Anxiety Complaints Research Articles

Vida nômade, fugindo do saber sobre si para encontrar o mundo: Um estudo de caso no existencialismo

The case study described here explores the clinical understanding developed in an internship in a clinic-school, between August 2021 and December 2022, when the university still maintained social distancing. Through online consultations, adapted from the existentialist approach, the case of a woman with complaints of anxiety, depression and a history of suicide attempts, living a nomadic life, living in a van with her husband, both musicians, who performed in several cities as a form of survival, is discussed. The condition of online consultations, which began in the Covid-19 pandemic, made it possible for the patient to undergo psychotherapy, however, the conditions were precarious, due to lack of private space for sessions and difficulties in accessing the internet, requiring strengthening the therapeutic alliance and clinical management to overcome challenges. Among the initial complaints, the patient identified herself as "the daughter of a narcissistic mother," a conclusion she reached after reading a self-help book and which provided her with an explanation for behaviors she could not understand in herself. Existentialism rejects any determinism, understanding that the subject is a constant totalization in progress and never encloses itself in a tendency, pathology or a priori vocation. The case illustrates the complexity of family relationships and how identification with labels can both help and limit the psychotherapeutic process. The existentialist approach provided a mediation to question these fixed identities and opening a resignification of their history and new existential possibilities, taking into account their choices and project of being.

Sensorimotor Feedback Control Dysfunction as a Marker of Posttraumatic Stress Disorder

BackgroundPosttraumatic stress disorder (PTSD) is characterized not only by its direct association with traumatic events but also by a potential deficit in inhibitory control across emotional, cognitive, and sensorimotor domains. Recent research has shown that a continuous sensorimotor feedback control task, the rapid assessment of motor processing paradigm, can yield reliable measures of individual sensorimotor control performance. This study used this paradigm to investigate control deficits in PTSD compared with both a healthy volunteer group and a non-PTSD psychiatric comparison group. MethodsWe examined control processing using the rapid assessment of motor processing paradigm in a sample of 40 individuals with PTSD, matched groups of 40 individuals with mood and anxiety complaints, and 40 healthy control participants. We estimated Kp (drive) and Kd (damping) parameters using a proportional-derivative control modeling approach. ResultsThe Kp parameter was lower in the PTSD group than in the healthy control (Cohen’s d = 0.86) and mood and anxiety (Cohen’s d = 0.63) groups. After controlling for color-word inhibition, Kp remained lower in the PTSD group than in the healthy control (Cohen’s d = 0.79) and mood and anxiety (Cohen’s d = 0.62) groups. Mediation analysis showed that Kd significantly mediated the relationship between PTSD and control deficits in the Kp parameter, with 96% of the effect being mediated by Kd. ConclusionsThese findings underscore the potential of using dynamic control paradigms to elucidate the control dysfunctions in PTSD and suggest that different psychiatric conditions may distinctly influence subcomponents of sensorimotor control.

Implementing paper-based patient-reported outcome collection within outpatient integrative health and medicine.

To investigate the feasibility of pre- and post-encounter patient-reported outcome (PRO) measure collection within an outpatient integrative health and medicine (IHM) clinic and to characterize factors associated with successful completion. We conducted a retrospective review of 27,464 outpatient IHM encounters including 9,520 chiropractic; 8,237 acupuncture; 5,847 massage; 2,345 IHM consultation; and 1,515 osteopathic manipulation treatment encounters at four clinics offering IHM over 18 months. Patients were asked to complete paper questionnaires rating pain, anxiety, and stress from 0-10 immediately pre- and post-encounter. Generalized linear mixed effect regression models were used to examine the relationship between demographic, clinical, and operational covariates and completing (1) pre-encounter and (2) paired (i.e., pre and post) PROs. Patients (N = 5587, mean age 49 years, 74% white, 77% female) generally presented for musculoskeletal conditions (81.7%), with a chief complaint of pain (55.1%). 21,852 (79.6%) encounters were among patients who completed pre-encounter PROs; 11,709/21,852 (53.6%) completed subsequent post-encounter PROs. Odds of PRO completion were more impacted by provider, operational, and clinical-level factors than patient factors. Covariates associated with increased odds of pre-encounter PRO completion included being female, having additional IHM encounters, and having a pain or anxiety complaint. Covariates associated with increased odds of paired PRO completion included being aged 31-40 vs. 51-60 years and having additional IHM encounters. Implementing a paper-based PRO collection system in outpatient IHM is feasible; however, collecting post-encounter PROs was challenging. Future endeavors should leverage the electronic health record and patient portals to optimize PRO collection and engage patients and clinical providers.

Stress-related eating in pregnancy? An RCT examining links between prenatal stress and food choices

BackgroundDiet quality during pregnancy is important for maternal health and offspring development. However, national dietary recommendations are not always met. A potential barrier for healthy food choices might be the experience of stress. Previous literature in non-pregnant populations suggests a negative effect of acute stress on diet quality. This preregistered study is the first to test whether an acute stressor leads to unhealthy food choices in pregnancy and examine the moderating role of stress, depressive and anxiety complaints in daily life. MethodPregnant women (N = 110, 3rd trimester) completed online self-reported surveys measuring stress, depressive and anxiety complaints in daily life. Hereafter, participants were invited for a laboratory visit, in which they were exposed to the Trier Social Stress Test or a control task. After this manipulation, self-reported and actual food choices and food intake were assessed. At the end of the visit, a hair sample was collected. Throughout the visit, visual analogue scales on negative affect were completed and saliva samples were collected. ResultsThe stress group experienced significantly more psychological stress than the control group during the experimental manipulation. Main regression analyses showed that the acute laboratory stressor did not cause unhealthy food choices in the third trimester of pregnancy. In fact, the stress group chose fewer unhealthy foods and consumed fewer kilocalories compared to the control group. Additionally, the findings point at a moderating role of depressive and stress complaints in daily life on food choices within the control group: higher scores were related to more unhealthy food choices and more kilocalories consumed. DiscussionAs this was the first study to test the effect of an acute stressor on food choices in pregnant women, more research is needed to obtain a better understanding of stress-related eating in pregnancy. This knowledge may inform future interventions to support pregnant women in improving their diet quality.

Transgenerational trauma and attachment.

An integrative approach is presented to understand the transmission mechanisms of attachment trauma and the quality of the internal working model through manifestations of bodily symptoms concerning physical and mental health. A case of dissociative symptomatology is described in a woman whose ancestors experienced individual and collective trauma related to the political regime. The approach allows for an analytical view beyond the standard complaints of anxiety, depression, post-traumatic symptoms, eating disorders, etc. A brief description of the transgenerational transmission of trauma is presented.

Cannabis Use and Its Interaction with Anxiety Disorders

Introduction Cannabis use has been reported to cause a myriad of acute adverse reactions, including those linked to anxiety disorders, such as panic attacks and derealization. Notably, in the emergency department, anxiety makes up a significant proportion of the complaints related to cannabinoid consumption. Several reports show these symptoms can persist after the cessation of cannabis consumption. Consequently, some questions have arisen regarding the role of cannabinoids as precipitators for anxiety disorders in vulnerable individuals. Alternatively, it has been hypothesized that patients with anxiety disorders are more prone to using cannabis.Objectives We aim to understand whether there is an established relationship between anxiety disorders and cannabis use. Moreover, we intend to identify what are the factors which make an individual more likely to experience anxiety following cannabis consumption.MethodsA search was conducted in the PubMed database using the MeSH terms “cannabis”, “panic disorder”, “anxiety”, “panic” and “generalized anxiety disorder”. Articles published in the last ten years were considered. Publications were selected after careful reading of their abstract. A non-systematic review of the selected articles was performed.ResultsEight articles were included in this review. While a majority of these publications did not find a significant association between cannabis use and anxiety disorders, a small subset of analyzed articles found that cannabis use may increase anxiety severity in general, devoid of specific diagnostic association. Individuals who presented to the emergency department with anxiety complaints after cannabis use were likely to be young and to have ingested edible cannabis. History of psychiatric disease, especially substance use disorder, was common in this population.Conclusions Most available data suggest cannabis use is not clearly linked to anxiety disorders. However, information around this topic is scarce and heterogenous. Further research is needed focusing on the natural evolution of acute anxiety after cannabis use. Factors such as young age, presence of psychiatric comorbidities and consumption of edible cannabis appear to contribute to a significantly increased risk of experiencing acute anxiety after cannabis use.Disclosure of InterestNone Declared

Terapi Akupresur pada Pasien Paska CABG

This study aims to determine the effect of acupressure therapy on patients who experience various complaints of nausea, vomiting, pain, sleep disorders, constipation, and anxiety after cardiac surgery. The method used is searching for several sources using Scoping Review using the PRISMA flow diagram, searching for sources from PubMed, EMBASE, Science Direct, and Scopus. The research results showed that ten articles reviewed the effects of acupressure therapy after CABG heart surgery, such as nausea, vomiting, pain, sleep disorders, constipation, and anxiety. In conclusion, acupressure intervention can be applied to reduce various complaints after CABG heart surgery at the Neiguan (PC6), Shenmen (HT7), Fengchi (GB20), Jiache (ST6), Yintang (EX-HN3), Yongquan (KI1), Hegu ( LI4). Keywords: Acupressure, Open Heart Surgery, Cardiac Surgical Procedures

(235) Use of Bremelanotide (Vyleesi) in Men with Sexual Dysfunctions

Abstract Introduction Bremelanotide (Vyleesi) is an FDA approved medication for the safe and efficacious treatment of hypoactive sexual desire disorder in premenopausal women, however phase 3 trials revealed it improved arousal and orgasm as well. As a centrally acting drug it was expected to be effective to treat sexual dysfunctions in men and has been prescribed off label routinely in our practice. Objective The primary aim of this study was to evaluate the use of bremelanotide in men with various sexual dysfunctions, the reasons why the medication was prescribed, improvements in sexual function and overall satisfaction, and side effects experienced. Methods This one-group study design involved men from a single clinic with various sexual dysfunctions prescribed bremelanotide beginning May 1, 2021. After signing consent participants answered the Quality of Life (QOL) Dimension of Sexual Quality of Life Questionnaire, the Patient Global Impression of Improvement (PGI-I) and the General Assessment Questions (GAQ) online. After confirming they had used the medication at least twice, participants completed a structured interview over the telephone with a single interviewer. Descriptive statistics were used to characterize the study cohort. Adverse events were collected. Results To date a total of 21 men signed consent and 19 completed the online questionnaires. 80% of these men were more satisfied with their lovemaking and duration of lovemaking; 93% reported vaginal insertion was easier and 71% said it was easier to orgasm. With regard to feelings about initiating lovemaking, 86% were more at ease and 79% anticipated it would be more pleasurable and more carefree. 69% believed orgasm was more pleasurable and 73% said that lovemaking was more pleasurable while 79% reported that the partner’s overall experience was more pleasurable. Using the PGI-I, 53% of participants felt that sexual function after using bremelanotide was a little better, much better, or very much better. Additional questions online revealed similar results. Twelve men completed the one-on-one interview: 69% of participants were prescribed bremelanotide for erectile dysfunction. 64% had at least other one sexual health issue, including anxiety about sex (54%), low sexual desire (45%), not enjoying sex (36%), orgasm difficulties (18%), and ejaculation difficulties and sensation loss (9% each). A total of 91% experienced improvements in sexual function, all with improved erectile function. 100% of those with complaints of low sexual desire and/or complaints of anxiety around sex reported improvement; 64% had decreased anxiety around sex; 55% had more enjoyment with sex; and orgasm improved for 36% of participants. Men reported longer erection and ability for additional erection for 18-24 hours after bremelanotide injection, better connection between genitals and brain, improved sensitivity, and increased confidence. Side effects included flushing (36%), nausea (36%), headache (27%), bothersome spontaneous erections without sexual stimulation for about 24 hours after injection (27%), and incontinence, cramping and abdominal burning (9% each). All adverse events were transient. Conclusions While bremelanotide is approved for hypoactive sexual desire disorder in premenopausal women, it has been prescribed and used successfully for men with erectile dysfunction and other concomitant sexual health issues. Disclosure Yes, this is sponsored by industry/sponsor: Palatin Technologies. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Palatin Technologies.

Vestibular disorders in blast injuries: additional symptoms

Previously, we showed that Anti-Terrorist Operation (ATO) participants had significant complaints of vestibular disturbances, objective and subjective vertigo, kinetosis. One hundred and ten patients were examined, including 65 participants of ATO with mild traumatic brain injury (mTBI), 44 non-ATO without mTBI. The questionnaire “Types of dizziness” was used according to the International Clinical Protocol for Vertigo Disorders (Dizziness). Complaints of optokinetic nystagmus (OKN) were found in 27 (43.08 %) ATO and 7 (15.91 %) non-ATO patients, F-test = = 0.04, T-test = 0.0026. Thus, complaints of OKN turned out to be a specific feature of patients with blast injury syndrome. Complaints of nausea were detected in 38 (58.46 %) ATO and 11 (25.00 %) non-ATO patients, F-test = 0.38, T-test = 0.00035, indicating that this complaint is present and quantitatively more pronounced in ATO patients, but it is not specific for patients with mTBI. Complaints of vomiting were found in 19 (29.23 %) ATO and 11 (13.64 %) non-ATO patients, F-test = 0.055, T-test = 0.046, showing that this complaint is not typical for patients with mTBI. Complaints of anxiety without a reason were detected in 35 (53.85 %) ATO and 15 (34.09 %) non-ATO patients, F-test = 0.75, T-test = 0.041. Thus, this complaint is present and quantitatively more significant in ATO patients. Complaints of blackout were found in 41 (63.08 %) ATO and 16 (36.36 %) non-ATO patients, F-test = 0.98, T-test = 0.006, demonstrating that this complaint is present and quantitatively more pronounced in ATO patients, but it is not specific for patients with mTBI. Complaints of depression and numbness did not differ reliably according to the statistical indicators used. There were certain correlations. OKN: with scotomas in migraine headaches, kinetoses, descendophobia, and nyctophobia. Nausea: with severity of dizziness, vomiting episodes, blackouts, migraine headaches, increased heart rate, kinetoses, nyctophobia, claustrophobia. Vomiting: with ascendophobia, migraine headaches, increased heart rate. Anxiety without a reason: with impaired movement coordination, depression, blackouts, hyperacusis, weather sensitivity, ascendophobia. Depression without a reason: with subjective vertigo, agoraphobia, blackouts, numbness, throbbing headaches, weather sensitivity, electromagnetic hypersensitivity, increased heart rate. Blackouts: with weight gain, objective vertigo, orthostatic and throbbing headache. Numbness: with dizziness and its severity, agoraphobia, ascendophobia, migraine headaches and increased heart rate. Correlations are discussed from the point of view of vestibular dysfunction.

Aplicação da Terapia de Reprocessamento Generativo (TRG) em um caso de depressão e ansiedade generalizada

Introduction: Generative Reprocessing Therapy (TRG) can serve as an alternative for individuals who have not achieved satisfactory results through conventional psychotherapies. This study aims to discuss a case of depression and anxiety in an individual who had previously undergone unsuccessful conventional therapies and was later subjected to TRG. It also intends to present the benefits obtained by this individual through the successful reprocessing of these experiences. Clinical Case: A 52-year-old man underwent 30 sessions of TRG with primary complaints of depression and anxiety, for which he was using prescribed medications under the supervision of a psychiatrist and psychologist. Before and after starting treatment, the individual responded to a qualitative questionnaire concerning his quality of life, in addition to the DASS-21 test. Besides the disappearance of depression, anxiety, and panic symptoms, he reported no longer having suicidal thoughts and remained free from addiction, which was not the case before treatment. It is worth noting that even nearly two years after completing the treatment, the positive results have persisted, and the patient no longer requires previously prescribed medications. Conclusion: In this specific case, TRG proved to be an effective therapeutic approach that improved the quality of life of the study subject, showing satisfactory outcomes in this clinical context. TRG can be tested as a viable alternative for those who have not found success with other forms of psychotherapy.

Evaluation of Hyperammonemia and Cognitive Impairment in post-COVID patients

The paper presents the results of an assessment cognitive function and ammonium levels in individuals who have had a novel coronavirus infection (COVID-19). The study included 60 people: 41 - confirmed COVID-19 during last 3 months and 19 - the control group. There have been performed clinical examination, psychometric test - connect-the-numbers test (CNT) and Mini-Mental State Examination (MMSE). Blood ammonium level has been determined. Post-COVID-19 syndrome (PCS) was diagnosed in 70.7% of patients, which was manifested by complaints of memory loss, weakness and anxiety. In patients who underwent COVID-19, cognitive impairment was detected on the MMSE scale in 27 people (45%), and the changes were more pronounced in the group with PCS. In the post-COVID group, 66% of the subjects had an increase CNT result. The cognitive impairment according to the MMSE correlated with the CNT results. Hyperammonemia was found in 54% of COVID-19 survivors, with higher values observed in the PCS group. No correlation was found between hyperammonemia and cognitive impairment.

Lidocaine-induced anaphylactic shock – A case report

IgE-mediated hypersensitivity reactions (HRs) to local anaesthetics are extremely uncommon. One of the most widely used local anaesthetics for minor dental and other surgical procedures is lidocaine. The incidence of anaphylactic reaction by Inj. Lidocaine among global population is <1%. The first anaphylactic reaction reported in 1902. A 69-year-old female patient shifted to community hospital emergency department. She presented with complaints of vertigo, anxiety, tachypnoea, hypoxia, and sudden onset of breathlessness. History revealed on administration of Inj. Lidocaine a local anaesthesia to her before knee surgery developed above-mentioned symptoms after 15 minutes. After receiving her from OT patient vitals observed as pulse rate-97bpm, GRBS-140mg/dl, blood pressure-170/70mmHg, spo95% with 0. On emergency basis treated her with anti-histamines (Inj. Chlorpheniramine), steroids (Inj. Hydrocortisone-400mg, Inj.solumedrol-1gm), oxygen support of 7 to 8 lit/min, after 4 days she recovered completely and discharged. We used a scale (Naranjo scale) to evaluate the severity of the adverse drug reaction as per scale, score was five that indicates probability of happening adverse reaction. We conclude the case as anaphylactic reaction to lidocaine could have been cause of the event. It is important to collect patients complete past medical history and their allergic history. Also by giving importance to drug sensitivity testing at least to the list of drugs that are reported to show allergic reactions or anaphylactic reactions in post marketing surveillance. Optimised management protocols can save both the patient life and dilemma faced by physicians.

Effectiveness of cognitive behavioral group therapy, psychodrama, and their integration for treatment of social anxiety disorder: A randomized controlled trial

Background and objectivesAlthough cognitive behavioral group therapy (CBGT) is an effective treatment for social anxiety disorder, many socially anxious patients are still symptomatic after treatment. A possible improvement for CBGT could come from the more experiential group psychotherapy, psychodrama (PD). The integration of CBGT and PD (labeled CBPT) might offer an even more effective treatment than CBGT or PD alone. With the present study, we investigated first whether three kinds of group therapy (CBGT, PD, and CBPT) are superior to a waitlist (WL). Second, we investigated whether CBPT is more effective than CBGT or PD alone. MethodsOne hundred and forty-four social anxiety patients were randomly assigned to three active conditions or a WL. After wait, WL-participants were randomized over the active treatment conditions. ResultsThe results of a multilevel analysis showed that all treatments were superior to WL in reducing social anxiety complaints. Only CBGT and CBPT differed significantly from WL in reducing fear of negative evaluations. There were no significant differences between active conditions in any of the variables after treatment and after six-month follow up, neither were there significant differences in treatment dropout. LimitationsFirst there is the lack of a long-term follow-up. Second, because of loss of participants, we did not reach the planned numbers in the active treatment groups in comparison to WL. Moreover, this study was not designed as a non-inferiority or equivalence trial. ConclusionsAlthough the integrative CBPT showed good results, it was not more effective than the other treatments.

Relationship between saliva 17 beta-estradiol levels with anxiety and depression in menopause paramedic at Prof I.G.N.G Ngoerah Hospital Denpasar

Background: Hospital Services rely on Medical and Paramedics at the Hospital, Hospital Paramedic services, especially women, are greatly influenced by mood, in women it is especially influenced by hormonal balance, including menstruation and menopause. The drop in estrogen levels after menopause causes many physical and emotional changes. Estradiol is the largest estrogen. It is estimated that the number of women who have menopause will experience a very significant increase of estradiol. Methods: An analytic observational study with a cross-sectional study design on 85 menopausal paramedics at Prof I.G.N.G Ngoerah Hospital Denpasar using a Hospital Anxiety and Depression Scale (HADS) questionnaire and examined salivary levels of 17? estradiol and looked for its relationship with anxiety and depression. Results: Based on the low salivary 17? estradiol level of the sample aged above 50 years (76.5%). Outpatient (75%), underweight (100%), married status (74.4%), and sample >5 years (76.5%). It is also a significant result where the salivary 17? estradiol level is lower in the sample compared to anxiety and depression complaints, with the chi-square test (p-value = <0.001). Conclusion: There is a significant relationship between low salivary 17? estradiol levels and complaints of anxiety and depression in menopausal paramedics.

STRATEGIES FOR USING AROMATHERAPY THROUGH A COMBINATION OF NON-PHARMACOLOGICAL INTERVENTIONS IN THE CHRONIC DISEASE MANAGEMENT PROGRAM (PROLANIS) : SYSTEMATIC REVIEW

Chronic disease is one of the main causes of premature death worldwide. This study aims to identify and evaluate the use of aromatherapy through a combination of non-pharmacological interventions in PROLANIS. The method used is a systematic review through the ProQuest, PubMed, Science Direct and Google Scholar databases. The selection of articles uses the PRISMA diagram method. This study shows significant results that aromatherapy such as lavender, lemon, peppermint, and rose is widely used in chronic diseases, especially cancer, heart disease, DM, osteoarthritis and CRF for complaints of pain, nausea, vomiting, sleep quality, anxiety and fatigue and pruritus. In conclusion, aromatherapy with a combination of non-pharmacological interventions can help reduce pain, nausea, vomiting, quality of sleep, anxiety and fatigue and pruritus in chronic diseases.

Awake craniotomy does not lead to increased psychological complaints.

Patients with brain tumours are increasingly treated by using the awake craniotomy technique. Some patients may experience anxiety when subjected to brain surgery while being fully conscious. However, there has been only limited research into the extent to which such surgeries actually result in anxiety or other psychological complaints. Previous research suggests that undergoing awake craniotomy surgery does not lead to psychological complaints, and that post-traumatic stress disorders (PTSD) are uncommon following this type of surgery. It must be noted, however, that many of these studies used small random samples. In the current study, 62 adult patients completed questionnaires to identify the degree to which they experienced anxiety, depressive and post-traumatic stress complaints following awake craniotomy using an awake-awake-awake procedure. All patients were cognitively monitored and received coaching by a clinical neuropsychologist during the surgery. In our sample, 21% of the patients reported pre-operative anxiety. Four weeks after surgery, 19% of the patients reported such complaints, and 24% of the patients reported anxiety complaints after 3months. Depressive complaints were present in 17% (pre-operative), 15% (4weeks post-operative) and 24% (3months post-operative) of the patients. Although there were some intra-individual changes (improvement or deterioration) in the psychological complaints over time, on group-level postoperative levels of psychological complaints were not increased relative to the preoperative level of complaints. The severity of post-operative PTSD-related complaints were rarely suggestive of a PTSD. Moreover, these complaints were seldom attributed to the surgery itself, but appeared to be more related to the discovery of the tumour and the postoperative neuropathological diagnosis. The results of the present study do not indicate that undergoing awake craniotomy is associated with increased psychological complaints. Nevertheless, psychological complaints may well exist as a result of other factors. Consequently, monitoring the patient's mental wellbeing and offering psychological support where necessary remain important.

Let's play pretend: Towards effective modelling in experimental psycho(patho)logy

Background and objectivesModels are omnipresent in science. We introduce a novel framework to achieve more effective modelling practices in general psychology and experimental psychopathology. MethodWe analyze three types of models that are common in psychology: laboratory models, computational models, and cognitive models. We then evaluate two common ways to assess the translational value of models (phenomenological similarity and deep similarity) as well as an arguably underappreciated way (functional similarity). Functional similarity is based on an assessment of whether variables (e.g., the administration of a pharmacological substance) have a similar effect (a) in the model (e.g., in a fear conditioning procedure) and (b) on the real-life target phenomenon (e.g., on real-life anxiety complaints). ConclusionsWe argue that the assessment of functional similarity is a powerful tool to assess the translational value of models in the field of experimental psychopathology and beyond.

The Mental Health of a Society in Crisis: Complaints of Depression and Anxiety

The Mental Health of a Society in Crisis: Complaints of Depression and Anxiety

The pain of every day: student health before and during the Covid-19 pandemic

For 4 years, our team has been monitoring the physical and mental complaints of Federal University of Paraíba (UFPB) students, mainly those from the healthcare field. We have verified oscillations in headache complaints and other psycho-emotional symptoms during this period. In 2022, perhaps as a result of the impacts of the Covid-19 pandemic, complaints of headache and anxiety were above 70%. This public, today, demands integral care appropriate to their socio-cultural reality. We warn about the importance of local diagnosis and respective offer of appropriate social support to each reality to foster, care and accompany these communities.

LBSAT314 Diagnosis And Management Of A Rare Case Of Marine-Lenhart Syndrome

Abstract Introduction Marine-Lenhart syndrome is defined as Graves’ disease with co-existing toxic thyroid nodules. Approximately 25% to 30% of patients with Graves’ disease have accompanying nodules. More than 95% of these nodules are hypoactive, and thus, only a tiny percentage are hyperactive. In these patients, Graves’ disease and toxic nodules both contribute to thyrotoxicosis11. Here we present a case that details this syndrome's diagnosis, management, and treatment complication. Clinical Case A 68-year-old female presented to the primary care physician's office with complaints of anxiety and heat intolerance. Three years before this visit, the patient was diagnosed with Graves’ disease. She had achieved remission after one year of methimazole therapy. During the office visit, the patient was in sinus tachycardia at 112 BPM. There were no signs of exophthalmos on examination, and the thyroid was not palpable. Further testing revealed thyrotoxicosis with suppressed TSH of <0. 01 mcIU/mL (0.36-3.74) and elevated free T4 of 2.49 ng/dL (0.76-1.46). Thyrotropin receptor antibody (TRAb) was positive at 2.60 IU/L (0. 00-1.75). The patient was started on atenolol. Although TRAb was positive, thyroid ultrasound and radioactive iodine uptake scan (RAIU) were ordered to look for alternative diagnoses. The thyroid ultrasound showed four nodules in the left lobe, the largest of which was 1.8×1.5×1.3 cm. RAIU showed increased 24-hour uptake of 45% and three areas of increased focal uptake in the left thyroid lobe consistent with toxic nodules. Definitive treatment was needed due to both toxic nodules and Graves’ disease. The patient agreed to radioiodine ablation therapy (RAI) and received a dose of 21 uCi. One month after receiving RAI, the patient complained of worsening anxiety and heat intolerance. On repeat testing, TSH was <0. 01mcIU/mL, and free T4 was 4.78 ng/dL. The patient developed radiation thyroiditis and was given methimazole 10mg daily for two weeks. Three weeks after the course of methimazole, the patient became hypothyroid and was managed with 88 mcg of levothyroxine daily with no symptoms. Conclusion Common causes of hyperthyroidism are Graves’ disease or autonomous functioning thyroid nodules per the American Thyroid Association12. However, in hyperthyroid patients, Marine-Lenhart syndrome should be considered, especially those with thyrotoxicosis recurrence. This diagnosis steers management away from antithyroid drugs and toward RAI or thyroidectomy. For patients treated with RAI, antithyroid medications should be included as an adjunct therapy to reduce post-radiation thyroiditis. References 1 Cakir, Mehtap. "Marine-Lenhart Syndrome.," Journal of the National Medical Association 97, no. 7 (July 2005): 1036-38.12 Ross, Burch, et al., Thyroid. Oct 2016, 26(10): 1343-1421. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.