Very few research about atrioventricular blocks (AVB) and use of antipsychotic drugs has been made, although it may play an important role in the outcome of any patient affected by psychosis and AVB.

To describe a case and review clinical data about AVB progression and neuroleptic treatment.

We describe a 37 years old inmate male patient who suffered from a first degree AVB and Schizophrenia, being long term treated with neuroleptics (risperidone 9mg/day, switched to paliperidone 9mg/day). Our patient presented very mild symptoms of asthenia and dizziness. An EKG was performed, showing AVB progression to Mobitz Type I1. No structural pathology was assessed by ecocardiography. Holter EKG showed also episodes of third degree AV block. Electrophysiology studies were performed showing a supra-hisian AV Block.

Lower doses of Paliperidone were used (6mg) and maintened until nowadays. Control EKG showed regression to a known first degree AVB.

Being asymptomatic and studies revealing a supra-hisian AVB, no pacemaker was needed.

There is only a few cases described in scientific literature, and very limited data about AVB and neuroleptic drugs, although it is described as possible side effect using risperidone at higher doses. We suggest monitoring EKG to patients affected by AVB, using high doses of neuroleptic drugs. There is no data available about paliperidone metabolites and a possible progression of AVB.

We suggest more studies are needed to better understand and prevent side effects of neuroleptic drugs.

No significant relationships.

Although ADHD is the most frequently diagnosed psychiatric disorder in childhood, the majority of adults with ADHD are not diagnosed and 90% of the cases remain untreated. One of the main reasons that may lead to the missed diagnosis of ADHD in adults may be the high rate of comorbid psychiatric conditions masking the main symptoms.

In this study, it was aimed to present a case who was followed up with the diagnosis of ADHD since childhood and developed psychosis after a recent traumatic life event.

A 19-year-old male patient was consulted because of his complaints of persecution delusions, and disorganized speech that started 2 years ago. IIt was learned that the first psychiatry application of the patient was 10 years ago with complaints of impulsivity, aggression, increased psychomotor movements, and methylphenidate treatment was started during this period. The patient, whose current clinical picture was evaluated as psychosis, was discharged after the symptoms subsided with paliperidone depot 100mg/month treatment after hospitalization. It is understood that his psychotic complaints completely regressed in the follow-ups.

It is stated that approximately 80% of adult ADHD cases have at least one accompanying psychiatric disorder. However, there are limited studies in the literature on the relationship between psychotic disorders and ADHD.

Recent studies indicate that beyond the fact that ADHD is a feature of the schizophrenia prodrome, ADHD diagnosis may be associated with an increased risk of psychosis in the future. Therefore, this association can be better clarified in further studies on comorbidities.

No significant relationships.

Numerous studies have shown evidence that cannabis use increases the appearance of psychotic symptoms and disorders, and worsens the course of the disease in those with schizophrenia. However, a causal relationship between cannabis and schizophrenia has not been well established yet.

In this presentation we try to review the relationship between cannabis use and prevalence of schizophrenia.

We performed a search of Medline looking for systematic reviews and methodologically robust studies in the field published in English in the last 5 years.

A number of studies, both cross-sectional and prospective, find a prevalence of schizophrenia several times higher among cannabis users than in non-users. This association becomes stronger the lower the age of cannabis use onset, the higher the amount consumed and the higher the THC concentration are. Half of the patients with a cannabis-induced psychotic disorder turn into a diagnosis of schizophrenia within a few years. So far, it has not been possible to demonstrate a global increased prevalence of schizophrenia in relation to the increase of cannabis use in the population in recent decades.

Cannabis and schizophrenia have a complex relationship model; we still cannot clearly establish whether it is causal or the first works as a trigger for pathology in vulnerable subjects.

No significant relationships.

Several studies have shown an association between oculocutaneous albinism and several neuropsychiatric entities, including schizophrenia.

We present through this work the first case of resistant schizophrenia described in this type of patient.

Demonstrate the safety of clozapine in albinos patients and discuss the linkage between the two disorders.

We describe the case of a 23-year-old patient with oculocutaneous albinism who developed treatment-resistant schizophrenia, successfully treated with clozapine.

We received the patient referred by his private psychiatrist, after the absence of improvement despite the use of several first and second generation antipsychotics, alone and in combination, at therapeutic doses, with good compliance and for a duration of more than 3 months.

The onset of psychotic symptoms was at the age of 18 years, and the evolution was continuous.

On admission, the patient was agitated and assessment of thought content were difficult due to intellectual disorganization. The initial PANSS score was assessed at 120. The somatic examination was normal, except for generalized hypopigmentation and horizontal and rotatory nystagmus. A biological workup, MRI, and electroencephalogram revealed no abnormalities.

The diagnosis of resistant schizophrenia was retained and the patient was put on clozapine 12.5 mg/d with progressive titration to a dose of 400 mg at the 6th week, with marked improvement; the patient became motor calm, with understandable speech and adapted responses, the PANSS score at the 2nd month decreased markedly by 33 (from 120 to 87).

This case report suggests that clozapine can be safely introduced in patients with oculocutaneous albinism.

No significant relationships.

Alpha-pyrrolidinohexanophenone (α-PHP) is a synthetic cathinone with uneven distribution throughout the world. Its use is not uniformly regulated and its distribution is legal in some European countries. Easily accessible and available through different websites. Synthetic cathinones inhibit monoamine transporters which include dopamine, norepinephrine, and serotonin, resulting in increased neurotransmitter synaptic concentration. Ways of administration show wide range regarding latency period. Onset and appearance of symptoms as well as their duration and intensity may fluctuate. A decreasing order of latency (oral, inhaled, sublingual and intravenous) has been reported. α-PHP can result in the appearance of psychiatric symptoms, include among others, intoxication with sensory perception disturbances and α-PHP -induced psychotic episodes.

The aim of our study was to assess the epidemiology, clinical and legal features regarding Alpha-pyrrolidinohexanophenone (α-PHP).

Review the current bibliography to upgrade the existing knowledge. -Present assorted cases with diverse clinical features. All cases include variability through psychopathological interview, symptoms assessment and treatment response according to rating scales (PANSS, YMRS). -Evaluate different treatment administration ways during acute phase and after hospital discharge.

Differences were observed after hospitalization in the response using diverse rating scales. We used antipsychotics to treat intoxication with sensory perception disturbances and α-PHP -induced psychotic episodes. α-PHP had a negative impact on the quality of life of the patients.

α-PHP is a synthetic cathinone with potential risk to mental health and life of users. It is mandatory to implement common legislation all through the European Union to prevent its use and possible implications on population’s mental health.

No significant relationships.

Parkinson’s disease (PD), the second most common neurodegenerative disease after Alzheimer’s disease, affects 1% of the population after the age of 60. Motor symptoms are the most common features that may be associated with non-motor symptoms including psychotic symptoms.

Faire le point sur les modalités de prise en charge des symptômes psychotiques au cours de la maladie de Parkinson

Nous décrivons 3 cas de développement de symptômes psychotiques, survenus chez des patients atteints de la maladie de Parkinson, et faisons le point sur la prise en charge des manifestations symptomatiques psychiatriques dans la maladie de Parkinson, par une brève revue de la littérature.

Case 1: 42-year-old man, with 5 years’ history of PD, presented with auditory hallucinations comorbid with paranoid personality disorder, which occurred 12 months following antiparkinsonian drugs use. Case 2: 58-year-old man, with 17 years’ history of PD, presented jealousy delusions and behavioral disorders, which occurred 12 years following antiparkinsonian drugs use. Case 3: 76-year-old man, with 36 years’ history of PD, presented visual hallucinations, subjective sensation of a presence and jealousy delusion, which occurred 26 years following antiparkinsonian drugs use.

Les symptômes psychotiques de la maladie de Parkinson sont fréquents. La prise en charge consiste à traiter les symptômes psychotiques sans aggraver les symptômes moteurs liés à l’hypo-dopaminergie.

No significant relationships.

Parkinson’s disease (PD) and its pharmacological treatment can be associated with a long list of neuropsychiatric complications.

The aim of our case report is to investigate through a case analysis the possible association of dopaminergic dysregulation syndrome and Othello syndrome

we carried out a case analysis and a review of the literature by searching the PubMed database

Case report We present the case of a 43-year-old man suffering from early PD since the age of 16, started on levodopa since the age of 19.

Since 2 years, the patient has resorted to a considerable increase in the doses of levodopa up to 2500 mg / day, the evolution was marked by the installation of disabling dyskinesias and by a change in his behavior and mood.

He was then hospitalized in psychiatry following aggressive behavior towards his wife. The admission examination found a patient who was motor unstable with an interpretative delirium of jealousy and persecution.

The diagnosis of Othello syndrome associated with SDD was retained.

Our therapeutic strategy has been to put the patient on quetiapine, reduce the doses of levodopa, add a dopamine agonist and involve psychoeducation of the patient and his family. Evolution has been marked by the reduction of delusions of jealousy.

This case reports a rare case of delirium of jealousy induced by the misuse of dopaminergic drugs in a patient with PD in its early form. These complications can have catastrophic consequences for the patient. Researching and recognizing these psychiatric manifestations should help avoid devastating consequences.

No significant relationships.

Dissociative identity disorder(DID) is characterized by the existence of two or more distinct identities which involve changes in consciousness, emotion, memory, and behavior. It is associated with childhood traumatic experiences and other psychiatric disorders. Comorbidity in DID can lead to complex clinical presentations, poor treatment responses. Thus, it is crucial to identify patients with comorbidity and take them into the treatment plan.

We aim to report a case of DID and Attention-Deficit/Hyperactivity Disorder(ADHD) comorbidity.

A case report is presented alongside a review of the relevant literature regarding “dissociative identity disorder” and “attention deficit hyperactivity disorder”.

We describe the case of a 39-year-old woman with DID, onsetting at age 25, who had consistently responded poorly to long-term psychotherapy and pharmacological treatment. She presented with anxiety, distinct personality states, alterations in memory, consciousness and behavior problems in functioning, and high Dissociative Experiences Scale(DES) scores. Throughout the interviews, we noticed that she had limited attention, excess movements. After a detailed evaluation, diagnosis of ADHD is established, using the Diagnostic Interview for ADHD(DIVA) and ADHD Self-Reporting Scale(ASRS). Methylphenidate was prescribed in addition to previous medication. İmprovement in the severity of both ADHD and DID symptoms was presented with lower scores in DES and ASRS after the introduction of methylphenidate with progressive dose adjusting till 60mg/day.

Although previous studies demonstrated ADHD symptoms are related to dissociation, there is no well-established strategy for this. We believe that this case report provides a better approach to the comorbidity of ADHD and DID.

No significant relationships.

Many individuals with severe mental illness (SMI) have substance use disorder comorbidity. Dual diagnosis makes the approach and management of these patients even more challenging since the lack of improvement in either pathologies can lead to a deterioration of both.

To illustrate, through the presentation of two cases, the clinical challenges in managing a patient with dual diagnosis

Clinical case presentation through retrospective review of clinical notes and non-systematic literature review on this topic

We present the clinical cases of two women diagnosed with Bipolar Disorder and (poly)Substance Use Disorder since adolescence, who have a history of multiple hospitalizations due to mostly maniform symptoms. The complexity of case management is evident, both at the pharmacological level and in psychosocial intervention. This is aggravated by the difficulty in maintaining adherence to the therapeutic project and frequent relapses.

Current evidence points to the beneficial effect of a combined pharmacological and psychosocial approach, which must be comprehensive, individualized and require differentiation at various levels that are difficult to achieve and make the treatment of these situations an even greater challenge.

Using illustrative examples, this review draws attention to the practical difficulties in managing situations where substance use is associated with SMI.

No significant relationships.

Neuroimaging has been a highly utilized technique for studying traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) independently of one another, however, neuroimaging has increasingly been identified as a useful tool in better understanding TBI-related psychiatric conditions, such as PTSD.

To complete a systematic review of the literature examining neuroimaging findings in TBI-related PTSD and to highlight the current literature’s limitations in order to strengthen future research.

A PRISMA compliant literature search was conducted in PubMed (MEDLINE), PsychINFO, EMBASE, and Scopus databases prior to May of 2019. The initial database query yielded 4388 unique articles, which were narrowed down based on specified inclusion criteria (e.g., clear TBI definition, clinician-diagnosed PTSD, statistically analyzed relationship between neuroimaging and PTSD, quantified time interval between TBI and neuroimaging).

A final cohort of 10 articles met inclusion criteria, comprising the findings of 482 participants with TBI. Key neuroanatomical findings among the included articles suggest that PTSD is associated with significant changes in whole-brain networks of resting state connectivity and disruptions in bilateral frontal and temporal white matter tracts, fronto-limbic pathways, the internal capsule, and the uncinate fasciculus (Figure 1).Figure 1a:

Neuroimaging Findings in TBI-related PTSD.

Replicated Neuroimaging Findings in TBI-related PTSD in the Right Uncinate Fasciculus.

Additional inquiry with attention to specified imaging timing post-injury, consistent TBI definitions, clinician-diagnosed TBI and PTSD, and control groups is crucial to extrapolating discrepancies between primary and TBI-related PTSD. Prospective studies could further differentiate predisposing factors from sequelae of TBI-related PTSD.

No significant relationships.

The primary aim of our study was to assess the psychoscial impact of infertility amongst female infertile patients. We selected infertile women visiting the gynaecological OPD of R.G.Kar Medical College and Hospital - one of the busiest and most reputed government hospitals in eastern India. Most of the research on psychological aspects on infertility has been done in the developed rich nations of the world, our study is one of the very few to have been conducted in a developing nation like India.

Incidence of depression , psychopathology and anxiety in female infertile patients in comparison to control fertile group. Impairment in quality of life Impact of other variable factors

Source of data : RGK Medical College, Kolkata, India

Sampling technique : Consecutive Random Sampling

Tools for data collection: Beck’s Depression Inventory, Beck’s Anxiety Inventory, SF36, SCL 90, Mini International Neuropsychiatric Interview, Self Reporting Questionnaire, Socio Demographic Proforma.

Data Analysis: The data was collected and analyzed by means of descriptive and inferential statistics.

Inferential statistics- Data analyzed by using SPSS. The relationship between continuous and binary explanatory variables with SF36, SCL 90, BDI and BAI scores were assessed using unpaired t test.

Statistical analysis by independent t test shows significant increased levels of depression, anxiety, significant difference in psychopathology and quality of life in the 2 study groups.

Infertility has a significant impact on psychosocial well being of infertile patients, Greater collaboration is required between psychiatrists, psychologists and infertility specialists to assist infertile couples.

No significant relationships.

As liaison psychiatrists, it is very important to mantein a good relationship with other medical specialties in order to obtain the best result for our patients. Most of the times, the somatic process affects direct or indirectly to mental healt and vice versa, so our cooperation is extremely important for the patient’s welbeing.

With this study we try to find special considerations and necesities of every specialty that count on us in our hospital. We have design this batebase with the aim of discovering which are the main problems that suffer the admitted patients, which doubts face our colleagues when evaluate mental health patients, etc. Thus, our team could help other physicians properly or so we could stablish a proper liaison in order to make things easier.

A database has been created with all the patients evaluated by our liaison psychiatry team during half a year. We have taken into account sex, age, referral specialist, mental health diagnosis (after our evaluation), previous mental health follow-up, if they are on psycopharmacology treatment, if they requiere psycopharmacology treatment and if they requiere follow-up once discharged.

22,9% were kid/adolescent patients. 25,8% were elderly people (>70 yo). 47% were men (of which, 6% were trans men), 53% were women. 22,9% suffered from adjustment disorder, 14,1% had no acute mental health problem, 11,76% presented substance abuse. Main petitions were made from Internal Medicine (30%)

With this information we can explore other specialists’ and admitted patients’ needs and concerns and focus our effort in solving them.

No significant relationships.

Wernicke Encephalopathy (WE) is the best characterized neurological complication of thiamine deficiency. Its clinical presentation can be diverse, including hallucinatory or delusional symptoms, and not necessarily associated with the classical triad of WE. This correlates with higher rates of under diagnosis. We present the case of a 72-year-old man with a history of alcoholism who was admitted to the hospital due to behavioural disturbances and subacute delusional ideas of harm.

To review the epidemiology and clinical features of WE, as well as its clinical management.

Review of the literature on WE clinical presentation and management, focusing on psychopathological symptoms, applying the information to this specific case.

Classical triad of WE is only to be found in 10-17% of patients. The most common clinical presentation is changes in mental state (82%), varying from subtle changes in memory, apathy, subtle disorientation or indifference to more severe presentations such as delirium, stupor or coma. Other frequent symptoms include oculomotor dysfunction and gait ataxia. High dose thiamine supplementation therapy has proven effective in preventing clinical progression and permanent neurological damage.

- WE is the most prevalent complication of thiamine deficiency, being associated to alcoholism in 50% of cases. - Changes in mental state is the most frequent form of clinical presentation, not necessarily associated with the classical triad of WE. - WE is a medical emergency that requires high dose thiamine supplementation therapy to prevent permanent neurological damage.

No significant relationships.

Primary care physicians tend to examine patients with conversion disorder (CD) first. A good knowledge of this disorder will allow an early diagnosis and avoid unnecessary investigations for the patient.

To assess the knowledge of primary care physicians about patients with CD.

We conducted a cross-sectional and descriptive study among 90 primary care physicians in Sfax (Tunisia). We used an anonymous self-questionnaire for data collection.

The response rate to our questionnaire was 60%. The participants’ age ranged from 25 to 70 years, with a median of 41 years. The sex ratio (M/F) was 0.92. The majority of physicians (75.9%) have practiced in the public sector. Among the respondents, 75.9% had theoretical training in CD, 14.8% had continuing medical education (CME), and 42.6% had hospital experience in a psychiatric department. The overall proportion of correct answers was 71.8%. The most recognised symptoms of CD were: dysphonia-aphonia, paresthesia or paresis. All doctors mentioned at least one criterion to distinguish CD from epileptic seizures and loss of consciousness.

There are some gaps in primary care physicians’ knowledge of CD. Thus, we propose to reconsider the conduct of CME, to favour small group training workshops with role-playing and to improve the collaboration between the psychiatrist and the primary care physician.

No significant relationships.

Conversion disorder (CD) is largely managed by primary care physician. A good knowledge of this disorder and a mastery of adequate therapeutic means will allow patients to recover promptly and reduce recurrences.

To evaluate the management of CD by primary care physicians.

This cross-sectional and descriptive study involved 90 primary care physicians in the region of Sfax (Tunisia). We submitted a self-administered anonymous questionnaire to physicians to explore their practice towards patients with CD.

Among the 90 doctors contacted, 54 (60%) responded to our questionnaire. Their age ranged from 25 to 70 years, with a median of 41 years. The sex ratio was 0.92. The average number of years of practice was 15 years (SD = 9.7). Half of the physicians reported that the consultation of a patient with CD lasted between 15 and 30 minutes. Faced with a first episode of CD, 61.1% of the doctors decided to treat the patient alone and 18.5% preferred to take the advice of a psychiatrist. In the case of a recurrence, 59.2% chose to refer the patient immediately to a psychiatrist. The use of pharmacological treatment was indicated by 64.8% of participants. Half of the doctors stated that they had difficulties in managing patients with CD.

According to our results, the management of CD by primary care physicians remained restrictive and difficult. It is therefore necessary to encourage primary care physicians to express the difficulties they encounter and to turn to their psychiatric colleagues for help.

No significant relationships.

The coronavirus disease 19 (COVID-19) pandemic has prompted concerns regarding increased suicide rates and exacerbation of underlying mental illness symptoms. •There is evidence suggesting neurocognitive changes as well as immune response in COVID-19 infection may increase a patient’s propensity for suicidal ideation. • Patients who are diagnosed with COVID-19 may be affected by psychological factors of anxiety, stress related to having this novel virus as well as depression, post-traumatic stress disorder and sleep disorders throughout treatment and post-treatment of continued concerns. •The combination of psychiatric, neurological, and physical symptoms associated with COVID-19 may elevate suicide risk

We present a case of a female with no prior psychiatric history who impulsively attempted suicide after a recent COVID-19 diagnosis and subsequent quarantine. Will explore possible link between increase of suicidal ideation and COVID-19 infection.

A case report.

Link between increase of suicidal ideation and COVID-19 infection has not been clearly established but there have been reports, as in our case, of the possible vulnerability to mental illness and new onset suicidal ideation that COVID-19 survivors may experience. It may be useful to screen all patients for depressive symptoms after a COVID-19 infection. Early identification and treatment of depression in recovered COVID-19 patients will help to improve psychological impact on COVID-19 survivors and potentially reduce suicide rates.

As COVID-19 infection may trigger new onset mental illness, exacerbate symptoms of underlying mental illness, and may increase suicidal ideation, further research is needed to evaluate links between COVID-19 infection and depression with suicidal ideation

No significant relationships.

Addison’s disease (AD) is a rare disorder of the adrenal glands which causes deficiency of cortisol and aldosterone. It presents with a variety of symptoms, including neuropsychiatric manifestations. We discuss the case of a patient who exhibited psychotic symptoms in clear consciousness and no other clinical sign of AD.

To investigate the association between AD and neuropsychiatric symptoms; to make clinicians aware of psychotic manifestations of AD as first presentation.

Case Presentation of a patient with psychosis and AD. A review of the literature was conducted in PubMed using the following keywords: Addison’s disease, Addison crisis, psychosis, psychotic, neuropsychiatric

A 32-year-old alert male patient presented with delusions of persecution, auditory hallucinations and mild psychomotor agitation after a stressful life event. Lab tests showed hyponatremia (132 mEq/L). Patient exhibited rapid clouding of consciousness after admission and further lab results showed low levels of cortisol. He was therefore started treatment with high doses of hydrocortisone with good response. A close association between AD and psychiatric manifestations was indicated by the literature review, especially in males and those with thyroid dysfunction comorbidity. These include a wide range of symptoms, such as apathy, catatonia, anxiety, depression, lethargy, delirium, cognitive disorder, irritability, behavioural disorders, agitation, delusions, hallucinations, and rarely psychotic symptoms in clear consciousness. The aetiopathogenetic mechanism involves electrolyte disturbances, cortisole deficiency and increase in endogenous endorphines

Clinicians should be alert of the manifestation of AD with psychiatric symptoms ;patients with AD should be informed of the risk for Addison crisis after stress.

No significant relationships.

16-year-old female who starts psychiatric follow-up due to episodes of anxiety crises with dizziness and tremors.

To expose a case in which it is essential to rule out organic pathology in cases where there is anxiety and physical symptoms.

Case report and literature review

The patient explains that she was in a situation of conflict with her ex-partner, commenting that he did not accept the breakup. Sertraline was prescribed in ascending doses up to 100 mg per day with complete remission of anxiety. 8 months later, she went to the emergency room for loss of consciousness and tremor of the lower limbs. She was diagnosed with conversive disorder and was prescribed lorazepam up to 3 mg per day. Since then, there has been a worsening in the frequency of syncope occurring up to 10 times a day, limiting her academic and social life. She was evaluated by a cardiologist who diagnosed Pots Syndrome (postural orthostatic tachycardia syndrome) and started treatment with ivabradine and mineralocorticoids. With this treatment, the episodes were drastically reduced and spaced out to 1-2 per week. The dose of lorazepam is decreased until its withdrawal without worsening of the anxious symptomatology.

This disorder consists of an involvement of the autonomic nervous system in which there is a sudden drop in blood pressure together with an abrupt increase in heart rate. Its treatment is based on increasing blood volume with drugs such as corticosteroids as well as postural measures with adequate water intake.

No significant relationships.

Glaucoma is a heterogeneous group of conditions which result in optic neuropathy and visual defects, majorly linked with the increase of intra-ocular pressure (IOP). It is known that psychotropic drugs have been implicated in drug induced angle-closure glaucoma, mostly through its anti-cholinergic effect.

Systematize the drugs most and least implicated in its appearance and worsening and understand the care needed on prescribing.

A search on Pubmed database was made having in consideration the Mesh Terms Glaucoma and Psychotropic Drugs and its different classes. Specific searches were made when appropriate on different platforms.

Implications on the appearance and worsening of glaucoma are clear for tricyclic antidepressants. The evidence is not clear for SSRIs, SNRIs and mirtazapine, but they might be related with increased IOP. Other classes of antidepressants seem to be of lower risk. Antipsychotics do not seem to be greatly associated with angle closure, although there are some case reports. There are descriptions of the potencial use of haloperidol, anti-convulsive mood stabilizers, with exception of topiramate, melatonin and anti-dementia drugs on the treatment of this condition. In practice, benzodiazepines do not seem to precipate angle-closure. Methamphetamines are contraindicated. Eletroconvulsive therapy its an option.

Although not prevalent, angle-closure glaucoma can have serious implications and culminate in irreversible blindness. In patients with known risk-factors its important to have it on consideration at the time of the prescription and warn on seeking immediate help if having acute ocular pain, redness and/ or cloudy vision.

No significant relationships.

Huntington’s Disease (HD) is an autosomal dominant, neurodegenerative condition with a prevalence of 10.6-13.7 per 100,000, caused by the trinucleotide CAG (cytosine, adenine, guanine) repeat expansion in the HTT gene. HD is characterized by a range of motor, cognitive, and psychiatric symptoms, the latter of which usually manifest prior to the onset of motor or cognitive disturbances. Amongst psychiatric symptoms, changes in personality are most common, followed by depression. Psychosis has a higher prevalence in those with early-onset HD.

This case report aims to demonstrate an apporach to the management of neuropsychiatric disturbances in HD as well as expose the need for development of an evidence-based apprach to treatment.

PubMed was searched for the criteria Huntington’s Disease AND Psychosis, with a secondary search for Management of Psychosis in Huntington’s Disease.

The patient is a 54-year-old male with no psychiatric history and reported past medical history of Huntington’s Disease, diagnosed one month ago. He was brought to the Psychiatric ED due to agitation and disorganized behavior at home. On admission, he demonstrated disorganized behavior, grandiose delusions, neurocognitive deficits, and reported auditory hallucinations. With the initiation of tetrabenazine and risperidone his psychiatric symptoms improved and he was able to be discharged to a long-term care facility.

Literature is scarce regarding treatment of psychiatric manifestations of HD. We catered our approach towards safe and effective symptoms management in a multidisciplinary manner. Further research is required to reach an evidence-based consensus as well as develop specific guidelines for managing psychiatric conditions related to HD.

No significant relationships.