Acute Psychotic State Research Articles

Pharmacotherapy of acute psychotic states: The reason for benzodiazepines and valproic acid augmentation

Acute psychotic states (APS) usually are diagnosed as schizophrenia spectrum and affective disorders and make up about 45% of cases. The goal of the study was to elucidate the effect of benzodiazepines (BDZ) and valproic acid augmentation in the APS pharmacotherapy. The study was carried out on 102 inpatients diagnosed up to ICD-10 as schizophrenia (n = 24), acute and transient psychotic disorders (n = 40), other mental disorders due to brain damage and dysfunction and to physical disease (n = 17), schizoaffective disorder (n = 12), bipolar affective disorder (n = 9). Patients were randomized into four therapeutic groups:– benzodiazepines (BDZ);– one neuroleptic or combination of one neuroleptic and one BDZ (NBDZ);– combination of valproic acid with BDZ or neuroleptic (VBDZN);– polypragmasy (PP): from two drugs of one group up to four and more drugs at the same time.The mental state of the patients was evaluated daily and estimated before, weekly and after APS termination by BPRS and CGI scale. The APS in all groups lasted from 1 to 50 days (mean 11.4). The shortest duration of APS was In BDZ group – 4.7 days; in VBDZN and NBDZ, the duration was 7.0 and 7.4 days (P < 0.05); in PP group, the treatment lasted 24.5 days (P < 0.001). Before therapy, average BPRS rate was 43.5 ± 8.1, CGI – 6.2 ± 0.8; after APS, BPRS was 18.9 ± 2.1, CGI – 1.1 ± 0.3. All rates did not differ among subgroups. APS therapy by BDZ and its combination with neuroleptics and valproic acid was effective compared to the polypragmasy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Insights into reproductive psychiatry: A literature review

This review article scrutinizes the role of male and female reproductive hormones on behavioural and psychological levels. Research suggests that estrogen serves as a protective hormone against psychosis in females, and that women are most prone to acute psychotic states during their menopausal years. Estrogen-driven dopamine levels are regulated, as shown by strong evidence that younger females are less likely to experience psychosis than older women. However, higher testosterone levels in males can cause an upsurge of dopamine levels, making younger men more prone to psychosis than older males. The role of other reproductive hormones (such as pregnenolone) on dopamine levels and therefore risk of psychosis is also explored from a psychiatric angle.

Fifteen minute consultation on children ‘hearing voices’: when to worry and when to refer

Auditory hallucinations are uncommon paediatric presentations, but they can be alarming and lead to emergency consultations. This review outlines the phenomenology of auditory hallucinations, their assessment and clinical significance. Auditory...

6-year Follow-up of Patients with Acute Transient Psychotic Disorders Without Symptoms of Schizophrenia

to studythe clinical, dynamic and prognostic aspects of acute transient psychoticdisorders. 67 inpatients with acutepsychotic state which was developed for the first time, free of schizophreniasymptoms (23.0 F; F 23.3; 23.8 F; F 23.9 ICD − 10) were examined. Mean age ofthe patients: 31,7±11 years. Clinical and psychopathological, clinical follow-up, statistical methods were used. The follow-up period of observation lasted 6years from the moment of reduction of psychotic symptoms of the 1st psychotic episode. Up-to-one-week ?sychoses were observed in 31 patients (46,3%), whereas prolongedpsychotic disorders (longer than 30 days) occurred with 7.5% (n=5). Criticalcoming out of psychosis occurred with 25 patients (37,3%), lytic variant ofreduction of psychotic symptoms was observed in 62,7 % of cases (n=42). Duringthe 6-year term, recurring psychotic attacks were observed in 21 patients(31,3%). One relapse of illness was observed in 57,1% of cases (12 patients outof 21). In 9 patients (42,9%), from 2 to 5 psychotic attacks were recorded. Allrecurring attacks of the disease were characterised by psychotic episodes ofschizophrenic patterns combined with specific deficit symptoms withinpostpsychotic period (autistic symptoms, decreased energetic potential ofindividuality, flattened affect, impaired abstract thinking). theresults have enabled to identify 31,3% of 23.0 F cases as atypical beginning ofschizophrenic process, thus affording ground for maintenance therapy afterclinical reduction of the first psychotic episode. Lytic coming out of psychotic state revealed statisticallysignificant relationship with further relapse of the disease.

An Unexpected Cause of Hyperactive Delirium in Patients with Decompensated Nonalcoholic Cirrhosis

Delirium is a complex neuropsychiatric syndrome that typically involves a plethora of cognitive and non-cognitive symptoms, resulting in a broad spectrum of differential diagnosis dominated by mental disorders. The prevalence of delirium in elderly patients admitting to hospital is 5-55% [1]. Delirium is a common neuropsychiatric syndrome that may occur in several different settings and one of them is vitamin B12 deficiency. Vitamin B12 deficiency causes many cerebral cortex abnormalities such as confusion, mood and memory changes, delirium with or without hallucinations, depression and acute psychotic states [2,3]. Hepatic encephalopathy (HE) describes the spectrum of potentially reversible neuropsychiatric abnormalities seen in patients with liver dysfunction after exclusion of unrelated neurologic and/or metabolic abnormalities. The clinical manifestations of HE is characterized by cognitive and motor deficits of varying severity without specific lesions in the central nervous system. The symptoms range from minimal changes in personality to coma, including delirium [4]. Usually, in the elderly patients with cirrhosis, it is hard to differentiate two clinical situations. Here we report a case of an elderly patient with cirrhosis who experienced delirium due to vitamin B12 deficiency, but was treated as HE before.

Prediction of the changes of immunological status and psychopathological data in HIV-infected schizophrenia patients

To predict the immunological status in HIV-infected patients with schizophrenia based on a set of clinical and psychopathological characteristics of the endogenous process. The study included 28 patients with confirmed diagnosis of schizophrenia and HIV status. Authors used psychopathological method, along with psychometric scales (PANSS), in patients with schizophrenia and an immunological method for the determination of HIV-associated status and viral load. Affective syndromes with severe depressive symptoms, volitional impairment, high impulsivity and social features of autism can be prognostically favorable factors for the immune status of HIV-infected patients with schizophrenia that obviously indicates an acute psychotic state. Negative (deficit) symptoms were prognostically unfavorable for the immune status of HIV-infected patients with schizophrenia and for psychosis course. Favorable immune status corresponds to acute psychosis whereas the forms with severe deficit are associated with immunosuppression in HIV-infected patients.

Crisis Dialogue for Acute Psychotic State and Ethical Difficulties: What Do You Do When Trials Are Interrupted Because Clinicians Find the Intervention Too Effective?

Clinical studies carry with them a paradox: The more obviously efficient an intervention is, the more ethical problems its trials pose. This article discusses the ethical problem of breached equipoise principle because of the perceived effectiveness of a nonblindable verbal technique, crisis dialogue (CD). CD is designed to help establish a therapeutic relationship with persons in a suspected psychotic state. In a pilot randomized controlled study in Yverdon, Switzerland (usual treatment vs. usual treatment + CD), after inclusion of 30 patients, clinicians expressed a consensual opinion that CD was effective in most cases. Following their opinion, the joint clinical and research team decided that the study had to be discontinued and that CD should be tried with all patients for ethical reasons. This poses an ethical problem with potential far-reaching consequences: In this interrupted study, differences between groups in terms of clinical outcome (Brief Psychiatric Rating Scale, Clinical Global Impression), therapeutic alliance (Working Alliance Inventory, Difficult Doctor–Patient Relationship Questionnaire), and patient satisfaction were consistent in favoring CD, but these differences did not reach statistical significance in most measurements. The early interruption of the study because of perceived effectiveness of the intervention can be seen as unethical as well because chances were high that a larger sample would have shown more conclusive results, allowing for faster introduction of CD in various clinical settings with corresponding improvement of patient care.

Auditory verbal hallucinations reflect stable auditory attention deficits: a prospective study

Introduction. Previous studies have shown that auditory verbal hallucinations (AVHs) in psychosis are associated with reduced verbal auditory attention. Whether this is an effect of ongoing AVH or reflects a more stable cognitive vulnerability also present after treating the AVH is unknown. The aim of this study was to follow patients with acute psychosis with and without AVH, and to test their auditory attention in a more stabilised clinical phase.Methods. Fifty patients (35 males and 15 females) were examined when admitted to an acute psychiatry ward and tested three months later with a dichotic listening test with attention instructions. The patients were divided into a frequent (n = 33) and non-frequent (n = 17) AVH group based on their score on the Positive and Negative Syndrome Scale item hallucinatory behaviour (≥4 and ≤3, respectively) at baseline.Results. A significant interaction emerged between AVH group and attention instruction condition; the frequent AVH group failed to control their auditory attention as opposed to the non-frequent AVH group.Conclusions. Patients with frequent AVH in an acute psychotic state showed impaired auditory attention three months after their AVH had been treated, indicating a stable cognitive vulnerability factor for experiencing AVH.

Short-Term Hospitalization Underlies the Similarity between Involuntarily and Voluntarily Admitted Patients: A One-Year Cohort Study

ABSTRACTThis study compared individuals admitted to a psychiatric hospital under a civil involuntary commitment order (IA) and patients admitted voluntarily (VA) using a one-year, shortest-stay cohort. Data were collected for 439 patients consecutively admitted to a university-affiliated Mental Health Center from March 1, 2012, to February 28, 2013, and discharged within seven days (one-year, shortest-stay cohort). A cross-sectional comparison between IA (n = 106) and VA (n = 333) groups was conducted. Mean length-of-stay was found to be slightly longer (4.7 ± 1.7 days) for the IA group compared to the VA group (3.8 ± 1.9 days; p = 0.019). Both IA and VA groups were similar regarding age, gender, marital status, age of onset, illness duration, and diagnosis. An acute psychotic state as reason for admission was observed 3.4 times more (p < 0.001) for IA compared to VA, whereas suicidal thought (p = 0.002), major depressive episode (p < 0.001), and hallucinations (p = 0.014) were found less frequently among IA patients. About one quarter of the patients (26.6 percent) in the study cohort were discharged for lack of adequate reason to remain hospitalized. There were no significant differences between IA and VA inpatients. The shortest length of stay underlies the similarity between involuntarily and voluntarily admitted patients. The obtained data point toward the need for more accurate assessment of the criteria for involuntary admission.

The explosion of the present and the encapsulation of time: Transference phenomena in the analysis of a psychotic patient

The paper deals with some basic problems concerning the experience of time and space in the psychoanalytic treatment of psychotic patients. Whereas borderline patients tend to distort the experience of time and space under emotional pressure, the concepts of time and space seem to dissolve in acute psychotic states of mind. Sometimes this manifests itself in an explosion of the present, where the past is ubiquitous and the future is perceived as the end of all times.The case of a 48 year‐old patient with the external diagnosis of ‘paranoid–hallucinatory schizophrenia’ is presented to illustrate that the main task is to recreate a structure to contain the experience of space and time. Such a development may occur if primitive psychotic anxieties can be taken up and metabolized. A near‐psychotic decompensation before the first break and the development of a transference psychosis in the second year of the analysis are depicted in detail. Subsequently some developments became visible which helped the patient to better tolerate catastrophic fears of loss. This included the formation of a structure which the patient called ‘hibernation’ enabling her to psychically survive without falling apart. By retreating into her ‘time capsule’ she managed to overcome breaks and to delay her fears of fragmentation until they could be taken up and worked through in the transference. The creation of a structure like the patient's ‘time capsule’ is considered to be an attempt to construct the experience of time and space. It prevented a collapse of her internal space thereby enabling further steps towards thinking and symbolization. In conclusion, some theoretical and clinical aspects are discussed including the role of the countertransference.

Symptoms, toxicities, and analytical results for a patient after smoking herbs containing the novel synthetic cannabinoid MAM-2201

We report a case of intoxication by the synthetic cannabinoid MAM-2201 ([1-(5-fluoropentyl)-1H-indol-3-yl](4-methyl-1-naphthalenyl)-methanone). A 31-year-old man smoked about 300 mg of a herbal blend. He experienced an acute transient psychotic state with agitation, aggression, anxiety, and vomiting associated with a sympathomimetic syndrome. MAM-2201 was detected and quantified in a plasma sample using liquid chromatography-tandem mass spectrometry (LC–MS–MS). The level was 49 ng/ml 1 h after smoking. The use of other drugs was analytically excluded. The presence of MAM-2201 was confirmed in the herbal blend using gas chromatography–mass spectrometry (GC–MS) and LC–high resolution MS. This is the first description of an analytically confirmed intoxication and of the determination of MAM-2201 in human blood plasma.

Superoxide dismutase activity and malondialdehyde levels in patients with travel-induced psychosis.

BackgroundOxidative stress is a neurotoxic factor that may precipitate acute psychoses.AimAssess the relationship of travel-induced psychosis and oxidative stress.MethodsTwenty-one inpatients with travel-induced psychosis related to prolonged train travel were evaluated using the Brief Psychiatric Rating Scale (BPRS) at the time of admission and their plasma superoxide dismutase (SOD) activity and malondialdehyde (MDA) concentrations were assessed on the morning following admission. These assessments were repeated after the psychotic symptoms resolved, which typically occurred after 2-6 days of low-dose antipsychotic treatment. The SOD and MDA results in the patients were compared to those of 21 normal age and gender matched control subjects.ResultsAt admission the patient group had significantly higher SOD activity and MDA concentrations than the control group. After resolution of the psychotic symptoms the BPRS scores, SOD activity, and MDA concentrations all showed significant declines but the SOD activity and MDA concentrations remained higher than in the matched control group. At admission there was a non-significant positive correlation of the BPRS total score with SOD activity (r=0.32, p=0.164) and with MDA concentration (r=0.34, p=0.126). The before versus after drop in the BPRS total score was weakly correlated with the drop in the SOD activity (r=0.28, p=0.217) and with the drop in the MDA concentration (r=0.29, p=0.211).ConclusionThese findings suggest that the neurotoxic effects of oxidative stress are directly related to the development of travel-induced psychosis. This may be relevant to the understanding of other acute psychotic states such as schizophrenia.

The Application of the Cognitive Behavioral Therapy in Schizophrenia

ObjectivesZZCognitive behavioral therapy for treatment of schizophrenia was designed as a psychological therapy for treatment of drug resistant patients with schizophrenia. This therapy is currently being widely applied from early psychosis to chronic condition. The aim of this article is to review the main results of research articles on cognitive behavioral therapy of schizophrenia and prompt practicing the therapy in Korean mental health services. MethodsZZThe important original and review articles were referred in order to understand the main results of research from published international books, and the English website Pubmed was searched in order to update recent findings. This article reviewed the results of four areas of different phases and types of cognitive behavioral therapy for treatment of schizophrenia: drug resistant chronic patients, acute psychotic state, prodromal phase, and group cognitive behavioral therapy. ResultsZZCognitive behavioral therapy for treatment of drug resistant patients with schizophrenia can attenuate the positive and general symptoms more than that for patients who receive supportive psychotherapy or treatment as usual. However, the effect appears to be less than previously expected, small to moderate. Cognitive behavioral therapy for patients of acute psychotic state can reduce the time of recovery from acute psychotic symptoms by approximately 25%. The result of cognitive behavioral therapy for patients of prodromal phase shows that the therapy can reduce the rate of transition to schizophrenia by up to one third. Group behavioral therapy has recently been tested. Group therapists have suggested that the therapy should be applied through the way of groups with relatively homogenous symptoms. However, whether the therapy can reduce the severity of hallucination in the voice hearer group is inconclusive. ConclusionZZAlongside pharmacotherapy for treatment of schizophrenia, cognitive behavioral therapy is a distinct psychological therapy for attenuation of psychotic symptoms. The effect of cognitive behavioral therapy appears to last for one year and requires additional therapeutic sessions after one year. The effect is not still clear in group cognitive behavioral therapy for treatment of schizophrenia. Cognitive behavioral therapy for treatment of schizophrenia should be practiced widely in the Korean mental health system. J Korean Neuropsychiatr Assoc 2012;51:359-366 KEY WORDSZZ Schizophr enia · Cognitive behavioral therapy · Drug resistant patient ·

RÉALITÉ LT : Recherche Épidémiologique sur l’Activité de la Loxapine et ses Indications en Thérapeutique quotidiennE lors d’une utilisation à Long Terme. Étude pharmacoépidémiologique : sémiologie et stratégie thérapeutique d’une population de patients présentant des troubles schizophréniques traités par loxapine

Data concerning the clinical and therapeutic characteristics of patients with schizophrenia treated by antipsychotic in naturalistic conditions are useful. Two national pharmacoepidemiological studies were conducted in France, a retrospective survey RÉALITÉ and a prospective study RÉALITÉ LT, to examine the use of loxapine, first in acute and chronic psychotic states and second in long-term treatment prescribed for patients with schizophrenia. The aim of RÉALITÉ LT is to specify the clinical characteristics of schizophrenic patients treated by loxapine for at least 4 months and the description of the methods of use of this antipsychotic medication during a 6-month follow-up in "real life" conditions. RÉALITÉ LT is an epidemiologic, observational, longitudinal, prospective (during a half-year period), multicenter and national study of the prescription of loxapine in routine clinical practice. For this study, 645 patients with schizophrenia treated by loxapine were recruited, assessed by PANSS, CGI, GAF, MeDra-SOC-PT for side effects and Girerd questionnaire for compliance; statistical analysis used SAS 9.2. Six hundred and forty-five adult patients were included and assessed at inclusion, month 3 and 6. These patients were mostly male (69%), with an average age of 41, inactive (68%), lonely with no child (79%), under psychiatric care for more than 5 years (81%), less than one third were inpatients. The subtypes of schizophrenia were paranoid (59%), disorganised (21%), undifferentiated or residual (10%), the outcome of psychotic illness was episodic (50%) or continuous (33%). The daily mean dosage of loxapine was 168,4 mg/d, in antipsychotic loxapine monotherapy (27%) or in combination with other antipsychotics (63%); it was often associated with psychotropic medications (anxiolytic [72%], antidepressant [21%], normothymic [19%]). The stability of the dosage of loxapine during the 6 months follow-up (60%) was associated with strict loxapine monotherapy or antipsychotic monotherapy (loxapine associated with other psychotropic medication). Safety, side effects and compliance were compared with previous studies. These results are discussed, comparing the two pharmacoepidemiological studies RÉALITÉ and RÉALITÉ LT, loxapine is used in compliance with the two indications (smpc) and French guidelines (HAS, Haute Autorité de santé).

Whack induced psychosis: A case series.

'Whack' is a new psychoactive substance available until recently in 'head shops'. It contains two active constituents, 4-fluorotropacocaine and desoxypipradrol. We present two case reports of subjects who developed acute psychotic states after using Whack. Both individuals displayed similar affective and anxiety symptoms in the presence of significant psychotic symptoms. Both required inpatient treatment but displayed a good treatment response to atypical antipsychotic agents. To our knowledge, this is the first published case series relating to this psychoactive substance.

Evidence for aberrant salience processing in unmedicated schizophrenia patients

Event Abstract Back to Event Evidence for aberrant salience processing in unmedicated schizophrenia patients Benjamin Wagner1*, Martin Voss1, Björn Schott1 and Joachim Behr1 1 Department of Psychiatry, Charité University, Germany The orbitofrontal cortex (OFC) is considered to be one of the core structures constituting a "salience-network", which enables switching between neural networks involved in task-processing and self-referential processes, respectively. Studies of various kinds point to a dysfunction of the salience network in schizophrenia, which in turn might lead to aberrant salience attribution to irrelevant events (Kapur, 2003; White, 2010). This disturbed dopamine based mechanism may explain clinical phenomena such as delusions or hallucinations (Heinz, 2010; Roiser, 2009; Walter, 2010). However, one major limitation of previous studies is the fact that they have been carried out in medicated patients. We aimed at investigating the processing of novel, thereby salient, but behaviourally irrelevant events in a group of unmedicated schizophrenia patients in an acute psychotic state using functional magnetic resonance imaging (fMRI). The aim of the study was to further establish the connection between aberrant salience processing and positive symptoms, e.g. delusional perceptions. Compared to healthy controls, patients exhibited a significantly enhanced blood oxygenation level dependency (BOLD)-response to novel versus familiar oddballs in the right OFC, a brain region that has been previously linked to processing of salient stimuli. To our knowledge, this is the first evidence for hyperactivation of the OFC in an fMRI based task exploring salience processing in a group of unmedicated schizophrenia patients in an acute psychotic state. Thereby we provide substantial new evidence for the suggested link between aberrant salience attribution based upon chaotic dopaminergic signaling and clinical phenomena, i.e. positive symptoms Keywords: decision-making, Schizophrenia Conference: XI International Conference on Cognitive Neuroscience (ICON XI), Palma, Mallorca, Spain, 25 Sep - 29 Sep, 2011. Presentation Type: Poster Presentation Topic: Poster Sessions: Decision Making, Reward Processing & Response Selection Citation: Wagner B, Voss M, Schott B and Behr J (2011). Evidence for aberrant salience processing in unmedicated schizophrenia patients. Conference Abstract: XI International Conference on Cognitive Neuroscience (ICON XI). doi: 10.3389/conf.fnhum.2011.207.00402 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 24 Nov 2011; Published Online: 28 Nov 2011. * Correspondence: Dr. Benjamin Wagner, Department of Psychiatry, Charité University, Berlin, Germany, wagner_b@gmx.net Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Benjamin Wagner Martin Voss Björn Schott Joachim Behr Google Benjamin Wagner Martin Voss Björn Schott Joachim Behr Google Scholar Benjamin Wagner Martin Voss Björn Schott Joachim Behr PubMed Benjamin Wagner Martin Voss Björn Schott Joachim Behr Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Elektrokrampftherapie

Electroconvulsive therapy (ECT) is one of the most effective forms of treatment for severe and persistent psychiatric disorders. ECT is used for a broad spectrum of diseases; however, it has proven particularly helpful in the treatment of therapy-resistant depressive episodes. In addition it has also been successfully used in the treatment of other disorders, such as acute mania and acute psychotic states. Basically ECT should be considered in all cases of severe psychiatric disorder in which an adequate psychopharmacological and/or psychotherapeutic treatment strategy has failed or when the side-effects of medications have proven unbearable. As with other forms of psychiatric treatment ECT is not always used in the same manner and in different institutions in the same way and there are also differences in opinions between clinicians and researchers on various aspects of ECT. In this article the up-to-date standards for effective ECT treatment are outlined and discussed in the light of the current knowledge.

The default-mode, ego-functions and free-energy: a neurobiological account of Freudian ideas

This article explores the notion that Freudian constructs may have neurobiological substrates. Specifically, we propose that Freud’s descriptions of the primary and secondary processes are consistent with self-organized activity in hierarchical cortical systems and that his descriptions of the ego are consistent with the functions of the default-mode and its reciprocal exchanges with subordinate brain systems. This neurobiological account rests on a view of the brain as a hierarchical inference or Helmholtz machine. In this view, large-scale intrinsic networks occupy supraordinate levels of hierarchical brain systems that try to optimize their representation of the sensorium. This optimization has been formulated as minimizing a free-energy; a process that is formally similar to the treatment of energy in Freudian formulations. We substantiate this synthesis by showing that Freud’s descriptions of the primary process are consistent with the phenomenology and neurophysiology of rapid eye movement sleep, the early and acute psychotic state, the aura of temporal lobe epilepsy and hallucinogenic drug states.

P02-233 - Acute paranoid psychosis due to past chronic mangenese exposure

A male patient aged 49 was referred for evaluation of an acute paranoid psychotic state followed by an apathy syndrome. Since his history, apart from hypertension, did not mention any somatic complaints or psychiatric symptoms, and he had been involved in an adequate professional career as metalworker and welder, MRI- scanning of the brain was performed. There appeared to be bilateral hyperdensity of the globus pallidus, suggestive for chronic manganese (Mn) intoxication. Subsequently, a Mn plasma level of 31 nmol/l (range: 7-20nmol/l) that confirmed the diagnosis.Mn is a trace element that regulates many enzymes and is essential for normal development and body function. Chronic Mn intoxication has an insidious and progressive course and usually starts with complaints of headache, fatigue, sleep disturbances, irritability and emotional instability. Later, several organ systems may be affected leading to increased heart rate and/or blood pressure, elevated total cholesterol levels, and lowered fertility in males. With respect to neurotoxicity, Mn primarily affects the globus pallidus and the striatum of the basal ganglia, and induces damage to the dopaminergic system. This may ultimately lead to dystonic movements and a parkinsonian syndrome that is dominated by generalized bradykinesia and rigidity.As to neuropsychiatry, an array of symptoms may develop up to 30 years after intoxication of which gait and speech abnormalities, cognitive and motor slowing, mood changes and hallucinations are the most common. Psychotic phenomena are rarely reported.In conclusion, subacute psychotic symptoms in the absence of a psychiatric history, may point towards rare occupational diseases.

P03-139 Spiritual beliefs and therapeuticall adhesion

Introduction:Personal and familiar spiritual and religious beliefs are important factors to be considered when prescribing an antipsychotic drug to a schizophrenic patient.Description:A case report of a 29 years old male patient with a schizoaffective disorder is presented. in this case the border between what was delusion and what was the result of the patient personal and familiar spiritual beliefs was impossible to made. Only after the medication precribed has produced its effect this distinction has become clearer.Method:A literature revision about this issue was made.Discussion/conclusion:Spiritual beliefs are important factors that influence therapeuticall adhesion. A clear distinction between them and delusion symptomatology is very difficult to made, mainly in an acute psychotic state. after medication, the delusion symptomatology disappears and personal spiritual beliefs persist.