain and at least one negative symptom using standardized scales; analysis of the relationship between at least one neurocognitive or social cognition domain and a negative symptom.

Databases search produced 8497 results. After title and abstract screening, 395 articles were selected, of which 103 met inclusion criteria. The analysis of retrieved data is still ongoing. Preliminary evidence highlighted: a correlation between social cognition and negative symptoms, in particular with the “expressive deficit” domain; a positive correlation between the severity of negative symptoms and that of neurocognitive deficits (in particular with the “processing speed” domain); an association of verbal working memory deficits with alogia and anhedonia.

The study of the relationship between negative symptoms, neurocognitive deficits and social cognition could contribute to the understanding of the aetiology of psychotic disorders and therefore to the identification of therapies for the improvement of overall functioning and quality of life. The studies analysed so far show some interesting associations between cognition and negative symptoms, but the presence of often inconsistent results, partially attributable to the different conceptualizations of the various domains of negative symptoms adopted, hinders the generalization of the results.

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Primary hypothyroidism has been extensively associated with the presence of depressive symptoms in major depressive and bipolar disorders; however, the association between psychosis and hypothyroidism has received less attention.

We aimed to present two cases of patients with delusional disorder (DD) and hypothyroidism and review studies focused on this association.

(1)Two case studies of DD patients. (2)Narrative review on the association of hypothyroidism and psychosis by using PubMed database (2000-August 2022). Search terms: [Hypothyroidism AND (psychosis or delusional disorder)].

Two case-studies. Case A: 58 year-old woman with DD who presented a worsening of psychotic symptoms in association with the occurrence of newly diagnosed hypothyroidism. Risperidone 1mg daily was initiated. A combination of levothyroxine 100 mcg/day and paroxetine 20mg/day was started. Case B: 51 year-old DD women with remission of delusional symptoms, who presented occurrence of depressive symptoms and panic attacks with agoraphobia. Olanzapine 5 mg/day and venlafaxine 225 mg/day were started combined with levothyroxine 75 mcg/day.

Review: From a total of 159 records, 52 studies described an association between psychosis and hypothyroidism. Most of the studies are focused on the Myxedema madness, treatment of psychosis with comorbid hypothyroidism, and the role of thyroid function on emerging psychoses. Others: intellectual disability, epilepsy, psychosis, asthma, diabetes and heart failure. Genetic associations of Xq13 gene, encoding for nuclear receptors of thyroid receptors, with psychosis.

Many questions pertaining to DD and thyroid function remain unanswered. Treatment of hormonal comorbidities may be associated with a clinical improvement of psychotic symptoms.

None Declared

48-year-old man from Spain who lived with his wife until he got divorced 4 months before starting the follow up in Mental Health. The debut was in September 2021 with a hospitalization in the Brief-acute hospitalization unit due to florid psychotic clinic-

He consumed several drugs in his twenties (cocaine, marihuana and heroin IV) and was diagnosed of HIV at the age of 29. He abandoned the use of drugs after the diagnoses and keep good adherence to the antiretroviral treatment (Abacavir + Lamivudine +Efavirenz).

At the age of 46 (January 2020), he was successfully transplanted a kidney. Afterwards, he started taking inmunosupresor medication to avoid transplant rejection

At the few months of the transplant and the beginning of the inmusosupresor medication, the patient became more irascible with moments of remarkable disinhibition and progressive abandon of the work obligations.

In January of 2021, he got divorced after months of difficulties with his wife, married 28 years before, due to the mentioned problems as well as moments of bizarre and disorganized conducts and suspicion towards his wife with probable delusional jealousy. He, therefore, lost his job, hose and marriage and started taking drugs again after 17 years of abstinence.

He was hospitalized in e Brief Acute Inpatient Unit in September 2021 with distrustful and hypervigilant attitude- He was suffering from delusional ideation of harm and persecution with high distress and emotional repercussion. He also presented disorganized conduct and probable auditory hallucinations. He was positive to amphetamines and cocaine After 3 days without consuming; there was no remission of the clinic.

Discussing the association between the initiation of inmunsupresor medication and the beggining of psychotic clinic

First psychotic episode (FEP) has a likely consequence of the initiation and maintenance of Tacrolimus -due to a kidney transplant- with the concomitant abuse of amphetamines and cocaine as a trigger factor.

The psychotic clinic progressively remitted in one week after the administration of 3 mg/day of risperidone.

The antiretroviral treatment was changed due to the poor adherence during the disorganization period. The tacrolimus was not removed because of the good response to the neuroleptic and the risk of transplant rejection

The patient started with prodromic symptoms of psychosis at the time he began with the inmunosupresor medication. Progresively, the psychotic clinic worsen wit the consequence of a biographical break with the consequence of a divorce, therlost of work and home and a drug relapse.

There is evidence of the association between psychotic episodes in people with no psychiatric history and the inmunosupresor medication for the kidney transplant (Above all, tracolimus). This case remarks the need of an exhaustive medical anamnesis in the diagnosis of psychiatric pathologies.

None Declared

Psychotic disorders have been consistently associated with aggressive behaviors. Psychiatrists are frequently asked to perform assessment regarding potentially aggressive patients. Thus, many psychometric instruments can be useful for identifying the risk of violence and thereby offering appropriate treatment for these individuals.

The aims of this study were to assess the risk of agressive behavior in inpatients with schizophrenia or schizoaffective disorder and to determine its correlates.

Using face-to-face interviews, inpatients diagnosed with schizophrenia or schizoaffective disorder, in psychiatric department of the University Hospital in Sfax (Tunisia) were included in this cross-sectional, descriptive and analytical study, carried out between novembre 2020 and octobre 2022.

The modified overt aggression scale (MOAS) and historical clinical risk management-20 (HCR-20) questionnaire were used for data acquisition. The HCR-20 score of 20 was used as threshold to divide the sample to violent patients (scoring>20) and non-violent patients (scoring ≤ 20).

The sample consisted of 60 male inpatients. The mean age was 38.23± 10.37 years.

In our sample, 68.3% were single, 35% didn’t reach the secondary educational level, 16.7% used psychoactive substance(s), 35% had prior criminal record, 30% had a history of suicidal attempt and 81.7% had previous hospitalization.

The mean score of MOAS was 13.08±8.19. The mean total HCR-20 score was 19.25±5.26. The Historical, Clinical and Risk Management subscales showed mean scores of 8.33±2.96, 5.62±1.89, and 5.28±2.42, respectively.

The violent patients represented 45% of the sample.

The mean scores of the items H3, H10, C1, C2, C4 and R5 of HCR-20 were respectively : 1.33±0.79, 1.20±0.77, 1.22±0.88, 0.38±0.71, 1.30±0.64 and 1.28±0.73.

There was no statistical difference between the two groups in socio-demographic factors.

A history of suicidal attempts was significantly more common in the group of violent patients (p=0.029).

Regarding the HCR subscales, H3 score (relationship instability) and H10 score (Prior supervision failure) were significantly higher among violent patients (p=0.018 and 0.003 respectively). The C1 score (lack of insight), the C2 score (negative attitudes) and the C4 score (impulsivity) were also significantly higher among violent patients (p=0.016, 0.009 and 0.005 rescpectively).

The item R5 (stress) of the risk management subscale was significantly higher in the group of violent patients (p=0.003).

The total MOAS score detected severe agression in the nonviolent group (p=0.031).

Our study suggests the efficacy of HCR-20 in identifying and distinguishing between violent and nonviolent patients with schizophrenia or schizoaffective disorder. The use of such reliable instrument in clinical psychiatric settings should be encouraged.

None Declared

Depressive symptoms and suicidal behaviour are common among patients that suffered a first-episode psychosis. Depressive symptoms could occur in different phases of psychosis, including in post-psychotic period. Depression is a well-known risk factor for suicidal behaviour in psychosis with data showing that occurrence of depression in psychosis have a significant correlation with suicide risk.

The purpose of this paper is todo a brief review on the relation of causality that existes between first episode psychosis and depressive symptoms as well as suicidal ideation.

Brief non-systematic literature review on the topic.

First episode psychosis is not uncommonly followed by depressive symptoms and suicidal thoughts. The rate of suicide attempt in psychotic patients range from 10 to 50%. Individuals with first episode psychosis have a greater risk of suicidal behavior compared with normal population and chronic disorders. In several studies, factors identified as being associated with depressive symptoms after first episode psychosis were anomalies of psychosocial development, poor premorbid childhood adjustment, greater level of continuing positive symptoms and longer duration of untreated psychosis. Suicidal behavior was associated with sexual abuse, previous suicide attempt, comorbid polysubstance use, lower baseline functioning, longer time in treatment, recent negative events, older patients, longer duration of untreated positive and negative psychotic symptoms, family history of severe mental disorder, depressive symptoms and cannabis use. Data also indicate that treatment and early intervention programs reduce depressive symptoms and suicidal behavior after first episode psychosis.

There is convincing evidence that depressive symptoms and suicidal behaviour have high rates after first episode psychosis. The research for treatment of depressive symptoms and/or suicidal behaviour after first-episode psychosis is very limited, therefore this paper aims to bring to light the importance of more studies on the matter.

None Declared

Psychotic experiences (PE) are strongly associated with non-suicidal self-harm (NSA). NSA are present throughout life, but are more frequent during adolescence and young adulthood. Early psychotic episodes (PEP) are a particularly vulnerable group compared to later phases of psychosis psychosis.

Analyze risk factors for suicide attempts and NSA, in order to improve early detection and prevention of suicides in adolescents and young adults with PD

Review in the literature of the different risk factors associated with parasuicidal behaviors in early psychosis

• • Presence of positive psychotic symptoms: auditory hallucinations, Delusional ideation.

• • Social isolation

• • Longer duration of untreated psychosis.

• • Comorbid symptoms: irritability, depression, anxiety, psychotic distress, insomnia.

• • Traumatic events in childhood

• • Difficulty in regulating emotional, impulsivity and sensitivity to reward.

• • Consumption of substances.

• • Psychosocial stress.

We consider essential the inclusion of early intervention programs aimed at the prevention of suicide and NSA, evaluating all risk factors for suicide and NSA among individuals with a PEP and high-risk mental states.

Initial assessment and ongoing assessments of suicide risk and parasuicidal behaviors, positive psychotic symptoms, depression, and the other related risk factors mentioned are required. Integrating trauma management into PEP care is critical.

Bibliography:

1.- Honings S, et al. Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and meta-analysis. Psychol Med. 2016;46(02):237–51. doi: 10.1017/S0033291715001841

2.- Honings S, et al. Psychotic experiences and incident suicidal ideation and behaviour: Disentangling the longitudinal associations from connected psychopathology. Psychiatry Res. 2016;245:267–75. doi: 10.1016/j.psychres.2016.08.002

3.- Nishida A, et al. Risk for suicidal problems in poor-help-seeking adolescents with psychotic-like experiences: Findings from a cross-sectional survey of 16,131 adolescents. Schizphr Res. 2014;159(2–3):257–62. doi: 10.1016/j.schres.2014.09.030 39.

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This is the case of a girl, aged 13, starting on 2021 with a first psychotic episode. Before this episode, her psychiatric history was an adjustment disorder because of scholar bullying, fully recovered before the onset of the current symptoms.

To describe an interesting case of early-onset psychosis.

We have used the interviews with the patient and her profile in Diraya (the medical database software in Andalucía).

The first symptoms started 6 months before the first hospitalization, and consisted in mild behavioural disorders, with disobedience and rudenesses, which represented a significant change compared with the previous personality of the patient. 3 weeks before the first admission she abruptly started to experience disconnection, unmotivated laughs, decreaded academic performance and incoherent speech. Also, she showed motor symptoms, consisting in oral and right-hand stereotypies. Then, she was hospitalized in a Pediatric unit, in order to rule out organicity. The nuclear magnetic resonance showed an image suggestive of venous development anomaly, with no acute injuries. Her cerebral spinal fluid was widely studied, and all the results were negative, including: the technique of PCR for many virus and bacteria that can cause meningitis or encephalitis; a bacterial culture; a biochemical study; antineuronal antibodies; and a limbic encephalitis antibodies study. Besides, the blood count, the biochemistry, the gasometry and serology were also negative. No drugs were detected in the urinalysis. Once the organicity was ruled out, she was treated with Olanzapine and Diazepam, and destinated to my child and adolescent psychiatry unit. During the first hospitalization we observed that she looked very often to the mirror, showed soliloquies and took leaps. During the interviews she was desinhibited. She initiated a delusional speech, focused in sexual topics. She said that she’s had a baby in the future with his father, and talked a lot about things she had already made in the future. During this admission, we changed the treatment to Quetiapine and Valproate.

The second hospitalization was was done due to a lack of efficacy with the previous treatment and the presence of autolytic thoughts. We switched from Quetiapine to Aripiprazole. After a few days, she showed again a desinhibited behaviour, and kept the delusional speech, that now was more complex, refering that she had more than 20 babies, with many different men. After this we tried Lurasidone and suspended Aripiprazole, she showed a clinical improvement, at the cost of many side effects, though. So we finally changed to Clozapine, in combination with Gabapentin. Since she got clinical levels of clozapine, the delusions have been encapsulated.

The differential diagnosis is set with an early-onset schizophrenia and a schizoaffective disorder. Obviously, the evolution of the sypmptoms in the following months and years will have the last word.

None Declared