Carbamazepine is effectively used in treatment of bipolar disorder for its thymoregulatory virtues, but it can induce numerous side effects, including skin eruptions that can be severe sometimes.

To study the relationship between toxidermia and treatment with carbamazepine.

We report the case of a patient who developed a toxidermia following the intake of carbamazepine.

Mr. AD, 19 years old, with medical history of diabetes, has been diagnosed with bipolar disorder since the age of 17. He was initially treated with risperidone with an irregular follow-up.

He was hospitalized in our department for a manic episode with psychotic features with agitation and refusal of treatment.

The patient was put on injectable treatment 15 mg/day of Haloperidol and 20 mg/day of diazepam.

After 5 days in hospital, we switched to the oral route, gradually increasing haloperidol doses to 30mg, reducing diazepam doses and introducing carbamazepine for thymoregulatory purposes.

Carbamazepine was progressively increased up to a dose of 800mg per day.

Fourteen days after the introduction of carbamazepine, the patient presented a generalized rash requiring the discontinuation of this medication. He was treated with an anti-histamine and local corticosteroids, on the advice of dermatologists.

In the days following discontinuation of carbamazepine, skin lesions regress and then disappear.

Biologically, we observed a rise in eosinophilic polynuclear cells to 580, followed by a gradual decrease after stopping the treatment.

A pharmacovigilance opinion was sought, concluding that carbamazepine was responsible for the toxidermia, given the delay in onset and the favorable evolution after discontinuation of the incriminating treatment. Moreover, this undesirable effect is well described in the literature.

Hence the contraindication to further use of carbamazepine in Mr. AD.

In addition, the patient was put on sodium valproate with good tolerance.

Each prescribed drug must be considered as potentially capable of causing cutaneous reactions as an adverse effect. Both the prescriber and the patient must be made aware of this phenomenon. The attitude can be modulated on a case-by-case basis, after specialist advice, depending on the severity of the rash and the disease to be treated.

None Declared

Electroconvulsive therapy (ECT) is a therapeutic method that induces artificial seizure by electrical stimulation to resolve various psychiatric symptoms. ECT is particularly effective in resistant schizophrenia and may improve response to medication despite the presence of potential adverse side effects. Post-ECT delirium and Headaches are some of the most frequent side effects presented in literature. Fever is yet another unexplained reaction, however there are a few case reports and retrospective studies that report on it.

We aim to illustrate through a clinical case and a review of literature the prevalence of post ECT fever as well as the possible explanatory mechanisms.

In this study we report the case of a man with ultra-resistant schizophrenia who was treated successfully with ECT despite the development of transient febrile reaction and we present a review of literature on pubmed using the following key words : ECT, fever,resistant psychosis, mechanisms.

Our patient is a 48-year-old man with a psychiatric history of schizophrenia evolving since the age of 34. He has a history of matricide in 2021 resulting in his hospitalisation in a forensic psychiatric ward. He underwent trials of classic and atypical antipsychotics that weren’t efficacious thus he was diagnosed with resistant schizophrenia in 2022. He was treated initially with clozapine 500 mg per day and then with the association (clozapine + amisulpride) yet it wasn’t effective on his persecutory delirium and fratricide ideas. Plus, there was no reduction in his PANSS (Positive and Negative Syndrome Scale) scores. The diagnosis of ultra-resistant schizophrenia was established. The staff indicated the adjunction of ECT to Clozapine. In the inpatient unit, hours after his fourth ECT session he developed a fever (40°C), his blood pressure (120/80 mm Hg), pulse(85 beats per minute),and respiratory rate(20 breaths per minute) were normal. Blood samples, including cultures, were drawn, which showed normal blood cell count and CPK(140U/L) but CRP was elevated (31 U/L), a chest x-ray showed no acute pulmonary disease, and his urinalysis result and Covid test were negative. His fever resolved then spontaneously after two hours. The same transient febrile reaction occurred again 3 times. It was postulated in literature that fever may be due to inadequate muscle reaction. Data also suggested the potential influence of ECT on the hypothalamus that is a key region in regulating body temperature.

Further studies are required in order to establish the real prevalence of this side effect and its possible causes.

None Declared

The Alzheimer's patient assistance relationship is a morally painful experience, most frequently discussed in terms of “burden” in the literature, especially as professionals and institutional intermediaries are underdeveloped in Tunisia.

It is intended to assess the level of burden among caregivers of patients with Alzheimer's disease and to search factors associated with a high level of burden.

This is a retrospective descriptive study. Patients were recruited from neurology department of Razi hospital, which were hospitalised between the months of December 2012 and March 2013. The burden was measured using the Zarit inventory.

Thirty patients were included. The majority female, most caregivers are descendants (60%), then, daughters in law (33%), and finally the spouses (23%). 80% of caregivers lived in the same home as patients. Caregivers were asked about all the items of the grid Zarit. The average burden in our sample is 59.9 + 16 3. We observed that 33% have absent to light burden (score <21), 10% have a light to moderate burden (between 21 and 40), 36, 66% have moderate to severe burden (between 41 and 60) and 50% have a severe burden (>60), according to the classification proposed by Zarit. Sex, kinship and cohabitation with the patient were not associated with a higher burden.

The study of factors correlated with high levels of burden aims at finding ways of intervention and support to fight against the isolation of caregivers and the occurrence of anxiodepressive complications.

The authors have not supplied their declaration of competing interest.

Brain tumors can be associated with psychiatric symptoms in up to 50% of cases. The most frequent primary is meningioma and the clinic will depend on its location. Since surgical treatment does not always guarantee complete resolution of the condition, concomitant psychopharmacological treatment is usually recommended.

To review about organic mania and its differential diagnosis.

We carry out a literature review about organic affective disorder accompanied by a clinical description of one patient with organic mania.

A 50-year-old woman admitted due to psychotic symptoms. She had a diagnosis of frontal and parietal meningioma treated with surgical treatment 10 years ago. In this context she had a diagnosis of Organic Affective Disorder and 3 previous psychiatric admissions due to affective or psychotic symptoms. Current episode consisted in dysphoria, magalomanic ideation, delusional ideation of harm and mystical-religious content, high speech pressure and insomnia with little awareness of the disease. Cranial magnetic resonance showed postoperative right frontal changes and stability in parietal meningioma, with no significant differences compared to the previous study. Diagnosis of Organic Affective Disorder is maintained and reintroduced treatment with aripiprazole withdrawaled by the patient weeks before. Because of adverse effects and persistence of the symptoms described, it was changed to olanzapine with good response and tolerability. The behavior was progressively adapted with improvement of the dysphoria and without psychotic symptoms at discharge.

Affective symptons due to organic disorders such as brain tumors can be treated surgically and with psychopharmacological treatment.

None Declared

We investigated the relationship between tyrosine hydroxylase (TH) polymorphisms rs11042978, rs2070762 and rs6356 and early-onset schizophrenia in the Chinese Han population.

The tag single nucleotide polymorphisms (tag SNPs) rs11042978, rs2070762 and rs6356 in the TH gene were genotyped in 315 early-onset schizophrenics (188 male patients,127 female patients)and 391 controls subjects (219 males,172 females). Single nucleotide polymorphism association and haplotype analysis were performed.

There were significant differences in allele and genotype frequencies between patients and normal control subjects for rs11042978 allele (χ2 = 4.47, df = 1, P = 0.034) and genotype (χ2 = 6.35, df = 2, P = 0.042). No statistically significant differences were found in allele or genotype between patients and normal control subjects for rs2070762 and rs6356. The haplotype analysis revealed that there were significant differences between patients and normal control subjects for haplotypes GAC (χ2 = 6.35, P = 0.012).

Our study indicates that the TH gene may play major roles in the susceptibility to early-onset schizophrenia in the Chinese population.

According to the cognitive model of addiction by Beck taking substance represents the final common voice of the activation of beliefs through the involvement of craving.

To assess whether beliefs related to craving is a prognostic factor for relapse 6 months after a residential alcohol withdrawal and analyze the evolution of these beliefs.

107 participants were solicited for this non-interventional prospective study in a department of Psychiatry and Addictive Medicine. All patients showed a dependence on alcohol, and were hospitalized for alcohol withdrawal and had to master the French language and be reachable by telephone to help ensure follow-up. The presence of severe cognitive disorders or schizophrenia constitute a basis for non-inclusion. In the end, 68 patients were included. Beliefs related to craving on alcohol were assessed by Craving Beliefs Questionnaire (CBQ), psychiatric and addictive comorbidities by the MINI and consumption of alcohol by the AUDIT.

Among the 68 patients, 27 were abstinent and 25 had relapsed at 6 months. The CBQ score at baseline was positively correlated with relapse at 6 months (p <.05). Relapsers were characterized by more frequent presence of major depressive disorder, suicidal risk, antisocial personality and an AUDIT and alcohol dependence largest scores. Three months after hospitalization CBQ score drops significantly among non-relapsers (p <.001) but not among relapsers.

This study supports the role of beliefs related to alcohol craving in the relapse after residential withdrawal. These beliefs could be assessed in routine practice and treated with cognitive therapies.

Lithium is a mood stabilizer often used as a first-line treatment for bipolar disorder. Its narrow therapeutic window and changes in the absorption, distribution, and elimination of the drug following bariatric surgery have important implications regarding patient safety.

We present a 51-year-old female patient with bipolar disorder and a medical history of morbid obesity, type 2 diabetes mellitus, hypothyroidism, hyperlipidemia, and essential hypertension. She was mentally stable on lithium 1200 mg/day, valproate 500 mg/day, and quetiapine 400 mg/day. She had undergone laparoscopic sleeve gastrectomy. After a month, she showed up to the emergency room (ER) with nausea, vomiting, diarrhea, and fatigue. Gastroenteritis was suspected until the patient started showing neurological symptoms such as delirium, dysarthria, ataxia, chorea, and athetosis.

The patient was monitored and received aggressive intravenous hydration (3000 cc of 0.9% serum isotonic) in the intensive care unit (ICU). She was prescribed intramuscular biperiden injection of 5 mg/ml/day, pheniramine 45.5 mg/2 ml/day, and lorazepam 1 mg/day. Her lithium levels were checked every six hours. She was agitated and disoriented for the first five days despite lithium levels being in the therapeutic range. On day six, her blood lithium levels dropped to 0.399 mmol/L. Her psychiatric examination revealed that she resumed cooperation and orientation, her dysarthria subsided. However, her thought content and attitude were grandiose, and she had a labile affect. We prescribed 5 mg/day of olanzapine routinely and 1 mg/day of lorazepam on a needed basis. The next day, her labile affect became calmer, and her sleep improved so she was discharged from the ICU and admitted to general surgery inpatient service, and olanzapine was titrated to 10 mg per day since she had elevated mood symptoms.

After 7 days of intravenous hydration and supportive treatment, her neurological symptoms completely subsided except for a fine tremor, which lasted for another 3 days and then ceased. She was clinically stabilized without further need for intervention. Her lithium level was 0.206 mmol/L before her discharge.

We believe it is of utmost importance to build a consensus in guidelines and inform physicians about lithium toxicity and its symptoms after bariatric surgeries. We recommend a careful follow-up of the patient pre-and postoperatively. Preoperative psychiatric intervention includes decreasing the lithium dose gradually and discontinuing it. After the operation, lithium can be started with a much lower dose and may be increased by checking lithium levels every week for at least 6 weeks after the operation until the patient can digest solid food again, and then every 2 weeks for 6 months, and thereafter every month for one year.

None Declared

The author has not supplied his declaration of competing interest.

Recent evidence has questioned modern psychiatric clinical practice, specifically the prescribing of “atypical” antipsychotics. Our Pan-European Research Group wished to ascertain clinical practice amongst European trainees, which treatments trainees would desire for themselves, and factors influencing this.

A semi-structured survey was constructed from prior literature, piloted, and a homogenous sample size of at least 50 was agreed upon from each country, with 50% minimum response rate. It was distributed via web-link, with questions on preference of antipsychotic for patients in given scenarios, and factors influencing choice. Physicians were asked for their preference should they develop psychosis.

1. i) Treatment choice of antipsychotic for patients

93% (n=600) of respondents chose to prescribe “atypical” antipsychotics (excluding Clozapine), 6% (n=42) choosing “typical” antipsychotics, 1% (n=6) choosing Clozapine as first-line therapy.

1. ii) Treatment choice if trainees developed psychosis

89% (n=530) of responders chose to prescribe “atypical” antipsychotics (excluding Clozapine), 7% (n=40) choosing “typical” antipsychotics, 4% (n=23) choosing Clozapine as first-line therapy.

1. iii) Factors influencing choice

These mapped onto three domains: cost, efficacy and side-effect profile (less than 5% other reasons). 79% (n=458) of those who responded felt efficacy most important, 46% (n=270) felt side-effect profile most important and 3% (n=16) considered cost of paramount importance.

38% (n=272) of those who responded to the survey stated that the CATIE trial had influenced their decision-making.

Psychiatry trainees’ choice of antipsychotic medication for both patients and themselves is based on perceived benefits, as opposed to evidence base and recent literature.

At present, limited quantitative data about computer addiction of young people are available. The study was designed to obtain the prevalence rate of computer addiction of children. A further objective was to increase the know-how about cyber-related addictions and their comorbidity of mental disorders.

Survey among children/young people and their parents using questionnaires CBCL, YSR, CSVK, OSV and View. The children answered the questions of CSVK and OSV, adolescents over the age of 11 further filled in YSR. The parents were interviewed using CBCL and View.

Data collection was in the paediatric psychiatry in Munich, data analysis in the University of Mainz.

100 patients between 8 and 18 years of age, who asked for an outpatient or inpatient treatment of various mental disorders, filled in the questionnaires from July to November 2009 (63% male and 37% female).

The prevalence of computer addiction was 3%. The prevalence of computer abuse was 7%.

The study exhibited a significant difference in gender: boys showed to be mainly addicted, girls mainly improper users.

It was further observed that the young cyber junkies use games, chats, emails and communities more frequently than average users.

In accordance with other studies it was determined that possible comorbidities are depression, anxiety disorders and aggressive behaviour.

In addition to other mental disorders, 3-6% of the patients in a German psychiatry were found to be computer addicted. It is important to do research for a better diagnostic and therapeutic treatment or implementation of preventive interventions.

One third to two thirds of patients with obsessive compulsive disorder (OCD) do not respond adequately to selective serotonin reuptake inhibitors (SSRIs). Augmentation strategies have been tried and are recommended. Antipsychotic augmentation is the most studied, but more recently other strategies were attempted, including the use of medications acting on the glutamatergic system, such as memantine.

The author’s aim is to understand whether there are sufficient evidences for the use of memantine as an adjunctive therapy in OCD.

A literature research was performed, using the following key words: obsessive compulsive disorders, memantine.Retrieved papers were selected according to their relevance for the subject.

Several evidences have pointed to a glutamatergic dysfunction in OCD. Drugs that act on ionotropic receptors or modulate glutamate neurotransmission, such as riluzole, lamotrigine and memantine demonstrated improvements in symptoms when used as adjunctive therapy in refractory OCD.

The use of memantine in OCD has been demonstrated in open-label trials and in two recent randomized controlled trials (RCTs). The RCTs analyzed a total of 82 patients and found a significant improvement in short-term outcomes and higher rates of remission achieved with memantine than placebo, without significantly augmented side effects.

At the present time, there is little evidence to recommend the early use of augmentation strategies. Concerning the memantine’s use, more studies are needed before recommending its use as a routine augmenting agent.

To develop a toolkit (QuIRC) for assessing the living conditions, care and human rights of people with long term mental illness in psychiatric and social care facilities.

The QuIRC was developed by research partners across ten countries: UK; Germany; Spain; Czech Republic; Bulgaria; Italy; Netherlands; Poland; Greece and Portugal. Its content was informed by triangulation of the evidence on critical components of care collated from: a review of care standards in each country; an international literature review; and Delphi exercises. Its final format was agreed by an international panel of rehabilitation and recovery experts. QuIRC scores were compared against service users’ quality of life, autonomy, experiences of care and markers of recovery to assess whether the QuIRc could provide a proxy-assessment of the unit’s promotion of service users’ autonomy and Recovery.

The finalised tool was used to interview managers from 21 units throughout Germany. One hundred and eighty-eight service users were also interviewed. QuIRC domain ratings were compared by facility type and with service user assessments. The QuIRC’s ability to deliver assessments relevant to Germany’s established systems of change at local, regional and national level will be discussed.