Psychotic depression is a subtype of major depression, with worst prognosis but underdiagnosed and undertreated. We introduce the case of a 75-year-old patient who is attended in the hospital presenting sorrow and behavioral disturbances. He also had delusions of ruin and surveillance through his phone, adding amnesia, dizziness, constipation, tremor and bradykinesia. He had suffered a limited depressive episode regarding his wife’s death.

To highlight the importance of a correct differential diagnosis in psychotic depression to prescribe an adequate treatment that provides a better outcome for the patient.

A narrative search of the available literature on the subject through the presentation of a case.

The presumptive diagnosis is Parkinson vs psychotic depression. After some weeks of treatment with venlafaxine and olanzapine, the absence of improvement and fluctuating symptoms orientates towards Parkinson. This is later excluded due to a normal DATSCAN. Therefore, the diagnosis of psychotic depression is made, explaining parkinsonism as secondary to psychotropics. Olanzapine and venlafaxine are retired, introducing clozapine because of its lower incidence of extrapyramidal symptoms. After two weeks, the symptoms disappear, recovering the patient his basal functionality.

Depression with psychotic symptoms can take several weeks to respond to treatment, requiring a proper organic screening. In our case, the slow response to treatment made the organic etiology as one of the main differential diagnoses, specifically Parkinson disease. It ruled out because of the absence of findings in the DATSCAN and the resolution of the extrapyramidal symptoms with the change of treatment.

None Declared

Treating young patients with schizophrenia is a challenge, as these patients have much to gain from controlled pharmacotherapy and even more to lose with a possible relapse. Treating patients with long-acting injectable antipsychotics avoids the issue of non-compliance, the biggest risk factor for relapse, while also improving the quality of life. Receiving a drug once-a-month can provide greater flexibility and convenience to our patients.

Aim of the paper is to assess the efficacy and quality of life in monthly dosing of long-acting injectable antipsychotic in young adult schizophrenia patients.

The research included 7 patients aged 19 to 25 years who were diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Patients were assessed eight times over two years using the following clinical scales: Positive and Negative Syndrome Scale, Clinical Global Impression – Severity and Improvement Scale, Treatment Satisfaction Questionnaire for Medication (TSQM-9) and Quality of Life Scale (QOLS).

All treated patients achieved remission. There was a statistically significant improvement in measured scales in all patients. There were no side-effects reported during the study period, with no relapse or new hospitalizations

The monthly formulation of aripiprazole has proven to be effective and safe in our study and has great potential to improve patient quality of life as well.

None Declared

Despite a variety of pharmacological and psychotherapeutic interventions, treatment of schizophrenia can still be challenging, even more when certain comorbidities are present. Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junctions caused by antibodies against acetylcholine and tyrosine kinase. While co-occurrence of schizophrenia and MG is rare, treatment can be complicated as specific treatment of one condition can lead to worsening of other (e.g. anticholinergic side effects of psychopharmacotherapy, psychiatric side effects of corticosteroids).

To discuss treatment difficulties in the case of a patient with schizophrenia and multiple somatic comorbidities, including MG.

A case report and a review of literature.

We report a case of a 50-year-old female patient who was admitted to psychiatric hospital due to psychotic decompensation presented with dysphoria, paranoid delusions, agitation, verbal aggression and hostility. Clinical presentation and psychopharmacological treatment were complicated with her comorbid disorders, MG, which was recently treated because of a relapse, and hypothyroidism, which worsened as she neglected her regular check-ups. Multidisciplinary approach was needed to control the symptoms of her comorbid disorders, which, especially MG, limited psychopharmacological options. Combination of antipsychotics (aripiprazole, haloperidol) and mood stabilizer (sodium valproate) led to clinical improvement of psychotic symptoms. However, poor insight remained- the patient insisted on demission and was not interested in suggested psychotherapeutic and sociotherapeutic programs.

In complex cases like this, multidisciplinary approach is essential for adequate treatment of both psychiatric and comorbid somatic disorders. Conditions like MS can prolong treatment or even worsen the symptoms of a psychiatric disorder, especially since they limit the use of psychopharmacotherapy. Due to this, psychotherapeutic interventions could be even more important to keep a stable remission with a good insight and adherence to both psychiatric and somatic treatment.

None Declared

Mega cisterna magna is a developmental malformation of the posterior fossa, the cisterna magna is larger than normal, and the vermis and cerebellar hemispheres are morphologically normal. (Zimmer EZ et al. Obstet 2007; 276:487-490.) Although the relationship between this anomaly and psychiatric disorders is emphasized, its nature has not fully understood.

In this abstract, we report a case of schizophrenia with mega cisterna magna. We aimed to draw attention to the relationship between congenital malformations and schizophrenia since studies on congenital malformations were mostly conducted with epilepsy in the literature. (Lishman’s Organic Psychiatry: A Textbook of Neuropsychiatry, Fourth Edition, Chapter 6, 2009.)

The patient is a 28-year-old male, single, secondary school graduate and unemployed. The patient known to has used volatile substance, cannabinoids and synthetic cannabinoids between the ages of 15-22 and has a psychiatric history of approximately 8 years. He had a total of 5 hospitalizations, the last of which was in our clinic 2 years ago. The patient, who was known to have no substance use for 6 years, had negative symptoms for about 4 years. According to the information received from the patient’s relatives, he was admitted to our clinic with complaints of decreased mobility, decreased communication, refusal to eat and drink, decreased sleep, self-talk, standing for a long time and looking at a single point; which had started in the last 10 days after non-compliance of treatment for the last 3 weeks.

The physical and the neurologic examinations were unremarkable. In the psychiatric examination, he was conscious, oriented, and cooperative. Self-care and psychomotor activity were decreased. His mood and affect were dysphoric and limited. His speech rate, spontaneity and intonation were decreased. His thought content couldn’t be evaluated properly because of the mutism. His attention was decreased. Laboratory studies were unremarkable. Non-contrast brain CT and MRI showed an appearance compatible with mega cisterna magna in the mid-left parasagittal area in the retrocerebellar region. There was a history of staying in NICU for 8 days when he was a newborn. There was no family history of psychiatric illness.

The relationship between psychosis and clinical significance of MCM has not defined completely yet. Although the case we selected is rarely seen, there is one more example in the literature.(Karayilan S et al. Anatolian Psychiatry Journal; Sivas Vol. 14, Iss. 1, (Mar 2013):90-92.) Maybe the reason why there is so limited information in the literature on this topic is that congenital malformations are presented at a much younger age than psychosis with neurological diseases such as epilepsy. In conclusion, perhaps more detailed clinical follow-ups of these cases will enable new reports.

None Declared

Paraphrenia is a chronic psychosis that has generally lost its status as an independent nosological entity, not being included in DSM-5. From the perspective of the particular psychopathological picture and the impact of the disease on the patient’s functioning in roles, paraphrenia remains a challenge for the clinician in terms of nosological classification and the correct therapeutic approach.

We take into account a patient who presents the classic diagnostic criteria of paraphrenia with a clinical and evolutionary picture followed for 15 years, with the aim of bringing the paraphrenic phenomenology back to the fore.

The case presentation will focus on the richness and absurdity of the delusional ideas that are in great contrast with the good insertion into reality of the subject and the preservation of the core of the personality. We will also describe the main landmarks of positive and differential diagnosis.

We believe that paraphrenia deserves to be differentiated from other psychotic disorders through the particular variant of insight that also explains the significant capacities of dissimulation and as a result of insertion into the roles of life. This attribute also explains the increased potential for danger and unpredictability of the paraphrenic patient.

Our approach is an argument for the psychopathological understanding of paraphrenic psychotic phenomenology independent of different nosographic classification systems. We are trying to contribute to increasing the quality of differential diagnosis in psychoses.

psychosis, paraphrenia, differential diagnosis

None Declared

The core refers to the lumbo-pelvic complex located at the center of gravity of the body.Core stability has a crucial role in sudden balance change and body movements(Zemkova et al. Front. Physiol 2022; 13).The more stabilized core muscles indicate better movements and body balance.Therefore, core stability is related with exercise performance, falling risk and falling fear.However, patients with schizophrenia have lower motivation and capability to exercise compared to normal population that may result decrease in core stability.

The aim of this study is to determine the relation between core stability,functional exercise capacity and negative symptoms including especially anhedonia, motivation, psychosocial functioning in schizophrenia patients.As our knowledge,this is the first study to detect the core stability in schizophrenia.

Participants of the study were recruited from the Community Mental Health Service of Çigli Education and Research Hospital. Twenty-six individuals diagnosed as schizophrenia according to DSM-V criteria were included into the study.Symptom severity was evaluated with Positive and Negative Syndrome Scale(PANSS), psychosocial functioning was assessed with Personal and Social Performance Scale(PSP),depression was assessed using Calgary Depression Scale for Schizophrenia(CDSS),avoidance motivation assessed with Behavioral Inhibition System and Behavioral Activation System (BIS/BAS),social and physical pleasure were measured via Revised Social Anhedonia Scale (RSAS) and Revised Physical Anhedonia Scale Functional (RPAS) exercise capacity was assessed by 6-minute walking test(6MWT) and core stability was assessed using Mcgill Core Endurance Tests(MCET).Patients who exercise regularly, having metabolic diseases or comorbid psychiatric disorder were excluded from the study.The data was analyzed by IBM SPSS 24 with Pearson correlation test.

MCET scores were found to be moderately correlated to PSP scores (r=.45,p=.025) and BIS sensitivity was moderately correlated to psychosocial functioning (r=-.42,p=.035).Six-MWT scores were negatively correlated with BIS (r=-.51, p=.019),CSDC (r=-.47, p=.035) and PANSS negative subscale (r=-.42, p=.042).

In this study core stability was found to be related to psychosocial functioning.Also,patients having negative symptoms and depression showed lower functional exercise capacity.Lower scores in social functioning and higher behavioral inhibition sensitivity may be related to psychosocial dysfunctioning and negative symptoms of schizophrenia.However, appropriate core stability training and physical exercise may help individuals with schizophrenia to improve these skills.This may lead patients to exercise,have better social performance,self-care and lower avoidance behavior.

E. I. Hoşgelen: None Declared, N. Bozbıyık: None Declared, Ö. Akgül: None Declared, F. Şimşek: None Declared, N. Gelecek: None Declared, K. Alptekin Grant / Research support from: TUBITAK, Consultant of: Abdi Ibrahim, Abdi İbrahim Otsuka, Janssen, Ali Raif

The reduction of vitamin D (VitD) has often been associated with pathological cognitive processes and in general with various mental illnesses2,3. More frequent reports of reduced concentrations of VitD concern patients with schizophrenia, however it has not been clarified whether this concerns the pathology itself of the disorder or if nutritional factors are involved1.

The measurement of VitD in the serum of hospitalized patients with mental illness (schizophrenia) compared to the levels of people without mental illness.

The serum levels of VitD were measured in the serum of 45 psychiatric patients of psychiatric hospital “Dromokaiteion” (22 men and 23 women) mean age 59 ±14 years. The control group consisted of 49 healthy subjects (24 men and 25 women) with a mean age of 57 ±14 years (Table 1). Serum VitD levels were measured on the Architect ci4100 immunobiochemical analyzer, Abbott Laboratories Ltd, by the chemiluminescent microparticle immune assay (CMIA) method and according to the manufacturer’s instructions. The statistical analysis of the data was done with the software program SPSS V.25.

Mean values of Vit D (ng/ml) were 15.8±10.7 and 15.3±12.5 in male and female patients, respectively. For the control group the mean values were 22.4±7.9 in men and 26.4±13.9 in women. Vit D values in the psychiatric patients of both groups compared to the control group were statistically significantly different (men p=0.021 and women p=0.006). (Table2, 3).

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The findings of the study are consistent with those of similar studies confirming low concentrations of VitD in the serum of patients with mental illness. This parameter should be taken into account as its measurement is not included in the routine laboratory control to date. Further future studies should correlate VitD deficiency with specific demographic and clinical characteristics.

1. Belvederi Murri M, Respino M, Masotti M, et al. Vitamin D and psychosis: mini meta-analysis. Schizophr Res. 2013;150(1):235-239. doi:10.1016/j.schres.2013.07.017

2. Kalueff A, Minasyan A, Keisala T, Kuuslahti M, Miettinen S, Tuohimaa P. The vitamin D neuroendocrine system as a target for novel neurotropic drugs. CNS Neurol Disord Drug Targets. (2006) 5:363–71. doi: 10.2174/187152706784111506

3. Oudshoorn C, Mattace-Raso FU, van der Velde N, Colin EM, van der Cammen TJ. Higher serum vitamin D3 levels are associated with better cognitive test performance in patients with Alzheimer’s disease. Dement Geriatr Cogn Disord. (2008) 25:539–43. doi: 10.1159/000134382

None Declared

Eye Movement Desensitization and Reprocessing (EMDR) is a powerful psychotherapy approach developed by Francine Shapiro in 1987 when she realized that rhythmic eye movements reduce disturbing thoughts. The effectiveness of the therapy has been proven by many studies after its discovery. EMDR, which was initially used only in the treatment of Post Traumatic Stress Disorder, has become a treatment option used in the treatment of psychiatric disorders of more than 2 million people today. EMDR, which is used today, contains elements from many therapy schools andconsists of a phased protocol (Shapiro, 2018). Increasing evidence acknowledging the relationship between trauma and psychosis indicates that EMDR can be a vital addition to the treatment of psychosis (Sin & Spain, 2017; Valiente-Gomez et al., 2017). However, the effect of EMDR on psychosis has not yet been sufficiently clarified. There is alsoIt has not yet been clarified whether the curative effect on the psychotic symptoms or on the anxiety symptoms.For this reason, in our study, the effect of EMDR on these symptoms will be investigated by comparing the case and control groups.

This study aims to evaluate the effect of EMDR therapy on post-traumatic stress symptoms, schizophrenia symptom severity and anxiety level in psychotic patients with at least one traumatic event.

This study is a randomized controlled, prospective follow-up study aiming to evaluate the effect of EMDR therapy on post-traumatic stress symptoms, schizophrenia symptom severity and anxiety level in psychotic patients with at least one traumatic event.Written informed consent to participate in the intervention study will be requested from all patients who meet the inclusion criteria. Consent participants receive pre-treatment (T0) measurements. After T0, participants will be randomized to EMDR or waiting list Participants will be randomly assigned to 26 people in each group. These groups will be made by the independent randomization bureau of the Parnassia Institute of Psychiatry using the scientific randomization program on the Internet (www.randomizer.org).

The effects of EMDR therapy on posttraumatic stress symptoms, schizophrenia symptom severity and anxiety level in psychotic patients were obtained from pretest and posttest measurements.

More studies are needed on the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) therapy.

None Declared

Hyperammonemic encephalopathy is an unusual but fatal consequence of patients being treated with valproic acid (VPA). The most relevant clinical features in cases of valproic acid-induced hyperammonemia include confusion, lethargy, vomiting, and increased seizure frequency and may progress to stupor, coma, and lead to death in isolated cases. The causes are not fully elucidated, but studies suggest alterations in liver and kidney function with abnormalities in the urea cycle causing increased ammonium levels.

Clinical review and treatment approach for VPA-induced hyperammonemia encephalopathy.

Clinical case and literature review.

A 23 - years - old male, admitted to the psychiatric unit for a psychotic episode in the context of drug use and associated affective symptoms. Treatment with antipsychotic (Risperidone 6mg per day) and mood stabilizer (valproic acid up to 1000/mg per day) was prescribed. After ten days of treatment, the patient started with low level of awareness and abnormal behaviour. Neurological examination showed marked somnolence, dysarthric language, unstable gait and behavioral alterations. In the physical examination the constants are stable with discrete tachycardia. Laboratory tests revealed hyperammonemia (609μg/dL), with normal liver function and serum concentration of total valproic acid was therapeutic (69mg/L). Brain computed tomography (CT) revealed no significant anomalies. Doctors initiated treatment with daily cleansing enema and VPA was suspended immediatly. After forty-eight hours the patient’s mental status gradually improved back to baseline and the ammonium levels were normalized in medical tests.

Valproate-induced hyperammonemic encephalopathy is an unusual but serious complication. It is often underdiagnosed, with an unclearly incidence. The consequences of undertreatment can be potentially deadly. Clinical suspicion should be established in all patients with decreased level of consciousness in patients receiving VPA. Hyperammonemia can be asymptomatic in half of the cases and can occur in people with normal therapeutic doses and normal serum valproate levels. The mechanism of VPA-induced hyperammonemic encephalopathy is unclear. At present, it is thought to be primarily due to propionic acid, a metabolite of VPA, which inhibits an enzyme necessary for the elimination of ammonia in the urea cycle. In addition, VPA can raise plasma ammonia levels through interaction with carnitine, leading to increased renal excretion of carnitine. In terms of treatment, the main recommendations agree that discontinuation of valproate is the most effective therapy, followed by administration of lactulose to reduce ammonium levels. Carnitine supplementation may be useful in the following cases: for seizure disorders in children at risk of developing carnitine deficiency, in VPA poisoning and in VPA-induced hepatotoxicity.

None Declared

Patients with schizophrenia tend to have high rates of suicidal ideation (SI), which consists of thoughts of self-destruction, which increase the risk of self-extermination.

To determine the prevalence of SI and investigate associated factors in a sample of patients with schizophrenia.

Descriptive and cross-sectional study, in which 49 patients with the condition were selected by convenience, treated at the Psychosis Outpatient Clinic of the Base Hospital of São José do Rio Preto/SP, between August/2021 and March/2022. The following were applied: 1) Sociodemographic Questionnaire, 2) Suicide Ideation Section of the Columbia Suicide Risk Assessment Scale (SISC-SSRS), 3) Suicide Risk Questionnaire from the Mini International Neuropsychiatric Interview (SRQ-MINI). Data were analyzed quantitatively (descriptive statistics and non-parametric tests; p<0.05). The study was approved by the local Research Ethics Committee.

The age of the participants ranged from 17 to 72 years (mean=45.8 ±14.02), most were male (n=34;69.4%), had not completed elementary school (n=25; 51%), did not have a paid job (n=41; 83.7%) and had a family income of up to three minimum wages (n=23;46.9%). 40.8% (n=20) reported at least one suicide attempt. According to the SISC-SSRS, in the last month: 22.9% (n=11) wished they were dead; 18.8% (n=9) thought about killing themselves; 12.5% (n=6) considered how they could perform the act; 10.4% (n=5) had intention and active planning; and 10.4 (n=5) persisted for the purpose of execution. The mean of affirmative answers was equal to 0.75 (±1.55). In turn, in the SRQ-MINI, 79.6% (n=39) had a score indicating low risk for suicide, 18.4% (n=9) high risk and 2% (n=1) moderate risk. The overall mean was 5.77 (±10.31), which indicates a moderate risk for suicide. There was a non-significant negative correlation between the risk of suicide and the factors of education (r= -0.20; p=0.15) and family income (r= -0.21; p=0.13). There was a significant positive correlation (r=0.81; p=0.0001) between the SISC-SSRS and SRQ-MINI, which indicates that despite the adapted use of the instrument, there is consistency and reliability in the results.

The sample showed low rates of active SI and variation between low and moderate risk for suicide. SI should be asked to patients with schizophrenia, with a view to preventing suicidal behavior.

None Declared

Schizophrenia is a chronic illness, affecting approximately 1% of the general population. The more chronic a treatment is, the poorer the quality of adherence. In fact, approximately 60% of patients with schizophrenia are incompletely or non-adherent within one year of the first episode. Poor adherence has consequences in terms of clinical status, quality of life and psychosocial functioning due to associated relapses. One of the main factors of poor compliance is the use of addictive substances. Half of schizophrenic patients have, or have had, an addictive comorbidity during their life. Moreover, schizophrenic patients with addictive comorbidity have a more severe symptomatology and have more associated physical, psychological and social problems, representing a challenge in the management

The objective of our work is to evaluate the impact of addictive comorbidity on medication adherence and relapse.

This is a cross-sectional study, carried out in patients with schizophrenia hospitalized or followed in ambulatory consultation, at the psychiatric hospital Ar-razi of Salé. The data collection (sociodemographic, clinical and therapeutic) is carried out by a questionnaire established for this purpose. The use of substances is evaluated according to the DSM-V criteria

A total of 110 schizophrenic patients were followed or hospitalized, of which 61.8% had a substance use disorder. The average age of onset of substance use was 18 years. The duration of substance use ranged from 1 to 11 years and up to 49 years for tobacco and cannabis. 72% of the addicts tried to stop their use alone or in outpatient settings, only 17% in inpatient settings. The average duration of abstinence was 11 months and ranged from 1 to 18 years. 81% reported remission of the disease after abstinence. The hospitalization rate was 88.2% for addicts versus 85% for non-addicts. The number of hospitalizations was 180 for addicts versus 78 for non-addicts. The cumulative duration of hospitalization is 208 months against 96 months for addicts. The duration of remission is 5 months for addicts and 24 months for non-addicts. 71% of non-addicts patients have well observed their treatment against 57% of addicts

The weight of co-morbid addictions represents between 1/5 and 1/3 of the factors at stake in the compliance and the risk of relapse of patients suffering from schizophrenia. The development of specific care strategies for a global management of addiction and schizophrenia should be a priority.

None Declared

For many years, the question of the announcement of the diagnosis in psychiatry has been controversial. It is the starting point of a management allowing access to psychoeducation and to the patient’s recovery. In the case of schizophrenia, the cognitive impairment and the stigmatizing nature of the pathology jeopardize the announcement of the diagnosis. However, recommendations and legislation emphasize the need to inform the patient about his or her pathology. In Morocco, the law n° 131-13 of February 19, 2015 relating to the practice of medicine has made information about the diagnosis to patients an obligation for doctors and a right for patients

The interest of our work is to try to evaluate the current state of this practice, its ethics and its representations among psychiatrists.

This is a descriptive study on the announcement of the diagnosis of schizophrenia in a population of psychiatrists. The data collection was carried out by a questionnaire including: Socio-demographic and professional data, opinion on practice and training concerning diagnostic announcement in psychiatry, physicians’ representations concerning announcement: frequency, opinion on the importance of this practice.

31 participants responded to our questionnaire. More than 9 out of 10 participants would not benefit from training on diagnostic announcement. Only 22.6% of physicians reported being very or somewhat familiar with medical information laws and their content regarding the regulation of diagnostic announcement. All participants considered schizophrenia to be the most difficult pathology to announce, followed by personality disorders and bipolar disorder. 74.2 of the participants considered it “rather” or “completely” essential to inform the patient of his or her psychiatric diagnosis. 77.4% of the participants considered it necessary to announce the diagnosis of schizophrenia and 80.7 often or systematically announce this diagnosis. Three situations considered appropriate to announce a diagnosis of schizophrenia: 74.2% announce it in general when the patient or the family asks for information about the diagnosis, 42% advise the patient when he/she mentions schizophrenia on his/her own. The patient’s functional inability to understand the diagnosis (77.4%) and the fear of negative clinical and therapeutic repercussions (41.9 and 38.7 respectively) were reported to deter physicians from making the announcement. More than half of the participants (64.5%) thought that the announcement of the diagnosis improved therapeutic compliance. Conversely, 35.5% considered that the announcement had no impact on therapeutic compliance.

The announcement of the diagnosis of schizophrenia remains today a complex and evolving subject. Even if great progress has been made to inform patients as well as possible, practices remain disparate from one doctor to another and this information is not well traced.

None Declared

Natural caregivers of patients with schizophrenia constitute a main source of care as they have to shoulder a multitude of caregiving responsibilities and are then confronted with considerable difficulties while providing care. As a result, natural caregivers, often described as “the hidden patients” usually suffer from psychological consequences such as anxiety and depression.

This study aimed to asses anxiety and depression among natural caregivers of patients with schizophrenia and to identify risk factors for developing such disorders.

We conducted a cross-sectional, descriptive and analytical study, including 80 natural caregivers of patients with schizophrenia. We used the Hospital Anxiety and Depression Scale (HADS) to evaluate anxiety and depression.

The typical caregiver profile was consistent with a 55-year old married illiterate first degree relative (mostly parents or spouses) with a low socio-economic level.

The mean anxiety score was 10.6± 5,1 and the mean depression score was 11.6± 6.2. Depression and anxiety were diagnosed in 66% of caregivers.

Anxiety and depression scores were significantly higher among female illiterate unemployed caregivers, those with organic history and among parents and correlated with the caregiving duration.

Anxiety scores were higher when patients in charge had poor therapeutic adherence and aggressive behavior and correlated with the age of caregivers and the number of other sick persons in charge.

Caregivers reported higher levels of depression when patients in charge were not married, unemployed and had a history of suicide attempts.

Anxiety score were significantly correlated with depression scores.

Caregivers of patients with schizophrenia, although thought to be a privileged source of emotional and social support, are hardly taken into account following the deinstitutionalization movement.

None Declared

Prolactin adenoma, called “prolactinoma” is a benign neoplasm, it is the most common secreting pituitary tumor, and represents up to 40% of all pituitary adenomas. More than 90% are small intrasellar tumors which rarely increase in size.

the problem of management lies in how to stabilize the patient on a psychiatric level without increasing the level of prolactin.

We report the case of a young woman who presented a comorbid schizophrenia with a prolactinoma. We will try through this clinical vignette to study the different pillars of management of such pathologies.

At the same time, we did a literature review. The main search engines used were Pubmed, medline, and Science Direct. The keywords Prolatinoma schizophrenia olanzapine

This is Mrs. N. Q., 39 years old She is single, an engineer but currently without a profession, from an average socio-economic level of a teacher father and a housewife mother. She is the 3rd of his siblings of 6 . She is currently hospitalized at Ar-razi Tanger hospital for treatment of decompensation of her chronic psychotic disorder. The patient would have been born following a premature delivery of 34 weeks. For her antecedent, she was followed for asthma since her childhood. Her mother and her maternal grandfather would have been psychotic. The history of the disease dates back to 2017. The patient suffered from headaches resistant to any treatment. The patient would have consulted a neurologist. Magnetic resonance brain imaging would have been requested, which objectified at the left latero-pituitary level a lesional process of 7 mm discretely intense in T2, hypo-intense in T1 and not enhanced by Gd reflecting a pituitary micro adenoma. The patient was put on Cabergoline (Dostinex®). So the psychiatric symptomatology dates back to the end of 2019, by behavioral problems, social withdrawal, she will have stopped all professional activity. At the same time, she will have stopped all medication (Cabergoline). In 2020, the patient would have been hospitalized for the first time at the Ar-razi Tangier psychiatric hospital. The diagnosis of schizophrenia was retained according to the DSM 5 criteria. After a stay of 5 weeks, the patient would be stabilized on olanzapine 20mg/d. Currently, and following non-compliance with treatment (because of adverse effects such as amenorrhea and galactorrhea), the patient has returned, suffering from a relapse, justifying her second hospitalization. During his stay, a check-up would have been requested to show hyperprolactinemia 3 times normal. We therefore switched to Aripiprazole.

We have proposed an approach to the management of patients with comorbid schizophrenia and prolactinoma, an approach that balances the benefits and risks of managing the psychiatric stability of the patient on antipsychotics with the management of prolactinoma and symptoms. of hyperprolactinemia.

None Declared

Schizophrenia (SCZ) is a chronic mental illness characterized by a rich and diverse symptomatology. A generalized cognitive deficit has been widely recognized among the symptoms of this disease. Several authors have studied the relationship between peripheral markers of inflammation and cognitive dysfunctions in order to explain the etiopathogeny of these disorders.

The aim of our study is to better comprehend the nature of the relation between peripheral markers of inflammation and cognitive dysfunctions.

A systematic review of the literature was conducted following the guidelines provided by the PRISMA method. We performed a systematic search focused on two automated bibliographic databases: Pubmed and Google Scholar including the following keywords: “inflammation”, “schizophrenia”, “cognition”

A total of 17 articles were included.

Significant relations with cognitive function were reported with IL-6, IL-18, IL-2, IL-8, tumor necrosis factor α (TNF-α ) and chemokines. Memory was the cognitive domain where the most significant relations with cytokines were objectified.

BDNF levels were correlated with cognitive tests in 5 studies of SCZ populations. The domains concerned were inhibition, flexibility, verbal fluency, verbal memory, attention, and processing speed.

Elevated CRP in patients with SCZ was reported by all studies and a significant relation with cognition in 3 studies. This relations is objectified in the areas of memory, executive functions and processing speed.

The relations between CRP, BDNF, cytokines and cognitive functions was inconsistent across studies.

The majority of the results observed during the review were in favor of a significant relation between CRP, BDNF and cytokines. Nevertheless, these results were not constant and heterogeneous. It would be interesting to better explore the nature of this relation through prospective studies in order to establish therapeutic perspectives.

None Declared

Hypothyroidism is a common problem in clinical practice which can be seen with diverse psychiatric manifestations.

Here we report a case of psychosis with compulsive behavior in a 46-year-old man who had no previous history of psychiatric disorder was brought to the emergency department by his family.

During his evaluation, he described visual and auditory hallucinations. In addition, it was observed that dermatitis developed on her hands and around his mouth due to compulsive washing behavior. It was learned that he was diagnosed with hypothyroidism 2 months ago but he was not taking his medication. He was admitted inpatient clinic for 39 days and consulted to an endocrinologist. Inpatient treatment was initiated with haloperidol 10mg PO and levothyroxine. Given the persistence of irregular intake, it was decided to switch to haloperidol long-acting treatment.

After only requiring both antipsychotic drugs and thyroxine replacement our patient showed progressive clinical recovery attaining full remission within 5 weeks.

It was clear that physicians should be aware of the possible different manifestations of endocrinologic disorders. All patients presenting with a first episode psychosis and compulsive behavior should be screened for thyroid dysfunction

None Declared

Sexual dysfunction (SD) is a prevalent side effect of antipsychotic drugs (AP), and it impairs patients’ quality of life. Because of the distress caused by it, it should be borne in mind when prescribed since it is responsible for treatment nonadherence or discontinuation. SD affects about 45- 80% of males and 30-80% of females that take it. In SD, all phases of the sexual response cycle may be compromised.

This non-systematic review of the literature aims to better understand the antipsychotic-induced SD and its management to better compliance of AP-treated patients without compromising their quality of life.

A semi-structured review on PubMed linking SD as a side effect of AP drugs.

All AP drugs can cause SD. It seems related to their mechanism of activity at receptors D2, 5-HT2, α1, H1, and M, which are also involved in sexual function. They do it by diminishing arousal, decreasing libido by blocking motivation and reward system and orgasm indirectly, provoking erectile dysfunction by vasodilatation, and decreasing woman lubrification. Hyperprolactinemia is a significant cause of sexual dysfunctions. Haloperidol, Risperidone, and Amisulpride (prolactin elevating AP) are more likely to cause SD than Olanzapine, Clozapine, Quetiapine, and Aripiprazole (prolactin sparing AP). Although psychotic disorders (Schizophrenia and other psychotic disorders) can impact sexual functioning, according to evidence, there is no denying the role of AP in this issue. Aripiprazole, a D2 partial agonist, has been associated with lower rates of SD and seems to reduce the rates of SD in patients previously treated with other AP. Other AP with the same potential dopamine agonist activity, such as Cariprazine and Brexpiprazole, can probably have the same effect. The management of SD induced by AP drugs should include measuring serum prolactin and modifying risk factors like hypertension, smoking, hyperglycemia, and hypercholesterolemia. In that regard, waiting for spontaneous remission, reducing the dose of the AP prescribed, or switching to Aripiprazole are all viable strategies, if possible. Although the evidence supporting the addition of symptomatic therapies is weak, adding dopaminergic drugs (amantadine, bromocriptine, cabergoline) or drugs with specific effects on sexual functioning (such as phosphodiesterase inhibitors or yohimbine) may be helpful in selected cases.

Although all AP drugs can cause sexual dysfunction, it is difficult to determine its true prevalence accurately. AP-induced sexual dysfunction can adversely affect compliance and is one of the factors that must be considered when selecting treatment. In summarizing, Aripiprazole has shown to be the AP with the most favorable profile concerning SD. Cariprazine and Brexpiprazole, being also D2 partial agonists, may cause less SD.

None Declared

Clozapine is well known for its unique efficacy in treatment-resistant schizophrenia and to reduce violent behaviour. Unfortunately, life-threatening adverse reactions including ileus, myocarditis and agranulocytosis can hinder its use. In this context, some clinicians may be reluctant to initiate clozapine in patients who are prone to these adverse drug reactions.

To describe a complex clozapine initiation despite the presence of serious adverse effects and contraindications. The management of these adverse events, using effective multidisciplinary team leadership strategies, will also be described.

A case report will be presented. The challenges faced while using clozapine and strategies implemented to pursue the use of this medication will be described.

A young black man with severe first episode psychosis was admitted to the early intervention outpatient clinic in Québec, Canada. Multiple aggression and critically disorganized behaviour prompted patient transfer to a specialized long-term care unit. Given the severity of the resistant disease and after a shared decision-making process with the family, clozapine was introduced despite ethnic neutropenia (down to 0,2 X 109/L) and idiopathic cerebral lesions. Both gave rise to multiple concerns. A specific hematological surveillance protocol was designed. Facing multiple severe neutropenia episodes, the use of prophylactic granulocyte colony-stimulating factor (300 mcg SC weekly) was added after literature review and a favourable consult of both pharmacist and hematologist. Cardiac enzyme elevation also requested specialized investigation and follow-up. Specialized educators, social workers, and nursing all needed to be deeply involved in the treatment process and team coordination requested strong team building capacities. After 6 months, the patient is now taking clozapine 325 mg daily and his symptomatology has sufficiently reduced to allow hospital leave. The patient is now engaged in his recovery process.

Using an evidence-based approach, promoting expertise from multiple healthcare professionals, and allowing a substantial amount of time to develop team cohesion were all crucial elements of this success story.

None Declared

Catatonia due to cerebrovascular stroke is a rare condition that needs further observation and research.

To review the opinions of psychotic disorders experts worldwide as to this issue based on evidence and clinical experience and to consider strategies for future investigations.

This case shows a 64 years old female who suddenly developed wish for isolation, followed 10 days later by discontinuity of ideas, hallucinatory behavior and food refusal. She had verbal and physical aggression due to a fixed belief that family members are conspiring somehow to harm her.

On examination she was mute with waxy flexibility and negativism. Extensor plantar reflex was evident. MRI Brain showed small vessel disease and right basal ganglia acute ischemic infarction. On IV midazolam 7.5 mg, patient’s mutism, negativism and waxy flexibility improved. Lower limb Venous Duplex revealed acute right popliteal and left soleal veins thrombosis. CT angiography showed Bilateral pulmonary embolism with no pulmonary infarction. D dimer was positive.

Early diagnosis and intervention improves outcome if psychiatric teams gives attention and has enough awareness with warning symptoms and prompt necessary interventions.

None Declared

Acute and transitory psychotic disorders comprise a polymorphous picture such as Leonhard’s cycloid psychoses, which alternate episodes of affective symptoms such as psychosis between two poles (anguish/happiness, incoherence/stupor, or akinesia/hyperkinesia).

To describe a case report of a 20-year-old man, in outpatient psychiatric follow-up, after debuting at age 18 with a severe depressive episode of endogenomorphic characteristics without psychotic symptoms, with subsequent complete remission. Two years after clinical stability, he required prolonged hospitalization due to polymorphous psychotic syndrome of abrupt onset in a context of previous continuous use of cannabis and cocaine. Suspicion towards parents, bizarre behaviors, rushing desires, unmotivated laughter, fixed gaze, bewilderment, anguish with a feeling of imminent death, alternates with euphoria and senseless purchases.

We present the case report of this patient with a mental examination of conscious, scattered attention with marked distractibility, confusion and experiences of strangeness, memory gaps, subjective sensation of well-being with tachypsychia, which fluctuates with thymic oscillations and alternates with episodes of marked indefinite anguish, intense anxiety with delusional fear of the death of him or his family. Little systematized ideas of reference and prejudice based on intuitions or delusional occurrences in their environment. Megalomaniac and religious-messianic ideation. No sensory perception disturbances. Disintegrated course of thought, with frequent illogical associations, ambivalence of thought, affectivity and psychomotricity. Motor restlessness and behavioral disorganization. Global insomnia. Judgment of reality and superior functions diminished. No auto/heteroaggressiveness.

Various psychoactive drugs were tested for two months, obtaining a response only with valproic acid 1500mg, pregabalin 450mg and olanzapine 15mg, presenting slow improvement in a situation of absence of consumption, with a predominance of symptomatic polymorphism, decreasing fluctuation between episodes of expansiveness and psychotic anguish, remitting disorganization and motility alterations, persisting poor awareness of the disease and cognitive complaints. He was referred for follow-up at the mental health center where his gradual recovery continued.

A differential diagnosis of polymorphous psychosis is proposed, compatible with a cycloid psychosis of the anxiety-happiness type with marked affective symptoms, precipitated by substance use.

Cycloid anxiety-happiness psychosis stands out for intense and fluctuating anxiety, oscillating with feelings of happiness, ecstasy, and placidity, mystical-religious delusions, and preoccupation with death, which may comprise a different psychotic debut.

None Declared