Crohn’s disease is a chronic inflammatory bowel disease of multifactorial etiology. Its association with psychiatric disorders has frequently been reported, mainly with depressive or anxiety disorders.However, its association with schizophrenia remains exceptional.

we will try to discuss this association.

In this regard, we report the case of a young patient, aged 24, diagnosed 5 years ago with Crohn’s disease, evolving by remission flares, currently treated with Azathioprine, after failure of corticosteroid bolus.

The patient was admitted to psychiatry for aggression towards his parents.In view of the history of the disorders as reported by the family and the psychiatric interview, the diagnosis of schizophrenia was retained and the patient was put on amisulpride.

Schizophrenia and Crohn’s disease are relatively frequent diseases, generally occurring at a young age, whose etiopathogenesis, multifactorial, involves in both cases genetic, environmental and immunological factors.Their association does not seem fortuitous and arouses both etiopathogenic and therapeutic interest, but studies involving a large number of patients would make it possible to elucidate the link between these two diseases.

None Declared

Patients with mental disorders have a decreased life expectancy, being the main reason the cardiovascular disease. An important proportion of patients present a comorbid drug consumption. Amongst drugs, alcohol is the most frequent, and it is associated with a higher cardiovascular risk. The metabolic syndrome is one of the most employed tools to assess cardiovascular risk.

- To describe the demographic characteristics of the patients with an active alcohol consumption that were admitted to the hospital during the period of study.

• - To describe the prevalence of metabolic syndrome in the sample, according to the Adult Treatment Panel III (ATP-III) criteria.

Retrospective observational study of three months duration. Data was collected from all patients admitted to the hospital during the period of study, with no specific exclusion criteria. Descriptive statistics were performed.

During the period of study 172 patients were admitted to the hospital (56.4% women and 43.6% men). A 44.8% presented alcohol consumption (25% sporadically, 6.4% weekly and 13.4% daily). Amongst women, 1% presented daily and 1% weekly consumption. Amongst men, 21.3% presented daily and 5.3% weekly consumption.

The prevalence of metabolic syndrome in the study sample was 29.11%. In the alcohol consumption group, the prevalence was 24.7% and differed according to the pattern of consumption: 43.5% in the daily consumption group, 27.3% in the weekly and 14% in the sporadically consumption group.

On the one hand, in the sample of study a higher percentage of men present an active alcohol consumption, compared to women. It is remarkable the high percentage of daily alcohol consumption amongst men in our sample.

On the other hand, the prevalence of metabolic syndrome in our sample is similar to the one found in scientific literature regarding patients with mental disorders. It is noteworthy in our sample the increased prevalence of metabolic syndrome found in patients with a daily alcohol consumption, and a decreased prevalence in those with a sporadic pattern.

None Declared

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by frequent comorbidity including mood, anxiety and psychotic disorders. Psychiatric comorbidity in ASD has been associated with poor prognosis.

To summarize clinical data regarding the relationship between autism spectrum disorder and psychosis comorbidity, namely its epidemiology, diagnosis, treatment and prognosis.

We conducted a non-systematic review of the literature relevant to the topic published in the PubMed database. Articles were selected based on title and abstract review.

Epidemiological studies report significant rates of comorbidity between ASD and psychosis. According to a recent systematic review, prevalence of non-affective psychosis in ASD has been estimated at 9,56%, despite heterogeneity across included studies.

The differential diagnosis of psychosis in a patient with ASD is frequently a challenge and depends on the severity of intellectual and language impairment, medical comorbidities (including epilepsy and associated pharmacological iatrogenic factors), psychiatric comorbidities and substance use. Conversely, establishing the diagnosis of ASD in a patient presenting with psychosis is not always clear, and clinicians must rely on collecting a detailed developmental history.

There are no large controlled studies regarding the treatment of psychosis in this specific patient group, but risperidone and aripiprazole have been used based on efficacy in primary psychotic disorders, as well as efficacy and safety profile in other symptomatic clusters of ASD, namely irritability.

ASD and psychosis comorbidity has been associated with lower response rates to antipsychotic treatment and negative long-term prognosis.

Psychosis is a common and serious comorbidity of ASD, with limited data regarding treatment options. Further research is needed to improve global outcomes.

None Declared

Multiple Sclerosis is a neurodegenerative, demyelinating disease that affects the Central Nervous System. Except for motor dysfunction and sensory deficit, patients suffering from this disorder often have neuropsychiatric symptoms, such as: depressive mood, fatigue, and cognitive impairment. Depression is the most common mental disorder in Multiple Sclerosis, and the risk that MS patients develop depression during their entire life is >50%.

Factors impacting on the development of depression

A regular, clinical study approach has been used on a 49-year old woman, who was diagnosed with depressive Disorder 2 years ago and then Multiple Sclerosis, as well as recent literature on depressive disorders in comorbidity with Multiple Sclerosis.

The factors that considerably impact the development of depression are age, gender, insomnia, cognitive impairment, MS clinical picture, and immunotherapy treatment. Depression was diagnosed at the clinical interview, based on DSM-5 diagnosis criteria and Beck Inventory, whereas MS diagnosis was determined by neurological examination and head MRI. The patient was treated with tricyclic antidepressants, SSRIs, SNRIs, atypical antipsychotics for depression, and teriflunomide for MS. Depression has been recurrent, despite being regularly treated with psychotropic medications

Depressive disorders in comorbidity with multiple sclerosis are often undiagnosed and improperly treated. Many factors influence the development and progression of depression, as well as the Multiple Sclerosis clinical picture, above all. Early diagnosis and optimal treatment of them are essential to control the disease and improve the quality of life.

None Declared

Recent studies is showed that adults with Cerebral Palsy (CP) have an elevated prevalence of mental health disorders, especially increased risk of depression or anxiety. Perceptions of the CP condition, and coping behaviors often affect the impact of the condition on the child with CP and his/her family.

Several studies have affirmed that some factors such as interpersonal relationships, sexuality, and physical conditions are also crucial to a higher QoL in the persons with CP.

A Danish study showed that 55% of Danish adults with CP (aged 29–35 years) were unemployed, did not cohabit with a partner and did not have children, compared with only 4% of the control population.

to show a case of a 50-year-old male person with cerebral palsy

case study

The three functional classifications (GMFCS-E&R, CFCS and MACS) is used to provide functional description together with The Quality-of-Life Scale (QOLS), World Health Organization Disability Assessment Schedule 2.0 – (WHODAS-interview), Flourishing Scale Self-perceived success (FS), Depression Anxiety Stress Scales - 10 (DASS-10), the Brief Illness Perception Questionnaire (Brief IPQ)

male, 50 år

Quality of Life score: 90

Flourishing scale (FS): 47

Depression Anxiety Stress Scales: 9

the Brief Illness Perception Questionnaire (Brief IPQ):45

Communication issues: CFCS (Communication Function Classification System): Level I

Having a Partner: Domestic partner- reside together with partner, don’t have children. having af parents and brothers that are a great support

Type of Housing: Independent living (own housing, 1 hour of assistance per week)

Mobility issues: GMFCS (Gross Motor Function Classification System): Level II, MACS (Manual Ability Classification System): Level I

Case is showing 50 years old male with cerebral palsy who has not an intellectual disability and who has a high life quality, high self-perceived success, moderate anxiety and high perception of illness. Social, family and romantic relationships together with leisure time and sustainable physical activity and exercise was emphasized.

None Declared

Cannabis use is frequent among patients with psychotic disorders. However, the relationship between cannabis consumption and transition to psychosis has not been fully elucidated.

The aim of this study was to assess the prevalence of cannabis use in first episode psychosis and its correlation with transistion to psychosis and severity of symptoms.

A cross-sectional study was conducted at the psychiatric department D of Razi hospital including 50 patients hospitalized for first episode psychosis. The evaluation focused on sociodemographic and clinical characteristics of the patients. We used the cannabis abuse screening test (CAST) and positive and negative syndrome scale (PANSS).

The sex ratio of our patients was 4 men per 1 woman. The mean age was 25.6±6.16 years. Two-thirds of the patients had secondary education (n=24). Half of them had no occupation (n=17). Twenty-five patients (71%) had no psychiatric history. The total PANSS score showed a mean of 58.29±12.90 with extremes between 35 and 91. About 60% of the patients used cannabis with high addiction risk in 81% of cases. The mean duration of cannabis use was 7,04 years, 3 times a week. Cannabis use was correlated to the gender. However, no correlation was found between cannabis use and duration of untreated psychosis niether the negative or positive symptoms.

Although cannabis use is knownto accelerate transition to psychosis, it does not affect the severity of symptoms. Further work is necessary to identify the factors that underlie individual vulnerability to cannabinoid-related psychosis and to elucidate the biological mechanisms underlying this risk.

None Declared

Smoking prevalence in patients with mental illness ranges between two to 4 times higher than general population. This higher prevalence has a multifactorial origin, and some of the possible causes are still unknown.

They have a higher prevalence of tobacco-associated diseases and higher mortality.

Additionally, these patients have greater difficulty in treating and quitting smoking.

A relationship has been found between severity of mental illness and smoking. Risk of suicide seems to be higher in patients with higher tobacco consumption. Schizophrenia is the mental illness that has been most closely related to smoking, with a prevalence close to 90%.

The aim of this work is reviewing the current bibliography referring to smoking treatments for patients with mental illness

A literature search using electronic manuscripts available in PubMed database published during the last ten years and further description and discussion of a single-patient clinical case

The treatment of tobacco dependence in patients with mental illnesses is sometimes waited until there is psychiatric stability, which can take a long time in those cases with more severe mental disorders, which can have negative physical and psychiatric consequences.

The combined treatment of cognitive behavioral therapy and pharmacological treatment is the most effective approach. Nicotine replacement therapy can be useful, while combined use of antidepressants or anxiolytics is also recommended.

Bupropion has shown efficacy. In patients with schizophrenia it does not seem to worsen positive symptomatology, but improving the negative one. It should not be used in patients with bipolar disorder or bulimia.

Varenicline has shown efficacy in the general population, but limitations were established in patients with mental illness, although it is the drug that has shown greater efficacy. However, is not currently available in our country.

Cytisine is a drug with limited number of studies in the psychiatric population but it may be a reasonable treatment alternative.

The prevalence of tobacco use in patients with mental illness is higher than the general population, especially in paranoid schizophrenia. The consequences on physical health and the evolution of psychiatric illness are very relevant. Based on above, a multidisciplinary and coordinated management involving psychiatrists and other specialists in the treatment of these patients should be desirable.

None Declared

Habituellement, nous voyons dans la consultation psychiatrique des patients épileptiques pour des plaintes psychologiques. Souvent pour un trouble anxieux ou dépressif. Dans d’autres cas, nous prenons en charge des patients psychiatriques atteints d’épilepsie.

L’objectif de notre travail est d’étudier la prévalence de la comorbidité psychiatrique dans une population de patients épileptiques.

Nous avons mené une étude transversale auprès de la consultation de l’hopital ar-razi de salé, à l’aide d’un questionnaire et d’échelles d’évaluation préétablies : le MINI (mini entretien neuropsychiatrique international), l’inventaire de la dépression de Beck, et Échelle d’anxiété de Hamilton.

55 patients ont répondu aux critères d’inclusion. L’âge moyen de nos patients est de 25,9 ans. Le sex-ratio F/H est de 1,6. Plus de la moitié de nos patients sont célibataires (78%). Seuls 21 % des patients ont une activité professionnelle régulière. La prévalence des troubles psychiatriques dans notre étude est de 66,6%. L’anxiété est retrouvée dans 68,2 % des cas, alors que la dépression est évaluée à 58,9 % des cas dont 23,7 % ont une dépression sévère qu’il faut traiter, avec une prédominance du sexe féminin (66,8 %).

Dans notre étude, l’ anxiété et la dépression sont les troubles psychiatriques les plus rapportés en cas d’épilepsie. Ils doivent être systématiquement recherchés pour tout épileptique et traités pour améliorer la qualité de vie des patients.

None Declared

The herpes zoster oticus results from the reactivation of the varicella zoster virus, a DNA virus of the Herpesviridae family with strictly human-to-human contamination, affecting the geniculate ganglion of the facial nerve. The manifestations of shingles and post-herpes signs are associated with psychiatric manifestations such as anxiety, insomnia and depressive disorder. Shingles and depressive disorder share common features, such as decreased cellular immunity and a high prevalence in the elderly

Is there a correlation between the intensity of depression and the comorbidity of herpes zoster and depression? Is there an explanation for this association? Can adequate therapy of the infection prevent the occurrence of the depressive disorder? Does the existence of this comorbidity affect the response to antidepressants?

case report and litterature

case report

We will try to answer these questions in this work while illustrating by the case of a patient having been touched by this comorbidity and while being based on what was published in literature.

None Declared

Asthma is the most common allergic respiratory disease and is frequently associated with symptoms of depression and anxiety. However, this association remains poorly understood, especially in active military personnel with asthma who are particularly exposed to a high mental and physical load.

To investigate the presence of anxiety and depression in active military personnel with allergic asthma.

This is a descriptive cross-sectional study conducted at the pneumology department of the Tunis military hospital that interested active military personnel followed for asthma and who consulted the department in the period from January 1, 2022 to October 31, 2022. The Hospital Anxiety and Depression Scale (HADS) was used to assess depression and anxiety.

During the study period, 36 asthma patients were included. The mean age was 35±8 years with a male predominance of 83%. The majority of the participants were non-commissioned officers (91%), whom were in field positions in 68% of cases. The median professional seniority was 9 [6; 17] years. Active smoking was noted in 47% of the participants. Half of the patients had comorbidities. A history of major depressive syndrome was reported by 8% of patients. Current antidepressant treatment was mentioned by only one patient. Asthma was well controlled in 66.7% of cases. Definite anxiety was found in 30% of the patients while it was doubtful in 26% of the population. Depression was present in 18% of the participants. Specialist psychiatric care was recommended for patients with depression and anxiety.

Anxiety and depression are significant comorbidities in asthma patients. Screening for these risks is necessary, especially in the military population whose work requires mental and physical integrity.

None Declared

Despite the rapid increase in disability and death due to Parkinson’s disease and associated psychiatric comorbidities (psychosis, depression, cognitive impairment, anxiety), the quest for a clear pathophysiological mechanism and treatment remains elusive. Numerous studies aim to identify a metabolomic fingerprint for PD and new, promising biomarkers are discovered with implications beyond neurodegenerative diseases, such as novel markers as predictors of bipolar type in depressed patients.Changes in neuronal microenvironment employ electrochemical techniques, such as cyclic voltammetry, used in both animal and human models of PD to monitor dopamine (DA) alterations in vivo, with high spatial and temporal resolution.

Our aim is to investigate the latest scientific literature on PD and associated neuropsychiatric disorders and review the applications cyclic voltammetry has in recent technological advances in the field.

To gain a broad understanding of the subject, we have consulted multiple scientific literature databases (PubMed, Google Academic, Science Direct) using the keywords “cyclic voltammetry, Parkinson’s disease, psychiatric disorders, dopamine” and included original research articles published in the last 10 years

The first in situ measurement of DA release in the human brain has been demonstrated in a sequential investment task, with implications for future research in decision-making behavior.

One study combines cyclic voltammetry and wireless telemetry for in vivo recording of changes in extracellular levels of DA, with high temporal and spatial resolution.

Disulfide nanorod-graphene-β-cyclodextrin nanocomposites biosensors have been succesfully used in detecting DA in rodent brain and human blood serum samples, with implications for minimally invasive measuring techniques.

Animal studies use cyclic voltammetry to monitor changes in DA levels in cerebrospinal fluid and plasma of mouse models of PD and investigate DA metabolism, release, uptake and receptor sensitivity in Knock-out mice, with implications for the diurnal variation of extracellular DA tone and release.Furthermore, a human alpha-synuclein-expressing mouse model of PD exhibited increased extracellular DA concentrations, decreased DA uptake and relieved paired-stimulus depression.

Cyclic voltammetry is a powerful tool in the expansion to humans of electrochemical recording techniques in PD. The final aim is to investigate DA neuron physiology before neurodegeneration onset and to measure neurotransmitter release in real time.

None Declared

Drug use and misuse continue to create public health challenges in the world, leading to overdose deaths, infections, and other chronic health conditions. Illegal addictive drugs can lead to functional or structural impairment of the central nervous system (CNS). Because clinical findings alone are often nonspecific, and some patients are unlikely to admit substance abuse, the neuroimaging may play an important role in establishing the diagnosis and initiating treatment.

We aim to provide an overview of the structural imaging findings on computed tomography (CT), magnetic resonance (MR) imaging related to chronic and acute abuse of commonly addictive substances, including cannabis, alcohol, cocaine, and opioids.

Non systematic review of the literature on the subject and description of three clinical cases.

Pathomecanisms of drugs misuse include excitotoxicity, which may lead to an acute or subacute leukoencephalopathy, and vascular complications, including vasoconstriction, vasculitis, or hypertension, which may lead to intracranial hemorrhage or ischemia. Alcohol abuse may lead to Wernicke-Korsakoff syndrome, revealing in MR bilateral symmetrical hyperintense signals on T2-weighted; Marchiafava-Bignami disease (MBD) is a very rare condition which may present hypodense lesions in the corpus callosum; and alcoholic cerebellar degeneration is a common type of acquired cerebellar ataxia and may present cerebellar volume loss localized to the anterior superior vermis. One of our clinical cases is a female, 39 years, and present cocaine induced multifocal leukoencephalopathy, associated with inflammatory/immune mediated mechanism. Other clinical case (female, 24 years) demonstrate spongiform leukoencephalotpathy from “chasing” heroin, with a characteristic presentation.

The main pathomechanisms related to the abuse of drugs are ischemia, hemorrhage, and leukoencephalopathy related to excitotoxicity of the drug or its derivatives. Clinical findings are nonspecific, highlighting the need to recognize these complications at both CT and MR imaging. Therefore, diagnostic imaging modalities can play a pivotal role in the recognition and timely management of drug-related complications in the CNS.

None Declared

Dry eye disease (DED) is a multifactorial disease of the tear film and ocular surface representing one of the most common problems in ophthalmological practice and significant public health problem. Characteristic symptoms of DED include gritty, sandy foreign body sensation as well as visual disturbances that have a negative impact on the patient’s daily activities and also affecting patient’s quality of life (QOL).

The objective of this research is to point out the importance of transdisciplinary approach to treatment of dry eye disease in patients with psychiatric disorders.

We reviewed all current available literature in Pubmed dealing with the topic of connection of dry eye disease and psychiatric disorders.

In recent years, the relationship between DED and psychiatric disorders has been gaining attention. A number of epidemiological studies have reported a possible association between dry eye and psychiatric disorders showing that the subjective symptoms of dry eye can be affected not only by changes of the tear film and ocular surface but also psychological factors such as anxiety, depression, schizophrenia, post-traumatic stress disorder (PTSP) and subjective happiness. Apart from psychiatric disorders, psychiatric medications are also considered as risk factors for DED due to their influence on the tear film status. The incidence of ocular side effects increases rapidly with the use of polypharmacy, a very common form of treatment used in psychiatry.

Mental health disorders may be one of considerable contributing factors for dry eye symptoms and undiagnosed mental health conditions can be an influencing element for unexplained levels of DED symptoms. Depression, anxiety, stress, hypochondriasis, neuroticism, sleep and mood disorders may be associated with the exacerbation of symptoms to degrees that are not consistent with the objective signs related to tear dysfunction as well as changes in the anterior surface of the eye.

There is often inconsistency between signs and symptoms of DED, where symptoms often are more related to non-ocular conditions including psychiatric disorders than to tear film parameters. Consequently, in many cases DED may be considered as a psychiatric as well as ophthalmological problem. Psychiatrists and ophthalmologists need to be aware of the potential influence of psychiatric disorders and medications on tear film stability.

A detailed medical history, thorough ophthalmological examination and referral to a psychologist or psychiatrist may be essential in the treatment of those patients. In treatment of psychiatric patients, an integrative and transdisciplinary approach will result in better functioning and higher QOL.

None Declared

Many research studies and clinicians consider a heterogeneous IQ profile as a specific developmental characteristic to High Intellectual Potential (HIP), despite difficulties in handwriting. We propose to illustrate by a case study, the interest of supplementing a scale IQ with a standardized neuropsychomotor assessment.

We report the complex evaluation of a 8.5 years old boy with an IQ = 137, assessed HIP with a heterogeneous profile at the WISC-V but presenting a clumsiness with a dysgraphia (using the right hand) and difficulties in geometry. These disorders have been attributed by a psychologist to a fast thinking that can impact his graphomotor gesture. However, we aimed to better understand the gap between some IQ index scores.

We have conducted a complete standardized assessment of developmental neuropsychomotor functions (NP-MOT battery, Vaivre-Douret. Digital Ed Neuralix®, 2021; https://neuralix-editions.com/) with age-related normative data, and of neuropsychological functions, in addition an oculomotor examination (Eye-tracking).

The IQ index scores are: VCI = 155, VSI = 108, FRI = 137, WMI = 138, PSI = 92. We found with the NP-MOT battery, a left-handed laterality and at the muscular tone examination, a motor dysfunction of the pyramidal tract on the left body distal side (mild spasticity) and oculomotor disorders of the visual pursuits, associated to visual-spatial motor and visual motor integration impairments.

It is a neurologically right-handed child because he can not effectively use his left hand to correctly write but he is not so good with the right hand to write. Moreover, he presents a visual-spatial motor subtype (< -2 SD) of developmental coordination disorder (DCD according the DSM-5) with oculomotor abnormalities, explaining his clumsiness and dysgraphia, and his difficulties in geometry. Thus, the subtests that make up VSI and PSI highlight a motor component (graphomotor, oculomotor, visuomotor) that should be analyzed in the light of additional neuropsychological and normed assessments of developmental neuropsychomotor functions.

Comorbidity of neurological and motor coordination disorders do not spare the child with a high intellectual potential, despite his high mental abilities helping him to compensate. It is important to complete the WISC-V scale by other investigations, particularly in the motor field, to explain the heterogeneity of the IQ profile with scattered index scales.

None Declared

There is clear evidence of the association of hypothyroidism with depression. It is known to be effective in some cases of adding triiodothyronine (T3) to antidepressant treatment in resistant depressive disorders. However, depression and anxiety can also be linked to hyperthyroidism.

Graves’ disease is an autoimmune disorder that is the most common cause of hyperthyroidism. Some of the symptoms associated with the disease are goiter, ophthalmopathy and psychiatric manifestations such as mood and anxiety disorders.

It is known that different psychosocial factors such as traumatic events, relevant life events, daily stressors, lack of social support, or different personality traits may correlate with Graves’ disease.

The case of an 18-year-old boy diagnosed with Mixed Adaptive Disorder and Graves’ Disease is presented.

Clinical case presentation and non-systematic narrative review in PubMed.

Clinical case: 18-year-old male patient presenting with nervousness, obsessive thoughts, insomnia, decreased anorexia with marked weight loss, tachycardia, involuntary periorbital muscle movements, trichotillomania and wounds in the oral cavity secondary to bites in the context of serious problems with his family and with the law. Anxiolytic and antidepressant treatment is started but the paitent does not take regularly. Admission to Subacute Unit for clinical stabilization and containment of the situation at the social area. Through blood analysis, a diagnosis of Graves’ disease is made and antithyroid treatment is started, presenting significant clinical improvement. Later, with the adequate intake of the psychopharmacological treatment, aims a complete resolution of symptoms.

Review: 1)The association between anxious depressive symptoms and thyroid function is significant. 2) The psychiatric symptoms of Graves’ disease do not follow a specific pattern and are similar to those of an anxiety disorder or a primary anxiety-depressive disorder. 3)They have observed changes in psychopathological aspects in patients with subclinical hyperthyroidism. 4)In various studies it is shown that neuropsychiatric symptoms persist for a later time than thyroid function is normal and in some cases the complete resolution of these symptoms is not resolved. 5)Recent studies conclude that stress can be related to the debut and the evolution of Graves’ disorder despite the difficulty in quantifying it objectively.

1) Routine screenings for thyroid disorders are important in patients with mood and anxiety disorders. 2) When neuropsychiatric symptoms persist despite normalization of thyroid function it should be considered the coexistence of a primary psychiatric disorder as well as the existence of psychosocial factors. 3) It is of interest to carry out research based on a biopsychosocial model to expand the study of the impact of stress on Graves’ Disease.

None Declared

Darier’s disease, also known as Darier-White disease or keratosis follicularis, is a rare autosomal dominant genodermatosis. Clinical experience has long suggested an association between neuropsychiatric abnormalities and Darier’s disease. Moreover, associations with mental retardation, schizophrenia, mood disorders and suicide have been reported.

We studied the association between Darier’s disease and schizophrenia.

We illustrate a case of schizophrenia and Darier’s disease comorbidity with a small review of the literature that summarizes the characteristics of such an association.

Mrs SD, 48 years old, with a prior history of schizophrenia, moderate intellectual disability and several hospitalizations in psychiatry.

She was hospitalized in our department of psychiatry "A" of the Hedi Chaker university hospital after she was brought by the police for odd and disorganized behavior, environmental violence and refusal of treatment.

On somatic examination, the presence of crusty maculopapular skin lesions, non-pruritic, yellowish brown in color and a few millimeters in diameter, located on the back of both hands and feet, face and neck was noted. The patient reported that her brother has similar skin lesions. A dermatological consultation was sought for assessment of her skin condition and a skin biopsy confirmed the diagnosis of Darier’s disease.

Schizophrenia and intellectual disabilities are frequently associated with Darier’s disease. Physicians should be aware of this association in order to allow a rapid diagnosis and early management of psychiatric disorders associated with this genodermatosis.

None Declared

Wernicke’s encephalopathy (WE) is a potentially reversible neuropsychiatric emergency caused by thiamine deficiency, whose classical triad consists of acute onset of confusion, gait ataxia, and oculomotor dysfunction. The diagnosis is missed in 75-80% of cases and approximately 80% of untreated patients develop Korsakoff Syndrome, which is characterized by memory impairment associated with confabulation. Early recognition of nutritional deficiency or any portion of the triad is critical and should prompt treatment, since WE is readily reversible if treated with adequate doses of parenteral thiamine.

Starting from a case report of suspected WE, we pretend to discuss the differential diagnosis of seizures in dual pathology.

Non-systematic review of the literature was performed in PubMed database using the keywords “Wernicke’s Encephalopathy”, “Seizures”, “Alcohol” and “Benzodiazepines”. The articles were selected according to their relevance. A patient´s clinical record was reviewed and presented.

We present a case of a 44-year-old Ukrainian man with suspected background of chronic alcohol abuse and psychiatric history of schizoaffective disorder, who presented with acute onset of confusion, psychomotor agitation, gait ataxia and nystagmus. Anamnesis was hampered by the language barrier and absence of past medical history and patient’s alcoholic habits remained unclear. After suspicion of WE it was introduced thiamine and diazepam, with significant improvement. After discontinuation of diazepam, the patient presented with several episodes of tonic-clonic seizures. He was medicated for seizures with clinical stabilization. At time of discharge the diagnostic discussion prevailed.

Seizures are a common presentation of various conditions associated with alcohol use, whose differential diagnosis is difficult, especially in patients with dubious alcohol consumption. Alcohol abuse is a major precipitant of status epilepticus as seizure threshold is raised by alcohol drinking. Seizures may also occur during alcohol withdrawal, for which treatment with benzodiazepines is recommended, however carefully, since both abrupt cessation and high-dose use are critical for the appearance of seizures. Although very rare, WE may also present with seizures, whereby overdiagnosis and overtreatment are preferred to prevent persistent neurocognitive impairments.

This case illustrates the complexity of neuropsychiatric diagnoses in dual pathology. It requires a longitudinal assessment for a better understanding of clinical conditions and establishment of the best therapeutic approach.

None Declared

Charles Bonnet Syndrome (CBS) is an age-related disorder characterized by complex visual hallucinations in older persons with vision loss and underlying ocular pathology. The management of these symptoms is imprecise and combines psychological measures with psychotropic drugs.

to discuss the non-pharmacological management of Bonnet syndrome through a case report.

We report a case of atypical CBS in a 76-year-old male patient presenting with visual and auditory hallucinations that were improved by reassurance.

The past medical history was significant for diabetic retinopathy, difficulty hearing due to bilateral sensorineural hearing loss. He recognized these visions as unreal and felt distressed by them. No cognitive impairment was observed on several neuropsychological tests. He was reassured of the false nature of the visual experiences after explanations that he had no mental illness and that the problem could disappear. He was taught how to keep the images away by closing his eyes for sometimes and repeated blinking. After six weeks of psychological intervention, the visual experiences had disappeared without using any drug

In the management of CBS drug treatments remain partially satisfactory. Nonpharmacological interventions focus on the reduction of the visual pathway deprivation. This therapeutic alternative seems to provide positive benefits.

None Declared

ADHD is a neurodevelopmental disorder that occurs in childhood and can persist in adulthood in a percentage of cases ranging from 15% to 70% (Cheung, C. H. et al. J. Psychiatr. Res. 2005; 62, 92–100). In these cases, if not treated, ADHD symptoms can cause severe dysfunction (Biederman, J., et al. Am. J. Psychiatry 2000; 157(5), 816–818) often leading to misdiagnosis.

The aim of this case report is to describe the clinical picture of a 26-year-old boy with ADHD and the consequences deriving from the missed diagnosis of the disorder during childhood.

We report a case of undiagnosed and untreated ADHD and the ensuing consequences.

G.V. is a boy who came to our attention complaining about a vague depressive symptomatology. After psychopathological examination we detected mood instability, with the alternance of phases characterized by deep despair and melancholy and phases of agitation with internal tension and generalized anxiety. He reported a tendency to act on an impulsive basis and an occasional abuse of cocaine together with a daily abuse of high doses of Alprazolam. During the past years the boy had been visited by several psychiatrists who made various diagnoses (borderline or avoidant personality disorder, cyclothymic disorder) and prescribed various drugs but none of these were able to stabilize the psychopathological condition. The clinical history revealed the presence of a pervasive picture of inattention and hyperactivity since childhood which had heavily conditioned the patient’s functioning over time. The inattentive pattern has persisted unchanged over the years, while the hyperactive one has improved leaving room for a stable sense of internal tension and generalized anxiety on which mood fluctuations are cyclically inscribed. A diagnosis of ADHD, combined presentation type, was made by using the DIVA-5. The patient was first prescribed lithium, which was subsequently replaced with valproic acid. After mood stabilization and the reduction of anxious symptoms prolonged-release methylphenidate was added to therapy, obtaining resolution of the clinical picture.

Almost all adults with ADHD exhibit a lifelong pattern of frequent mood swings and irritability. Given that many mental health practitioners are unfamiliar with emotional lability in adult ADHD, a bipolar, or cluster B/C personality disorder is more likely to be considered as the cause of the mood swings (Fayyad, J. et al. BJPsych 2007; 190, 402–409). An accurate collection of clinical history can guide the diagnosis and help to address adequate treatment.

None Declared

Patients with autism spectrum disorder are characterized by high anxiety when facing social situations and dealing with interpersonal relationships on a daily basis. Although initially because of their rigid personality with the norm, and their tendency to social distancing, we do not have in mind this pathology as the most likely to develop a substance use disorder. However, it is observed in the literature a remarkable percentage of patients who resort to consumption, mainly alcohol, as an anxiolytic to be able to interact in society.

To show the case of a 19-year-old adult with a diagnosis of ASD who resorts to alcohol consumption in her daily life as a strategy to manage anxiety in social situations.

Case report and literatura review

This is a 19-year-old woman with a recent diagnosis of ASD. She is studying biotechnology and lives with her parents and 3 siblings. The patient reports difficulty in social relationships since early childhood, with experiences of school bullying. She expresses desire to relate with others, although she does it in an inadequate way, with difficulty in detecting nonverbal language, irony and anger when she does not understand a joke. The patient confesses that since she was 16 years old she has consumed alcohol to mitigate the anxiety caused by facing a group of people. She says that she feels that it relaxes her and facilitates interaction, making it more fluid and less tense. However, she recognizes that initially she used to drink 1 or 2 beers, but now she needs to drink up to 2 glasses of gin, recognizing this as something problematic.

The literature shows how patients with ASD can also present substance use disorder. It has been shown that about 10% of these patients have an abusive use of alcohol. Other samples show wider ranges (7-71%) of prevalence of alcohol consumption in patients with autism. In relation to cannabis, it is seen that around 3% of these patients consume it. These patients seek its anxiolytic effect and to reduce mental health symptoms. In addition, the purchase of alcohol does not involve high social interaction to obtain it, since it is a substance that can be purchased legally. It is important to explore alcohol consumption in consultation with patients with ASD to help them develop more functional anxiety management strategies.

Prevalence of psychiatric disorders in adults with autism spectrum disorder: A systematic review and meta-analysis. Lugo-Marín.J et al. 2019. Research in Autism Spectrum Disorders Volume 59, March 2019, Pages 22-33

None Declared