Huntington’s disease (HD) is a hereditary neurodegenerative disorder characterized by motor, cognitive, and psychiatric symptoms. Initially, the patient’s involuntary movements were attributed to anxiety-related restlessness and psychomotor agitation, leading to a diagnosis of anxiety disorder. During hospitalization, the patient was referred to neurology for his movements, where functional movement disorder was considered. However, due to worsening cognitive decline, apathy, and the psychiatrists’ suspicion that the movements were not functional, further investigations were conducted. Cranial MRI, followed by a dementia protocol MRI, revealed caudate nucleus atrophy, leading to the diagnosis of HD.

To illustrate the diagnostic challenges in identifying Huntington’s disease in a patient initially misdiagnosed with anxiety disorder and functional movement disorder.

A 58-year-old male presented with anxiety and involuntary movements, leading to initial diagnoses of anxiety disorder and functional movement disorder. As symptoms progressed—including worsening involuntary movements and cognitive decline—a comprehensive reassessment was conducted. This included neurological examination, neuroimaging, neuropsychological testing, and genetic testing via blood test for CAG repeat analysis.

Cranial MRI revealed bilateral caudate atrophy and dilated lateral ventricles, consistent with Huntington’s disease. Neuropsychological assessment showed significant impairments in verbal learning, memory, and executive function. The patient was treated with venlafaxine 150 mg/day, mirtazapine 30 mg/day, and haloperidol 6 drops/day, leading to significant improvement in anxiety symptoms and a reduction in chorea.

This case underscores the importance of considering neurodegenerative disorders such as Huntington’s disease in the differential diagnosis of patients presenting with psychiatric symptoms and involuntary movements. Early identification, comprehensive assessment, and a thorough understanding of HD’s clinical presentation are crucial for appropriate management.

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Alexithymia is characterized by difficulty in verbally expressing emotions, a trait commonly observed in patients with psychosomatic symptoms, such as those with asthma. These individuals struggle to identify their emotions and are more prone to developing somatic health issues.

• - To study the prevalence of alexithymia, anxiety and depression in asthma patients

• - To identify the relationship between these aspects.

It was a cross-sectional, case-control, descriptive and analytical study, conducted in the pulmonology department at Hedi Chaker University Hospital in Sfax. The study involved 50 asthma patients and a control group consisting of 50 healthy nurses. Data collection was based on a sociodemographic and clinical questionnaire, as well as two psychometric scales: the Toronto Alexithymia Scale 20 (TAS-20) and the Hospital Anxiety and Depression Scale (HADS).

The mean age of the patients was 44.08 ± 12.78 years and the male-to-female ratio (M/F) was 0.92.

More than half of the patients (62%) had experienced an acute severe asthma requiring hospitalization. The disease was controlled in 70% of the cases.

The prevalence of alexithymia was 40% in the asthma patients and 36% in the control group, with no significant difference between the two groups (p = 0.68).

The prevalence of anxiety was 38% in patients and 34% in the control group with a significant difference between the two groups (p = 0.012).

The prevalence of depression was 38% in patients and 28% in the control group with a significant difference between the two groups (p = 0.002).

Alexithymic patients were significantly more anxious (p = 0.01) and more depressed (p = 0.01) than non-alexithymic patients.

Patients with ashtma present high rates of anxiety, depression and alexithymia. This latter does not appear to be a determining factor in asthma. However, it seems to be associated with the emotional distress caused by anxiety and depression. Timely screening for emotional distress and its early management is essential in this population.

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Chemsex is typically described as the use of specific substances to enable or enhance sex during extended sessions with multiple partners among men who have sex with men (MSM). Numerous studies have linked chemsex with different physical and mental health risks and other potential harms.

According to the latest European online survey por MSM (EMIS-2017), the section on substance use revealed the prevalente of substance use for sexual purposes in the last twelve months was 14.1% with Spain being one of the countries with the highest prevalence of chemsex at the European level.

As the prevalence of chemsex is increasing, consequences from this phenomena arises and a progressive increase in the number of psychiatric consultations and admissions related to chemsex practice have also been described, with substance abuse disorders, depression, and anxiety as the most prevalent diagnoses.

From our Liaison and Emergency Psychiatry Service consultations related with mental health issues and chemsex are increasing with growing number of suicide attempts, psychotic, maniac and depressive episodes.

Our objective in this poster is to describe the mental health risks of chemsex, its peculiarities and the main manage issuses in the Liaison and Emergency Pscychiatry Service.

Systematic review of the scientific literature related with chemsex and mental health risks will be carried out and we will also analyse some of our cases to describe presentation and management of the symptoms.

Chemsex is related with an increased rate of mental health issues and consultations related with substance use disorders, depression and anxiety. Clinical features due to this disorders are unique and integral treatment in coordination with Infectious Medicine Specialist is needed.

Chemsex is an increasing phenomena and it is intimately related with psychiatric disorders.

Psychiatrists must be concerned about it and trained to approach and treat these complex disorders in an integrative way.

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Post-traumatic brain injury (TBI) is a leading cause of long-term neuropsychiatric consequences, which can significantly impair quality of life and complicate recovery. These consequences include cognitive deficits in memory, attention, and executive functions, depression, anxiety, apathy, obsessive-compulsive disorder, psychosis, personality changes, impulsivity and agitation in moderate to severe cases. In cases of repetitive head trauma, there is a higher risk of developing chronic traumatic encephalopathy, a neurodegenerative disorder charaterized by dementia and motor abnormalities. Understanding the spectrum and prevalence of these disturbances is crucial for developing effective management and rehabilitation strategies.

The aim of this study is to review the prevalence and treatment of neuropsychiatric consequences of traumatic brain injury.

The authors did a non-systematic review of the current literature.

This review revealed that neuropsychiatric consequences are present in approximately 80% of post-TBI patients, depending on the severity of the injury and the time passed from the trauma. Depression and anxiety disorders were the most prevalent, followed by cognitive deficits. Personality changes, impulsivity, and agitation were commonly observed in moderate to severe cases. Factors such as the extent of frontal lobe injury and the time elapsed since the injury were strongly associated with the severity of neuropsychiatric symptoms. There is no pharmalogical treatment approved by the Food and Drug Administration (FDA), but the literature recommends the use of SSRI (in cases of depression), beta blokers (in high doses for agitation), antipsychotics (only if necessary and with caution, because these patients are more propense to the side effects and it can impair cognition and motor rehabilitation) and anticonvulsants (carbamazepine or valproate in cases of agitation or irritability).

Neuropsychiatric complications of TBI are common and have significant implications for long-term recovery and quality of life. Early identification and comprehensive management strategies, including pharmacological and psychological interventions, are essential to address these challenges and improve patient outcomes. Further research is needed to refine diagnostic tools and therapeutic approaches tailored to the neuropsychiatric consequences of TBI.

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Post-ictal psychosis is a kind of epileptic psychosis in which psychotic features appear 12h – 7 days after the epileptic seizure causing them.

To present a challenging case reflecting upon presentation, management and considerations of post-ictal psychosis.

Case presentation and non-systematic literature review.

A 40-year-old female, living in a European foreign country with her partner and child, flies to Lisbon 5 days previously to her admission as a sudden decision because she believed she was the daughter of a portuguese yoga master. She was brought to psychiatry ER by the police due to disorganized and aggressive behavior in public, where she presented with severe agitation, disorganized and coprolalic speech, persecutory, mistic and filiation delusions, somatic and affective passivity, and very uncollaborative. She had no analytic or image alterations except for positive cannabinoids in urine. She was admitted in psychiatry and started on risperidone titled till 6mg and diazepam 15mg, with remission of symptomatology. When she was able to collaborate, she admitted she had a history of Epilepsy for which she was not having treatment, and a previous post-ictal psychotic episode some years ago. Family confirmed she had a generalized tonic-clonic seizure about a week ago, and delusional ideas starting the following day, having left home unannounced. Although the EEG was normal, considering suggestive history post-ictal psychosis was admitted ad most probable diagnosis and she was slowly stopped medication without symptom resurgence. The importance of anti-epileptic treatment in order to avoid subsequent seizures and post-ictal psychosis was explained, however the patient denied treatment and was discharged back to her hometown with indication to follow-up in neurology.

Post-ictal psychosis corresponds to 25% of epileptic psychosis. It is associated with temporal lobe epilepsy, psychotic symptoms of mistic and religious themes, aggressive behavior, and increased suicide risk. It has a sudden onset and complete remission although a risk of recurrence as in this case. Treatment consists of seizure control to avoid following episodes. Antipsychotics that don’t increase convulsive risk such has risperidone may be useful to acute control of psychotic features and behavior alterations.

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Systemic Lupus Erythematosus (SLE) is an autoimmune disorder characterized by systemic inflammation and high prevalence of neuropsychiatric symptoms. Among these, suicidal ideation represents a significant concern, with reported higher rates than in the general population. The etiology of suicidal ideation in SLE is multifaceted, encompassing both disease-specific factors and psychosocial variables. Recent research has highlighted the intricate interplay between SLE and psychiatric symptoms, suggesting a bidirectional relationship mediated by inflammatory processes, neurological involvement, and psychosocial stressors. However, the specific contributions of these factors remain unclear.

This study aims to elucidate the primary predictors of suicidal ideation in a cohort of SLE patients.

A cross-sectional study was conducted with a cohort of SLE patients from the Autoimmune Diseases Unit at Cruces University Hospital (Biscay, Spain). Each patient underwent a thorough clinical evaluation by a psychiatrist, and relevant clinical and sociodemographic data were collected. Suicidal ideation was assessed using the Plutchik scale, while predictor variables included autoimmune factors such as cumulative corticosteroid dose, disease activity, and accumulated organ damage. Psychiatric symptoms were assessed using various psychometric scales. A multiple linear regression model was employed to examine the associations between these variables and suicidal ideation.

A total of 92 SLE patients in active follow-up were included, with a female predominance (91%). Most patients were in an inactive disease state, receiving low-dose prednisone and antimalarial therapy according to our clinical protocol; the majority were in remission, as reflected by a mean SLEDAI-2K score of 1.59(±2.44). Despite a median disease duration of over 10 years, cumulative organ damage was low (mean SDI score 0.33 ± 0.84). In a multiple linear regression analysis, the model showed a strong fit (R=0.732, R²=0.535, p<.001), explaining approximately 53.5% of the variability in suicidal ideation. Suicidal ideation was significantly associated with cumulative corticosteroid dose (β=0.172, p=0.011), total anxiety score (β=0.248, p<.001), and frequency of traumatic experiences (β=0.118, p<.001). Collinearity statistics (VIF 1.03–1.07) indicated no significant multicollinearity issues.

Suicidal ideation in our SLE cohort was associated with corticosteroid use, anxiety, and traumatic experiences, highlighting the importance of addressing these factors in suicide risk management. The relationship between corticosteroid dose and suicidal ideation may be linked to the neuropsychiatric effects of these drugs, while anxiety and traumatic experiences contribute to the emotional burden of the patient. Notably, disease activity was not linked to suicidal ideation in this cohort.

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Cholesterol is important for the normal functioning of the central nervous system. However, its reduction by certain agents might be related to the psychiatric adverse reactions, which could vary in frequency, but some can be serious and even fatal, such as suicidality and severe aggression.

With this case report, we would like to draw attention to the possibility of serious psychiatric adverse reactions in patients receiving lipid-lowering drugs.

Bibliographic search and description of a clinical case of a patient under follow-up in outpatient treatment.

A-60year old woman with generalized anxiety disorder and hyperlipidemia in a previously good remission reported increased anxiety, nervousness, insomnia and irritability on a regular check-up. There were no external stressors, except for an approaching retirement, which she was looking forward to. However, she forgot to mention that she was switched from fenofibrate to a pill consisting of a combination of rosuvastatin and ezetimibe. Her antianxiety medication needed to be increased and some cognitive behavior interventions were administered. However, her condition continued to deteriorate in the following months. She even developed suicidal ideation and verbal aggression. She refused to be hospitalized, while going to a trip with her husband. During the trip, she was not taking her new antilipemic medication and she never restarted it. After two days of discontinuation of the combination pill, her psychiatric condition gradually improved. At the following examination, she revealed the modification of her antilipemic treatment and the new medication could be identified as a cause of intensification of her anxiety. Subsequently, she was switched to atorvastatin (later on ezetimibe was added). She went into a full remission and she remained in it, while her psychiatric medications were reduced to the initial dosages.

The treatment of the patient’s symptoms in our case report was directed towards reducing a substantial worsening of the anxiety disorder while lacking the information on the previous replacement of a lipid-lowering drug. Luckily it ended well. With our case report, we would like to re-emphasize the importance of caution and monitoring of side effects, education of patient and interdisciplinary professional communication when treating with lipid-lowering drugs, especially in patients with a known mental disorder.

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Breast cancer (BC), one of the most common cancer types among women, affects one in four women according to global cancer statistics (Ferlay et al., 2021; Yusof et al., 2021; Sung et al. 2021; Li et al. 2023). Despite the increase in the life expectancy of cancer patients with advances in treatments and developing technology, its diagnosis as a disease with a high risk of death causes anxiety and stress in individuals (Solomon et al., 2000; WHO, 2018; Miller et al., 2019; Abdollahi et al., 2019).

In addition to physical and emotional changes, the diagnosis of cancer brings about changes in social relationships and roles. In coping with these processes, it has been reported that social support and social support management will have positive effects on coping with the problems brought by the disease, improvement in prognosis and self-management levels of patients (Xiang, 2010).

Interpersonal Relationship Psychotherapy (IRPT), which has been recommended as monotherapy for mild to moderate depression in treatment protocols in recent years (Spinelli, 1997; Spinelli and Endicott., 2003; APA, 2010; Brandom et al. 2012) Interpersonal psychotherapy has been found to be effective in the short and long-term treatment of cancer patients with major depressive disorder (Blanco, Hershman et al., 2014). Grief, interpersonal conflicts, role changes and social isolation (lack of interpersonal skills), which are the focus of IPT, are frequently experienced problems in cancer-related processes. IPT works by associating the social support and interpersonal problems that patients receive with disease symptoms (Sayar & Omay, 2019).

This study will examine the effect of Interpersonal Relationship Psychotherapy (IRPT), which is recommended as monotherapy for mild to moderate depression in treatment protocols, in breast cancer patients.

Studies conducted in the last 10 years and in Turkish-English are included.

95 publications were reached. 73 publications were reached after removing duplicate publications.

We included randomized controlled trials of interpersonal relationship psychotherapy in breast cancer patients, comparing it with combination therapy, and applying it by telephone. The study included 4 studies.

Having examined a total of 73 abstracts, we retrieved 10 full-text papers for further study. Of these, we excluded 6 papers that did not meet inclusion criteria. A total of 4 studies met all inclusion criteria and were included in this systematic review.

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When the results of four studies examining the effectiveness of interpersonal relationship psychotherapy were examined, it was found to have a positive effect for breast cancer patients. This study, which examines the effects of interpersonal relationship psychotherapy, a therapy with proven positive effects on depression in different samples, on breast cancer patients, is important because it provides evidence to the literature.

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Diabetes and hypertension are chronic conditions that significantly impact mental health. Managing these diseases involves constant monitoring, lifestyle changes, and dealing with potential complications, which can lead to increased sleep disorders, anxiety, and depression.

the objectives of our study were to determine the frequency of anxiety, depression and sleep disorders in patients with hypertension and diabetes and to investigate factors associated with their occurrence.

This is a descriptive cross-sectional study conducted over a three-month period from October 1 to December 31, 2022, involving 720 diabetic and/or hypertensive patients followed at the primary health centers (CSB) in Kalaa Kbira Sousse. The assessment of sleep disorders was performed using the Pittsburgh Sleep Quality Index. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale.

Among the 720 patients included, the majority were women (70.6%), with a gender ratio M/F of 0.41. The average age of the participants was 63.45 ± 13.16 years. The chronic illness was hypertension in half of the cases (49.3%), diabetes in a quarter of the cases (26.3%), and both conditions together in a quarter of the cases (24.4%). Anxiety was present in nearly half of the participants (47.1%), depression affected 40.2%, while anxiety-depressive disorder concerned half of the cases (46.5%).The prevalence of sleep disorders was 54.3% according to the Pittsburgh Sleep Quality Index (PSQI) with a median score of 6 [IQR: 3-9]. The subjective quality of sleep was rated as poor in 41% of cases.The prevalence of sleep disorders was 46% among diabetics, 54.6% among hypertensive patients, and 62.5% among those with both conditions simultaneously.In multivariate analysis, factors associated with poor sleep quality according to the PSQI included age ≥ 65 years (p=0.026), comorbidities (p=0.012), anxiety-depressive disorder (p≤10-3), poorly controlled diabetes (p≤10-3), and insulin therapy (p=0.022).

Understanding the mental health challenges faced by individuals with diabetes and hypertension is crucial for developing comprehensive care strategies that address both physical and psychological needs.

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The alcohol use disorder has consequences on the metabolic, gastroenterological and especially neurological levels.

The somatic complications of alcohol use disorder add to the psychological and psychiatric complications and repercussions.

This involves presenting the case of Mr D;D admitted as part of the emergency for psychiatric evaluation.

Interest in highlighting multidisciplinary care for somatic and psychiatric liaison

Presentation of clinical case

Patient case

The management of patients with a psychiatric disorder or a request for psychiatric evaluation within the framework of the emergency liaison requires multidisciplinary and coordinated care.

Close collaboration allows early diagnosis and better overall patient care.

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Hypertension, a major global public health challenge, is often associated with mental health conditions, particularly depression. Several studies suggest a bidirectional relationship between depressive symptoms and hypertension, which may negatively affect individuals living with hypertension’s ability to maintain essential self-care practices, including adherence to prescribed medications and necessary lifestyle modifications.

This study aims to build upon our previous systematic review (doi: 10.5455/msm.2024.36.65-72) by incorporating new data to further investigate the relationship between depressive symptoms and various aspects of self-care, with a particular focus on medication adherence among individuals diagnosed with hypertension.

The electronic database CINAHL was added to those of PubMed, Scopus, and PsycInfo, with the search extending from April 2023 to the present. Given the substantial diversity among the studies, a narrative synthesis of the results was conducted.

A total of five new studies were included alongside the existing eighteen, involving 11,733 individuals with hypertension who met our eligibility criteria. Among these studies, ten reported a statistically significant association, highlighting the negative impact of depressive symptoms on medication adherence. The remaining thirteen studies did not confirm this association.

This systematic review reaffirms the diverse landscape of research examining the relationship between depressive symptoms and medication adherence in individuals with hypertension. It is advisable to conduct more robust longitudinal studies to thoroughly explore this relationship.

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Cytopenia is a common hematological issue in HIV/AIDS patients. Despite early disease identification and less toxic HAART reducing its prevalence, persistent thrombocytopenia remains. SSRIs, prescribed for depression in this population, can also cause thrombocytopenia. This review explores the potential combined impact of HIV and SSRI treatment on thrombocytopenia risk.

The objective of this study is to evaluate thrombocytopenia incidence in HIV/AIDS patients and those receiving SSRIs, and to provide clinical recommendations for monitoring in individuals affected by both conditions.

A comprehensive literature review was conducted using PubMed, MEDLINE, and the Cochrane Library. Studies on thrombocytopenia in HIV/AIDS patients or discussing SSRI-induced thrombocytopenia were included. Data on incidence and clinical management were extracted and synthesized to form a cohesive understanding of risks and recommended practices.

Thrombocytopenia (<150,000 platelets/μl) is a sentinel event frequently seen in HIV/AIDS patients, often prompting further evaluation. A 1982 study reported thrombocytopenia in up to 40% of AIDS patients pre-HAART. Recent data from the CHORUS cohort (1997-2006) showed a decreased prevalence of thrombocytopenia to 14%. However, 23% of those with severe thrombocytopenia (<30,000 platelets/μl) remained symptomatic despite HAART. A BC-CfE study found a 0.6% prevalence of symptomatic thrombocytopenia among HAART-treated patients (1996-2012), highlighting non-HIV causes. SSRIs can cause thrombocytopenia by interfering with platelet serotonin uptake, reducing platelet function and lifespan. Several case series reported isolated thrombocytopenia following SSRI introduction. While the concurrent use of SSRIs and HAART’s effect on thrombocytopenia risk is unclear, careful consideration and monitoring are necessary.

The relative risk of thrombocytopenia from the combined effect of HIV/AIDS and SSRI treatment has not been definitively established. HIV/AIDS patients on SSRIs should be carefully monitored due to the known hematological impacts of both the disease and medication. Regular monitoring of platelet counts is crucial, especially in those with advanced or poorly controlled HIV. Consider alternative psychiatric treatments with lower hematological risks where possible. Effective management requires interdisciplinary collaboration to address these patients’ complexities. This review underscores the importance of vigilant monitoring and individualized treatment strategies for HIV/AIDS patients on SSRIs to manage and mitigate the potential risk of thrombocytopenia.

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Autoimmune encephalitis is a new and increasingly well-described entity. The most common is encephalitis caused by antibodies against the N-methyl-D-aspartate receptor on the surface of neurons (NMDAR encephalitis). It is a predominant entity in women and young patients and it is often associated with ovarian teratomas, neuroblastomas, Hodgkin’s lymphomas and others.

NMDAR encephalitis can manifest with a diverse range of neurological and psychiatric symptoms (personality change, anxiety, insomnia, confusion, attentional and short-term memory deficits, emotional lability, psychotic symptoms, language impairment, fluctuations in the level of consciousness, seizures and dysautonomia).

Clinical review of Anti-NMDAR Encephalitis for differential diagnosis with Functional Neurologic Disorder.

Clinical case and literature review.

We present the clinical case of a 27-year-old woman with a history of depression and anancastic personality disorder. The patient went to the Emergency Department different days presenting both neurological (facial paresthesias, hypoesthesia, weakness, high-intensity occipital headache, dizziness, loss of consciousness and anterograde amnesia) and psychiatric symptoms (obsessive thoughts, anxiety, visual and auditory hallucinations). She was admitted to the Neurology Unit. Complementary tests were performed: EEG, cranial CT scan, MRI, lumbar puncture, blood tests (including tumour markers) and urinalysis, founding no alterations suggestive of encephalitis or other systemic pathologies. She was also evaluated by the Psychiatry service. The patient described that as a result of a recent change in her job she presented emotional lability, obsessive ruminative ideas and anxiety. Treatment with Sertraline 100mg/day and Lorazepam 1mg/8 hours was started.

After ruling out autoimmune encephalitis, the patient was diagnosed with Functional Neurologic Disorder, given the temporal relationship of the symptoms with the stressful history at work.

Given their growing prevalence autoimmune causes, such as NMDA anti-receptor antibody encephalitis, should always be considered in the cases of neuropsychiatric alterations. It is very important to carry out a correct organic screening prior to the diagnosis of psychiatric pathology. It is also essential an adequate coordination between different medical departments for an accurate and comprehensive approach to the patient.

None Declared

This case highlights the interdisciplinary management of a 28-year-old Filipino female with recurrent depressive disorder and multiple medical comorbidities, including HIV, tuberculosis, and sexually transmitted infections. Managing depression in patients with complex medical conditions is especially challenging in resource-limited settings like the Philippines, where drug-to-drug interactions and access to high-quality care must be carefully navigated.

The objective of this case report is to illustrate the importance of personalized treatment decisions, the rationale for choosing Venlafaxine over SSRIs, and the value of psychodynamic psychotherapy in addressing underlying emotional conflicts in the context of maternal health challenges.

The patient was referred to the Psychiatry service due to suicidal ideations. She has a history of depressive episodes linked to family stressors and initial flashbacks and nightmares related to her physical abuse from her previous partner. Her extensive comorbidities made the usual first-line antidepressants (SSRIs) unsuitable due to drug interactions. Venlafaxine 75 mg/day was selected, and psychodynamic psychotherapy, trauma-informed psychotherapy, and psychoeducation were integrated into her treatment. Coordination with infectious disease, obstetrics, and internal medicine specialists ensured comprehensive care.

Venlafaxine was effective in improving mood, sleep, and appetite, with no significant side effects. Regular follow-ups confirmed adherence to the medication, and psychodynamic psychotherapy helped her address deep-seated emotional conflicts, particularly surrounding her history of trauma. Ongoing psychiatric care, along with monitoring her medical conditions, provided a supportive framework for her continued improvement. Despite financial constraints, the patient adhered to her treatment regimen, showing improved mental health and commitment to her care.

This case underscores the complexity of treating depression in patients with multiple comorbidities, particularly in resource-limited settings. The selection of Venlafaxine was crucial due to the potential interactions of SSRIs with the patient’s medical regimen. Psychodynamic and trauma-informed psychotherapy, combined with interdisciplinary collaboration, were key to the successful management of this case. This highlights the need for an integrated approach to mental health care, especially in low-resource environments, where interdisciplinary coordination is vital.

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Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS) is an autoimmune disease caused by Group A Streptococcus bacteria. It usually affects children 3 to 12 years of age, however, have also been reported among adolescents. PANDAS presents with neuropsychiatric symptoms which can overlap or coincide with existing psychiatric disorders that often emerge further as children get older. Identifying the causation of events may be challenging making such cases difficult to manage.

To understand the presentation of PANDAS with concurrent mood disorder and its management.

Clinical case report

A 16-year-old female was initially admitted due to blank stares, disorganized behavior, paranoia, aggression, and depressive symptoms. Her EEG and MRI were normal. She did not tolerate Fluoxetine but improved with Olanzapine (12.5mg). At 17 years old, she had throat discomfort, colds, and headache with supportive management done. She felt depressed and suicidal due to school stress prompting her second admission. She was started on Escitalopram and Olanzapine was shifted to Quetiapine. Subsequently, she developed manic symptoms with hallucinations and worsened paranoia. Escitalopram was discontinued and Quetiapine was increased (300mg). Bipolar I Disorder with Psychotic Features was considered. Shortly after, she developed explosive motor and vocal tics, involuntary screeching with head gagging and jerking and urges to choke herself or hit her head on the wall. Quetiapine was discontinued and was placed on Clonazepam (0.25mg/8h). Work ups revealed normal EEG, positive ASO and ESR, and findings of Mild Rheumatic Heart Disease on 2D Echo, hence, the assessment of PANDAS. Treatment is multidisciplinary involving antimicrobial, immunomodulatory, and psychotherapeutic interventions. Medications were then adjusted to: Co-amoxiclav (625mg/10days) followed by Penicillin V (250mg/12h), Aripiprazole (15mg), and Divalproex Sodium (1000mg). Intravenous immunoglobulin was suggested due to her moderate to severe presentation. Henceforth, improvement of symptoms were noted and she was reintegrated back home.

Diagnosing PANDAS can be complex among adolescent due to concurrent issues with similar symptom presentation. PANDAS is episodic in nature but may also have sawtooth-like presentation which may indicate first admission as an episode and the second, a flare up. The case could have also been a combination of PANDAS and Bipolar Disorder thus the severity. Regardless, the interplay of biological and psychological facets have evidently magnified her predispositions leading to an intense manifestation of symptoms.

None Declared

Functional neurological disorder (FND) is diagnosed in approximately one-third of admissions to the general neurology outpatient clinic. Although it affects both gender in a wide age range, it occurs more frequently in women between ages of 35 and 50. As a common neuropsychiatric disorder affecting mostly young people at productive ages, FND also leads to an important socioeconomic burden. For this reason, clinical and research activities tended to increase recently in order to develop new neuroscientific approaches for the treatment of this disorder. Various new clinical centers that offer specialized and multidisciplinary treatment to FND patients, have been established around the world. Likewise, a study group was established in Hacettepe University Adult Hospital, where FND patients were started to be treated by a multidisciplinary team, by also considering the specific needs of our country’s population.

Here, we aim to share the phenomenological and clinical characteristics and treatment response of patients with functional neurological disorders (FND) who received short-term inpatient multidisciplinary treatment in a university hospital between 2020 and 2023.

FND study group at Hacettepe University Adult Hospital was founded by 2 neurologists, 2 psychiatrists, 1 psychologist and 2 physiotherapists.

Within the framework of the protocol, FND patients were first informed about the disease process by a neurologist and a psychiatrist and then followed up for further need for an inpatient multidisciplinary approach.

During hospital admission in the room reserved for FND patients in the neurology ward, the treatment protocol was implemented in such a way that each session included one hour of cognitive behavioral therapy-based psychotherapy and at least 2 hours of intensive physiotherapy including FND-specific approaches for at least 5 days.

Demographic and clinical characteristics of the patients were noted, their fitness levels before and after treatment were evaluated with a visual analogue scale, and the patients’ perceived improvement levels were also evaluated with VAS and recorded as a percentage.

The majority of patients were women (19/11).

The age range was wide, between 19 to 75 (average 44 years).

Patients were classified under four groups based on the predominant symptom (gait disorders:15, fixed dystonia: 9, swallowing and speech problems:3, sensorial problems:3)

The level of improvement perceived by the patients was the best in those with sensorial problems, and the worst in those with swallowing and speech problems (%40).

Those with the lowest level of perceived wellness in terms of general health were patients with dystonia component.

Multidisciplinary FND rehabilitation may provide different degrees of benefit to FND patients of different subtypes. Our results may have the potential to contribute to clinicians and academicians in predicting treatment outcomes.

None Declared

Acutely decompensated heart failure (HF) may be accompanied by depressive symptoms. Predictors of screening diagnosis of depression (SDD) in decompensated HF are poorly elucidated.

We sought to investigate independent determinants of SDD in patients with HF decompensation.

Enrolled were fifty-one patients with a median age of 67 years and left ventricular ejection fraction (LVEF) of <40% hospitalized due to HF decompensation. SDD based on the result of the Beck Depression Inventory (>10 points), PHQ-9 (>12 points) or Hamilton Depression Scale (lack of depression: <7 points; mild [<12 points], moderate [<17 points] or severe [≥18 points] depression). Neurotrophic potential and response to stress were assessed by brain-derived neurotrophic factor (BDNF) and FK506 binding protein 5 (FKBP5), respectively.

SDD was identified in 26 (51%) patients based on the Beck inventory and in 12 (24%) patients based on PFQ-9. According to the Hamilton scale mild SDD was found in 17 (33.3%), moderate in 9 (17.6%) and severe in 14 (27.5%) of patients. Male patients with HF decompensation had higher result of Beck inventory by 35% (P=0.029), PHQ-9 by 60% (P=0.014) and Hamilton scale by 64% (P=0.003) than female. The result of the Beck Depression Inventory was correlated with plasma levels of FKBP5 (R=0.34, P=0.017) and inversely correlated with BDNF (R=-0.39, P=0.004). In turn, LVEF was correlated with the result of PHQ-9 (r=0.33, P=0.020), Hamilton scale (r=0.33, P=0.18) and with BDNF (r=0.32, P=0.025) while inversely with FKBP5 (r=-0.32, P=0.023). By multivariate analysis the higher result of the Beck inventory was associated with male gender (β=0.26, P=0.048), a higher LVEF (β=0.27, P=0.042) and a lower plasma BDNF (β=-0.46, P<0.001).

SDD in patients with HF decompensation is independently associated with male gender, better preserved left ventricular systolic function and reduced plasma level of BDNF.

None Declared

The large-scale social stress of recent years (the COVID-19 pandemic, the large-scale invasion of the rf in Ukraine) has a powerful negative effect on the psyche of people and causes an increase in the incidence of stress-associated pathology. One of the vulnerable groups in the formation of distress conditions is patients with psychosomatic pathology, in particular, psoriasis, in the pathogenesis of which psychosocial stress plays an important role.

To determine the existence of a differentiated impact of a contain of the large-scale stressful events on the health of patients with psychosomatic pathology.

83 psoriasis patients interactively were examined using the Google Form developed by us, which provided for a structured interview with the purpose of determining anamnestic data and collecting subjective complaints of the patient in two time periods the year of quarantine due the Covid-19 pandemic (11.03.2020-11.03.2021), and the year from the beginning of full-scale russian aggression (24.02.2022-24.02.2023). Statistical analysis included descriptive statistics and assessment of the significance level of differences using Fisher’s exact test (one-sided).

In the 1st year of the Covid-19 pandemic, exacerbation of psoriasis was found in 36.1% of patients, of which 63.3% believed that this was associated with the

impact of stress through pandemic. The stress of war proved to be a more powerful psycho-traumatic factor (P<0.01): in the 1st year, exacerbation of psoriasis was observed in 61.4% of patients, 88.2% of whom associated it with the impact of war. The prevalence of almost all psychopathological symptoms in patients during a full-scale war was slightly higher than during the Covid-19 pandemic: fear and anxiety (80.0% VS 88.2%), reduced mood (66.7% VS 90.2%, P<0.01), dyssomnia (50% VS 45.1%), asthenia (36.7% VS 41.3%), emotional lability (33.3% VS 37.3 %).

The conducted study revealed the impact of strong social stress on the frequency of psoriasis exacerbations and mental maladjustment. The stress of the war turned out to be a more powerful stress factor, and the patients significantly more often associated this social stress, with the exacerbation of psoriasis. It is allows us to consider the content of the stress load and the peculiarities of individual perception of stress as a relevant factor in the exacerbation of psoriasis and comorbid mental disorders. But a larger study involving a larger number of patients is needed to reveal more subtle patterns.

None Declared

Prolonged symptoms of SARS COV2 infection known as Long COVID, are defined as symptoms persisting for more than four weeks after the initial diagnosis of COVID-19. Psychiatric symptoms such as anxiety, depression, cognitive deficits, fatigue, qualities poor sleep and somatic symptoms are common in patients with long-term COVID and could last weeks, even months, after recovery.

In this study, we tried to identify the psychiatric symptoms that can start after infection with SARS COV2, what could be the risk factors for the onset of these symptoms and how the quality of life is affected in these patients.

The study included 116 patients diagnosed with COVID-19 in the Suceava County Clinical Hospital, who were monitored for 12 months by applying standardized questionnaires for depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7) and cognitive disorders. (Montreal Cognitive Assessment), patients being periodically evaluated clinically, biologically, neurologically and psychologically.

A percentage of 26.9% of patients presented the following psychiatric symptoms more than 4 weeks after the diagnosis of SARS COV2 infection: anxiety (6%), sleep disorders (7.7%) manifested by insomnia or hypersomnia, lack of concentration and attention (10.3%), memory disorders (8.6%), depression (4.3%). The most frequent psychiatric manifestations were cognitive disorders (10.3%) expressed by deficits in attention and memory, followed by sleep disorders (7.7%). Women presented a higher percentage of psychiatric manifestations manifested by anxiety and depression, but we did not find a correlation between the age of the patients and the mental manifestations after COVID-19. The 2 patients with depression in the antecedents, presented an exacerbation of mental symptoms post COVID. Depression and anxiety were more frequent in patients who had prolonged hospitalizations or moderate and severe forms of the disease. In 12 patients who presented cognitive disorders, increased values of C-reactive protein and lactic dehydrogenase were found during SARS COV2 infection. The use of questionnaires showed an important impact on the quality of life, especially in patients diagnosed with depression, anxiety and insufficient sleep.

Recognition and treatment of psychiatric symptoms that started after SARS COV2 infection should be included in the management of the patient with chronic COVID. The use of screening questionnaires for depression, anxiety and cognitive disorders must be implemented in the current practice of post-COVID-19 monitoring. The collaboration between infectious disease specialist, psychiatrist and psychologist can be the key to success in the treatment of psychiatric disorders in patients with long-term COVID.

None Declared

Since the beginning of the health crisis caused by COVID-19, the impact of the pandemic context on the mental health of healthcare professionals has been widely studied. However, few studies have assessed psychological manifestations in healthcare workers affected by COVID-19.

Determine the prevalence and factors associated with depressive symptoms in healthcare workers with COVID-19.

This is a cross-sectional analytical study of health professionals at Farhat Hached University Hospital with COVID-19 over a 6-month period from September 2020 to February 2021. Depressive symptoms were screened using the Depression Subscale of Hospital Anxiety and Depression Scale (HADS-D).

Our study included 477 healthcare professionals. The mean age was 39.9 ±10.8 years, with a predominance of women (sex ratio =0.27). Almost a third of the participants were nurses (32.1%), followed by doctors (27.9% of cases). Most of the healthcare workers affected developed a pauci-symptomatic form of the infection (73.8%), with an average confinement time of 14.9±6.9 days. On returning to work, 74 staff (15.5%) noticed that their colleagues were withdrawing from work. According to the HADS-D scale, depressive symptoms were observed in 19.1% of cases. The predictive factors were gender (p<10-3), age (p=0.016), the symptomatic form of COVID-19 (p= 0 ,038), the duration of confinement (p<10-3) and the withdrawn attitude experienced by colleagues on returning to work (p<10-3).

Our results showed that psychological suffering, particularly depression, among care staff depended on several predictive factors. Psychological support during and even after the period of confinement is therefore necessary

None Declared