Identification of interrelationship immune reactivity with social adaptation types of schizophrenic patients.

We examined 38 schizophrenic patients (F20.00, F20.01, F20.02). The scale SASS (Bosc M. et al., 1997) was used to estimate the social adaptation of schizophrenic patients. The immunological examination included the definition of phenotypes of surface receptors of immunocompetent cells, immunoglobulins, circulating immune complexes and phagocytosis levels. The research was carried out in two points: first - at admission, second - in 6 weeks of treatment.

Three adaptation types have been revealed: normal type of social adaptation (15 patients, 39,47%), difficult social adaptation (18 persons), disadaptation (5 patients). By week 6 of treatment number of patients with normal social adaptation has heightened by 1,4 times (21 patients, 55,26%), improvement of indices of social adaptation was observed in 10 patients, type of social adaptation did not change in 28 patients. At admission T-immunodeficiency (CD2+, CD3+, CD16+-lymphocytes decrease), increase CD8+, HLADR+, CD20+- lymphocytes, IgM and phagocytosis decrease were diagnosed among schizophrenic patients. During therapy, features of psychoneuroimmunomodulation were as follows: the normal type of social adaptation is relatively favorable in the immunological context. Patients with low level of social adaptation were characterized by clinical-immunological resistance toward therapy with deepening of T-cellular immune deficiency. Improvement of indices of social adaptation was accompanied by positive dynamic of immunological parameters.

Thus, social differences between groups have been confirmed by data according to immune reactivity.

Synthetic Cannabinoids were recognized as drugs of abuse since 2008, they are sold under various names (Kush, K2, Spice).

The Patient N., 17 years old male was admitted to the hospital with a first-time psychotic episode. He is fond of extreme sports (ski jumping, gymnastic and acrobatic elements).

The patient was fully examined.

Then he was taken to the admission department. About a week before admission he fell, injuring his leg and head. After that he did not sleep, became excited, aggressive, “said strange things”. During the admission patient showed disorganized behavior, agitation, paranoid ideation, beliefs that others were inserting thoughts into his head (“thought insertion”) and that his thoughts could be read by others (“thought broadcasting”), imperative “voices”, bizarre delusional thoughts. The UDT showed positive K2 analysis. The patient was prescribed Diazepam, Zuclopenthixol, Valproic acid. No improvement observed. Haloperidol was prescribed next day. Then Haloperodol was changed to Quetiapine, and after 10 days of treatment no improvement was observed. The patient started to show catatonia symptoms such as elective mutism, mild rigidity, signs of cog-wheeling or clasp-knife rigidity. He experienced anxiety, fear, did not take care of himself. Every day he started to be aggressive, impulsive, started to experience auditory hallucinations. Due to that fact it was decided to prescribe Haloperidol, Chlorpromazine, Phenazepame, Diphenhydramine.That treatment improved behavior.

Thus, the intensive treatment with antipsychotic medications in combination with benzodiazepines and diphenhydramine is much more preferable for the management of the cases of oneiroid catatonia due to the usage of Spice.

The aim of our study was to determine the prevalence of depression in diabetic patients who consulted the Tunisian National Institute of Nutrition and to assess risk factors and clinical features of these disorders.

Cross-sectional study including a population of 100 diabetic patients. A form was designed for epidemiological data collection. Depression was measured using the Hamilton Depression Rating Scale (HAMD).

Our results showed a high prevalence of depression in diabetic subjects. 51% of diabetic patients have moderate to severe depression, 13% had mild depression, while 36% had normal values on the HAM-D. Moderate to severe depression was present in 37% of men and 42% women.

Diabetes is associated with a significantly increased risk for depressive symptoms. Our study confirms the usefulness of the assessment of depressive symptoms during follow-up of diabetic patients and the importance of an early multidisciplinary care. Pathogenetic mechanisms connecting diabetes with depression deserve further exploration.

PPA is characterized by progressive language dissolution, with remarkable spare of other cognitive domains for at least two years, and should be considered in the differential diagnosis of dementia.

A 56-year-old previously healthy man was seen for speech difficulties. He studied Portuguese for 4 years, and then went to live in France, where he learned French for 3 years. He returned definitely to Portugal when he was 42. Since early adolescence he was fluent on speaking, reading and writing in both languages. In the last 12 years he spoke French mainly when visiting his family. Three years ago he started showing disintegration of his second language preceding that of his native one. Upon examination he had laborious, effortful, nonfluent and agrammatic speech, with severe anomia and some repetition and complex-command comprehension difficulties. He could not name, understand or write any French word. The remaining neurological examination was near-normal to age and education level (MMSE - 25/30). Brain MRI showed left-side predominant frontotemporal cortical atrophy. PET scan revealed hypometabolism in the same area and the temporal lobe, anterior cynguli and dorsolateral frontal cortex.

Our patient has nonfluent variant of PPA. Cases like this can give further insight into the neural network subserving language acquisition and dissolution. In proficient bilinguals, the main point on language dissolution in PPA seems to be the recency of use. The best way to confirm this would be to systematically characterize PPA patients on secondary language usage, attained proficiency and disintegration sequence.

To evaluate and compare clinical characteristics of men and women who were admitted to psychiatric hospital after parasuicide.

Clinical examination, The Pierce Suicide Intent Scale, Beck Suicide Ideation Scale, Beck Hopelessness Scale, Beck Depression Inventory, The Symptom Checklist 90 Revised, Global Quality of Life Self - Rating Scale, The Barratt Impulsiveness Scale, The Toronto Alexithymia Scale.

Suicide attempters over 15 years admitted to the psychiatric hospital within one month after parasuicide (N=264; 114 – men and 149 – women).

Level of depression according to the Beck Depression inventory was higher in women (M=19,1; SD=13,1) than in men (M=12,9; SD=9) with ρ<0,001. The scores of general psychopathological state were higher in women (M=87,7; SD=68,1) than in men (M=69,1; SD=49,7), ρ<0,04. There were no statistical differences in the level of hopelessness according to Beck Hopelessness Scale, impulsivity according to The Barratt Impulsiveness Scale, alexithymia according to The Toronto Alexithymia Scale and perception of quality of life according to the Quality of Life Self- Rating Scale. There was no difference in the level of suicide ideation according to the Beck Suicide Ideation Scale and suicide intention according to The Pierce Suicide Intent Scale.

There weren’t considerable difference of parasuicide risk factors between men and women hospitalized because of mental disorders. At the same time women more often percept their psychological state as more severe.

In Portugal there are no national epidemiologic registers on the prevalence/incidence of suicidal ideation and attempts. Although there is no evidence that suicide is higher in University students than in other people of the same age, it is a cause of premature death.

To analyze the prevalence and characteristics of suicidality in university students

549 University students (80.1% females) filled in a booklet of questionnaires that included the Suicidal Behaviour Section of the Diagnostic Interview of Genetic Studies (Azevedo et al, 1993; Nurnberger et al., 1994), which was slight modified.

0.4% reported lifetime poor psychological health and 1.3% reported lifetime hospitalizations due to emotional/behavioural problems. Lifetime thoughts of death, lifetime active suicidal ideation, and lifetime suicidal attempts were described by 20.4%, 11.9% and by 2.3% of the students, respectively. Regarding the more severe lifetime suicide attempt (N=15) the method used was predominantly self-poisoning (medication) (9/13), 40% (6/15) were hospitalized after this attempt, 53.3% (8/15) reported death wishes when the act was performed, and 60% (9/15) considered that death could be the consequence of the act. During last month suicidal ideation occurred in 1.9% of the students. During the last two weeks suicidal ideation without planning was found in 2.2% and 0.2% refereed they are going to attempt suicide if they will have an opportunity.

In university students recent, frequent and severe suicide ideation might occur. Results highlighted the need for suicidality prevention/early intervention and that Health University Care Services should screen systematically suicidal ideation.

Several studies have independently suggested that schizophrenia patients are more likely to have an enlarged cavum septum pellucidum (CSP). However, neither finding has been consistently replicated.

We recruited the relatively homogeneity population: treatment resistant schizophrenia (TRS) and treatment resistant depression (TRD).To investigate whether CSP was present more frequently in TRS or TRD patients than controls and the difference of CSP morphological characteristic between groups.

1.5-Tesla MRI was used to evaluate the prevalence of CSP and morphology changes in 42 TRS, 45 TRD patients and 30 healthy controls. The CSP length, width and volume were measured using MRIcro and Analyze™ 8.1 software. A CSP equal to or greater than 6 mm in length was defined as big CSP.

TRS Patients had a significantly higher prevalence (6%) of the big CSP than TRD patients (0%) or controls (3.3%) while no significant difference on the prevalence of all CSP (TRS: 64.3%, TRD: 48.9%, controls: 50.0%) or small CSP between groups. Compared with controls or TRD patients, the values of CSP maximum width in patients with TRS were significant lower and CSP length were higher. There was no significant difference in the CSP volume between groups.

The incidence in Big CSP in TRS patients was higher than that of TRS patients or controls. The small CSP may be a kind of normal variant. There were different CSP developmental characteristics between TRS and TRD patients based on the MRI study.

In Brazil there is high number of children with Intellectual Disability (ID) who begin basic education but did not receive a diagnosis. The basic education teachers can be important agents in identifying signs of ID in the student so that they can be referred to health services.

To develop and implement a decision-making model for basic education teachers to identify students with predictive signs of ID.

The sample was composed by 51 teachers from 20 public schools and their 1758 students eligible for the study enrolled in a educational network in São Paulo state, Brazil. A standardized model was developed for the evaluation process using an open-source software named BONITA. For the screening of students with ID signs the teachers answered a checklist based on the diagnostic criteria of the DSM-5 and the students were evaluated with neuropsychological test WASI (Wechsler Abbreviated Scale of Intelligence) and neuropsychiatric assessment. A Classification Based on Association Rules (CBA) generated the predictive models of sensitivity for confirming ID from the items in the checklists.

35 children had suspected ID. The CBA showed an accuracy of 82%, identifying only 1 false-negative case and 3 false-positive cases for ID. According to the teachers, the most accurate signs were deficits in abstract thinking skills, deficits in communication and conversation and difficulties in emotional regulation in social interactions.

The decision-making model by elementary school teachers to identify students with ID showed high levels of sensitivity and can help the waiting for diagnosis.

No significant relationships.

Child sexual abuse is a major public health problem in Sri Lanka, with prevalence rates ranging from 14-44%.

We aimed to describe the victim and perpetrator characteristics, pattern of disclosure and psychological consequences of sexual abuse in children presenting to a tertiary care hospital in Sri Lanka.

This was a retrospective file review study of 164 victims who presented to a Teaching Hospital in Colombo, Sri Lanka, with alleged sexual abuse over a period of 5 years from 2015-2019.

Majority of the victims were female and older than 12 years. Majority (73.6%) have been subjected to penetrative sexual abuse with 58.5% of victims reporting more than one incident of abuse. Almost all (99.9%) of the perpetrators were male, with 94.5% being known to the child. Only 42.7% (n=70) of the children revealed about the incident within the first week. Delayed disclosure (i.e. more than 1 week since the incident) was significantly higher in penetrative abuse (p<0.01), multiple incidents of abuse (p<0.01) and in abuse by a known person (p<0.05). Children who disclosed after one week were significantly less likely to disclose about the incident spontaneously (p<0.01). Psychological sequel was seen in 28.7%, with depression being the commonest diagnosis (8.5%). Psychological consequences were significantly in higher those who had physical evidence of abuse (p<0.01), delayed (after 1 week) disclosure (p<0.05) and in those who did not disclose spontaneously (p<0.01).

The victim and perpetrator characteristics, pattern of disclosure is comparable with previous literature.

No significant relationships.

Obsessive-compulsive symptoms (OCS) are common in schizophrenia, with a prevalence ranging from 12 to 25%. They affect negatively disease outcome. Patients with comorbid OCS present more frequently resistant psychotic symptoms. Besides, the appearance and aggravation of OSC are more commonly reported with atypical antipsychotics.

To present through a clinical case and a brief literature review the treatment challenge of obsessive-compulsive symptoms in schizophrenia.

We reported the case of Mr. M.S., treated in our department since 2008 for comorbid schizophrenia and OCS, and discussed therapeutic alternatives through a literature review.

Mr. M.S. a 34-year-old male diagnosed with comorbid schizophrenia and OCS at age 20. To control psychotic symptoms, the patient received several trials of anti-psychotics with little improvement. We concluded that it was resistant schizophrenia. The introduction of clozapine reaching 300 mg daily led to significant improvement of psychotic symptoms but worsened OCS. The adjunction of fluoxetine and cognitive-behavioral therapy (CBT) was unsuccessful to manage obsessive symptoms. We opted for the association of aripiprazole 20 mg daily and clozapine, the doses of which were gradually tapered down to 150 mg daily. This association has guaranteed the improvement of both psychotic and obsessive symptoms.

Conclusion This clinical vignette highlights the need for clinical awareness about the possible exacerbation of OCS with atypical antipsychotics in schizophrenia.

No significant relationships.

We recruited n=15 SAD subjects and n=11 NC. We have utilized TMS on Primary Motor Cortex (M1) in order to study neuronal excitability and cortical inhibitory mechanisms. These has been achieved by examining EMG recording Motor Evoked Potentials (MEP). We measured MEP, Motor threshold, Cortical Silent Period (CSP), paired pulse inhibition both in patients and healthy controls. Clinical assessment was conducted with the MINI interview, Liebowitz Social Phobia Scale, TPQ

neurophysiological variables are not significantly different between groups. Patients with SAD showed a significantly higher Harm Avoidance and lower Novelty Seeking. There was a positive correlation between CSP and Novelty seeking and a negative correlation between LICI and Novelty Seeking among patients but not among HCs

Deficit in the ability to understand others' mental conditions, opinions, beliefs, fantasies and desires have been reported among schizophrenic patients so far. However, fewer studies have examined the type of positive/negative symptoms and delusions on their social cognition abilities. The main purpose of this study was to investigate the theory of mind (ToM) performance in schizophrenic patients and compare it with healthy controls.

This cross-sectional study conducted at Ibn-e-Sina psychiatric hospital in Mashhad, included 28 schizophrenic patients, aged between 18 and 50, based on DSM-IV-TR criteria and 14 healthy subjects. Evaluation of symptoms was performed by positive and negative syndrome scale (PANSS) test and the ToM assessed by the 'Reading the Mind in the Eyes” Test.

Analysis of variance showed a significant impaired ToM in schizophrenic patients as compared with the healthy controls (p=0.00). But the ToM deficits did not differ in positive and negative symptoms (p=0.951), genders (p=0.286) and the frequency of episodes (p= 0.470). The delusions of persecution and grandeur showed a significant lower ToM performance as compared with the delusions of control (p=0.041).

Although the ToM abilities impairment in schizophrenia has been proved, its relationship with types of symptoms and delusions, and the duration of illness require further investigations. This may help to improve the possible treatments and prevention potentials in future.

Parkinson disease is a frequent neurodegenerative disorder. Presence of psychopathology is well described in this illness, nevertheless the etiology is still unknown.

The authors present a clinical case of a patient with idiopathic Parkinson disease with depressive symptoms after the decline of his functioning. We aim to emphasize the importance of a multidisciplinary approach and the central role of general physicians in screening these situations.

The patient is a male with 64 years old, reformed with a personal history of hypertension. With 62 years old he started with mild motor complaints that got worse over time, culminating after a year and half on him being almost dependant for most of his daily activities. He also started to express feelings of sadness, despair, and recurrent thoughts of death. He refused to seek out medical help, but was convinced by his wife to consult his general physician that observed the patient and referenced him to Neurology and Psychiatry consultations. He also started sertraline 50 mg/day. He was diagnosed with Parkinson disease and started medication with ropinirole, levodopa and carbidopa with a good response. In Psychiatry consultation the dose of sertraline was increased to 100 mg/day with improvement, and it was provided information on the disease to the patient and family and also supportive psychotherapy.

General physicians have a privileged position on screening patients with psychopathology when other physical conditions or illnesses are present. The fast and correct referencing of these patients can improve the prognosis.

The authors have not supplied their declaration of competing interest.

Madness and creativity are thought to be related from ancient ages. Nowadays, thanks to new scientific developments and researches we are able to identify common genetic and brain patterns between creativity and psychosis.

Taking the inspiration of a psychotic patient with some shocking drawings, we want to get deep into the actual knowledge about the relation between creativity and psychosis.

Case report and bibliographic review.

A 19-year-old man was brought to the hospital after having been found making strange rituals in the public way. In the anamnese he showed to have experienced mystic delusions and hallucinations. He made some particularly creative drawings.

We made a review which showed that this patients may have a diminished latent inhibition, which could make them experiencing usual live irrelevant stimuli as something very exciting and creative at the same time. Genome wide association studies show also that people having creative jobs and psychotic patients share some genes, which could be linked to this abnormal latent inhibition.

Latent inhibition abnormalities could be related with psychosis and creativity. There are differences within the course of people having this oversensibility, which could be explained due to the presence of protective and risk factors.

The authors have not supplied their declaration of competing interest.

Brain connectivity changes have been recently demonstrated in victims of psychological traumas treated with the eye movement desensitization and reprocessing (EMDR).

Forty victims of psychological traumas were investigated at the first EMDR session (t0) and at the last one performed after processing the index trauma (t1).

To investigate differences in EEG functional source connectivity during bilateral ocular stimulation (BS) during EMDR therapy at t0 and t1.

Brain electrical activity during whole EMDR sessions was record with a 37-channel EEG. EEG functional connectivity analysis was based on the lagged phase synchronization (LPS), derived by a two-step eLoreta procedure: dimensionality reduction of inverse matrix from 6239 voxels to 28 regions of interest (ROIs); LPS index computation, for each spectrum band, in all possible ROI pairs.

Significant differences were detected between t0 and t1 in alpha band LPS indexes. A prevalent enhancement in right intrahemispheric functional connectivity was found in t1 respect to t0, particularly among ROI pairs of (a) frontal regions (anterior frontal, orbital frontal, lateral frontal cortices) and limbic structures (anterior cingulate cortex, ACC), (b) frontal regions and associative areas (insula cortex, parietal lobe), (c) ACC and primary visual cortex and (d) ACC and associative areas.

These findings suggest that EMDR efficacy is associated to electrical brain connectivity changes during BS. An enhancement in the right hemisphere alpha band functional connectivity of areas involved in cognitive control, emotional processing and visual associative functions may play a key role in the elaboration of psychological traumas.

Hydroxychloroquine an antimalarial medication has been approved in March 2020 by FDA for treatment of hospitalized patient with COVID-19 infection. Even thus, its efficacy has been controversial, it still being used worldwide. This medication also causes some serious side effects. Here we present a case of a woman with a very long history of treatment resistant schizoaffective disorder, on clozapine, who develops QT prolongation after receiving hydroxychloroquine for the treatment of COVID-19 infection.

Despite the controversy, this case aims to shed light on the importance of monitoring QTc via EKG in patient receiving hydroxychloroquine7. More importantly to avoid antipsychotic while patient is receiving this medication since both hydroxychloroquine and most antipsychotic can increase QTc.

This case report was written by reviewing chart of the patient and also via direct interaction and interviews with the patient.

This case report showed and increased in QTc interval after receiving hydroxychloroquine, which is also reported by others including Moussa Sleh et al in their article on Effect of Chloroquine, Hydroxychloroquine, and Azithromycin on the Corrected QT Interval in Patients With SARS-CoV-2 Infection4. The increase in Qtc could have been worse if Clozapine was not stopped during this time.

COVID-19 pandemic has caused more than 700000 deaths around the globe and more than 150000 deaths in the United States of America. Psychiatric patients are also getting hospitalized and receiving treatment with hydroxychloroquine. Holding anti-psychotics and monitoring of QTc via EKG resulted crucial in limiting the adverse effect of QT prolongation of both medications.

No significant relationships.