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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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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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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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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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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The conversion symptom, present in current medical practice, traces its origins to Ancient Egypt, having had, over time, several interpretations. Under the name Hysteria, it was studied by Charcot with hypnosis at the Salpêtrière Hospital. Currently, it belongs to Conversion Disorders, and neurology has given the term psychogenic nonepileptic seizures (PNES), to differentiate these phenomena from epileptic seizures.

This work proposes to describe the history of Conversion disorder, from Freud’s hysteria to the concept of psychogenic nonepileptic seizures, and to summarize useful concepts in approaching patients with conversion disorder, in different contexts.

Non-systematic review of the literature with selection of scientific articles, using PUBMED as database the following keywords: «Conversion disorder», «hysteria» and « psychogenic nonepileptic seizures». Seven articles were included. We also selected 5 reference books.

In the 19th century, the conversion symptom constituted a very important milestone in Psychiatry, as it was through monitoring patients with hysteria that Freud created Psychoanalysis. Then, the physical symptoms of hysteria (paralysis, convulsions…) began to be understood as symptoms of psychic origin, and as a symbolic expression of a representation that was unacceptable to the Self and, therefore, repressed. According to psychoanalysis, in hysteria, body is invaded by psychic and serves as a stage for unconscious representations. Nowadays, the term hysteria can include psychogenic nonepileptic seizures, which are paroxysmal episodes of changes in behavior, movement, sensitivity or consciousness, similar to epileptic seizures, but which, unlike epileptic seizures, are not caused by a change in brain’s electrical activity.

With the description of the evolution of conversion disorder, from Freud’s hysteria to nowadays, it is possible to find that conversion pathology will not tend to disappear. It represents a specific mode of psychic functioning, characterized by an organization of defense mechanisms, cognitive styles, memory functions and specific personality traits. Therefore, it is important to continue investigating strategies to individualize the approach to these patients. Also, it would be beneficial to extend access to important psychological knowledge to more general doctors, in order to improve the capacity of managing conversion disorders cases that arise in different health contexts. We highlight the importance of understanding the suffering of these people. Patients with conversion symptoms do not choose to have a certain symptom and shouldn’t be a target of stigma. Each person develops their own psychic functioning process, as each person constitutes an unique identity and deserves an individualized and inclusive approach.

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The study of anxiety-phobic states as an integral part of psychosomatic relationships in cardiovascular pathology allows us to detail the pathogenetic mechanisms of formation, develop approaches to early diagnostics, psychotherapy and psychoprophylaxis, which is of unconditional medical and social importance in solving this problem.

Improving the effectiveness of therapy for patients with hypertension, including in combination with ischemic heart disease (IHD), with anxiety states based on the personalization of psychotherapy.

The survey included the use of clinical, socio-demographic, instrumental, clinical-psychopathological, psychodiagnostic and statistical methods.

The study sample consisted of 120 patients who were treated at the Kharkiv Clinical Hospital on Railway Transport No. 1, JSC Ukrzaliznytsia. It was revealed that the main psychopathological variants of anxiety states in patients with hypertension are anxiety and combined fears (biological, situational and social, enhanced by psychotraumatic events related to war). The intensity and spectrum of anxiety states have a direct correlation with the duration, severity of the somatic disease and the severity of psychopathological symptoms.

For patients with hypertension with IHD, the dominant fear is typically focused on their own biological well-being (90.5%), for patients with hypertension – on the biological and social well-being of significant others (74,4%).

The dynamics of anxiety states are different: in 57,7% of patients with hypertension, fear initially develops as a result of traumatic social or situational factors, in 69,1% of patients with hypertension with IHD, unreasonable anxiety acquired a plot due to somatic distress. Psychopathological symptoms in patients with hypertension with anxiolytic states are represented by pronounced asthenic manifestations (95,8%) in combination with hypochondriacal (37,5%), depressive (24,2%), and vegetative (15,0%).

A differentiated psychotherapeutic model for the correction of psychosomatic relationships has been developed, aimed at deactualization of fears, reduction of anxiety, elimination of psychopathological manifestations, improvement of the somatic state, improvement of the quality of life and social adaptation.

The application of the developed model has shown its high efficiency in the complex therapy of patients with hypertension.

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We present the case of a 58-year-old male patient with a history of bipolar disorder, schizoaffective disorder, renal insufficiency and diabetes insipidus who developed malignant catatonia (MC), possibly related to the administration of ciprofloxacin. In a first admission to our care facility, the patient presented a neuroleptic malignant syndrome (NMS) due to antipsychotic medication, with partial remission following the discontinuation of these drugs and introduction of benzodiazepine (BZD) and dantrolene treatment. However, after this first hospital discharge, the patient required a second hospitalization due to a worsening of his general condition, apparently related to a urinary tract infection (UTI). During this last admission, antibiotic therapy with ciprofloxacin was administered, resulting in the worsening of his neuropsychiatric condition and developing clinical symptoms compatible with catatonia. The clinical presentation of his condition eventually requires treatment with BZD and electroconvulsive therapy (ECT).

The aim of this work is to describe the course and therapeutic approach of a case of MC possibly induced by ciprofloxacin, clarifying the differential diagnosis between NMS and MC.

A thorough review of the patient’s clinical history was performed from the onset of symptoms in the care facility through his ICU and inpatient hospitalizations. Pharmacological changes were documented, including antipsychotic interruption and BZD administration. Treatment with ECT was initiated after an insufficient response to BZD. Finally, a literature review was conducted to explore the relationship between MC and ciprofloxacin.

Initially, the patient showed a partial remission of the catatonic symptoms with BZD and dantrolene after discontinuing antipsychotics, achieving a temporary stabilization. However, after the introduction of ciprofloxacin, he developed a severe catatonic symptoms characterized by central fever, extreme rigidity, mutism, and withdrawal from the environment. Despite BZD treatment, the catatonic symptoms persisted, leading to the decision to initiate ECT. After multiple sessions, the patient experienced a significant improvement on autonomic, motor and cognitive symptoms of catatonia, as well as a more robust clinical stabilization.

This case suggests a possible association between the administration of ciprofloxacin and the onset of MC in a chronic psychiatric patient with a history of NMS. The favorable response to ECT highlights the utility of this therapeutic option in the management of severe catatonia when other treatments are not fully effective. The chronology on this case suggests a neurotoxic effect of ciprofloxacin, emphasizing the importance of considering interactions between antibiotics and psychiatric pathologies in vulnerable patients.

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In consultation-liaison work, oftentimes the “consult question” is elusive. Primary teams can sense that there is a need for psychiatric consultation, but may not be able to formulate those concerns into the “right question.” Therefore, when the consult team receives the question, the presenting problem may be very different from the reason for consultation. This is never more true than in the case of delirium. Studies have shown that delirium often goes unrecognized by medical and surgical services. (Armstrong et al. Psychosomatics 1997;38:433-439).

This study sought to determine the reasons for consultation when a diagnosis of delirium was given by the consulting psychiatrist.

A retrospective chart review of one year of consecutive consults to the Psychiatry Consult & Liaison service was done for three hospitals comprising the majority of consults to the University of Pittsburgh Medical Center C&L service originating from other teaching services. This yielded approximately 3000 new consults. Each consult was coded for the following variables: the exact quotation from the referring team, the summary statement of what the consultant felt were the most relevant issues, and the DSM-V F-code. We analyzed the consults that were either specific requests for help managing delirium or that resulted in a diagnosis of delirium by the C&L service.

We found that a large majority of consults for “agitation” were ultimately aimed at helping to manage a patient with low cognitive reserve, in the form of dementia, delirium or traumatic brain injury. “AMA” consults were typically involving a patient withdrawing from alcohol or opioids. “Lack of engagement with the treatment team” corresponded to many patients who were delirious. Of the consults that resulted in the diagnosis of delirium the most common reasons for consultation were: delirium/altered mental status (AMS) (21%), depression/adjustment (16%), agitation (11%), psychosis (11%), substance use or overdose (10%), and previously existing psychiatric disorder (26%). Often more than one reason was given for consultation. When only one reason was given previously existing psychiatric disorder (18%), depression (11%), and delirium/AMS (10%) were the most likely reasons for consultation.

The role of the psychiatric team is often to help primary teams figure out which question to ask, and this is then the first step towards getting the patient the help they need. This work adds to the literature because shows patterns between consultation requests and ultimate diagnoses. If we can notice patterns in the diagnoses based on the types of questions that are asked, this may help teach the teams to broaden their differential to include patterns that we have noticed.

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Breast cancer is the leading cancer among women, and its early diagnosis is vital for improving survival rates. However, many women delay seeking medical attention after noticing symptoms. Factors such as lack of awareness, fear of diagnosis, financial constraints, and family responsibilities often contribute to these delays. In addition to the physical burden of cancer, psychological distress is a common but often overlooked aspect of the patient experience.

To identify the prevalence and causes of delayed consultation as well as the different types of psychological distress (practical, familial, emotional, spiritual, and physical) among patients with breast cancer.

We conducted a descriptive and analytical study over a one-year period (June 2021 - May 2022) in the oncology department of the Maternity and Neonatology Center of Monastir. Data were collected using information sheets, interviews, and medical records. Psychological impact was assessed using the Distress Thermometer (DT), a visual scale from 0 to 10, accompanied by a questionnaire on practical, familial, emotional, spiritual, and physical issues. The median consultation delay and reasons for the delay were also examined.

Among the 150 patients diagnosed with breast cancer who received treatment and follow-up at the Maternity and Neonatology Center of Monastir, the median consultation delay was 28 days, with delays ranging from 1 to 912 days. Thirty-five patients (23.3%) experienced late consultations, defined as a delay of more than 90 days. The main reasons for the delay included 62.2% of patients not suspecting cancer after the first functional signs, 11.1% fearing the diagnosis, and 8.9% facing financial issues or family and professional responsibilities. Among the 104 patients who completed the Distress Thermometer questionnaire, 31.7% had a distress level below 4, while 68.3% had a distress level of 4 or above. The most frequently reported practical problems were child care (26.92%) and meal preparation (18.26%). Familial problems mainly concerned relationships with children (26.92%). Emotional issues included fear (50%), nervousness (50.96%), and sadness (50%). Regarding spiritual concerns, 32.6% of patients had spiritual or religious concerns, and 67 patients reported physical problems.

The results show that the majority of patients experience high psychological distress, particularly in emotional and practical domains. The median consultation delay is 28 days, with a significant delay in 23.3% of patients. It is therefore crucial to improve awareness and psychological support to reduce consultation delays and optimize breast cancer management and patient well-being.

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Lack of compliance is well-known limiting factor in achievement of the therapeutic targets in medical care. The frequency of noncompliance as well as the factors contributing to this condition are currently not well understood. In hemodialyzed patients lack of precise adherence to medical recommendations is particularly important for long time survival. Depression occurrence may have an adverse impact on the medical compliance of these patients.

The aim of this study was to analyze prevalence of depression symptoms and its impact on compliance to medical recommendations in patients on chronic hemodialysis.

Forty (M=26;F=14) patients undergoing routine hemodialysis session have taken part in a two-part survey consisting: Beck’s Depression Inventory and IMB-Q - The Information-Motivation-Behavioural Skills Questionnaire. IMB test includes three subcategories as a basis for tailoring of the model to an individual health-related behavior – a) information about disease and treatment, b) motivation and c) behavioral skills to comply with treatment. Additionally, in all patients weight gain between dialysis session was analyzed.

Seventeen patients (47.5%) fulfilled depression criteria, out of which 5 (12.5%) had moderate or severe grade disease. Depression symptoms were inversely correlated with behavioral skills to comply with treatment measured by IMB-Q test in men (r= -0,416; p=0,034). There was no significant correlation between results of Beck Depression Inventory and body mass change between dialysis sessions. There was also no significant difference in the interdialytic weight gain between patients with and without depression.

Depression is frequently found in male patients with end stage kidney disease treated with chronic hemodialysis. Male hemodialysis patients with depression are less likely to be compliant to medical recommendations because of weaker behavioral skills. Improvement of the compliance in hemodialysis patients may play an important role in the prolongation of life in these group.

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Panhypopituitarism is a rare and life-threatening endocrine condition characterized by the loss of pituitary hormone function. Literature mentions the very rare occurrence of iatrogenic panhypopituitarism caused by neurosurgical operations, radiotherapy, and pharmacotherapy – long-term use of corticosteroids can suppress the HPA axis, leading to secondary cortisol insufficiency, which, in very rare cases, progresses to global panhypopituitarism. Psychological symptoms are often present but are unfortunately rarely recognized.

A case of a patient with psychological symptoms due to panhypopituitarism is presented.

A case report is presented with a literature review.

A 37-year-old patient, has experienced fatigue, tremors, loss of sexual desire, blood pressure and glucose fluctuations, and impaired temperature and pain sensation. Endocrinological testing revealed insufficiency of all pituitary hormones. Multiple MRI scans of the brain showed a normal appearance of the pituitary gland. It was discovered that he had a severe car accident with a head injury 10 years ago. Since then, he has been taking high doses of corticosteroids on his initiative due to severe spinal pain. It is believed that the condition developed iatrogenically due to corticosteroid medication. His psychological condition significantly worsened after one of the adrenal crises. He describes an experience of “encountering death” during one of the adrenal crises. Furthermore, he describes that after this adrenal crisis, his corticosteroid dosage was significantly increased, resulting in feelings of excessive energy, worse anxiety, insomnia, and irritability. Because of this, he began self-reducing the corticosteroid dose, leading to a “vicious cycle” where he fears another crisis. In complex patients like this one, it is crucial to develop a comprehensive treatment plan and ensure good collaboration with somatic physicians. This patient presents with depressive and anxiety symptoms within the context of an adjustment disorder. Additionally, corticosteroid therapy contributes to emotional instability, and the patient also exhibits symptoms of PTSD due to a near-death experience. Also, the patient’s complex psychodynamic profile presents significant challenges to treatment. The therapeutic goals for this patient are: mood stabilization and anxiety reduction, sleep regulation, and breaking the “vicious cycle”. CBT is the treatment of choice for addressing the patient’s anxiety, fear of adrenal crisis, and self-reduction of corticosteroid doses. The patient’s complex psychodynamics and high cognitive functioning make him an excellent candidate for long-term psychodynamic psychotherapy.

The psychiatrist plays a crucial role in treating such complex patients, and close collaboration with somatic physicians, along with an adequate and thorough therapeutic treatment plan, is necessary.

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Early detection of neurodevelopmental disorders (NDD) allows for timely intervention and tailored support to address behavioral and learning issues and reduce the impact of severe disabilities. Certain populations of newborns, particularly premature infants, are at higher risk for developing such disorders; identifying them enables the establishment of preventive monitoring and screening.

to evaluate the frequency of neurodevelopmental disorders (NDD) in preterm children seen at the outpatient Neonatology department

Our study was a descriptive cross-sectional study conducted on 193 premature infants hospitalized in the Neonatology service. All children underwent at least two psychiatric assessments evaluating child development, early interactions, and behavioral problems. These assessments were conducted at the Neonatology outpatient department by a child psychiatrist in the presence of at least one parent, from 2016 to June 2024. Sociodemographic and clinical data were collected from their medical records.

In our sample, the average age of infants was 2 years, with a range from 10 months to 3 years. The sex ratio was 1:1. According to the psychiatric interview and clinical examination, we found that 74.1% of children exhibited psychomotor developmental delays, 15% of them have global developmental delays, 11.4% of children have language delays, and 6.7% of them have been diagnosed with autism spectrum disorder, according to DSM-5 criteria. Among the assessed children, 6.7% showed behavioral issues, and 2.5% presented with reactive attachment disorders. Among the examined children, 24.4% were referred for regular follow-up at the outpatient child psychiatry clinic.

Our study indicates that preterm infants are at a high risk of developing neurodevelopmental disorders due to the immaturity and vulnerability of their brains during critical developmental periods. These findings underscore the importance of Child Psychiatry examination for this population.

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Delirium has been considered a reflection of diffuse cerebral metabolic insufficiency, and the pathophysiology of underlying delirium is quite diverse.

We present a rare case of mixed delirium with shifting activity level between the hyperactive and hypoactive delirium types as the only manifestation in a 42-year-old woman presented with psychotic symptoms without any prior psychiatric history, one month after a reconstructive breast cancer operation.

To provide an overview, describe the clinical features and differential diagnosis, as psychiatric conditions are among the most difficult to differentiate from delirium, and finally review the clinical management.

Presentation of a 42-year-old female with a history of right breast cancer with triple negative B5b invasive carcinoma, twice operated after local recurrence (first operation 4 years ago), and a second reconstructive operation one month ago, with no past psychiatric history, who presented with symptoms of mixed delirium. During the clinical and laboratorial investigation, exams revealed hyperprolactinemia. The patient showed no other clinical signs or symptoms compatible with adrenal insufficiency and displayed normal ACTH and serum cortisol concentrations. Brain magnetic resonance imaging revealed pituitary macroadenoma without any brain metastasis. The patient was treated with antipsychotics and not corticosteroids, resulting in rapid remission of the psychotic symptoms.

Clouded sensorium and behavioral dysregulation in delirium can be easily mistaken as thought and behavioral disorganization in acute psychotic episodes, and detailed evaluation of precipitating factors is required to differentiate delirium.

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Gardner-Diamond Syndrome (GDS), also known as psychogenic purpura, is an uncommon psychosomatic disorder characterized by painful, ecchymotic, purpuric lesions that typically appear after a period of stress, surgical operations or hard physical work, predominantly affecting women. The pathophysiology of GDS is still poorly understood, and diagnosis is often challenging due to its overlap with other hematological, dermatological, or psychosomatic disorders. Appropriate diagnosis is essential for symptom management and patient risk reduction.

This review aims to synthesize the current knowledge on GDS, encompassing its etiology, clinical presentation, diagnostic criteria, and treatment approaches while identifying areas for future research.

We performed a narrative literature review by searching PubMed, Google Scholar, and ScienceDirect articles written in English. Relevant studies, case reports, and reviews published from 1955 to 2023 were included.

Gardner-Diamond Syndrome predominantly affects middle-aged women, but the literature has also published reports concerning men and children. It is often associated with psychological stress, anxiety, or depression. Many authors suggest the presence of histrionic personality traits and a tendency toward somatic reactions in affected individuals. In 1955, Frank Gardner and Louis Diamond identified and described Gardner-Diamond Syndrome after observing four women who experienced recurrent bruising, accompanied by localized pain, erythema, and swelling, following minimal or no trauma. The spontaneous bruising observed in GDS lacks a hematological cause, with most studies suggesting a psychosomatic origin. The diagnosis is made with a detailed medical and psychiatric history, physical examination, laboratory examination, and exclusion of other possible causes. Psychological therapies, such as cognitive-behavioral therapy, alongside pharmacological treatments, have shown variable success in symptom management. However, most patients experience long-term cycles of remission and relapse, and a standardized treatment protocol has yet to be established.

Gardner-Diamond Syndrome represents a complex interaction of psychological and somatic factors, highlighting the importance of a multidisciplinary approach to both diagnosis and treatment. Diagnostic challenges persist due to the absence of definitive biomarkers and reliance on exclusionary criteria. Also, GDS lacks treatment options. While psychological interventions play a central role in management, further research is needed to clarify the underlying pathophysiology and improve therapeutic outcomes. Most patients benefit from a combination of cognitive behavioral therapy and antidepressant treatment. Increasing clinician awareness may help reduce diagnostic delays and improve the quality of life for patients.

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Approximately 16 million individuals experience a first-time stroke annually, with vertebrobasilar (VB) strokes accounting for 20% of all strokes and transient ischemic attacks. Neuropsychiatric symptoms affect at least 30% of stroke survivors and are associated with low quality of life, an increase in the burden of caregiving, and impaired functional status. These complications can range from mood disorders to psychosis. Psychosis is a relatively rare complication after stroke but is among the most serious of the poststroke syndromes. However, there are no specific guidelines for its treatment.

To describe a case of psychosis following a vertebrobasilar stroke and review the relevant literature on the topic.

We report a case of post-stroke psychosis in a man with no prior psychiatric history and conduct a non-systematic review of the literature.

A 46-year-old man with a history of dyslipidemia and testicular cancer 13 years prior and no previous psychiatric history was admitted to the Stroke Unit under the care of Internal Medicine and Neurology due to a vertebrobasilar stroke. Liaison Psychiatry was called to assess the patient on the 27th day of hospitalization due to visual hallucinations. On examination, the patient presented with a suspicious facial expression, persecutory and infidelity delusions, and both visual and auditory hallucinations. No other psychopathological changes were observed. The case was discussed with the Neurology team, and the patient underwent laboratory tests, a new head computed tomography, and an electroencephalogram, none of which showed recent significant abnormalities. The patient was started on olanzapine 5 mg daily. The patient was reassessed after one week and continued to have the described psychotic symptoms, leading to an increase in the olanzapine dose to 10 mg. After two weeks of treatment, there was a noticeable reduction in the psychotic symptoms.

Psychosis is a possible complication of stroke and is associated with impairment and increased mortality. According to the literature, strokes in the vertebrobasilar territory can cause hallucinations. Guidelines for managing poststroke psychosis are currently lacking, and to assure evidence-based care, further research is needed. This case underscores the importance of early detection and intervention, emphasizing the need for a multidisciplinary approach to managing post-stroke psychosis.

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We are seeing an increasingly diverse population in the Emergency Department. There have been increasing numbers of displaced Ukrainians attending the Emergency Department and referred from the general medical/surgical wards for psychiatric assessment since the Russian invasion of Ukraine in 2022.

The objective of this retrospective audit was to examine the demographic and clinical characteristics of displaced Ukrainians presenting to the University Hospital Galway with psychiatric presentations. Our aim was to review the impact of psychiatric presentations of displaced Ukrainians on the Liaison Psychiatry/on-call Psychiatry service

We utilised the Liaison Psychiatry patient database to extract data on status as a displaced Ukrainian, presenting complaint, working diagnosis, use of interpreter, location of review, outcome of review and other demographic data. This was a retrospective audit using anonymised data.

We found that a total of twenty-eight patient presentations were seen by Liaison Psychiatry or by the on-call Psychiatry doctor from March 2022 to December 2023 (inclusive). Twenty-three patient presentations (82.1%) were seen in the Emergency Department. Nineteen patient presentations (67.9%) required the services of an interpreter. 16 patient presentations (57.1%) were in relation to low mood with or without suicidal ideation. 16 patient presentations (57.1%) resulted in a referral to a Community Mental Health Team.

There is a significant number of Ukrainian refugees attending the Emergency Department for psychiatric reasons. The vast majority of these patients do not speak English and require an interpreter. Being able to communicate effectively is crucial in taking a psychiatric history and further improvements should be made to improve the experience that this population of patients have in the Emergency Department. This audit can be used to inform service development in the Liaison Psychiatry department to better serve the needs of displaced Ukrainians, such as through the introduction of translated patient information documents.

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We present a case study of a 19-year old Ukrainian refugee presenting with delirious mania, with no personal or family psychiatric history. Delirious mania is a complex and severe neuropsychiatric condition that remains under-recognised in diagnostic manuals. Delirious mania describes a neuropsychiatric state where a patient is exhibits signs and symptoms of mania, delirium and often catatonia. Most of the patients described in past case reports are older in age than our patient and have a personal or family history of a mood disorder.

Our objectives were to investigate the signs and symptoms of delirious mania in this this 19 year-old patient. We sought to compare his presentation to the existing diagnoses in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition and International Classification of Diseases 11th Revision. These include delirium, mania and catatonia. In addition, we aimed to study existing literature on delirious mania as well as cross-cultural factors in formulation of this complex case.

We assessed this patient daily as part of the Liaison Psychiatry team and compared his presentation to existing diagnostic criteria of delirium, mania and catatonia. We performed a literature review of delirious mania to identify suggested diagnostic criteria, management strategies and cultural considerations.

Our patient presented to the Emergency Department with a four-day history of bizarre behaviour and poor sleep. He had no past psychiatric history. He was admitted to the general medical ward for a medical work-up, which ultimately yielded no organic pathology. During this time, our patient fulfilled separate diagnostic criteria for delirium, manic episode and catatonia. We found that there was no overarching diagnosis within international diagnostic manuals that encompassed this patient’s presentation. However, delirious mania has been described in the literature since 1849. There are various suggested diagnostic criteria for delirious mania suggested in the literature, such as those by Bond (1980) and Fink (1999). This patient was successfully treated with intramuscular lorazepam. In our discussion, we considered various unique factors in the formulation. These included the cultural considerations given that the patient had recently entered the country as a Ukrainian refugee, difficulties in assessment and treatment due to language and cultural barriers and the limitations of psychiatric treatment on a general medical ward.

Delirious mania continues to be unrepresented in diagnostic manuals, which in turn leads to confusion over diagnosis and treatment. Given the complexity of this neuropsychiatric condition, early recognition is key in providing effective treatment before progression into a malignant state. This would be aided by having delirious mania recognised in international classifications.

None Declared

Chimeric antigen receptor–engineered T-cell (CAR-T) therapy is a newly approved treatment that has shown high remission rates among patients with acute lymphoblastic leukaemia. However, its neuropsychological impact remains largely unknown. To our knowledge, this is the first study to examine the neurocognitive effects of CAR-T therapy in children.

To analyse attentional and executive functioning outcomes in paediatric patients with acute lymphoblastic leukaemia after CAR-T therapy.

This study was conducted at the Child Neuropsychology Unit of La Paz University Hospital in Madrid, Spain. Thirteen paediatric patients aged 7–16 years (mean age = 12 years and 1 month; 75% male) were assessed. Neurocognitive assessments were performed at an average of 1 year and 4 months after CAR-T therapy (ranging from 3 months to 3 years and 4 months). Neurocognitive measures included the Symbol Digit Modalities Test (SDMT), the Omission score from the Continuous Performance Test Third Edition (CPT 3), the Test of Nonverbal Intelligence Fourth Edition (TONI-4), and the Verbal Fluency Test (FAS). Descriptive analyses were conducted, including median, minimum and maximum scores for age- and sex-adjusted z-scores, with significant impairment defined as z < -1.5.

Findings revealed that 58.3% of the children scored significantly below norms on non-verbal abstract reasoning (TONI-4: Median = -1.53; Min = -3.27; Max = 1.27), 53.9% displayed significant sustained attentional deficits (Omission CPT 3: Median = -3.1; Min = -4.0; Max = 0.70), and 41.7% showed relevant impairments in both processing speed (SDMT: Median = -1.5; Min = -5.7; Max = 1.9) and phonological verbal fluency (FAS: Median = -0.7; Min = -2.9; Max = 1.5).

Paediatric acute lymphoblastic leukaemia survivors treated with CAR-T therapy show deficits in processing speed, sustained attention, abstract reasoning, and phonological verbal fluency. These findings underscore the need for both short- and long-term neuropsychological monitoring, and tailored interventions targeting attentional and executive functioning deficits in this population. Future studies should replicate these analyses by using larger sample sizes.

None Declared

The abrupt occurrence of neuropsychiatric symptoms in patients with alcohol-related cirrhosis requires detailed evaluation not only for hepatic encephalopathy but also for other etiologies like Wernicke-Korsakoff Syndrome. In this case, we present a patient with alcohol-related cirrhosis who was initially admitted to gastroenterology unit with a preliminary diagnosis of hepatic encephalopathy but was ultimately diagnosed with Korsakoff Syndrome.

This case highlights the critical need for comprehensive neuropsychiatric assessment in patients with alcohol-related cirrhosis and offers a review of the current literature on the definition and clinical presentation of confabulation.

Description of a clinical case and literature review

45-year-old male with a history of alcohol-related cirrhosis was admitted to gastroenterology unit with symptoms suggestive of hepatic encephalopathy. On hospital day two, he was consulted to consultation-liaison psychiatry unit with the complaints of sleep disturbances and meaningless talking. In his story; over the past 3 months, he was talking about unrealistic events, having anger outbursts and disrupted sleep cycle, although his total sleep duration remained normal. Aside from grandiosity, mild irritability and disruptions in thought content, there were no signs of manic episode, such as euphoria, distractibility or reduced sleep. In mental state examination, he was alert, oriented in time, place and person, displaying normal psychomotor activity, speech, and impulsivity with euthymic mood. Neurological examination revealed no signs of Wernicke encephalopathy, such as nystagmus, ataxia or confusion. Subsequent psychiatric evaluations revealed fluctuations in narrative, lack of insight, mild memory impairment, and grandiose thought content suggestive of momentary confabulation, all indicative of Korsakoff Syndrome. He was transferred to the psychiatry inpatient unit and treatment with amisulpride at 200 mg daily and thiamin at 300 mg per day were initiated. Following treatment, there was a gradual improvement in aggression; however, no significant enhancement in confabulations or memory function was observed.

To our knowledge, this is the first case report of Korsakoff Syndrome presenting with a preliminary diagnosis of hepatic encephalopathy. The neuropsychiatric components of hepatic encephalopathy can manifest with a variety of symptoms, posing a challenge in differentiation from psychiatric disorders, such as mania or Korsakoff Syndrome. This report highlights the importance of a collaborative evaluation for patients presenting with neuropsychiatric symptoms and a history of alcohol-related cirrhosis.

None Declared