Organic Disorders Research Articles

Medical students' knowledge and perception of irritable bowel syndrome in comparison to inflammatory bowel disease.

Gastroenterologists may hold less positive attitudes toward disorders of gut-brain interaction (DGBI) like irritable bowel syndrome (IBS) compared with organic GI disorders like inflammatory bowel disease (IBD). This contributes to worse health outcomes in patients with DGBI and decreased patient satisfaction. Medical student knowledge and perception of these two disorders have not been directly studied. A cohort of medical students (n = 106) completed a survey where they read clinical vignettes about patients with IBS and IBD and answered questions regarding their knowledge of and attitudes toward these two diseases. IBS was perceived as a less real and a more exaggerated disorder when compared to IBD, and patients with IBS were seen as more difficult to treat. With more clinical exposure across 4 years of training, students were more likely to perceive IBS as a "less real" illness, though they held fewer negative attitudes toward patients with IBS. Greater familiarity with both IBS and IBD was associated with fewer negative attitudes. Biases observed in gastroenterologists toward patients with IBS originate as early as the beginning of medical school, including seeing IBS as a "less real" disease and more difficult to treat. Earlier educational interventions may be helpful in identifying and addressing these biases.

Organic Aciduria Disorders in Pregnancy: An Overview of Metabolic Considerations.

Organic acidurias are a heterogeneous group of rare inherited metabolic disorders (IMDs) caused by a deficiency of an enzyme or a transport protein involved in the intermediary metabolic pathways. These enzymatic defects lead to an accumulation of organic acids in different tissues and their subsequent excretion in urine. Organic acidurias include maple syrup urine disease, propionic aciduria, methylmalonic aciduria, isovaleric aciduria, and glutaric aciduria type 1. Clinical features vary between different organic acid disorders and may present with severe complications. An increasing number of women with rare IMDs are reporting successful pregnancy outcomes. Normal pregnancy causes profound anatomical, biochemical and physiological changes. Significant changes in metabolism and nutritional requirements take place during different stages of pregnancy in IMDs. Foetal demands increase with the progression of pregnancy, representing a challenging biological stressor in patients with organic acidurias as well as catabolic states post-delivery. In this work, we present an overview of metabolic considerations for pregnancy in patients with organic acidurias.

DIAGNOSTIC TRENDS IN PATIENTS WITH ORGANIC BRAIN SYNDROME PRESENTING TO TERTIARY PSYCHIATRIC HOSPITAL IN GOA

Organic Brain Syndromes also known as Organic Mental Disorders, are afictions of the brain that can lead to severe behavioural or psychiatric problems. These disorders may be temporary or permanent in nature, and may be attributed to hereditary or caused by disease, injury, or a structural or systemic defect in body chemistry or hormones. Common symptoms include confusion, memory loss, hallucinations, depressive and maniac symptoms. Examples of common Organic Mental Disorders are delirium, amnesia, dementia, hallucinosis and mood disorders. However, diagnosis of dementia was not included as a part of our study as majority of patients usually present with the same which would dilute the distribution of the samples in our study. There is a dearth of literature on organic disorders in psychiatry. Our study highlights the variable presentation and proportions of different organic disorders in subject of psychiatry. Our study attempts to underline the importance of multiaxial diagnosis and physical examination and investigations in patient presenting with psychiatric symptoms.

The effect of psychological therapies on treatment efficacy of temporo-mandibular disorders

Temporomandibular disorders are characterized by high prevalence and difficulty in diagnosis and treatment. Along with organic disorders, psychological factors play an important role in the development and progression of these diseases. The objective of the present study was to evaluate the impact of psychotherapy on the oral health-related quality of life, pain intensity, and treatment completion in patients with temporomandibular disorders. A total of 53 patients (aged 49.0±10.1) with temporomandibular disorders and moderate to high anxiety level participated in this non-randomized clinical study. Patients who agreed to undergo psychotherapy were included in the study group (n=36), while the others were included in the comparison group (n=17). The group with psychotherapy showed a significantly greater decrease in reactive anxiety, pain intensity, and a significantly greater improvement in oral health-related quality of life (total score and scores for physical pain, psychological discomfort, and psycholodical limitation) compared with the group without psychological treatment. The complex treatment including dental treatment and psychotherapy in patients with temporomandibular disorders and anxiety provided higher treatment success than dental treatment alone. In the psychotherapy group, 83% of patients completed treatment fully (11%) or partially (72%), while 59%of patients in the comparison group dropped out before significant improvement was achieved.

Psychiatric Morbidity: A Retrospective Study From a Tertiary Care Center.

Background It is crucial to monitor the psychiatric morbidity patterns of patients to comprehend the burden and trends of mental illness, as well as to create targeted prevention and intervention strategies. Due to the significant regional differences in mental illness, the current study assessed the psychiatric morbidity pattern from a tertiary care center in Central India. Methods We conducted this retrospective record-based study using data from the outpatient department register of the Psychiatry Department of Government Bundelkhand Medical College, Sagar, Madhya Pradesh, India. All records from January to December 2022 were included, while duplicate and incomplete records were excluded. Data from 2005 cases were finalized for analysis after considering inclusion and exclusion criteria. Data abstraction was done for age, gender, marital status, family history of any psychiatric disorder, and diagnosis (according to ICD-10) from the records. Data analysis was conducted using SPSS Version 26.0 (IBM Corp., Armonk, NY). Quantitative data were presented as means ± standard deviation (SD), whereas qualitative data were presented as frequency and percentages. The chi-square test was applied to determine the association, and p-values <0.05 were considered significant. Results The mean age of the patients was 37.2±16.9 years, where the youngest patient was of four years of age and the eldest was 85 years of age. Most patients were males (50.6%), married (61.1%), and from rural areas (71.8%). Mood (affective) disorder (32.4%) was the most common, followed by schizophrenia, schizotypal and delusional disorders (20.0%), and neurotic, stress-related, and somatoform disorders (17.4%). Organic mental disorders and substance use disorders were more common in unmarried individuals and males. Females had higher rates of mood disorders and somatoform disorders, with varying age distributions. Adult personality disorder and mental retardation had equal frequencies among males and females, with different age distributions. Hyperkinetic disorder was more common in males, while headache syndrome was more common in females. Psychiatric disorders were more prevalent in the urban population, except for substance abuse and hyperkinetic disorder. Conclusion Our study highlights the types of psychiatric disorders among patients at a tertiary care center, aiding clinicians in improving care and emphasizing early detection and treatment of mental illnesses.

Survey of psychiatric symptoms among inpatients with COVID-19 using the Diagnosis Procedure Combination data and medical records in Japan

Physical symptoms such as fatigue and muscle weakness, and psychiatric symptoms like depression and anxiety are considered as complications and sequelae of COVID-19. This epidemiological study investigated the actual status of psychiatric symptoms and disorders caused by COVID-19, from four major university hospitals and five general hospitals in Fukuoka Prefecture, Japan, having a population of 5 million. We conducted a survey of psychiatric disorders associated with COVID-19 using Diagnosis Procedure Combination (DPC) data and the psychiatric records of the hospitals. In the study period from January 2019 to September 2021, 2743 COVID-19 admissions were determined from DPC data across the nine sites. These subjects had significantly more anxiety, depression, and insomnia, and were receiving higher rates of various psychotropic medications than controls influenza and respiratory infections. A review of psychiatric records revealed that the frequency of organic mental illness with insomnia and confusion was proportional to the severity of COVID-19 infection and that anxiety symptoms appeared independent of infection severity. These results indicate that COVID-19 is more likely to produce psychiatric symptoms such as anxiety and insomnia than conventional infections.

Diagnosis of psychogenic (functional) gait disorders

Psychogenic gait is common in patients with medically unexplained neurological symptoms and provides significant challenges to healthcare providers. Clinicians may arrive at a correct diagnosis earlier if distinctive positive signs are identified and acknowledged. Psychogenic disorders of posture and gait are common and are the major manifestation in 8–10 % of patients with psychogenic movement disorders. Psychogenic movement disorders can present with varied phenomenology that may resemble organic movement disorders. The diagnosis is based on clinical evaluation with a supporting history and classic features on neurologic examination. In functional gait disorders, walking is often bizarre and does not conform to any of the usual patterns observed with neurologic gait disorders. Astasia-abasia, an inability to stand (astasia) or walk (abasia) in the absence of other neurologic abnormalities, was the term applied by investigators in the mid to late 19thcentury to describe certain patients with a frankly functional gait. Other descriptive terms include gaits that resemble walking on ice, walking a sticky surface, walking through water (bringing to mind excessive slowness), tightrope walking, habitual limping, and bizarre, robotic, knock-kneed, trepidant, anxious, and cautious gaits. Ancillary testing, such as imaging and neurophysiologic studies, can provide supplementary information but is not necessary for diagnosis.

Establishment of Age Specific Reference Interval for Aminoacids and Acylcarnitine in Dried Blood Spot by Tandem Mass Spectrometry.

The Extended Screening for Inborn Errors of Metabolism is done for aminoacidopathies, fatty acid oxidation disorders and organic acid disorders. In a single dried blood spot, the tandem mass spectrometry is capable of measuring multiple analytes like amino acids, acylcarnitines, nucleosides, succinylacetone and lysophosphatidylcholines. This study was proposed to establish age specific reference internal for aminoacids and acylcartinitine in dried blood spot by tandem mass spectrometry. A total of 480 apparently healthy children were enrolled for the study and sub classified into four groups as follows: Group A: 0-1month, Group B: 1month-1year, Group C: 1-5year and Group D: 5-12years each having 120 participants. Sample size were calculated as per CLSI approved guidelines. Tables 1 and 2 presents the age-specific percentile distribution of aminoacids and acylcarnitines established from healthy subjects as per rank-based method recommended by the IFCC and CLSI. Tables 3, 4 and 5 presents the cut-off values of primary and secondary marker/ratios for screening of aminoacidopathies, fatty acid oxidation disorders and organic acid disorders respectively. As a general principle, the interpretation of extended newborn screening results should be based on age specific cut-off established by the laboratory for primary analyte concentration and secondary analyte concentration/ ratios. This study was useful in establishing age specific cut-off values for various amino acids and acylcarnitines in South Indian population. [Table: see text] [Table: see text] [Table: see text] [Table: see text] [Table: see text].

Factors of Anxiety-Affective Symptoms Persistence in Depressions of Various Origins

The aim of study: the current study has been caried out in order to find the anxiety-affective symptomatology persistence duration (AASPD) under standard antidepressants therapy and its neurobiological and premorbid personality predictors in different diagnostic groups.Patients and methods: 191 patients were included into study. Among them 57 patients with organic anxiety affective disorder (OAAD), 41 with endogenous depression (ED), 14 with anxiety neurotic disorder (AND) and 93 with schizophrenia. The Munich personality test and Toronto alexithymia scale were used for assessment of premorbid personality, while SCL-90 and MMSE — for the assessment of psychopathology structure. For the assessment of handedness Annett scale has been used. The product moment correlation analysis was performed for the assessment of relationships between premorbid personality, MMSE and Annett scale score and psychopathology persistence.Results: the symptomatology persistence was maximal in OAAD (21.37 ± 8.33) and smallest in ED (16.27 ± 4.38). Neuroticism correlated positively with AASPD in ED (r = 0.481; р = 0.001). Duration of disorder correlated positively with AASPD (r = 0,286; p = 0.031), while MMSE correlated negatively (r = –0.267; p = 0.045) in OAAD. In AND the negative correlation between MMSE and AASPD (r = –0.585; p = 0.028) and between Annett score and AASPD (r = –0.617; p = 0.032). No stochastically significant correlations were revealed in schizophrenia.Conclusion: the data obtained are important both for further study of the pathogenesis of these disorders and for the prediction and prevention of affective disorders in clinical practice.

Efficiacy of Pharmacotherapy in Patients with Hypothimic Mental Disorders Suffered from Covid-19 Infection

IntroductionIn organic mental disorders in people who have undergone COVID-19, it has been established that the complex use of periciazine in combination with paroxetine, diazepam, 3-hydroxypyridine succinate and hyperbaric oxygenation is superior in effectiveness to traditional therapy with an antipsychotic drug, antidepressant and anxiolytic. The inclusion of 3-hydroxypyridine succinate, hyperbaric oxygenation in the complex therapy of this pathology corrects the concentrations of adrenaline, norepinephrine, dopamine, serotonin in the peripheral blood of patients, eliminates hormonal status disorders and humoral immune responses.ObjectivesThe aim of the work was to optimize approaches to the treatment of hypothymic disorders in organic mental illness, to substantiate the complex use of periciazine in combination with paroxetine, diazepam, 3-hydroxypyridine succinate and hyperbaric oxygenation in patients who underwent COVID-19.MethodsThe object of the clinical study were patients with organic mental disorders who underwent COVID-19. To assess the condition, laboratory research methods were selected taking into account the etio- and pathogenesis of diseases: determining the level of catecholamines, some indicators of humoral immune responses, and the hormonal profile.ResultsTable 2.3 - Nosological structure of patients included in the studyNosological formAssociated hypothymic disorder Number of patientsGender Average age (years)MalesFemalesOrganic mental disorderOrganic anxiety disorder F06.42115628,7±6,3Depressive Episode F3322129Organic mental disorder associated with COVID-19Organic anxiety disorder F06.418153Depressive Episode F331610643,7±7,4ConclusionsIn patients with organic mental disorders, occurring with hypothymic symptoms, compared with healthy donors, there is a complex of disorders in plasma concentrations of catecholamines. Traditional and, to a greater extent, combination therapy increase the levels of serotonin, dopamine, norepinephrine, both in the group of patients who did not have COVID-19, and in those who underwent a new coronovirus infection.In patients with organic mental disorders, occurring with hypothymic symptoms, compared with healthy donors, there is a complex of disorders in plasma concentrations of catecholamines. Traditional and, to a greater extent, combination therapy increase the levels of serotonin, dopamine, norepinephrine, both in the group of patients who did not have COVID-19, and in those who underwent a new coronovirus infection.Complex therapy with periciazine, paroxetine, diazepam in combination with 3-hydroxypyridine succinate and HBO for organic mental disorders causes a more complete reduction of hypothymic disorders both in the group of patients who did not have COVID-19, and in those who underwent a new coronovirus infection.Disclosure of InterestNone Declared

Organic affective disorder due to meningioma, case report

IntroductionBrain tumors can be associated with psychiatric symptoms in up to 50% of cases. The most frequent primary is meningioma and the clinic will depend on its location. Since surgical treatment does not always guarantee complete resolution of the condition, concomitant psychopharmacological treatment is usually recommended.ObjectivesTo review about organic mania and its differential diagnosis.MethodsWe carry out a literature review about organic affective disorder accompanied by a clinical description of one patient with organic mania.ResultsA 50-year-old woman admitted due to psychotic symptoms. She had a diagnosis of frontal and parietal meningioma treated with surgical treatment 10 years ago. In this context she had a diagnosis of Organic Affective Disorder and 3 previous psychiatric admissions due to affective or psychotic symptoms. Current episode consisted in dysphoria, magalomanic ideation, delusional ideation of harm and mystical-religious content, high speech pressure and insomnia with little awareness of the disease. Cranial magnetic resonance showed postoperative right frontal changes and stability in parietal meningioma, with no significant differences compared to the previous study. Diagnosis of Organic Affective Disorder is maintained and reintroduced treatment with aripiprazole withdrawaled by the patient weeks before. Because of adverse effects and persistence of the symptoms described, it was changed to olanzapine with good response and tolerability. The behavior was progressively adapted with improvement of the dysphoria and without psychotic symptoms at discharge.ConclusionsAffective symptons due to organic disorders such as brain tumors can be treated surgically and with psychopharmacological treatment.Disclosure of InterestNone Declared

Influence of sociodemographic factors, diagnostic variations, and phenomenology toward the treatment response in adolescent catatonia in a tertiary care centre in Eastern India

Background: Catatonia remains an area of lesser research especially in the adolescent age group. It has subtle differences in the presentation and background diagnoses as compared to adult catatonia. There is paucity of literatures regarding the role of different sociodemographic and clinical factors attributing to different treatment response. Aims and Objectives: The aim of the study was to assess the association of socio-demographic features, background psychiatric diagnoses, and different catatonic symptoms with treatment outcome of adolescent catatonia. Materials and Methods: The study considered 10–19 years old patients admitted in the in-patient department as per diagnostic and statistical manual diagnosis. They were assessed by Pediatric Catatonia Rating Scale (PCRS) and treated with lorazepam initially with varying dosage and duration. Modified electroconvulsive therapy was administered in resistance. Factors of these two groups were statistically analyzed to assess predictability towards outcome. Results: There were 47 participants with mean age of 16.66±1.21 years of whom 29.8% showed positive family history of different psychiatric illnesses. Most of them came with schizophrenia and related disorders (53.2%), though mood disorders, conversion and organic brain diseases were also there. Among them 30 (63.8%) patients responded to lorazepam treatment. Positive family history, urban background, and catatonic severity in terms of higher PCRS score showed predictability to lorazepam non-response. Clinical features such as stupor, staring, negativism, withdrawal, mutism, urinary incontinence and refusal to eat or drink were associated with non-response, whereas waxy flexibility, stereotypy, verbigeration, and mannerism were seen in the response group. Conclusion: There is need to identify warning signs such as family history, greater symptom load and certain clinical features that can lead to resistance to the treatment with benzodiazepines based on this study. It can necessitate further large-scale study to alleviate disease burden to this young and productive population.

“The cat and the calcium”. A case of delirium secondary to hypercalcaemia.

IntroductionInterconsultation with the psychiatry service is frequently requested from other specialties for the assessment and treatment of patients who present neuropsychiatric symptoms secondary to organic alterations. On the other hand (and in relation to this case), within the possible causes for the elevation of calcaemia figures, the most frequent are hyperparathyroidism and neoplasms, representing between these two entities 90% of cases (1).Among the organic mental disorders, Delirium stands out, with an approximate prevalence between 1 and 2% (general population), which increases in hospitalized and elderly patients (2).ObjectivesPresentation of a clinical case about a patient with delirium secondary to hypercalcemia, with hallucinations and behavioral disturbance.MethodsBibliographic review including the latest articles in Pubmed about delirium (causes and treatment) and hypercalcaemia secondary to neoplasms.ResultsWe present a 52-year-old male patient, who went to the emergency room accompanied by his wife, due to behavioral alteration. Two days before, he had been evaluated by Neurology, after a first epileptic crisis (with no previous history) that resolved spontaneously. At that time, it was decided not to start antiepileptic treatment.The patient reported that he had left his house at midnight, looking for a cat. As he explained, this cat had appeared in his house and had left his entire bed full of insects. His wife denied that this had really happened, and when she told the patient to go to the emergency room, he had become very upset.As background, the patient used to consume alcohol regularly, so the first hypothesis was that this was a withdrawal syndrome. However, although the consumption was daily, in recent months it was not very high, and at that time no other symptoms compatible with alcohol withdrawal were observed (tremor, tachycardia, sweating, hypertension…).We requested a general blood test and a brain scan. The only relevant finding was hypercalcaemia 12.9mg/dL (which could also be the origin of the previous seizure). It was decided to start treatment with Diazepam and Tiapride in the emergency room, with serum perfusion, and keep under observation. After several hours, the patient felt better, the hallucinations disappeared, and calcium had dropped to 10.2mg/dL. A preferential consultation was scheduled, due to suspicion that the hypercalcaemia could be secondary to a tumor process.Image:ConclusionsIt is important to rule out an organic alteration in those patients who present acute psychiatric symptoms. Hypercalcaemia is frequently associated with tumor processes (1) due to secretion of PTH-like peptide (4), so a complete study should be carried out in these cases.Delirium has a prevalence between 1 and 2% in the general population (2).Psychopharmacological treatment is used symptomatically, with antipsychotics (3). For the episode to fully resolve, the underlying cause must be treated.Disclosure of InterestNone Declared

Model of qualification for physical therapy program: experiences from the Mental Health Support Centre in Tarnowskie Góry, Poland.

IntroductionIn terms of physical and mental health benefits, psychiatric rehabilitation requires diverse therapeutic activities offered by an interdisciplinary team. In order for patients to be able to fully participate in social life, it is necessary to strengthen health-promoting activities, control the symptoms and side effects of pharmacological treatment, effectively manage resources and counteract interpersonal and environmental barriers caused by disability. Physical activity and exercise programs answer both psychosocial and biological aspects of health leading to higher self-efficacy, lower self-perceived stigma, longer lifespan and overall better quality of lifeObjectivesThe aim of this study is to present qualification process of adult patients for physical therapy program at the Mental Health Support Centre’s (Centrum Wsparcia Zdrowia Psychicznego, CWZP) daily rehabilitation unit in Tarnowskie Góry.MethodsAdult patients with diverse diagnoses (schizophrenia, affective disorders, anxiety disorders or organic mental disorders) and varied degree of functioning who met the admission criteria were accepted to the ward for a period of 12 weeks. During the stay, a wide range of therapeutic activities was offered, including individual psychological support, group work, art therapy, relaxation sessions, culinary/ dietary workshops, individual training and general fitness group exercises, as well as cognitive training (also via computer-based programs). Due to the COVID-19 epidemic, some of the activities have been limited.ResultsPhysical exercises, just as any treatment, should be offered in appropriate doses. Patients with mental disorders, especially severe mental illnesses, experience many barriers in engaging in physical activity and are under a greater risk of sedentary lifestyle. Thus, for the qualification, exercise tolerance assessment was performed in the form of 6-min Walk Test (6MWT) with Borg scale for subjective fatigue. Through aerobic capacity and endurance assessment patients’ respiratory system, cardiovascular system, and neuromuscular system functions can be evaluated. Functional fitness was assessed through 3 elements of Senior Fitness Test (SFT) (Back Scratch test, Up and go test, Chair Sit-and-Reach test) along with Romberg Test to evaluate the static and dynamic balance as well as flexibility of the upper and lower body.ConclusionsProperly planned and carried out qualification for the physical therapy program allows to adjust the activities to the needs of the patient. Additionally, it can be a tool to evaluate the achieved results at the end of the rehabilitation process.Disclosure of InterestNone Declared

Decreased plasma concentrations of kynurenine and kynurenic acid in schizophrenia patients

IntroductionThe kynurenine pathway of tryptophan catabolism has come into the spotlight of schizophrenia research since its catabolites exert neuroactive effects. A strong body of evidence suggests that kynurenic acid, a catabolite of kynurenine pathway, acts as the only endogenous NMDA receptor antagonist leading to the weakening of circuits in layer III of dorsolateral prefrontal cortex of schizophrenia patients. Studies exploring the levels of kynurenic acid and other metabolites of tryptophan in peripheral blood did not yield any definite conclusions.ObjectivesPrimary objective of this study was to assess differences in concentrations of key constituents of kynurenic pathway in blood plasma – tryptophan (TRP), kynurenine (KYN) and kynurenic acid (KYNA) between schizophrenia patients (SCZ) and healthy controls (HC). Secondary objective was to explore correlations between these concentrations and clinical characteristics.MethodsIn our two-centre prospective case-control study we measured plasma concentrations of TRP, KYN and KYNA in 36 healthy controls (HC) and 38 schizophrenia (SCZ) patients during acute exacerbation and remission and explored the correlations with clinical parameters using PANSS scale. The patients were matched with HC by age, sex and body mass index and exclusion criteria included obesity class 2 or higher, any concomitant organic mental or neurological disorder, acute or chronic inflammatory disease, and use of immunomodulatory drugs or psychoactive substances.ResultsTRP concentrations were significantly higher in HC than in SCZ patients in acute phase (p&lt;0,001) and remission (p&lt;0,001), while SCZ patients in acute phase had significantly higher TRP levels than in remission (p&lt;0,01). Levels of KYNA and KYN were significantly lower in SCZ patients than in HC both in acute phase and remission, all with high statistical significance (p&lt;0,001). There was no statistically significant difference between acute phase and remission neither for KYN (p&gt;0,05), nor for KYNA (p&gt;0,05). There was no correlation of plasma levels of TRP, KYN and KYNA with total PANSS score, PANSS positive scale score, PANSS negative scale score and PANSS general psychopathology scores, both in acute phase and remission (p&gt;0,05). Also, there was no correlation between plasma levels of TRP, KYN and KYNA in SCZ patients in remission with improvements measured with PANSS scale (p&gt;0,05).ConclusionsAlthough there are concerns about the value of measurement of metabolites of kynurenine pathway in the peripheral blood, our data suggest that significantly decreased levels of KYN and KYNA could suggest that disrupted TRP degradation in SCZ patients may be reflected in the peripheral blood as well. Further studies of peripheral levels of kynurenine pathway metabolites on larger samples should also explore effects of antipsychotic therapy, but also their correlation with other clinical parameters such as neurocognition.Disclosure of InterestNone Declared

Biomarker Variability, Severity of CORADS and Impact of Psychotropic Medications on Course and Outcome of Neuropsychiatric Sequalae of COVID-19 ICU Patients: A Preliminary Observation from South India

IntroductionThere is growing evidence of neuropsychiatric presentations in patients of COVID-19, but literature is scarce on laboratory, clinical and radiological markers as well as impact of psychotropic medications during the course of hospitalization in critically ill patients.ObjectivesThe primary outcome measure was variability of clinical biomarkers and CORADS scores with severity of COVID-19 infections and the impact of psychotropic medications like risperidone and aripiprazole.MethodsWe screened 430 ICU patients admitted to our tertiary care hospitals, out of whom 67 were diagnosed positively with definitive neuropsychiatric sequalae and receive psychotropic interventions during their hospital stay. We compared their D-dimer levels, C-reactive proteins, serum ferritin levels, serum procalcitonin and Vitamin D levels and further analyzed CORADS severity score with psychiatric severity and outcome.ResultsThe mean age of the patients was 42.38 years, majority (44.8%) of them belonged to 21-34 years with slight (52.2%) male preponderance and none of them were more than 60 years. We observed a 43.3% were having organic mood disorder and 37.3% of individual had significant history of alcohol dependence while hypertension and diabetes mellitus were noted in 34.3% and 29.9% respectively. Only D-dimer levels were found to be significant and positively associated with outcome of psychiatric disorders (p&lt;0.05), accounting for 41% of covariance on linear regression analysis.ConclusionsOur study has found significant association of elevated levels of D-dimer variability but not the other laboratory biomarkers among various neuropsychiatric comorbid sequalae in ICU admitted COVID 19 patients. This particular observation might have potential for serum D-dimer levels to be possibly used as an early biomarker to screen or suspect for comorbid neuropsychiatric presentations.Disclosure of InterestNone Declared

Catatonia in depressive disorder, more usual than it is supposed to be

IntroductionCatatonia is a psychomotor syndrome characterized by various motor, affective and behavioral symptoms. It can occur as a cause of various underlying organic and psychiatric disorders. In Psychiatric nosology is used to specify a subtype of the disorder underlying.Unlike what was assumed in the past, today it is accepted that catatonia is more frequent in affective disorders than in schizophrenia. But despite this, diagnosis and treatment are still late in affective cases on many occasions.Objectives -A case of catatonia is presented to review the diagnostic difficulties that can sometimes entail.-Review treatment algorithm.MethodsWe present the case of a 62-year-old woman, initially diagnosed of major depressive symptoms with psychotic symptoms, showing no response to different treatments, evolving to catatonia, which is diagnosed after screening for neurological and medical diseases.ResultsThe patient had an adequate evolution after the withdrawal of antipsychotics and the application of ECT (Electroconvulsive therapy).Conclusions- It is important to carry out an adequate screening, because many times the symptoms are caused by medical or neurological diseases.-Catatonia has a good prognosis with an early treatment, but it may increase the risk of mortality after 5 days from the onset of symptoms.-It is important to avoid the use of antipsychotics or other dopamine blockers. The use of benzodiazepines and ECT is indicated.Disclosure of InterestNone Declared

Clinical Recovery and Long-Term Association of Specialized Early Intervention Services vs Treatment as Usual Among Individuals With First-Episode Schizophrenia Spectrum Disorder

The OPUS 20-year follow-up is the longest follow-up of a randomized clinical trial testing early intervention services (EIS) among individuals with first-episode schizophrenia spectrum disorder. To report on long-term associations of EIS compared with treatment as usual (TAU) for first-episode schizophrenia spectrum disorder. A total of 547 individuals were included in this Danish multicenter randomized clinical trial between January 1998 and December 2000 and allocated to early intervention program group (OPUS) or TAU. Raters who were blinded to the original treatment performed the 20-year follow-up. A population-based sample aged 18 to 45 years with first-episode schizophrenia spectrum disorder were included. Individuals were excluded if they were treated with antipsychotics (>12 weeks prior to randomization), had substance-induced psychosis, had mental disability, or had organic mental disorders. Analysis took place between December 2021 and August 2022. EIS (OPUS) consisted of 2 years of assertive community treatment including social skill training, psychoeducation, and family involvement by a multidisciplinary team. TAU consisted of the available community mental health treatment. Psychopathological and functional outcomes, mortality, days of psychiatric hospitalizations, number of psychiatric outpatient contacts, use of supported housing/homeless shelters, symptom remission, and clinical recovery. Of 547 participants, 164 (30%) were interviewed at 20-year follow-up (mean [SD] age, 45.9 [5.6] years; 85 [51.8%] female). No significant differences were found between the OPUS group compared with the TAU group on global functional levels (estimated mean difference, -3.72 [95% CI, -7.67 to 0.22]; P = .06), psychotic symptom dimensions (estimated mean difference, 0.14 [95% CI, -0.25 to 0.52]; P = .48), and negative symptom dimensions (estimated mean difference, 0.13 [95% CI, -0.18 to 0.44]; P = .41). The mortality rate was 13.1% (n = 36) in the OPUS group and 15.1% (n = 41) in the TAU group. Likewise, no differences were found 10 to 20 years after randomization between the OPUS and TAU groups on days of psychiatric hospitalizations (incidence rate ratio, 1.20 [95% CI, 0.73-1.20]; P = .46) or number of outpatient contacts (incidence rate ratio, 1.20 [95% CI, 0.89-1.61]; P = .24). Of the entire sample, 53 participants (40%) were in symptom remission and 23 (18%) were in clinical recovery. In this follow-up study of a randomized clinical trial, no differences between 2 years of EIS vs TAU among individuals with diagnosed schizophrenia spectrum disorders at 20 years were found. New initiatives are needed to maintain the positive outcomes achieved after 2 years of EIS and furthermore improve very long-term outcomes. While registry data was without attrition, interpretation of clinical assessments are limited by high attrition rate. However, this attrition bias most likely confirms the lack of an observed long-term association of OPUS with outcomes. ClinicalTrials.gov Identifier: NCT00157313.

Incidence and genetic variants of inborn errors of metabolism identified through newborn screening: A 7-year study in eastern coastal areas of China.

The incidence of inborn errors of metabolism (IEM) varies across countries and areas. Currently, there are no studies on IEM using newborn screening (NBS) in eastern coastal areas of China. We aimed to estimate the incidence and genetic variants of IEM and understand the spectrum of diseases caused by IEM and variants among them in this area. The NBS performed by tandem mass spectrometry (MS/MS) from 2016 to 2021 was retrospectively reviewed. Heel blood was collected from all newborns 72 h after birth. Targeted massively parallel sequencing was performed for genetic analysis. Among 245,194 newborns, 95 were diagnosed with IEM, the overall incidence observed was-IEM: 1/2581; amino acid metabolism disorder: 1/4715; organic acid metabolism disorder: 1/11676; and fatty acid metabolism disorder: 1/11145. The incidence of different IEM was in the range of 1/245194 to 1/6452. Phenylketonuria (PKU, 1/7211) was the most common IEM, followed by methylmalonic acidemia (MMA, 1/27244), short-chain acyl-CoA dehydrogenase deficiency (SCADD, 1/30649), and citrin deficiency (CD, 1/35028). For genetic variants, the common hotspot variants found were-PAH gene for PKU: c.728G > A, c.442-1G > A, c.611A > G, c.721C > T; PTS gene for non-classical PKU: c.259C > T; MMACHC gene for MMA: c.658_660delAAG, c.609G > A; MMUT gene for MMA: c.1663G > A; ACADS gene for SCADD: c.1031A > G and c.1130C > T; and SLC25A13 gene for CD: c.1638_1660dup, c.852_855del. This study displayed the diseases and varied spectrum of IEM in eastern coastal areas of China. Implementing NBS for IEM by MS/MS combined with massively parallel sequencing can offer an improved plan for NBS to detect IEM.

Frequency of Depression in Patients Suffering from Non-Epileptic Fits

Introduction: The most prevalent and severe type of mental disease, depression affects 60–70% of adults, primarily between the ages of 15 and 35. Not only are the patients affected by this terrible disorder, but also their care givers and families. It has long been known that depression often manifests as a variety of psychosomatic conditions, one of which is non-epileptic fits, which are typically more common in children and women than men. Therefore, the majority of patients who present to a psychiatric emergency room, outpatient department, or ward having non-epileptic fits have underlying depression. This was one of the few studies conducted on the prevalence of depression in patients experiencing non-epileptic fits in Pakistan, particularly in province, Khyber Pakhtunkhwa. Study Design and Study Area: In the psychiatry department of Khyber Teaching Hospital Peshawar, this descriptive cross-sectional study was conducted. Duration of Study: The duration of study was 06 months i.e. from 30th march, 2015 to 30th September, 2015. Materials and Methods: The study included 162 patients who presented to the hospital with non-epileptic fits and had ages ranging from 20 to 40 years. The study excluded non-consenting individuals, those with organic brain disorders, and those who had another psychiatric diagnosis already. On a proforma that was especially created, variables were recorded. The BDI depression scale was used to evaluate the depression screening process. Results: Of 193 patients, 162 met the requirements for study. The patients were estimated to have a mean age of 25.44 years, with a standard deviation of 14.25 years. Only 32 patients (20%) were female, while remaining 130 (80%) patient were male. Majority 88 (56%) individuals were uneducated. 46 people (32%) had education up to the primary level, 14 (8%) were matriculating, and 12 (4%) were graduates. 40 people (25%) were single, 94 people (58%) were wed, and 28 people (17%) were widows or widowers. 30 people (19%) were working and 132 (81%) were unemployed. 62 persons had been seeking care for more than 24 months, compared to 8 who had been doing so for less than 24 months, 20 persons for less than 18 months, 14 patients having duration of illness for less than 12 months and 12 patients of less than 6 months period of illness. Only when non-epileptic fits were linked to the depression (p value 0.004) was statistical significance observed. When depression was compared to the patient's gender, marital status, educational attainment, length of care, and occupation, there was no statistically significant difference. Conclusions: The majority of people who have non-epileptic fits also have depression. Age of onset of non-epileptic fits and depression are significantly correlated, whereas gender, educational level, marital status, occupation, length of illness, and patient's family history are not. Keyword: Psychological distress, depression, non-epileptic fits, KTH.