Wives of PTSD affected war veterans experience a wide range of psychosocial difficulties including secondary traumatic stress (STS).

To compare level of STS symptoms, emotional functioning and perceived quality of life between wives of PTSD affected veterans, wives of veterans without PTSD and wives of non-veterans in Croatia. To investigate the effect of veterans’ PTSD, wives’ knowing of the veterans’ war trauma, and wives’ personal war experiences on STS.

A total of 150 married women participated in the study. Fifty wives of PTSD affected veterans were recruited through Referral Center for Psychotrauma Rijeka, while 50 wives of veterans without PTSD and 50 wives of non-veterans were recruited using the snowball method. Sociodemographic questionnaire, Brief Symptom Inventory, Manchester short assessment of quality of life, and Modified questionnaire for secondary traumatization were administrated.

Thirty-six percent of wives of PTSD affected veterans meet the criteria for secondary traumatic stress disorder. Wives of PTSD affected veterans report significantly higher level of STS symptoms compared with wives of non-PTSD veterans. Also, wives of PTSD affected veterans report higher level of psychological difficulties and have lower percieved quality of life compared with other two groups. Multifactor analysis shows main effect of wives' knowing the veteran's traumatic event on STS, and main effect of veterans' PTSD on emotional functioning of their wives.

Clinicians working with war related PTSD should be aware of secondary traumatic effect on the spouses. Systemic approach in psychotherapeutic treatment of PTSD should be considered.

To develop a toolkit to assess the quality of institutionalised care, in both hospital and community settings, for individuals with long-term mental illness.

The toolkit was developed by the UK research teams. Items were included to assess the six domains (Living Environment; Therapeutic Environment; Treatments and Interventions; Self-management and Autonomy; Social Policy, Citizenship and Advocacy; Clinical Governance) and three cross-cutting themes (Social Inclusion; Human Rights; Recovery-based Model) which emerged from the international literature review, Delphi exercises and cross-country care standards. Following translation and piloting in each country, the toolkit was refined and tested for reliability in 20 units in each country (a total of 200 units).

Test-retest reliability was assessed using intra-class correlations and Cohen's Kappa coefficients. Factors with low reliability or extreme response biases were dropped. Remaining items were subjected to an exploratory factor analysis to test the allocation of items to domains and cross-cutting themes and improve their internal consistency. Correlations between domains were explored to determine whether or not domains could be combined.

In the next phase of the study,the toolkit domain ratings will be analysed for associations with standardised assessments of service users' quality of life, autonomy and markers of recovery to investigate whether the toolkit can provide a proxy measurement of the institution's promotion of human rights and recovery.

Valid assessments require sufficient effort from the part of the testee. Motivation may be compromised, particularly in psychiatric conditions. We examined associations between response bias on free recall and self-reported symptoms in depressed and PTSD patients.

This is a cross-sectional study. Patients had depression (n = 48), or PTSD or other anxiety disorders (n = 37). A control group (n = 47%) had chronic pain disorder, fibromyalgia or chronic fatigue. The Green Word Memory Test (GWMT) was administered to all subjects. The Structured Inventory of Malingered. Symptomatology (SIMS), and the Beck Depression Inventory (BDI-II) were administered in subsamples. Study outcome was self-reported depressive symptoms in Symptom Validity Test (SVT) negative cases.

Average age of the participants was 45.1 years (SD 9.5), 48.5% were female. GWMT was positive in 52.3% of all cases, GWMT and SIMS were positive in 33.8%, and GWMT and SIMS were negative in 37.7%. No significant group effects on GWMT were found. Average BDI-II scores were 32.8 (SD 13.9) for depressed patients, 28.3 (15.5) for those with anxiety disorders, and 27.6 (14.1) for controls (P = 0.43). Seventy-eight percent of depressed GWMT negative cases reported at least moderate depressive symptoms (BDI-II > 18), and 44.4% severe symptoms (BDI-II > 29). Approximately half of the GWMT negative cases with anxiety disorders and controls scored BDI-II > 18.

Non credible test performance is prevalent in disability claimants with affective, mood disorders. However, depressive symptoms per se do not explain poor effort on cognitive tasks.

The authors have not supplied their declaration of competing interest.

Vulnerable groups like patients suffering from alcohol use disorders (AUD) are expected to be particularly affected by the negative consequences of the COVID-19 pandemic. In a prior study (N=127), we found that psychosocial COVID-19 factors and living alone elevated the probability for relapse during the initial stage of the pandemic, whereas long-term effects on mental health have yet to be investigated.

Here we aimed to investigate the risk of PTSD, as well as levels and developments in depression, anxiety and stress symptomatology as a consequence of the COVID-19 pandemic among patients with AUD.

Data was collected from a clinical sample of patients with AUD (N=136) in late 2020 and early 2021. PTSD symptoms due to the pandemic were assessed using an adapted version of the impact of event scale (IES-R). Levels in clinical symptoms were collected on the depression, anxiety and stress scale (DASS-21), and changes since the onset of the pandemic were assessed additionally.

The high-risk PTSD-group showed higher levels of depression, anxiety and stress, and reported more severe deteriorations in these symptoms, when compared to the low-risk group. A binary logistic regression model revealed psychological and social aspects of the pandemic to increase the probability for PTSD, whereas sociodemographic and other COVID-19 related factors showed no significant effects.

About 30% of patients with AUD indicated an elevated risk of PTSD due to the pandemic, as well as deteriorations in levels of depression, anxiety and stress. These concerning findings should be especially considered in current and future treatment settings.

No significant relationships.

There are several case reports describing clozapine side effects such as agranulocytosis, constipation,tachycardia but rarely cases describing oesophagitis caused by clozapine were reported.

To report the first case in our country about clozapine induced oesophagitis.

We describe a case in which a patient who has no gastrointestinal past history,has developed an oesophagitis stage 2 of Savary and Miller Classification without any gastroesophageal reflux disease, few weeks after introducing clozapine at therapeutic dose.

A 25 years old male patient with resistant schizophrenia managed with clozapine,was admitted to reinitiate his treatment after weeks of stopping his medication.During hospitalization, our patient developed a sudden haematemesis in 10 days after commencement of clozapine. The patient had no history of gastrointestinal symptoms or disease. The clinical examination and blood tests did not find any signs of bleeding severity.A gastroscopy was performed, revealing esophagitis stage 2 of Savary and Miller classification and a cardiac polyp removed with biopsy forceps that showed no malignant lesions .The patient was treated with acid suppressant therapy.There was no further episode of haematemesis and our patient healed uneventfully within a week.As for clozapine, it wasn’t interrupted and we continued increasing doses very carefully with no further incident.

Although it is a rare side effect, oesophagitis may appear at therapeutic doses of clozapine, and this possibility should be taken into account when treating patients with resistant psychiatric disorders.

No significant relationships.

While several studies have assessed the impact of the COVID-19 pandemic on sexuality and sexual behavior in the general population, very few studies have assessed sexuality after Sars-Cov 2 infection.

The objective of our study were to assess sexuality in women recovered from COVID-19 and to compare it to healthy controls.

This is a cross-sectional case-control study.

We randomly recruited women, from April 1st to 30th, 2021.The women in the case group have been infected with Sars-Cov 2, with a benign or pauci-symptomatic clinical form, and cured for one to two months at the time of the study without any post-COVID complications. Women included in the control group have not been infected with Sars-Cov 2. Sexuality was assessed by the Female Sexual Function Index (FSFI).

In total, we recruited 30 women in the case group and 30 women in the control group.The average age of the case group was 35.8 ±6.8 years versus an average age of 35.3 ± 6.33 years in the control group. The majority of coronavirus infections were symptomatic (83.3% (n=25)). An FSFI score <26.55 and corresponding to impaired sexual function was found in 63.33% of women in the case group (n=19), versus 53.33% of women in the control group (n=16) with a significant difference between the two groups (p=0.009)

COVID-19 is significantly associated with sexual dysfunction, even in mild or pauci-symptomatic clinical forms.

No significant relationships.

Studies assessing the psychological impact of COVID-19 have shown that patients with COVID-19 had significantly higher levels of depression, anxiety, and post-traumatic stress symptoms than healthy controls.

The objectives of our study were to assess depression in women recovered from COVID-19 and to compare it to healthy controls.

It was a cross-sectional case-control study.

We randomly recruited women, from April 1st to 30th, 2021.The women in the case group have been infected with Sars-Cov 2, with a benign or pauci-symptomatic clinical form, and cured for one to two months at the time of the study without any post-COVID complications. Women included in the control group have not been infected with Sars-Cov 2 .Depression was assessed by the Beck Depression Inventory (BDI).

In total, we recruited 30 women in the case group and 30 women in the control group.The average age of the case group was 35.8 ±6.8 years versus an average age of 35.3 ± 6.33 years in the control group. The majority of coronavirus infections were symptomatic (83.3% (n=25)).

The average depression score for the case group was 10.8 ±9.6 corresponding to moderate depression, while the average depression score for the control group was 6.1 ± 6.1 corresponding to mild depression. The presence of depression was more significant in the case group compared to the controls (p=0.003).

COVID-19 is significantly associated with depression, even in mild or pauci-symptomatic clinical forms.

No significant relationships.

Heath workers especiallyin the emergency rooms and emergency medical services are exposed to sustained stress which had increased due to the Pandemic situation

To search for factors associated with mental disorders among health workers during the Covid 19 pandemic

Data were collected through a questionnaire,with demographic variables anddifferentscales to evaluate the degree of symptoms of depression, anxiety, insomnia, distress, and the level of work engagement(PHQ-9,GAD-7,ISI,IES-R,UWES-9).

Of the 217 participants, 46% were physicians, 42% were nurses and 12% were emergency medical technicians. We also found a femalepredominance of 66%, 55% were single and a total of 155 participants of whom 71% were frontline health workers. In our study, 54.8% of the HCWs had symptoms of depression, 68.2% had symptoms of anxiety and insomnia and 71.4% had symptoms of distress. Binarylogisticregressionanalysisshowedthat being married was associated with depression, anxiety, and insomnia, and being a frontlineworkerappeared to be a risk factor for depression and insomnia. Psychiatric support was an independentrisk factor for all psychiatric symptoms.In addition, living in a rural area was associated with depression, and age 31 or older was associated with anxiety. In addition, having a history of psychiatric illness was a risk factor for insomnia. Being a nurse was identified as a risk factor for psychiatric distress. We also found a moderatelevel of professional commitment to be a protective factor.

Protecting healthcare workers is a crucial part of the public health response to the COVID-19 outbreak.

No significant relationships.

COVID-19 infection may lead to encephalopathy and various neurotrophic effects which can result in neuropsychiatric complications. Here, an asymptomatic adolescent female developed acute onset catatonia and psychosis manifesting during the resolution of Covid-19 infection.

Discuss differential diagnosis, medical workup, and initial treatment optimization for acute stabilization.

This 15-year-old female with no previous psychiatric history nor prodromal symptomatology was hospitalized secondary to Covid -19. During the immediate three-month recovery phase following resolution of Covid-19, the patient exhibited gradually increasing anxiety, paranoia, delusions, disorganized behavior, and weight loss leading to re-hospitalization secondary to catatonia. Negative workup included rapid strep test, urinalysis, chest and abdominal x-ray, EEG, and brain MRI. Lumbar puncture revealed elevated WBC of 18 but was unremarkable for NDMA receptor antibodies, CSF HSV, and encephalitis panel. IV steroids, IVIG, and Anakinra were all given without benefit. Inadequate response to olanzapine, clonidine, and lorazepam led to an Index Series of bilateral electroconvulsive therapy (ECT).

The provisional diagnosis of psychotic disorder secondary to COVID-19 infection responded robustly regarding sleep, behavior, and affect by session #6, yet positive symptoms of psychosis persist. Ongoing ECT, psychopharmacology, and narrowing of the differential diagnosis continue.

As more COVID-19 cases evolve during the pandemic, potential post-infectious neuropsychiatric complications should be considered as potentially contributory and kept in a thoughtful differential diagnosis. Regardless of ultimate causation, the acute symptom profile responded robustly to an initial Index Series of ECT.

No significant relationships.

Current evidence contradicts the idea that cannabis-induced psychotic disorder (CIPD) has an overall benign prognosis, with up to half of these patients being with a schizophrenia spectrum disorder later in life.

To characterize sociodemographic and clinical characteristics and treatment plan of inpatients with multiple admissions for CIPD over a one-year period, compared to those with a single admission.

Retrospective observational study of inpatient episodes with CIPD between january 1st 2018 and september 30th 2021 in a tertiary psychiatric inpatient unit. Statistical analysis was performed using SPSS software, version 27.0.

Our sample included 80 inpatients, 15 (18.8%) with multiple admissions for CIPE within one year period and 65 (81.3%) with a single admission. The multiple admissions group had a median of 1 ±0,915 admissions within the same year. Being readmitted for CIPE was associated with outpatient compulsory treatment at discharge (OR 3,01 (95% CI 1,27-7,18, p=0,034). These patients had 3.14 higher odds of future admissions to psychiatry unit (CI 95% 1.70-5.78, p<0.001). We found no statistically significant differences regarding the sociodemographic and clinical characteristics, daily vs. occasional use of cannabis in patients with multiple admissions for CIPE.

Patients with multiple admissions for CIPD tend to have more relapses and require assertive treatment measures. However, they did not differ regarding the sociodemographic and clinical characteristics studied from patients with single admissions. This suggests that additional assessment of these patients might be important to predict the course of the disease.

No significant relationships.

Social stigma indicates a process of negative connotation of a person which results in discrimination. The victim of stigma experiences a condition of social exclusion that negatively affects his relationships. The COVID-19 pandemic has spread the fear of being “contaminated”, which has led to the discrimination of a part of population.

The purpose of this work is to analyze which people have suffered from stigma due to the COVID-19 pandemic by examining the negative effects on their health during this period.

A literature review of peer-reviewed articles was performed on Pubmed NCBI database by inserting the keywords: stigma and COVID-19 in the period 2020-2021.

The data showed that the categories most at risk were positive patients and their families; healthcare workers in COVID-19 wards; Asian people. Discrimination has included avoidance attitudes, physical or verbal abuse, hypersurveillance in public places. Negative effects on victims included anxiety, depression, feelings of rejection and shame, self-harm and suicide. COVID-19 patients attempted to hide the disease by avoiding access to hospital; health personnel developed risk of burnout; Asian restaurants experienced a drop in reservations, even after quarantine period.

Social stigma is a public health problem and greater efforts are mandatory to reduce it including correct information, with the help of social and mass media; social interventions aimed at generating empathy; avoiding the use of negative language focused on stereotypes that could generate fear or discrimination. Such interventions are crucial to reduce discrimination in such a fragile period as COVID-19 pandemic.

No significant relationships.

Depression is associated with high impact on health-related quality of life (HRQoL). Health state valuations are used for cost-effectiveness analysis to provide results for health-policy interventions.

The study aims to estimate a population-based value set of depression described by Patient Health Questionnaire (PHQ-9). We intend to assess vignettes describing PHQ-9 health states to estimate utility values

Current research elicited direct utility scores using time trade-off (TTO) method obtained from the Hungarian general population (N=2,000). TTO vignettes were created to describe hypothetical health states of depression based on the nine items of PHQ-9. The hypothetical health states were sorted orthogonally in 11 blocks, each containing 4 vignettes (combinations of no; mild; moderate; severe depression). All respondents valued the four health states of one randomly given block. Conventional TTO method was applied, using a 10-year timeframe, while the first iteration step was randomized to 1,3 and 5 year. Preference weights were estimated using regression model fitted to TTO utility results.

Altogether 1,999 respondents valued overall 34 different health states. The mean age was 47.3 (16.9) years, the majority was female (57.2%). Nearly half of the respondents were secondary educated 45.4%, 27.3% higher educated and 27.2% completed primary school. The mean TTO utility of selected mild, moderate and severe depression was: 0.83; 0.82 and 0.77 respectively.

Our results constitute the first population-based value set for PHQ-9. Utility scores give useful information for cost-effectiveness assessments. Estimates provide preference-based quality of life weights for the Hungarian population.

No significant relationships.

Hwa-Byung is a cultural-related mental syndrome that reflects the cultural characteristics of Korean in DSM-IV. This syndrome is caused by anger or resentment towards unreasonable social violence and trauma.

The purpose of this study is to revise and validate the ’Hwa-Byung scale’, which can be used to diagnose Hwa-Byung and evaluate the severity of its symptoms.

To begin with, the factors of the Hwa-Byung scale were set based on the previous studies. Additionally, the respective subfactors were generated by the semi-structured interviews with these patients. Based on these factors and previous studies, a 142-item pool was developed and verified by six Oriental Neuropsychiatrists. A pilot study was conducted on 50 patients with Hwa-Byung and the main study for the validation was conducted on 200 Hwa-Byung patients. Item analysis, internal consistency, and exploratory/confirmatory factor analysis were performed. Lastly, this study analyzed the ROC curve to present the diagnostic cut-off score of the scale.

As a result of analyzing the content validity of the item pool, we constructed a preliminary scale. We excluded the inadequate questions from the pilot study results. In the main study, The Hwa-Byung scale showed high internal consistency and its items were suitable for the factor structure. Finally, we suggest an optimal cut-off score of the symptoms sub-scale for screening Hwa-Byung.

Overall, the results of this study indicated the reliability and validity of the Hwa-Byung Scale. Based on these results, we discussed several values and limitations of this study and provided suggestions for further research.

No significant relationships.

Residency training has been reported as being stressful which may lead to different mental disorders.

To study the prevalence and associated factors of anxiety and depression symptoms among psychiatry residents.

A cross-sectional study was conducted through an online survey among psychiatry residents. Participants completed an anonymous self-administered questionnaire and the HADS questionnaire for screening anxiety and depression.

Forty responses were collected.The average age of the sample was 28.08 ± 2.43 and the sex-ratio (F/M) was 0.875. Eleven participants were married. Eight residents were smokers. The prevalence of alcohol use and cannabis use was 22.5 % and 5% respectively. Half of participants were first year residents and near three-quarter of them (72.5%) declared working in poor conditions. A considerable proportion of participants had symptoms of anxiety and depression. The prevalence of anxiety case and depression case was 52.5% and 47.5% respectively. The prevalence of Anxiety symptoms and depression symptoms was significantly higher in female participants (p = 0.017, p=0.034 respectively). Poor conditions of the workplace were significantly associated with depression symptoms (p=0.004).

Training residents in psychiatry showed high rates of anxiety and depression symptoms. Screening and early management of these psychiatric manifestations is necessary. In addition, improving working conditions would upgrade their training and quality of life.

No significant relationships.

Individual abilities to perceive internal and external sensations are defined respectively as interoception and exteroception: the dysregulation of these functions can explain many psychotic symptoms. (Ardizzi et al. 2016)

We evaluated the differences in the interoceptive and exteroceptive perception between 39 patients with psychosis and 250 healthy controls using self-administered questionnaires. The association between interoception and exteroception in the two groups was also tested.

The tests we used are AASP (Adolescent / Adult Sensory Profile) and MAIA (Multidimensional Assessment of Interoceptive Awareness). Differences were measured with t-tests, associations with spearman’s correlation.

Significant differences emerged between the two samples in the AASP total score and in its Low registration (LR) and Sensory Avoiding (SA) sub-scales and in the MAIA total score and in all its sub-scales except “Not Worrying” (Fig.1). Different patterns of associations between AASP and MAIA were observed: psychotic patients showed negative correlations between MAIA and AASP in the LR and Sensation Seeking (SS) sub-scales and in the auditory (AU) and tactile (TO) sensory channels. Healthy controls, positive correlations emerged between MAIA and AASP in the Sensation Seeking (SK) sub-scale and in the “perception of movement” (MO) sub-score (Fig.2)(Fig.3).

Higher scores of psychotic patients in AASP and MAIA reveal both a disregulated sensory related behavior and a hightened awareness towards internal stimuli. The negative correlation between the two scales in psychotic subjects highlights the importance of the interaction between internal and external perception in determining the global subjective experience.

This longitudinal, community based cohort study assessed the mother-offspring transmission of BPD and examined whether maternal parenting styles and offspring temperament are associated risk factors.

At baseline 315 mothers and 414 offspring of the general population were investigated. Five years later the offspring were followed up and diagnostic interviews were carried out. BPD risk in children of BPD-mothers was compared to the BPD risk in children of healthy mothers. The contribution of an anxious-impulsive temperament in offspring and invalidating maternal parenting style to the prediction of BPD features was analyzed.

Offspring of mothers with BPD were 8.5 times more likely to exhibit the diagnosis of BPD than offspring of healthy mothers. Prediction analyses suggest that mother-offspring transmission of BPD may be partially mediated by reciprocal transactions between a vulnerable temperament and an overprotective maternal parenting style.

Given that offspring of mothers with BPD are not only at heightened familial risk of BPD but also other mental disorders, specificity of factors that are shared between mothers and their offspring is questioned. Early prevention needs to be provided to this high-risk group, especially if there are additional risk factors, as the transaction between vulnerable temperament and maladaptive parenting.

Dysregulation in the neuroendocrine stress system has been attributed repeatedly to the stressful and anxiogenic state observed during alcohol withdrawal. Activity of the atrial natriuretic peptide (ANP) has been shown to inhibit the release of corticotrophin releasing hormone (CRH) and corticotrophin (ACTH) and opioid neurotransmission also plays a role in counteracting effects of sustained stress by facilitating the termination of the hypothalamo-pituitary-adrenocortical (HPA) axis stress response. Thus ANP and ß-endorphin may be involved in modulating the HPA axis activity in alcohol withdrawal. Aim of the study was to evaluate the anxiolytic activity of ANP and ß-endorphin during alcohol withdrawal in mice habitated to chronic alcohol intake.

24 male mice (C57/Bl6J) were studied following 21 days of free-choice and forced alcohol intake. Anxiety related behavior (elevated plus maze, open field) was tested during acute ethanol withdrawal (12 hours after last ethanol consumption). 30 minutes before testing, randomized groups of mice were given i.p. injections of ANP (60 μg/kg), ß-endorphin (2 μg/kg) or saline.

Acute alcohol withdrawal in alcohol habituated mice was associated with increased anxiety related behavior. Application of both, ß-endorphin and ANP, was significantly associated with reduced anxiety related behavior.

Taking into consideration data from studies in humans, where decreased levels of ß-endorphin and ANP were associated with anxiety during acute and protracted alcohol withdrawal, our results suggest a causal relationship between ANP, ß-endorphin and withdrawal-induced anxiety in alcohol related disorders.

While the links between cyclothymia and creativity are well documented, the experts have tried to determine whether temperament would influence the major choices of life such as career.

The study aims mainly to evaluate the temperaments of a sample of Tunisian students, and to look for the possible correlations between the temperament and the choice of studies.

The Tunisian version of the TEMPS-A which is a self-evaluation measure to assess affective temperaments was administered to 100 medical students and 100 humanities students.

Student populations differed in their socio-demographic and scholar variables such as age, sex ratio or socio-economic level, choice of studies and their religiosity. The temperamental prevalences were close between our two populations by considering the threshold score Mean +1standard deviation; they ranged between 13 and 18%. Hyperthymic and cyclothymic scores were significantly higher among humanities students (11.38 ± 4.385 versus 9.00 ± 4.192 and 11.96 ± 4.497 versus 9.63 ± 4.499 respectively) and irritable scores were higher in the latter, though not significant (6.45 ± 3.823 versus 5.39 ± 2.998). Depressive and anxious temperament scores were close in both groups. The study showed significant temperament differences within gender, socioeconomic status, high school marks, religiosity and political affiliation.

It is relevant and even necessary to include such studies in the selection of candidates who could adapt to a specific professional field on the basis of objective criteria such as conscientiousness, and privileging profile diversity.

To determine long term effects of intensive early intervention programme (OPUS)for first episode psychotic patients.

RCT of two years of intensive early-intervention programme versus standard treatment. Follow-up was two and five years.

547 first-episode psychotic patients were included and interviewed after two years (N=369) and five years (N=301). Registerbased information was available for all patients.

The intensive early intervention programme OPUS consisted of ACT with family involvement and social skills training.

At five-year follow-up, the positive effect of the OPUS treatment seen after two years had equalized between treatment groups. A significantly smaller percentage of patients from the experimental group were living in supported housing (4% vs. 10%, OR 2.3, 95% CI 1.1 to 4.8, P =0.02) and were hospitalized fewer days (mean days 149 vs. 193, mean difference 44, 95% CI 0.15 to 88,12 P= 0.05) during the five-year period.

The OPUS treatment improved clinical outcome after two years, but the effects were not sustainable up to five years after. A difference on supported housing and use of bed days were found after five years in favour of the OPUS treatment.

This is the case of a girl, aged 13, starting on 2021 with a first psychotic episode. Before this episode, her psychiatric history was an adjustment disorder because of scholar bullying, fully recovered before the onset of the current symptoms.

To describe an interesting case of early-onset psychosis.

We have used the interviews with the patient and her profile in Diraya (the medical database software in Andalucía).

The first symptoms started 6 months before the first hospitalization, and consisted in mild behavioural disorders, with disobedience and rudenesses, which represented a significant change compared with the previous personality of the patient. 3 weeks before the first admission she abruptly started to experience disconnection, unmotivated laughs, decreaded academic performance and incoherent speech. Also, she showed motor symptoms, consisting in oral and right-hand stereotypies. Then, she was hospitalized in a Pediatric unit, in order to rule out organicity. The nuclear magnetic resonance showed an image suggestive of venous development anomaly, with no acute injuries. Her cerebral spinal fluid was widely studied, and all the results were negative, including: the technique of PCR for many virus and bacteria that can cause meningitis or encephalitis; a bacterial culture; a biochemical study; antineuronal antibodies; and a limbic encephalitis antibodies study. Besides, the blood count, the biochemistry, the gasometry and serology were also negative. No drugs were detected in the urinalysis. Once the organicity was ruled out, she was treated with Olanzapine and Diazepam, and destinated to my child and adolescent psychiatry unit. During the first hospitalization we observed that she looked very often to the mirror, showed soliloquies and took leaps. During the interviews she was desinhibited. She initiated a delusional speech, focused in sexual topics. She said that she’s had a baby in the future with his father, and talked a lot about things she had already made in the future. During this admission, we changed the treatment to Quetiapine and Valproate.

The second hospitalization was was done due to a lack of efficacy with the previous treatment and the presence of autolytic thoughts. We switched from Quetiapine to Aripiprazole. After a few days, she showed again a desinhibited behaviour, and kept the delusional speech, that now was more complex, refering that she had more than 20 babies, with many different men. After this we tried Lurasidone and suspended Aripiprazole, she showed a clinical improvement, at the cost of many side effects, though. So we finally changed to Clozapine, in combination with Gabapentin. Since she got clinical levels of clozapine, the delusions have been encapsulated.

The differential diagnosis is set with an early-onset schizophrenia and a schizoaffective disorder. Obviously, the evolution of the sypmptoms in the following months and years will have the last word.

None Declared