Sickle cell anemia (SCA) is a genetic disorder resulting in chronic hemolysis and vaso-occlusive crises, which can lead to severe systemic complications. Schizophrenia is a major psychiatric disorder characterized by persistent psychotic symptoms, including delusions and hallucinations. The intersection of these two conditions presents unique clinical challenges, as the management of SCA may complicate the treatment of schizophrenia and vice versa. Despite the prevalence of such comorbid cases, there is a significant gap in research addressing the complexities of managing these conditions concurrently.

This case report aims to describe a rare and complex case of schizophrenia in a patient with sickle cell anemia, including the clinical presentation, diagnosis, and management. Additionally, it seeks to highlight the challenges of managing these co-occurring conditions and to promote further research into integrated treatment strategies for such comorbidities.

We present a 32-year-old male with a history of sickle cell anemia and schizophrenia who was admitted to the psychiatric department at Razi Hospital, LaManouba. The patient was admitted following a suicide attempt driven by acute psychotic symptoms, including delusions and auditory hallucinations commanding self-harm. Upon admission, he was started on a regimen of benzodiazepines to manage severe anxiety and antipsychotic medication to address the hallucinations and delusions. The initial physical examination revealed no significant abnormalities. On the third day of hospitalization, the patient began exhibiting respiratory symptoms, including chest pain and difficulty breathing, which prompted further diagnostic evaluation.

On the third day of hospitalization, the patient developed respiratory symptoms including chest pain, fever, and dyspnea. Evaluation, including lab tests and imaging, revealed acute chest syndrome. Given the risk of benzodiazepines worsening respiratory issues, their use was discontinued, and Haloperidol was introduced at 5 mg to manage psychotic symptoms, with close monitoring for suicidal ideation. The hematology and pneumology departments initiated a treatment protocol involving oxygen therapy, intravenous hydration, paracetamol for pain management, and antibiotics (ceftriaxone and clarithromycin). Within a week, both psychiatric and respiratory symptoms significantly improved, leading to a reduction in supplemental oxygen and discharge with a comprehensive follow-up plan.

This case underscores the complexity of managing co-occurring schizophrenia and sickle cell anemia, highlighting the need for a multidisciplinary approach. Integrated treatment strategies are crucial for effectively addressing both psychiatric and medical complications in such comorbid conditions

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There can be a considerable mental health burden to living with diabetes. Health behaviours are modifiable factors that influence mental health in the general population. However, despite the centrality of health behaviours to diabetes management, there are significant gaps in our understanding of their longitudinal impact on mental health in people with diabetes.

This scoping review aimed to synthesise the longitudinal evidence from observational and intervention research on the impact of health behaviours on mental health and related psychological factors in people with type 1, type 2, and gestational diabetes.

PubMed, PsychINFO, Embase, CINAHL, and PsycArticles were searched for intervention and observational studies examining the effect of health-promoting, health-risk, or diabetes-specific health behaviours on aspects of mental health, diabetes distress, and quality of life, in people with all types of diabetes. Abstracts, titles, and full texts were screened by two independent reviewers.

In total, 100 relevant studies were identified, including 29 observational studies and 71 intervention studies. Studies had a mean follow-up time of 12.9 ± 17.8 months. The health behaviours investigated in the included studies were adherence, alcohol, carbohydrate-counting, diet, diet and exercise combined, exercise, fasting, medical visits, sleep, self-monitoring blood glucose, smoking, and weight. The review identified knowledge gaps surrounding diabetes-specific behaviours, behaviour interactions/clusters, sleep, sedentary behaviour, screen-time, gestational diabetes, mood and ecologically valid and objective measurements. Exercise was the most freqently investigated health behaviour and also the most likely to be found to have a mental health promoting impact.

Findings suggest that health-promoting behaviours influence mental health in people with diabetes. There is less conclusive evidence regarding the impact of health-risk or diabetes-specific health behaviours. In particular, a broad range of physical activities may improve mental health and wellbeing in people with diabetes.

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The management of coexisting schizophrenia and rheumatoid arthritis (RA) is complex due to the lack of clear guidelines. While immunosuppressants are the cornerstone of RA therapy and clozapine is the gold standard for treatment-resistant schizophrenia, their shared adverse effects make combined treatment challenging, requiring alternative therapeutic options.

present the therapeutic complexity of managing treatment-resistant schizophrenia alongside RA.

We report a case of drug-induced toxidermia in a patient being treated for RA with some therapeutic particularities.

Mr. W, a 66-year-old man, has been under treatment since 2007 for schizophrenia. Somatically, he has rheumatoid arthritis (RA) that has been progressing since 2016, for which he is treated with Methotrexate.

The diagnosis of treatment-resistant schizophrenia was made. Given this resistance, the introduction of Clozapine was proposed. However, the issue of an interaction between Methotrexate and Clozapine, contraindicated according to pharmacologists’ report, required therapeutic reevaluation.

Clinical and biological evaluation showed remission of RA with an EVA score of 0, NAD of 0, NAG of 0, a DAS28 score of 1.13, and an VS of 5 mm. The choice then fell on Sulfasalazine to replace Methotrexate, with a progressive introduction of the drug, starting at 500 mg and increasing by 500 mg every 7 days up to a dose of 2000 mg/day, accompanied by weekly control tests.

Twelve days after the introduction of Sulfasalazine, at a dose of 1000 mg/day, the patient presented with a diffuse rash associated with erythroderma, facial and eyelid edema, an infiltrated, pruritic maculo-erythematous rash, confluent in places but sparing the palms and soles. Given the characteristics of the dermatological lesions and their timing, drug-induced toxidermia caused by Sulfasalazine was strongly suspected. Consequently, Sulfasalazine was discontinued, as well as the antipsychotic, and the patient was treated with topical skin treatments and two boluses of intravenous corticosteroids.

The initial biological workup was normal. However, seven days after stopping Salazopyrin, the patient became febrile with a temperature of 40°C, accompanied by erythematous pharyngitis, an elevated CRP of 45, monocytosis, and the presence of activated lymphocytes on the blood smear. Pharmacovigilance opinion: a DRESS syndrome was suspected, with a Regi score of 2. Two weeks later, the clinical course was favorable, with the complete disappearance of dermatological lesions and normalization of biological parameters.

Managing treatment-resistant schizophrenia alongside rheumatoid arthritis poses a therapeutic challenge due to drug interactions. The case of Sulfasalazine-induced toxidermia highlights this complexity. Close monitoring and tailored treatment alternatives are crucial to minimize risks while ensuring efficacy.

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The widespread prevalence of neck pain does not mean that one should stoically endure suffering. There is some truth in the fact that many people have such problems, but it is not true that one should not go to the doctor for such trivial reasons. Therefore, if pain in neck occurs, you should go to a neurologist immediately. This is especially true in cases where episodes of pain are repeated, they are persistent or intensify.

There are many causes of neck pain:

Fractures, dislocations, injuries to the vertebrae, joints, muscles and ligaments in the neck.

Infections that cause inflammation of bone and cartilage tissue, muscles, cervical lymph nodes and nerves (osteomyelitis, abscess, shingles).

Radiating pain in diseases of the heart, lungs, stomach, esophagus, and other organs. Rheumatological diseases (arthritis, myalgia, fibromyalgia).

Statistical analysis was performed.

Neuroendocrine pathologies, non-specific factors (herniated and displaced intervertebral discs, problems with intervertebral joints, narrowing of the spinal canal, arthrosis, muscle spasms, osteochondrosis, problems caused by insufficient muscle activity), Intracranial diseases (benign or malignant neoplasms of the brain, stroke, abscess), and also psychosomatics.

There are several reasons that cause depression due to depletion of cartilage tissue. First of all, we are talking about the disruption of cerebral circulation associated with disorders in the cervical spine. Lack of blood flow, and therefore oxygen, leads to starvation of various parts of the brain responsible for certain important functions of the body. This is how nervous system disorders begin to develop: depression, aggression, panic attacks and insomnia.

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People with mental health conditions frequently encounter diet-related challenges that contribute to the onset of physical comorbidities, further diminishing their quality of life and life expectancy. To date, diet-related problems often are not adequately addressed in mental health care for reasons like overshadowing.

Psychosomatic rehabilitation clinics are a potential setting for tackling these problems as the admission takes place beyond acute crisis and as multi-professional teams, including dietitians, are available. However, little is known so far about the extent to which this potential is being exploited.

In summer 2024, we conducted 22 qualitative interviews with physicians, dietitians and other staff members at six psychosomatic rehabilitation clinics in Germany to explore the current state of action in handling diet-related risks in psychosomatic rehabilitation clinics.

Interviewees elaborated on their eexperiences with the prescription and utilization of diet-related interventions in psychosomatic rehabilitation and their subjective assessments of the potential added value of screening tools in care planning. Preliminary analyses indicate that diet-related problems have not yet been systematically captured in the rehabilitation process. Due to a lack of time, a comprehensive nutrition-related assessment is hardly possible and therefore the diet-related activities tend to be one-size-fits-all services.

The findings of the qualitative study endorse the implementation of a multi-faceted screening tool, such as the NutriMental screener. By this way, diet-related problems of service users might be recognized at the beginning of inpatient rehabilitation and being addressed appropriately during the inpatient stay by selecting suitable rehabilitation measures, especially dietary interventions.

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Depressive disorders and anxiety disorders are typical comorbidities in autism spectrum disorder (ASD), with a reported prevalence of 20% and 9%, respectively (Lai, 2019). Autistic subjects are more at risk for suicidal thoughts and behaviors compared to typically developing peers; moreover, depressive symptoms are often resistant to both pharmacological and psychotherapeutic treatments. In 2019 intranasal esketamine was approved in Italy for treatment-resistent depression (TRD). We observed two young outpatients affected by autism (diagnosis made by “Lab-Aut”, a specialized mental health service in Pavia) treated with esketamine in our ambulatory for TRD. Clinical information and personal details were summarized in Image 1.

To evaluate the clinical response to intranasal esketamine in subjects with major depression in ASD and to compare the outcome with neurotypical patients.

Autism diagnosis wase made according to ADOS-2 and ADI-R scores, confirmed by a clinical judgment of senior psychiatrist. Our follow-up protocol during esketamine treatment consists in the following scales: MADRS, C-SSRS, DES-II, Psychace Scale, Reading the Mind in the Eyes Test, HAM-A, HAM-D, BDI, PANSS. Psychometric evaluation was performed at T0 (before esketamine), T1 (one week of pharmacotherapy), T2 (one month), T3 (2 months) T4 (3 months) and T5 (6 months). We collected results from neurotypical patients (n=12) and autistic patients (n=2) between 2022 and 2024.

Both in autistic patients and in neurotypical ones we noticed a premature decrease in depressive symptoms and a reduction of suicidal thoughts. This improvement was testified by a reduction from T0 to T1 in MADRS total score and in C-SSRS sub-score focused on intensity of suicidal ideation. The reduction was maintained during the observation period (Image 2). Due to the small sample size of autistic patients, we couldn’t reach the statistical significance threshold for this population. Considering the entire sample (n=14) we obtained significant results (T0-T1: MADRS decrease p=0,00006, C-SSRS decrease p=0,00009. T0-T5 MADRS and C-SSRS variations p<0,00001). Comparing our sub-samples, it’s possible to notice a similar trend in follow-up between autistic and neurotypical patients. (Image 3).

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Our preliminary data coming from clinical experience suggest the efficacy of intranasal esketamine in depressive episodes occurring in autistic patients. A larger sample size of autistic patients will be necessary to set a comparative study and to give significance to these results. Esketamine could represent an important therapeutic option in depressed patients with ASD comorbidity.

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Schizophrenia is a complex neuropsychiatric disorder, which affects 1% of people in the world. It presents marked heterogeneity in terms of clinical presentation, course and prognosis, although patient with schizophrenia may have diseases of other physical causes, in which pain has a protective role for the individual and diagnostic importance. Studies on pain in schizophrenia are rare and predominantly experimental. The cause of decreased sensitivity or lack of sensitivity to pain in patients with schizophrenia is unknown. Among the hypothesis are lesions in the thalamus and psychotic symptoms that would decrease the patient’s concentration or divert his attention from the pain.

The aim of this research was to study the presence/absence and intensity of pain compatible with the cause in 753 men that we have been treating for schizophrenia for 20 years.

We asked all our patients with schizophrenia at their first consultation in 2002 whether they would be willing to be clinically investigated for the presence/absence and intensity of pain compatible with any cause.

We divided our patients into 3 groups:

Group 1: 51 patients aged 17 – 25 years

First episode currently symptomatic-negative symptoms.

Group 2: 325 patients aged 27-31 years

Multiple episodes currently symptomatic, 25 negative symptoms, 300 positive symptoms.

Group 3: 377 patients aged 40-45 years

Continuous currently – 7 negative symptoms, 370 positive symptoms.

These patients were examined every 3 months by clinicians and dentists for 20 years.

Treatment

Patients with:

• - Positive symptoms (delusional beliefs, hallucinatory perception, and disorganization of thinking and behavior) associated with excessive dopamine release, who respond adequately to (FL-APM) First Line dopamine antagonist medication.

• - Positive symptoms which does not respond adequately to FL-APM, who respond adequately to chlozapine.

• - Refractory schizophrenia treated with electroconvulsive therapy.

100 patients quit of the survey

653 had (at least once in these 20 years) headache, toothache or earache.

51 did not complain of pain with trigeminal neuralgia.

30 patients did not complain of pain when they had herpes zoster.

Patients with negative schizophrenic symptoms and resistance to treatments showed an absence of pain (pertinent to their physical illness)

The causes of reduced or absent pain sensation in patients with schizophrenia are unknown. Proposed explanations include thalamic damage and psychotic symptoms that render the patient unable to perceive pain. Our patients did not have thalamic damage but had severe negative psychotic symptoms and resistance to treatments.

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Dual diagnosis, involving both a mental disorder and an addiction disorder, significantly impacts patients’ functionality and quality of life. In Colombia, from 2009 to 2017, an average of 20,590 individuals with dual diagnosis were treated annually, representing 7.2 Disability-Adjusted Life Years (DALYs) (Ministerio de Salud, Boletín de Salud Mental No. 7, 2018). This study investigates effective therapeutic strategies for this complex condition by examining six patients with schizophrenia or other psychotic disorders and comorbid addiction who were treated with depot antipsychotics. We assessed their personal and social functioning, symptom severity using various surveys.

Describe outcomes of long-acting injectable antipsychotics in patients with dual diagnosis beyond the clinic

To promote research involving a larger number of subjects with dual diagnosis and co-occurring mental disorders, like schizophrenia

Continue the pursuit of tools aimed at improving the quality of life in patients with dual diagnosis.

This case series involved six patients, all men, aged 20-40 years, all of them using depot antipsychotics (paliperidone quarterly = 2, paliperidone monthly = 3, and risperidone biweekly = 1), followed over 12 months in an addiction program with quarterly evaluations (T0=initial contact, T1=three months, T2=six months, T3=nine months, T4=twelve months) from July 2022 to August 2024 on an outpatient basis. All participants had an addictive disorder and schizophrenic and schizoaffective disorder diagnosed. We administered four periodic surveys (ASSIST, CGI-I, PSP) to evaluate personal and social functioning and symptom severity. Results were collected in a database through in-person visits or telephone contact, with surveys conducted by a multidisciplinary team including psychology, social work, occupational therapy, and psychiatry.

the ASSIST scores improved from [T0=1.333 (44.43%) to T4=2 (44.67%)], CGI-I scores decreased from [T0=4.33 (61.9%) to T4=3 (42.8%)], and the PSP scale showed improvement from [T0=1.666 (55.53%) to T4=2.166 (72.20%)]. These results reflect enhanced cognitive and social functions, particularly in social functioning. Similar results were observed in patients with schizophrenia in a study by Shi et al. (Neuropsychiatr Dis Treat. 2016;12:2095-2104), supporting the potential benefits of depot antipsychotics for dual diagnosis patients.

Depot antipsychotics can be a valuable tool for managing dual diagnosis, enhancing treatment adherence, general functionality and reducing symptom severity. However, this observational study did not account for substance types or socioeconomic factors.

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Appearance and performance-enhancing drugs (APEDs) are a group of loosely-related substances that are used to improve characteristics perceived as desirable, such as external appearance, mental efficiency and sexual prowess. Besides the increasingly popular anabolic-androgenic steroids (AAS), there is an ever-growing array of anorectics, anabolism-enhancers, sedatives and nootropics available to the public.

This case report aims to explore the connection between emotional dysregulation, self-actualization and side-effects that arise in users of these drugs.

We present the case of a 34-year-old male diagnosed with posttraumatic stress disorder and comorbid use of both anabolic-androgenic steroids (including testosterone, nandrolone and trenbolone) and chemsex-related substances (such as mephedrone, GHB and sildenafil). He reported frequent mood swings, constant feelings of loneliness and despair and occasional suicidal ideation; and attributed his pattern of substance abuse to a desire to escape from his “ordinary” self. After being admitted at a local emergency room during a suicidal crisis, he was referred to a mental health outpatient service and informed about the area’s addiction treatment resources. During the first outpatient interventions he related his symptoms (tachycardia, excessive sweating, restlessness, bursts of rage and paranoid reactions) to his pattern of APED consumption. He is currently undergoing both individual and group therapy in an MBT-based intervention; reports several months substance-free and has been started on a course of antidepressants (vortioxetine, up to 20 mg per day) and sedatives (zolpidem, 10 mg a day) to help him cope with his distress.

Several authors have explored the relationship between personality and APED use. While some have found a correlation between the “dark triad traits” (mostly machiavellianism) and AAS consumption, others have noted the role these substances play in building up both identity and self-worth. According to Macho et al. (Front Psychol 2021; 12:648467) APEDs provide access to an “actualized” and “extraordinary” self that enables amateur athletes to escape both everyday life and previous trauma. This way out might be dangerous for the user’s health, but proves to be an enticing road, particularly to young males such as the one we present in this case.

APEDs are an increasingly popular group of substances, and they are going unnoticed in some clinical settings. Unlike other drugs, its use is not only recreational but directed to a specific goal; a quest for extraordinariness (in appearance, performance or prowess) that is deeply embedded in our culture. Having both a broad spectrum of physical side effects and a myriad of psychiatric implications, it is vital for mental health professionals to be familiar with this reality when assessing patients, particularly young men.

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Although complex post-traumatic stress disorder (CPTSD) is closely associated with dissociative symptoms, and although dissociation is often conceptualized as a response to trauma, less is known about the co-occurrence of dissociation and (C)PTSD.

This study examined the co-occurrence of CPTSD and dissociation and their relationship with depressive symptoms and functional impairments.

We analyzed baseline data from a clinical trial that evaluated a web-based trauma program. This study included 220 treatment seekers from Hong Kong (Mage = 35.3; SD = 7.9; 82.3% female). Participants completed measures of CPTSD, dissociation, depression and functional impairment, which were assessed with the International Trauma Questionnaire (ITQ), the Dissociative Experiences Scale-Taxon (DES-T), the Patient Health Questionnaire-9, and the Work and Social Adjustment Scale, respectively.

In this sample, 34.1% screened positive for CPTSD only, 10.0% for dissociative symptoms only (DES-T ≥ 25), and 25.0% for both conditions. For participants with CPTSD (n = 130), 42.3% had dissociative symptoms. For participants with dissociative symptoms (n = 77), 7.8% had PTSD, and 71.4% had CPTSD. Hierarchical multiple regression analyses showed that, after controlling for age, gender, education level, and trauma exposure, PTSD (β = .127, p = .033), disturbances in self-organization (DSO) (β = .524, p < .001), and dissociative (β = .169, p = .002) symptoms were all associated with depressive symptoms. Yet, only DSO symptoms were associated with functional impairments (β = .519, p < .001).

This study provides updated data regarding the co-occurrence of CPTSD/PTSD and dissociation. About half of people with CPTSD have considerable dissociative symptoms, while most dissociative individuals may be suffering from CPTSD/PTSD. Moreover, this study found that, among different trauma-related symptoms, DSO symptoms are the strongest predictor of depressive symptoms and functional impairments, highlighting the importance of providing skills training for trauma survivors to address these difficulties in clinical settings.

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There is increasing scientific evidence linking the influence of cannabis on the onset of a first psychotic episode (FEP). However, this association may not always be one-way when studying the relationship between cannabis use and cognition.

The role of polygenic risk score for Schizophrenia (PRS-SZ) and lifetime cannabis initiation (PRSCI) and cannabis use disorder (PRSCUD) use remains unresolved. For this reason, a study was carried out to clarify how these factors are related to each other.

To study the interaction between genetic risk and environmental factors

To analyze the relationship between polygenic risk scores and clinical features

To determine the impact of cannabis use on cognitive performance

A neuropsychological study was carried out on a sample of 138 cannabis users, divided into cases and controls according to the existence of a FEP. This assessment included domains of processing speed, verbal memory, attention, working memory, executive function, social cognition, and determination of premorbid IQ, using validated tests.

Three GWAS summary statistics were used to calculate individual PRS conferring risk for SZ, CI and CUD. PRS were constructed using PRS-CS.

The results obtained were then statistically correlated with the polygenic risk score for schizophrenia, cannabis use disorder, and lifetime cannabis use, respectively.

The patient group presented worse processing speed as the risk for schizophrenia increased. In the case of PRS-CU, an opposite effect was evident. For verbal memory, a higher PRS-CUD was associated with poorer performance. Cannabis consumers with lifetime risk presented better executive function than consumers with lower genetic risk.

The relationship between PRS for Schizophrenia and cannabis use remains uncertain. However, different clinical profiles can be determined thanks to the cognitive assessment.

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Adjustment Disorder (AD), introduced in DSM-III-R, is an emotional or behavioral reaction to a psychosocial stressor that causes significant distress and impairment. Symptoms include excessive worry, sadness, anxiety, and sleep disturbances. U.S. prevalence ranges from 11.5% to 21.5%, higher in those with suicide attempts and twice as common in women. Diagnostic criteria include symptom onset within 1-3 months, significant distress or impairment, and resolution within 6 months after the stressor or its consequences. Subgroups are based on predominant symptoms of anxiety, depression, or behavior (DSM-5).

Analysis of Adjustment Disorder cases in patients admitted to medical-surgical Units in 2023 at Hospital de Matosinhos.

Review of Clinical Records of all internal consultation requests made to the Liaison Psychiatry Team during 2023 at Matosinhos Hospital. Demographic data, psychiatric history, medical-surgical history, multidisciplinary intervention, and post-discharge guidance were obtained.

Out of the 420 patients observed in internal consultation in 2023, 67 were diagnosed with AD, representing 15.9%.

53% were men and 47% women.

The age distribution is represented in figure 1. Most of patients have an age gap between 50-70 years old. 58% is married, 9% single, 9% divorced and 22% widower.

79.1% of the patients live with their family and 20.9% lives alone.

All comorbidities found in patints with adjustment disorder is represented in figure 2. We can see that metabolic diseases and cardiovascular events are the most common comorbidities associated with AD.

Only 32% had seen a psyhiatrist before, while 68% had never contacted with a psychiatrist.

75% of the requests were made by internal medicine and general surgery.

According with the results of figure 3 we can tell that most of the patients started a new medication and just a few had psychological support.

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The diagnosis is subject to a degree of subjectivity and requires clinical judgment. There is a lack of clearly defined diagnostic criteria. It depends on a stressor and a reaction to the stressor that is considered excessive relative to what would be expected in the patient’s cultural and social context.

Treatment is underinvestigated. The basic pharmacological management consists of symptomatic treatment of insomnia, anxiety and panic attacks. The use of benzodiazepines to relieve these is common. In this study it is clear the need of giving medication to treat the symptoms even though we know that most of them would stop naturally. However, there is a lack of brief psycological interventions even though they are recommended.

It is now a critical time for advancing our knowledge of the disorder and further studies should be done.

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Obsessional-Compulsive Disorder (OCD) can involve poor insight, which may complicate the differential diagnosis of schizophrenia. Otherwise, few cases may associate both diagnosis highlighting the need for a clearer understanding of the factors of their coexistence.

Understand the factors that contribute to the comorbidity between OCD and schizophrenia.

Our study employed a case report approach that describes a patient admitted in our psychiatric unit. Data were collected through clinical interviews, personal and family medical history. We also conducted a literature research focusing on articles published between 2000 and 2023 in PubMed using the keywords « OCD », « schizophrenia » and « comorbidity ».

The case concerns Mr. N, a 43-year-old man with no significant medical or psychiatric history and no reported substance use behaviors, who was admitted to our psychiatric unit. He was diagnosed with both OCD and schizophrenia. The therapeutic evaluation revealed that Mr. N was initially prescribed anxiolytics, with a second-generation antipsychotic subsequently added. Some researches suggests that second-generation antipsychotics may induce obsessive-compulsive symptoms which could explain the coexistence of the two diagnosis in Mr N. Additionally, other studies have indicated that genetic factors can predispose individuals to both conditions whereas our patient does not have any notable family history of psychiatric disorders. Finally, literature says that neurobiological factors particularly shared dopaminergic and serotonergic pathways may provide an explanation for the comorbidity of OCD and Schizophrenia.

The comorbidity of OCD and schizophrenia may be explained by several factors, making diagnosis and treatment challenging.

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Several medications in use in the psychiatry field, particularly in severe mental illness (SMI), are associated with weight gain and other cardio-metabolic side effects and are usually prescribed long-term. Extensive research has been conducted on the contribution of these effects to poorer physical health and a 10- to 20-year mortality gap in patients with SMI. Many factors have been reported, such as patients’ lifestyle behaviours, lower search for medical care, delayed diagnosis and treatment, diagnostic overshadowing by mental illness, and stigma towards this population. In this context, psychiatrists may have a role in monitoring medication’s side effects their role is still to be defined.

To access usual practices and barriers on cardio-metabolic monitoring of patients by psychiatrists.

We conducted a narrative review on general psychiatrists’ practices of cardio-metabolic monitoring. A search was conducted in Pubmed and PsycNet using the keywords “practice”, “assessment”, “weight gain”, “metabolic”, and “psychiatrist”. Further papers were included after references and citations review of relevant articles. Papers focused exclusively on guidelines or on border programs (such as first psychotic episode protocols) were excluded.

Most of the research dedicated to reporting psychiatrists’ practices regarding monitoring of cardio-metabolic side effects focused on patients treated with long-term antipsychotics. Despite knowledge and concern about these side effects being transversally reported, it doesn’t always translate into clinical practice, and practices are widely diverse. Many factors were appointed as explanations; the most commonly reported were training limitations, poorer physical examination skills, underestimation of side effects, overshadowing of co-occurring physical disease by mental symptoms, lack of scientific consensus amongst different specialties resulting in contradictory guidelines, fragmentation of care across different healthcare providers and specialties, and the still undetermined role of psychiatrists in diagnosing and treating cardio-metabolic complications.

Despite knowledge and awareness of cardio-metabolic side effects are almost transversal in psychiatrists’ practice and translated into the selection of treatments, management of these complications still needs to be put into action. Some strategies may be introduced, such as improving medical training and including this training in residency programs, developing consensual and multidisciplinary guidelines for the assessment and treatment of these side effects, defining the responsibility and improving the coordination of different health care providers in a community setting.

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Catatonia due to myocarditis is rare and poses a significant diagnostic challenge. We present a case of classical catatonia secondary to viral myocarditis.

We want to highlight the clinical issues in diagnosing catatonia due to specific medical conditions, especially in a resource-limited setting like Pakistan.

The case is discussed, followed by suggestions and a literature review.

A 22-year-old male with no known medical and psychiatric comorbidities presented to the emergency department in April 2023 with avolition, alogia and fever for 2 weeks. Patient was admitted to Neurology for workup; CSF analysis, CSF autoimmune screen, CSF culture, CSF HSV PCR, blood culture, urine culture, serum ceruloplasmin, MRI Brain were all unremarkable. He was treated with broad-spectrum antibiotics, following which his fever remitted.

On initial psychiatric exam, patient scored 13 on Bush Francis Catatonia Rating Scale for mutism, staring, posturing/catalepsy, stupor, grimacing, mitgehen, gegenhalten and rigidity. Initial work up included normal CBC, CMP, TSH, HIV/Syphilis, Urine toxicology, ESR and a CRP of 43 mg/L. He underwent echocardiography which revealed a severely reduced Ejection Fraction of 30% and dilated cardiomyopathy, consistent with viral myocarditis; which was considered in remission and thus managed conservatively by Cardiology. The patient then received IV infusion of Diazepam 10mg BID which adequately treated his catatonia over 3 days and he was discharged with instructions for close follow-up. On followup visits, the patient continued to display remission of catatonic symptoms, but exhibited new symptoms of acute psychosis including 2nd person auditory hallucinations and delusions of reference and persecution. These were treated with Olanzapine 5mg PO resulting in complete remission over 4 weeks. The patient continued to have residual symptoms of social withdrawal, decreased motivation and poor concentration on his most recent presentation. Patient was also noted to have an exaggerated startle reflex which was not associated with any other neurologically relevant symptoms. It prompted a workup to rule out seizure disorder, the results for which are pending at time of this submission.

This case underscores the clinical complexity and diagnostic challenge of catatonia linked to medical conditions. It also depicts the evolving presentation over time. It is important to note that the patient did not receive IV Lorazepam due to its unavailability in Pakistan. Electroconvulsive therapy should have been considered for his catatonic symptoms but was delayed due to his pending diagnosis. Limited findings from literature review related to catatonia associated with viral myocarditis demonstrate the need for further research to bridge the gaps in evaluation and management.

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Physical and/or psychological trauma may contribute to the onset of type 1 diabetes. Forensic medicine experts recognize post-traumatic diabetes in rare cases that meet specific criteria, including the severity of the trauma, its occurrence within a short timeframe before diabetes onset, and the absence of prior diabetes indicators.

This study aims to describe the clinical and biological characteristics of post-traumatic diabetes, with particular emphasis on the psychiatric aspects.

This retrospective, cross-sectional study analyzed cases of patients hospitalized for acute diabetes following physical or psychological trauma. The diagnosis of post-traumatic diabetes was based on the criteria of French forensic experts: acute autoimmune diabetes, trauma occurring within six months before diagnosis, and no signs suggesting pre-existing diabetes. Autoimmune involvement was confirmed by the presence of anti-pancreatic antibodies, specifically anti-glutamic acid decarboxylase (GAD) and/or anti-tyrosine phosphatase IA2.

The study included 10 patients (8 men and 2 women) aged between 17 and 47 years (mean age 29.5±11 years). Family history of autoimmune disease was present in 40% of cases, and type 2 diabetes in 60%. The average body mass index was 24±6 kg/m², with obesity in 30% of cases. The mean blood glucose at admission was 14.54±3.48 mmol/L, and the average HbA1C was 6.51±0.56%. Anti-GAD antibodies were present in all patients, while anti-IA2 antibodies were detected in 20%. Clinically, 60% of patients presented with ketosis, and 40% with ketoacidosis. Psychiatric trauma, including grief in 3 patients and divorce in 2 patients, was the triggering factor in 50% of cases. All patients required insulin therapy upon admission, with obese patients receiving additional metformin.

This study supports the hypothesis of post-traumatic diabetes, particularly in cases of severe psychiatric trauma. Although scientific literature remains inconclusive, the role of stress in the onset of diabetes warrants further investigation due to the heterogeneity of findings regarding stress episodes preceding diabetes development.

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Treatment-resistant schizophrenia can be of primay or secondary etiology. Systematic and thorough differential diagnostics is essential to exclude organic causes for treatment-resistant schizophrenia .Colloid cysts are congenital benign tumor accounting for 15-20 % of intraventricular mass but only about 1% of intracranial ones.They frequently cause psychiatric disturbances. The pathology behind these psychiatric symptoms remains unclear.

Through a case report and a review of the literature, we hypothesize that a colloid cyst in the third brain ventricle is the cause of resistance in a patient with treatment-resistant schizophrenia.

Starting from a case report, we conducted a literature review on “PubMed”, using key words “colloid cyst and psychosis”, “colloid cyst and treatment-resistant schizophrenia”,

We present a 48-year-old male who has a family history of malignant neoplasm.There was no history of physical illness. His past psychiatric history revealed a diagnosis of schizophrenia, having been admitted several times in different inpatient psychiatric wards.In the psychiatric examination, the presence of auditory hallucinations, dissociated thinking, and predominantly negative symptoms was observed.Recently, he has been diagnosed with treatment-resistant schizophrenia owing to the inadequate response to two sequential antipsychotic trials (with adequate dose, duration, and adherence). After a 2-month hospitalization, the severity of the psychotic symptoms had decreased but did not show remission. With no prodromes or triggering factors, our patient presented a drop attack without loss of consciousness and with instantaneous recovery to baseline status. He did not have any of the same experience previously.The physical and neurological examination did not reveal any positive findings. All biochemistry parameters were reported as normal range. Following the evaluation process, an urgent head CT scan showed a colloidal cyst at the anterior end of the third ventricle with dilatation of the lateral ventricles. A cerebral MRI was performed in order to get a more detailed image; it confirmed the diagnosis of a third ventricle colloid cyst immediately adjacent to the foramen of Monro with obstructive hydrocephalus. The patient was referred to the neurosurgical department for further evaluation. This neurological tumor didn’t require neurosurgery.

Our case implies the importance of neuroimaging in patients with treatment-resistant schizophrenia to rule out any underlying organic cause.It also emphasises the importance of considering an organic cause like any space occupying lesion in the brain (colloid cyst in the third brain ventricle in our case) for induction of psychopathological symptoms, even those of treatment-resistant schizophrenia.

None Declared

Arachnoid cysts are intra-arachnoid space-occupying brain lesions, typically of a benign, congenital nature.Such cysts are quite rare, accounting for only 1% of all lesions in the intracranial space. In most cases, they are diagnosed accidentally by neuroimaging.Treatment-resistant schizophrenia (TRS) has a high burden both for patients and healthcare services. There is a need to identify treatment resistance earlier in the course of the illness, in order that effective treatment can be offered promptly. Recently, the co-occurrence of arachnoid cysts and schizophrenia has captured the popular attention about possible relevancy.

Through a case report and a review of the literature, we hypothesize that arachnoid cyst is the cause of resistance in a patient with treatment-resistant schizophrenia.

Starting from a case report, we conducted a literature review on “PubMed”, using key words “arachnoid cyst, arachnoid cyst and psychosis”, “arachnoid cyst and treatment-resistant schizophrenia”,

We present a 47-year-old who is single and unemployed. His past psychiatric history revealed a diagnosis of schizophrenia, having been admitted several times in different inpatient psychiatric wards. In the psychiatric examination, the presence of auditory hallucinations, dissociated thinking, and predominantly negative symptoms was observed. His symptoms showed only minimal responsiveness.He was diagnosed with TRS owing to the inadequate response to two sequential antipsychotic trials (with adequate dose, duration, and adherence).Our evaluation of TRS began with a thorough review of the patient’s psychiatric and treatment history. All nonpsychiatric causes, including untreated medical problems, that may contribute to ongoing psychotic symptoms have been ruled out. Physical examination and blood tests were unrevealing.Electroencephalography showed no signs of seizure activity. Following the evaluation process, a head CT scan showed a left paramedian cystic lesion at the level of the pineal gland. A cerebral MRI was performed in order to get a more detailed image. It confirmed the nature of the lesion and revealed the existence of an arachnoid cyst about 2.5 cm × 3.5 cm × 2.0 cm in size, centered on the quadrigeminal cistern with triventricular dilatation. This neurological tumor didn’t require neurosurgery.

Our case emphasises the importance of considering an organic cause like any space-occupying lesion in the brain (an arachnoid cyst in our case) for the induction of psychopathological symptoms, even those of treatment-resistant schizophrenia, which represents a major clinical challenge. This also underlines the interest of neuroimaging in the initial workup and supports the hypothesis of psychosis as a global network.

None Declared

Autism Spectrum Disorder (ASD) and ADHD are both neurodevelopmental disorders which share genetic heritability and often coexist in adults diagnosed with ADHD and vice versa. Despite the overlap between the two disorders there are enough phenomenological differences to indicate that these conditions are sufficiently distinct

To estimate the coexistence of ASD traits in an adult sample diagnosed with ADHD; to compare those screening positive for possible ASD to those scoring negative, in terms of functionality, quality life and clinical outcomes; to explore the effects of ADHD medication in three main outcomes (clinical, quality of life, and functionality) in those with only ADHD and in those with a coexistence of ASD and ADHD.

Prospective longitudinal study of an adult sample diagnosed with ADHD. Data collected on age, gender, medications and on scales: Autism Spectrum Quotient (AQ-10); Adult ADHD Clinical Outcome Scale (ACOS); Adult ADHD Quality of Life Questionnaire (AAQoL); Weiss Functional Impairment Rating Scale (WFIRS).

Sample of 165 participants was recruited. The AQ-10 showed that n=74 (44.8%) of the participants had traits of ASD. Longitudinal analyses demonstrated that people with ADHD and ASD traits have worse clinical outcomes, quality of life, social skills and family functioning compared to those with ADHD only. The effects of ADHD medications (stimulants, atomoxetine) were significant in the three examined outcomes across the time but no significant effects of medications to those with ASD traits was found.

Hight coexistence of ADHD and ASD traits. Perhaps lesser if clinical diagnosis for ASD was performed. Medications for ADHD did not improve those with ADHD and ASD traits. Service implications (for local services): neurodevelopmental clinics is necessity now and not only special for ADHD, where adults with ADHD and ASD can be diagnosed and treated accordingly.

None Declared

The high prevalence of mental health disorders makes investigating their etiology a fundamental activity. Factors influencing their physiology include genetic predisposition, substance use, environmental factors, etc. Among these, weather and atmospheric pollutants are two of the least studied. The biologically active agents in the atmosphere interact with living beings, disrupting their homeostasis and leading to alterations in both physical and mental health. This interaction was already noted in the Corpus Hippocraticum in the 4th century BC.

The objective is to analyze the impact of various environmental factors and atmospheric pollutants on daily emergency hospital admissions for mental disorders in the healthcare area of the province of León from 2011 to 2022.

An observational, retrospective, ecological, longitudinal, and time series study is conducted. Admission data is sourced from the coding office at the Complejo Asistencial Universitario de León, meteorological data from the Agencia Estatal de Meteorología, and pollutant data from the Junta de Castilla y León. A combined database in Excel is created for statistical analysis, both descriptive and analytical (Poisson regression), using the SPSS statistical package.

It was observed that hospital admissions for mental disorders are significantly related to sunlight hours, ozone, precipitation, average wind speed, CO, NO2, maximum atmospheric pressure, NO, and PM10.

The findings of this study show that meteorological factors and atmospheric pollutants are related to hospital admissions for mental disorders. Applying this information in psychiatric emergencies could improve forecasting and resource management during periods of higher demand.

None Declared