Course Of Episode Research Articles

Characteristics of personality in patients with endogenous psychoses with an episodicаl course in the context of post-manifest pathopersonаlogical transformations (comparative analysis)

Solution of the problems of differential diagnosis, treatment and social rehabilitation of patients with endogenous psychoses with episodic course is one of the most complex and urgent problems of clinical psychiatry, which is caused by polymorphism and variability of symptoms, decrease or loss of critical attitude toward the disease, with grave social and economic consequences. The aim of the study is to establish, on the basis of the results of the comparative analysis of the characteristics of the personal profile, the features and nosospecific differences of post-manifest pathopersonаlogical transformations in patients with schizophrenia, schizoaffective disorder and affective disorders in remission / intermissions. The study examined the personality characteristics of endogenous psychoses with an episodic course in remission / intermission conditions and established signs and nosospecific differences in post-manifest pathological transformations in patients with schizophrenia, schizoaffective disorder, and affective disorders. Existing pathopersonalogical transformations are characterized by signs of multidirectional tendencies of compensatory tension of personal resources, which is confirmed by the presence of several moderately elevated (65-75 T-points) indicators of individual scales and a simultaneous increase in indicators of both hyposthenic (2nd and 7th scales) and hypersthenic ( 4th and 9th scales) registers. In schizoaffective disorder, such scales are the 2nd (65.36±12.28 T-points), 4th (73.23±11.83 T-points), 8th (68.40±12.33 T-points) and 9th (66.05±12.02 T-points); in affective disorders, these are the 2nd, 4th and 8th scales (67.72±13.96, 67.08±9.53 and 65.90±10.08 T-points, respectively); for schizophrenia, such scales are the 2nd (72.37 ± 16.80 T-points), 4th (69.47±12.48 T-points), 7th (66.59±15.69 T-points) ) and 8th (71.73±19.95 T-points). The obtained data can be used as a component of the differential diagnosis system and personified psychotherapeutic support.

TYPOLOGY OF PATHOPERSONOLOGICAL TRANSFORMATIONS IN PATIENTS WITH SCHIZOAFFECTIVE DISORDER

The issue of diagnostics, treatment and social rehabilitation of patients with endogenous psychoses with episodic course remains one of the most urgent problems of psychiatry, which, despite the considerable advances of science and practice, has not found a definitive solution. Significant difficulties of nosological separation in the group of endogenous psychoses with episodic course and evaluation of the pathopersonological aspect of the clinic are related to schizoaffective disorder. The aim of the study was to establish a typology of pathopersonological transformations in patients with schizoaffective disorder based on the analysis of clinical-psychopathological, medical-psychological, clinical-ethological characteristics of remission. On the basis of “Regional Clinical Psychiatric Hospital” (Zaporizhzhіa) 102 persons with the established diagnosis of schizoaffective disorder were examined. The main methods of the study were clinical psycho-pathological, psychodiagnostic, patho-psychological, clinical-anamnestic, clinical-medical, social-medical and statistical analysis. As a result of the conducted research, on the basis of the analysis of clinical-psychopathological, medical-psychological, clinical-ethological characteristics of remission, the typology of pathopersonological transformations was established. The presence and prevalence of 4 main types of pathopersonological transformations in schizoaffective disorder (“affective-labile” (20.1 % of the contingent), “paranoid-dysthymic” (17.3 %), “hysteroid-agonistic” (25.9 %), “Neurocognitive-deficient” (16.9 %) and “mixed” (19.8 % of the contingent)), which differ in clinical-anamnestic, clinical-psychopathological, medical-psychological, neuropsychological and clinical-ethological characteristics and cause social (labor and family) maladjustment of varying degrees. The clinical-anamnestic, clinical-psychopathological, medical-psychological, neuropsychological and clinical-ethological features identified in the study can be used to determine the type of pathopersonological transformations and its severity in patients with schizoaffective disorder and, accordingly, quantitative characteristics of individually needed psychopharmacological, psychotherapeutic and social rehabilitation activities and evaluation of their effectiveness in dynamics.

The Relationship Between Course of Illness and β-Endorphin Plasma Levels in Patients with Schizophrenia.

ObjectiveExtensive investigations have been conducted into predictors of schizophrenia outcome. The heterogeneity of the illness implies that many factors should be taken into account. Some studies have reported the relationship between increased β-endorphin concentration and predominant negative symptoms.MethodsWe included 77 outpatients with schizophrenia and 74 healthy controls. Data referring to duration and course of illness, hospitalization number and treatment were collected on the basis of clinical interviews and medical documentation analysis. The β-endorphin concentrations were assessed once in all participants, at the onset of the study.ResultsA chronic course of illness was found in 44 of the 77 schizophrenics. Patients with schizophrenia, especially those with a chronic course of illness, revealed significantly higher β-endorphin concentrations than those with an episodic course and controls (mean 29.70 vs 19.86 pmol/L; p=0.0001). Increased levels of β-endorphin were related to longer duration of illness (R=0.294, p=0.009) and frequent psychiatric hospitalization (R=0.346, p=–0.002).ConclusionEndorphins may be potential biological predictors of persistent negative symptoms and final outcome in schizophrenia.

Effects of Kinesiotaping on the Improvement of Sensorimotor Function along with Disability in Chronic Mechanical Neck Pain

Introduction: Mechanical neck pain is a significant societal burden and may include symptoms in the neck and upper extremity. It has been reported that the lifetime and point prevalence of neck pain are almost as high as those of low back pain. It appears to run a chronic episodic course, which is characterised by episodes of persistent, recurrent, or fluctuating pain and disability. It has been found that an altered muscle activity in the Trapezius and the Serratus anterior muscles can be associated with the presence of pain in the neck during functional activities. Aim: To find out the effects of Kinesiotaping on the improvement of sensorimotor function and neck disability in patients with chronic neck pain. Materials and Methods: This was a pre-test, post-test control group design with 30 subjects randomly selected and divided into two groups, an experimental group (Group A) and a control group (Group B) with 15 subjects in each. Experimental group received Kinesio Tape (KT) for 1 week whereas control group received Sham tape. Measurements were taken on the first day and 1 week after the intervention for Cervical Joint Position Sense (CJPE), range of motion and neck disability using an inclinometer instrument, universal goniometer, Neck Disability Index (NDI) questionnaire, respectively. The data was analysed using SPSS 17 software package. Independent t-test was done to find effect between the groups and paired t-test was done to find out the effect within the group. Results: The study clearly demonstrated a significant improvement in CJPE, Cervical Range of Motion (CROM) and NDI within group A (p<0.05) whereas improvement showed significance in CROM and NDI for group B. While comparing both the groups, significant improvement in proprioception and NDI was shown but not in CROM. Conclusion: The study concludes that patients with chronic mechanical neck pain can be benefitted by the use of Kinesiotaping with improvement of sensorimotor function.

An Isolated Peculiar Gianotti-Crosti Rash in the Course of a COVID-19 Episode

An Isolated Peculiar Gianotti-Crosti Rash in the Course of a COVID-19 Episode

Clinical-psychopathological and medical-social characteristics of patients with endogenous psychoses with an episodic course in the context of post-manifestation pathopersonological transformations

The determination of the nosological affi liation of a separate clinical case in the group of endogenous psychoses is a decisive factor in adequate psychopharmacotherapy. The clinical aspects of post-manifestation pathopersonological transformations of endo genous psychosis with an episodic course remain the least studied and require study to improve the quality of diff erential diagnosis, treatment and rehabilitation. The aim of this study was to conduct a comparative analysis of personal characteristics, types of attitude toward the disease and adaptability of patients with schizophrenia and schizoaff ective disorder. On the basis of the Regional Clinical Psychiatric Hospital (Zaporizhzhia, Ukraine), 312 patients were examined, among them 102 patients with aff ective disorders; 102 patients suffering from schizoaffective disorder and 108 patients diagnosed with schizo phrenia, paranoid form, episodic course. The main research methods were clinical-psychopathological, clinical-follow-up, clinical-anamnestic and medical-social, as well as medicalstatistical analysis. The study revealed signs and nosospecific diff erences in indicators of social (labor and family) maladjustment, as well as positive, negative and general psychopathological disorders (according to PANSS) in endogenous psychoses with an episodic course, confi rming the presence of post-manifestation pathopersonological transformations. In the group of endogenous psychosis with an episodic course, pathopersonological transformations in schizoaff ective disorder are characterized by the most complex structure and are a nosospecific marker. Further studies of remission/intermission in endo genous psychosis open up the possibility of developing a differential diagnostic system and algorithms for providing personalized medical and rehabilitation care. Keywords: schizoaffective disorder, affective disorders, schizophrenia, clinic, social maladjustment, differential diagnosis, pathopersonological transformations

Type of course of schizophrenia and polymorphisms of neuronal protein kinase genes on the model of PIP5K2A, GSK3B and AKT1

The role of protein kinases in schizophrenia is being actively studied. However, the effect of protein kinase gene polymorphisms on the clinical manifestations of the disease has been little studied. We examined 384 patients diagnosed with schizophrenia in accordance with ICD-10 (F20) (269 patients with a continuous course of schizophrenia; 115 patients with an episodic course of the disease). Genotyping of polymorphisms PIP5K2A (rs10828317, rs8341, rs746203), GSK3B (rs334558), AKT1 (rs3730358, rs1130214) was carried out by real-time PCR method. An association of rs8341 PIP5K2A with the type of course of schizophrenia was revealed. The CT genotype was associated with a continuous type of schizophrenia, the TT genotype with an episodic one. Disorders of the phosphoinositide pathway may be a possible cause of the transition to a more severe continuous course of schizophrenia.

Characterizing Autoimmune Hemolytic Anemia in RAG Deficiency

Background: Autoimmunity is a fundamental consequence of impaired tolerance checkpoints in patients with hypomorphic mutations in recombination activating genes (RAG1 and 2), the major player in V(D)J recombination of antigen receptors. We recently published a cohort of 63 patients with partial RAG deficiency with autoimmune and/or hyperinflammatory manifestations. Autoimmune hemolytic anemia (AIHA) was most common, occurring in (60.3%) of patients at a median age of 1.9 years. The episodes of AIHA were often severe and refractory to first or second-line therapy. Despite the severity of early-onset disease, a large fraction of patients ware diagnosed later for an underlying genetic cause. This may be due to deceased awareness and lack of routine clinical biomarkers for underlying RAG deficiency. The natural course of AIHA episodes, diversity of antibodies targeting red blood cells (RBC) and the underlying mechanisms that promote AIHA remain elusive. Our previous study on RAG-deficient patients has revealed that autoreactive B cells are present early in B cell development, and autoantibodies are produced to a broad selection of self-antigens, including those on RBCs. A prevailing theory for the development of anti-RBC antibodies involves dysregulation of somatic hypermutation (SHM). There are specific regions of the immunoglobulin (Ig) that are naturally reactive to self-antigen in the germline state, and mutation away from self-reactivity occurs through SHM. On example is the germline Ig VH4-34 AVY segment that has been known to bind to the i/I antigen on RBCs. Increased awareness for detection and mechanistic understanding of the generation of anti-RBC antibodies are needed to promote targeted therapy in this highly vulnerable young patient population with AIHA and immune deficiency. Methods: Through retrospective chart review, we collected detailed information on the episodes of AIHA. This included clinical evidence of hemolysis, recurrence and severity of episodes, specifics on red blood cell reactivity, treatment and outcome. In addition, We performed B-cell repertoire studies to assess rate of SHM and "mutation away" from RBC reactivity. Results In our 42 patients with RAG deficiency and AIHA, we accumulated data on 20 patients. Many of the patients experienced the onset of AIHA after viral infections and often recurred (up to 8 times in lifetime). Most of the patients had warm AIHA with broad reactivity (direct, indirect, IgG, IgM, C3). In parallel, patients developed specific antibodies to cytokines targeting IFNa, IFNw and IL12. Second or third-line therapy was required in 50% of cases. One patient underwent HSCT due to severe refractory AIHA. The B-cell repertoire in selected RAG patients with AIHA contained more unmutated Ig VH4-34 segments (including the AVY segment), and demonstrate less evidence of SHM when compared to healthy donors. Conclusions Patients with partial RAG deficiency may develop severe, recurrent and treatment-refractory AIHA at early ages. Diagnosis may be expedited with increased awareness and serological evidence of broadly reactive antibodies to RBC and cytokines. Mechanistically, decreased SHM may promote the survival of naturally occurring antibodies to RBC. Studies should continue to advance understanding for targeted approach to serve as bridge therapy before HSCT is considered or indicated. Disclosures No relevant conflicts of interest to declare.

Theoretical Background and Clinical Aspects of the Use of EMDR in Patients With Bipolar Disorder

Bipolar disorder (BD) is associated with a lifelong episodic course of severe mood and behavioral disturbance. In last decades treatment improved with numerous pharmacological and psychosocial treatments; however, subsequent mood episode rates are still high and possible risk factors for subsequent mood episodes are not sufficiently addressed. Of note, childhood trauma and stressful life events represent significant, under-recognized, and often neglected environmental risk factors in the etiology and course of BD. Here, we summarize the evidence of eye movement desensitization and reprocessing (EMDR) therapy in BD with posttraumatic stress disorder (PTSD) or life traumatic events. So far, one case report study and one pilot randomized controlled trial (RCT) have been published suggesting positive effect of EMDR therapy in BD. Currently, two larger further RCTs are ongoing to increase scientific evidence of the use of EMDR therapy in this indication, especially with a focus on its effect on relapse prevention. In addition, a functional neuroimaging case report of a bipolar subject versus 30 healthy controls showed first evidence that EMDR might modulate the default mode network. These preliminary results suggest that EMDR could be a promising and safe psychotherapeutic approach for the add-on treatment of bipolar subjects, but confirmative large RCT are needed, with two currently being conducted.

Нейрокогнітивні розлади при ендогенних психозах з епізодичним перебігом як складова патоперсонологічних трансформацій (порівняльний аналіз)

Проанализизованы нейропсихологические нарушения у больных эндогенными психозами с эпизодическим типом течения в состояниях ремиссии/интермисии. При шизофрении выявлены нозоспецифические отличия как по распространенности, так и по степени выраженности. Изучение поведения пациентов в ситуации тестирования показало нозоспецифические отличия мотивационного компонента познавательной деятельности и модусов социального взаимодействия. Ведущими механизмами снижения рапорта при аффективных и шизоаффективном расстройствах является пассивно-агрессивное поведение обесценивания процедуры обследования, а при шизофрении - эмоциональное обеднение и явления аутизации.

PMH25 ASSOCIATION OF ADOLESCENT DEPRESSION WITH EARNINGS IN ADULTHOOD

To investigate the association between adolescent depression and earnings in adulthood. This study was based on Uppsala Longitudinal Adolescent Depression study (ULADS), initiated in Uppsala in 1991, in which all first-year students in upper secondary school (16–17 years old) were screened for depression. Comprehensive diagnostic interviews conducted in adolescence and early adulthood were combined with yearly register-based data on earnings from 1996 to 2016 (up to approximately age 40). Statistical analyses of the effect of depression during adolescence on earnings up to mid-adulthood were performed using Generalized Estimating Equations (GEE). A possibility of depression or recurrence in early adulthood to influence earnings was examined using mediation analysis. A total of 539 individuals (78.8% females) with a history of persistent depressive disorder, episodic major depressive disorder, subthreshold depression, or no depression in adolescence were included. Persistent depressive disorder, but not the other subcategories of adolescent depression, was significantly associated with reduced earnings in adulthood in both males and females. After adjustments for parental characteristics and psychiatric comorbidity at baseline, the relative differences in earnings were 0.85 (0.77-0.95) for females and 0.76 (0.60-0.95) for males. The relative mean difference remained unchanged over time, was mainly driven by the lower percentiles in each group, and was partially mediated by depression in early adulthood. Increased understanding of labor market outcomes in depressed adolescents can guide interventions to strengthen the human capital. Our findings demonstrate the importance of differentiating between diagnostic subgroups of adolescent depression. The duration and continued course of depressive episodes in adolescence proved decisive for adult earnings, underscoring the importance of early treatment and indicated preventive interventions.

Affect, motivation, temptation, and drinking among alcohol-dependent outpatients trying to maintain abstinence: An Ecological Momentary Assessment study

ObjectivesUsing Ecological Momentary Assessment we aimed to describe the time course of temptation episodes in alcohol-dependent outpatients in a real-life setting. We also examined whether affective and motivational variables were cross-sectionally and prospectively associated with temptation episodes. Additionally, we tested whether outpatients who drank against treatment goals (i.e., “lapsers”) differed in craving, affect, and motivation from abstainers. MethodsParticipants were 43 alcohol-dependent outpatients (13 female). Using personal digital assistants (PDAs), patients were signaled to complete three random assessments per day for 4 weeks. They were also instructed to complete a temptation assessment whenever they experienced the temptation to drink alcohol. ResultsThe number of temptation assessments declined over time and did not differ between lapsers and abstainers. Overall, craving was generally higher in lapsers (n = 14) than abstainers (n = 27). In lapsers, but not abstainers, abstinence motivation was lower at temptation assessments vs. random assessments. Across all patients, negative affect was prospectively associated with entry of temptation assessments later the same day. There were no significant effects for positive affect. ConclusionsIn alcohol-dependent outpatients attempting to remain abstinent, negative affect is cross-sectionally associated with entry of temptation assessments. There is more evidence that negative affect precipitates temptations than vice versa. Professionals should be watchful of outpatients who report generally high levels of craving, and who report more negative affect and lower abstinence motivation, when tempted.

Previous Syphilis Alters the Course of Subsequent Episodes of Syphilis.

Individuals with previous syphilis may be more likely to be asymptomatic when they are reinfected with Treponema pallidum. Individuals enrolled in a study of cerebrospinal fluid (CSF) abnormalities in syphilis were allowed to enroll in the study again with subsequent syphilis. For each participant, the index episode was defined as the most recent syphilis episode for which the study entry visit was performed within 30 days of the syphilis diagnosis date. Venipuncture and lumbar puncture were performed. The total number of syphilis episodes was determined by review of medical and public health records. Treponema pallidum DNA in blood and rRNA in CSF were detected using polymerase chain reaction (PCR) and reverse transcriptase PCR. Odds ratios (ORs) with 95% confidence intervals (CIs) were determined using logistic regression. 701 individuals had 1 (n = 478), 2 (n = 155), or ≥3 (n = 68) episodes of syphilis. The proportion of individuals whose index episode was asymptomatic significantly increased with increased number of syphilis episodes (P < .001). This difference was not explained by frequency of serological tests. Adjusted ORs (aORs) of detection of T. pallidum DNA in blood or rRNA in CSF at the index episode were significantly lower in those with previous syphilis (0.13; 95% CI, .08-.23, and 0.06, 95% CI, .02-.17). The aOR of neurosyphilis at the index episode was also significantly lower in individuals with previous syphilis (0.43; 95% CI, .27-.68). Previous syphilis attenuates clinical and laboratory manifestations of infection with T. pallidum.

Structure and types of response to disease and indexes of adaptability/maladaptation in endogenous psychoses with episodic course in the context of pathopersonalogical transformations in post-manifestation period

The study examined the structure and types of attitude toward the disease (ATD) and adaptability/maladaptation indices in 312 patients with endogenous episodic episodes (schizophrenia, schizoaff ective disorder (SAD) and aff ective disorders (AD)) in remission/ intermittent states and compared them. Characteristics of ATD and indicators of adaptability/disadaptation in endogenous psychosis with episodic course in the remission/intermission period are a sign of stable post-manifestation of pathopersonalogical transformations and have nosospecifi c diff erences. Patients suffering from endogenous episodic psychosis have a reserve of personal adaptive capacity. This is confirmed by the fact that among patients with maladaptive types of ATD, a signifi cant percentage is of the types with an interpsychic orientation (74.0 % of the contingent in AD, 55.9 % of those surveyed with SAD and 57.6 % with schizophrenia), which is a sign of the use of personal reserves in confronting the negative eff ects of the disease. The above-mentioned reserve of personal adaptation possibilities in AD is the largest, as shown by the larger (χ2 = 6.065, p &lt; 0.05) percentages of types with an interpsychic orientation in the structure of maladaptive types of ATD. The obtained data can be implemented into the system of diff erential diagnosis and counteraction to social maladaptation, which is formed as a result of the disease. Key words: schizophrenia, schizoaff ective disorder, aff ective disorders, clinic, adaptation, pathopersonalogical features

Tutorial on Diarrhea and Enteral Nutrition: A Comprehensive Step-By-Step Approach.

This tutorial suggests a current strategy toward a multiprofessional therapy based upon a comprehensive step-by-step approach to the course of intensive care unit diarrhea episodes. Evidence published in the last 10 years, obtained through a database search (PubMed), shows that its prevalence is quite variable. Although multicausal, it is often erroneously associated with the supply of enteral nutrition. Several complications affect not only nutrition status but also the development of skin lesions, which can become the focus of infections, and the length of hospital stay. Here, we propose an early, objective, directed, and multimodal approach, aiming at optimizing care for these patients. In a dynamic walkthrough, the reader will find a guide for the general diagnosis and for colitis resulting from Clostridium difficile infections, as well as current instructions and recommendations for drug treatment and supportive therapy for these 2 modalities. We also bring together ways to prevent and treat associated skin lesions in this setting. Because it is neglected in the critical environment, diarrhea is still a poorly addressed disease, and its complications bring about a significant worsening in quality of life and hospital stay.

Detecting Disparities in Medication Management Among Limited English Proficient and English Proficient Home Health Patients

According to the U.S. census Bureau, close to 20% of the U.S. population speaks a language other than English at home. Home health care (HHC) patients who speak English less than very well or have limited English proficiency (LEP) are at an increased risk for medication mismanagement and serious health consequences. The purpose of this study was to examine if there were differences in medication management between English-speaking patients and patients with LEP receiving HHC services. Data for this cross-sectional observation study were collected from 2010 to 2014. Medication management was measured by two items in the Centers for Medicare and Medicaid Services–mandated Outcomes Assessment Information Set (OASIS). All patients in the database who were taking medications and had a valid admission and discharge assessment from HHC were included in the analysis. Inverse probability of treatment weighting (IPTW) with a marginal structural model was used to address potential imbalances in observed patient characteristics when estimating the effect of having LEP or being an English-speaking HHC patient on changes in medication management over the course of a HHC episode. Estimates from marginal structural model with inverse probability weighting indicate that being LEP was associated with less improvement in medication management and increased likelihood of getting worse over the course of a HHC episode. This study is one of the first to demonstrate that patients with LEP experience disparities in medication management when compared to English-speaking patients in HHC.

White Matter Microstructure in Pediatric Bipolar Disorder and Disruptive Mood Dysregulation Disorder

Disruptive mood dysregulation disorder (DMDD) codifies severe, chronic irritability. Youths with bipolar disorder (BD) also present with irritability, but with an episodic course. To date, it is not clear whether aberrant white matter microstructure-a well-replicated finding in BD-can be observed in DMDD and relates to symptoms of irritability. We acquired diffusion tensor imaging data from 118 participants (BD= 36, DMDD= 44, healthy volunteers (HV= 38). Images of fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) were processed with tract-based spatial statistics controlling for age and sex. The data were also used to train Gaussian process classifiers to predict diagnostic group. In BD vs DMDD, FA in the corticospinal tract was reduced. In DMDD vs HV, reductions in FA and AD were confined to the anterior corpus callosum. In BD vs HV, widespread reductions in FA and increased RD were observed. FA in the anterior corpus callosum and corticospinal tract was negatively associated with irritability. The Gaussian process classifier could not discriminate between BD and DMDD, but achieved 68% accuracy in predicting DMDD vs HV and 75% accuracy in predicting BD vs HV. Aberrant white matter microstructure was associated with both categorical diagnosis and the dimension of irritability. Alterations in DMDD were regionally discrete and related to reduced AD. In BD, we observed widespread increases in RD, supporting the hypothesis of altered myelination in BD. These findings will contribute to the pathophysiological understanding of DMDD and its differentiation from BD. Studies of Brain Function and Course of Illness in Pediatric Bipolar Disorder; https://clinicaltrials.gov/; NCT00025935; Child & Adolescent Bipolar Disorder Brain Imaging and Treatment Study; https://clinicaltrials.gov/; NCT00006177.

Dynamics of neutrophil and C‐reactive protein reflect the clinical course of pyrexia during combination therapy with dabrafenib and trametinib

Pyrexia is the most common adverse event in patients with melanoma or other solid organ malignancies that are treated with the combination of dabrafenib and trametinib (combi-DT). Given the expanded indication for combi-DT, management of pyrexia is a high priority. No previous case series has revealed which blood markers reflect the course of pyrexia and there is no consensus on the management strategy for pyrexia. The current case series study describes the utility of neutrophil count (NC), neutrophil ratio (NR) and C-reactive protein (CRP) in 11 patients with metastatic melanoma and BRAF V600 mutations who experienced pyrexia during combi-DT in our department. We also described the clinical course of pyrexia episodes that were managed with the concomitant use of oral prednisolone and immediate withdrawal of combi-DT. Consequently, the analysis of 37 pyrexia episodes in 11 patients showed that the differences in NC, NR and CRP at the onset of pyrexia were significantly different from those at pyretolysis (P=0.01, 0.006 and 0.03, respectively). Additionally, in the 24 pyrexia episodes treated with the concomitant use of oral prednisolone and the immediate withdrawal of combi-DT, the mean duration of pyrexia and the mean time to restart combi-DT were 3 and 6days, respectively. Therefore, the blood markers that reflect the course of pyrexia during combi-DT may be helpful for the appropriate management of pyrexia; also, our management strategy for pyrexia successfully reduced the duration of pyrexia and did not require a long-term drug holiday. Further large-scale studies are required to verify our results.

Mentalization and Depression: Theoretical Concepts, Treatment Approaches and Empirical Studies - an Overview.

Objectives: The aim of this article is to outline the relevance of mentalization for the understanding of the dynamics and the psychotherapeutic treatment of depression, and to systematically review the literature on mentalization as it relates to the diagnosis of depression and the evaluation of depression treatment. Methods: The first part of the article consists of an overview of the theory of mentalization and its relevance for depression and its treatment. For the second part, a literature research was conducted in Scopus and PubMed to retrieve and then manually select empirical studies on depression and mentalization, focusing on studies applying the Reflective Functioning Scale based on the Adult Attachment Interview. Results: For our review, 15 studies were selected. These suggest that severe chronic and/ or treatment resistant depression is related to more pronounced mentalizing deficits. With respect to psychotherapy process and outcome, mentalization is a specific focus of psychodynamic therapy approaches, and proves to be an important mediating and moderating variable. Conclusion: Mentalization with its linkages to attachment theory offers rich possibilities for an in-depth understanding of the dynamics of depression and resulting mentalization based approaches to the treatment of the disorder. The small number of studies and their heterogeneous design allow only preliminary assumptions on the difference between severe, chronic and milder or episodic courses of depression with respect to mentalizing deficits and urge for further research.

PB2041 UTILITY OF INFLAMMATORY MARKERS IN DISTINGUISHING VARIOUS INFECTIVE ETIOLOGIES OF FEVER IN FEBRILE NEUTROPENIC PATIENTS

Background:Febrile neutropenia is a common cause in morbidity and mortality during treatment of hematological neoplasms. This leads to unnecessary use of broad‐spectrum antibiotics adding to the cost of treatment, selection pressure amongst bacteria and side effects of antibiotics.Aims:To study the utility of Procalcitonin and CRP in differentiating various causes of fever in patients with febrile neutropenia.Methods:Subjects included all cases admitted under hematology department with febrile neutropenia from February to June 2018 (age ranged‐1‐60 years). Institutional Ethics Committee clearance was obtained for the conduct of this study.Etiology of febrile episodes classified according to International Immunocompromised Host Society (ICHS) into four groups:• Microbiologically documented infections (MDI)• Clinically documented infections (CDI)• Fever of unexplained origin (FUO)• Invasive fungal infections (IFI)Diagnostic work up for each febrile episode was done including Procalcitonin (PCT) and CRP. PCT and CRP was sent at fever onset 0,24,48hour, day 7 and day 14 or defervescence.Results:A total of 72 patients evaluated out of which 17 patients excluded either due to incomplete data or fever due to non‐ infective causes. Data was analyzed for 52 febrile episodes in 50 patients. At fever onset no significant difference was observed in the PCT &amp; CRP values amongst various etiologies. PCT cut off value at 24 hours of ≤1.2ng/ml had a sensitivity and specificity of 62.5% and 87.5% for discriminating IFI and MDI (p = 0.033). PCT had a negative predictive value of 70% for the diagnosis of IFI as compared to MDI. PCT cut‐off of 0.4ng/ml on day 7 had a sensitivity and specificity of 60.98% and 100% respectively for discriminating IFI and PUO (p = 0.0001). Procalcitonin was significantly higher in the pneumonia group compared to other site infections (median‐11.42; IQR‐6.170 ‐ 13.003; p &lt; 0.05). Patients who developed signs of severe infection like Septic shock, hypoxia were noticed to have significantly high median PCT value at 24 and 48 hours (p value‐ 0.007 for PCT 24 and 0.001 for PCT 48). Patients with only MDI infections had the highest PCT level over the course of febrile episode. CRP cut off &gt;160 mg/dl at 48 hours was suggestive of fever due to fungal infection rather than other causes, with a sensitivity of 100%, specificity of 48%, PPV of 33.3% and NPV of 100%. There was a significant rise from baseline in CRP values at 48 hours in the IFI group when compared to the other groups (median = 33.6; p = 0.045). The CRP values at 24 hours and 48 hours were significantly lower in the PUO (disease fever) group (p = 0.001) when compared to the other groups. There was a significant fall in the level of PCT by day 14(median fall in PCT of 10.8) in the group of patients who had both IFI+ MDI when compared to other groups (p = 0.047).Summary/Conclusion:PCT level at 24 and 48 hours can be a predictor of severity of infection. High PCT level throughout the course of febrile episode were more suggestive of blood culture positive bacterial infection. Regarding CRP, significant rise from baseline at 48 hrs or CRP&gt;160 mg/dl at 48 hrs were significantly indicative of fungal infection rather than bacterial. PCT or CRP may be a useful adjunct to step down or step up antimicrobials.