Psychiatric Antecedents Research Articles

Psychotic Depression, Mannerisms and Alzheimer’s Disease: a case report

IntroductionWe present the case of a 56-year-old patient with two depressive episodes with psychotic symptomatology in a period of three years, who began with mania and developed Alzheimer’s disease.ObjectivesThe case is presented with the aim of providing a brief review of psychiatric symptomatology as a prodrome of Alzheimer’s disease.MethodsA 56-year-old patient, with no psychiatric antecedents of interest, who presented a depressive episode with psychotic symptoms, requiring admission to a short hospitalisation unit, as well as antidepressant treatment with sertraline at 200mg daily and olanzapine 20mg. He remained stable for two years and was able to withdraw treatment progressively. However, after remaining euthymic without pharmacological treatment for six months, he had another episode with psychotic symptoms. In this last episode, he did not require hospital admission, but he did require a change in antidepressant treatment, given that he did not tolerate treatment with sertraline. Treatment was therefore started with duloxetine 120mg, aripiprazole 20mg and as no clear improvement was observed, months later it was decided to use lamotrigine 100mg as a stabiliser.ResultsIn this last episode, despite the significant affective improvement and maintaining psychopathological stability, without presenting psychotic symptoms, the patient presented marked dysfunction in day-to-day life due to a striking attention deficit, lack of concentration and reduced short-term memory. At the same time, he also exhibits mannerisms which are observed in the consultation room, in the form of repetitive hand movements.For these reasons, it was decided to request MRI and SPECT, obtaining results compatible with possible incipient cognitive deterioration.ConclusionsIt seems that up to 40% of patients with dementia have depressive symptoms. It seems that depression at an advanced age may in fact be a prodromal symptom of dementia.Disclosure of InterestNone Declared

Racial differences in pathways to care preceding first episode mania or psychosis: a historical cohort prodromal study.

There is evidence suggesting racial disparities in diagnosis and treatment in bipolar disorder (BD) and schizophrenia (SZ). The purpose of this study is to compare psychiatric diagnoses and psychotropic use preceding a first episode of mania (FEM) or psychosis (FEP) in racially diverse patients. Using a comprehensive medical records linkage system (Rochester Epidemiology Project, REP), we retrospectively identified individuals diagnosed with BD or SZ and a documented first episode of mania or psychosis. Illness trajectory before FEP/FEM were characterized as the time from first visit for a mental health complaint to incident case. Pathways to care and clinical events preceding FEP/FEM were compared based on subsequent incident case diagnosis (BD or SZ) and self-reported race (White vs. non-White). A total of 205 (FEM = 74; FEP = 131) incident cases were identified in the REP. Duration of psychiatric antecedents was significantly shorter in non-White patients, compared to White patients (2.2 ± 4.3 vs. 7.4 ± 6.6 years; p < 0.001) with an older age at time of first visit for a mental health complaint (15.7 ± 6.3 vs. 11.1 ± 6.0 years; p = 0.005). There were no significant differences by race in FEM pathway to care or age of first seeking mental health. Overall non-White patients had lower rates of psychotropic use. These data are unable to ascertain reasons for shorter duration of psychiatric antecedents and later age of seeking care, and more broadly first age of initial symptom presentation. If symptoms are confirmed to be earlier than first time seeking care in both groups, it would be important to identify barriers that racial minorities face to access timely psychiatric care and optimize early intervention strategies.

Self-injury and Its Criminal Correlates among Hungarian Juvenile Offenders

Self-injury is an important problem in incarcerated populations worldwide. This behaviour may be explained by circumstantial factors as incarceration per se may trigger stress responses that result in suicide and other forms of self-harming. On the other hand, certain psychiatric disorders are associated with an increased risk of self-injury and recent findings suggest that psychiatric disorders are highly prevalent in prison and reformatory populations. As a first attempt to study this issue in Hungarian underage criminals, we investigated the prevalence of self-injury and suicidal ideation in reformatory institutions. These were established in 84 incarcerated male juvenile offenders by the MINI KID structured psychiatric inventory. The study lasted 2 years. About one sixth (16.66%) of offenders had a suicidal history. More than half showed self-harming behaviour (N = 47, 55.95%) and 5 subjects reported suicidal ideation at the time of the assessment (5.95%). The suicidal tendency did not reach the level of actual life-threatening condition in any participant. These findings show that self-harming behaviour is rather frequent in the correctional system and requires further research, e.g. studies on the psychiatric antecedents of this behaviour. The findings of such studies may be applicable both in practice and in the education of law enforcement professionals.

Antecedents to first episode psychosis and mania: Comparing the initial prodromes of schizophrenia and bipolar disorder in a retrospective population cohort

ObjectiveWe aim to compare the psychiatric antecedents of schizophrenia (SZ) and bipolar disorder (BD). MethodsUsing the Rochester Epidemiology Project, we searched for residents of Olmsted County that had a diagnosis of SZ or BD. We confirmed each case using DSM-5 criteria and obtained the psychiatric antecedents. ResultsWe identified 205 cases with first episode psychosis or mania (SZ = 131; BD = 74). The mean age at first visit for mental health reasons was 12.3 ± 6.3 years for SZ and 13.9 ± 5.6 years for BD. The duration of the initial prodrome (time from first mental health visit to first episode) was similar for both groups (SZ 8.3 ± 6.2 years vs BD 7.3 ± 5.9 years). We found that SZ and BD have overlapping antecedents, but SZ was more common in males and in foreign born and had more learning deficits before the first episode. BD was more common in white population and had higher rates of depressive and adjustment disorders prior to first episode. BD also had more affective symptoms, nightmares, and panic attacks before the first episode. Both groups had similarly high rates of substance use (SZ 74 % vs BD 74.3 %), prescription of antidepressants (SZ 46.6 % vs BD 55.4 %) and stimulants (SZ 30.5 % vs BD 22.9 %). ConclusionsThe psychiatric antecedents of SZ and BD usually start during adolescence, overlap, and present in unspecific ways. The initial prodromes are more alike than distinct. Further studies are encouraged to continue looking for specific factors that distinguish the antecedents of these two disorders.

Self-reported psychotic-like experiences: differences by age and associated psychopathology

This study aims to explore the differences in psychopathological symptoms that may exist in the general adult population with or without psychotic-like experiences (PLEs), depending on the age range. The presence of PLEs, self-reported general psychopathological symptomatology, and different sociodemographic and psychosocial characteristics were assessed in 216 participants without any record of personal psychiatric antecedents. The sample was divided into young adults (18-35 years) and mature adults (36-60 years). The young adults showed a higher expression of PLEs (33.6%). The mature adults with PLEs presented more psychopathological symptoms in the dimensions of hostility-anger, somatization, depression, and anxiety than mature adults without PLEs. Young adults with PLEs showed significantly more symptoms in the same dimensions, and in the obsession-compulsion dimensions, paranoid ideation, and psychoticism, than participants of this age without PLEs. PLEs are more frequent in people between 18-35 years old; however, PLEs can be present in different age ranges and could serve as an alert to high levels of affective and anger-hostility symptoms.

DEPRESSIONAND RELATED FACTORS AMONG MOROCCAN BREAST CANCER PATIENTS: RESULTS OF ACROSS-SECTIONAL STUDY

Introduction: Depression is frequently associated with breast cancer. Although its prevalence and its impact on patientsquality of life are far from negligible, depression is often under-diagnosed and less treated. Objectives: Our study aims to estimate the prevalence of depression in breast cancer patients, to describe their socio-demographic and clinical profile, and to determine the factors associated with this depression. Material and Methods: We carried out a cross-sectional, descriptive and analytical study, conducted from October to December 2021 at the Mohammed IV Cancer Treatment Center. The survey included 100 breast cancer patients. It was conducted using an anonymous questionnaire and the Beck scale to diagnose depression and to assess its severity. Results: Depression in a major form was diagnosed in 52% of breast cancer patients. Age under 40, psychiatric antecedents, metastatic breast cancer, refusal of treatment, heavy treatment regimens and the alteration of the conjugal relationshipwere the factors most associated with higher prevalence of depression in these patients. In the light of what has been demonstrated in the analytical study, we note that the occurrence of a major depressive episode is significantly correlated with the following parameters - Age ranging between 20 and 40 years. - Metastatic spread of breast cancer. - Negative attitude of the spouse. - Relapse of the cancerous disease. Discussion and Conclusion: The high prevalence of depression in breast cancer patients as well as the influence of personal characteristics and treatment in the occurrence of this ailment have been confirmed by several authors. We propose some suggestions to improve the psycho-oncological care of patients with breast cancer, in order to prevent the occurrence of depression in this population.

Identification de facteurs associés à un faible recours aux soins spécialisés en psychiatrie. À propos de 516 cas d’expertises psychiatriques réalisées dans le cadre du Comité médical départemental de Martinique

ObjectiveMental illness is noted for being in one of the first places in global burden of disease in terms of years lived with disability (YLDs). Notably, absences due to mental health problems greatly affect the world of work, and mental illness is one of the most economically important diseases. However, there is a high rate of those not seeking care in mental health, both in the general population but also in workers in private and public sectors with significant economic impacts. The aim of our study was to identify factors associated with low access to specialized psychiatric care among French Public Sector employees referred to a psychiatric expertise upon request from the Departmental Medical Board of Martinique (Comité médical départemental [CMD] de Martinique), between 2000 and 2013. MethodsWe carried out an observational and transversal study, analyzing sociodemographic and clinical data from psychiatric assessments done to help the CMD give notification on the medico-administrative situation of Public Sector employees, a large majority of whom had been on sick leave due to mental health for at least 6 months. The variable of interest – low access to psychiatric care – was defined as the absence of consultation at the time of the assessment provided by a psychiatrist since at least 12 months. Descriptive analyses were performed first, then univariate analysis using a non-adjusted binary logistic regression model, to identify factors associated with low access to psychiatric care. Finally, multivariate analyses using a binary logistic regression model were performed after excluding non-relevant factors (with significance level above 5%) during the univariate analysis. A significance threshold of 0.05 was adopted for all of the statistical analyses. ResultsWe retrospectively analysed the records of 516 Public Sector employees. Two hundred and ninety-three subjects (57% of the population) had a low access to psychiatric care as part of their regular clinical follow-up, even the 81% who were identified has having had psychiatric antecedents (55% with ‘mood disorders’, and 17% with ‘neurotic, stress-related and somatoform disorders’). Moreover, psychiatric expertise found a psychiatric diagnostic in 96 % of cases, mostly ‘mood disorders’, ‘neurotic, stress-related and somatoform disorders’ and ‘personality disorders’. For mood disorders, clinical characteristics of episodes were defined as ‘severe’ or ‘with psychotic symptoms’ in many cases. Suicidal thoughts were found in 96 subjects (18%) during the expertise. Fewer than half of the subjects (43%) had a specialized psychiatric care (mostly subjects with ‘mood disorders’ and ‘psychotic disorders’) and 41% only had care by a general practitioner (mostly subjects with ‘neurotic, stress-related and somatoform disorders’). In most of the cases, psychotropic drugs were insufficiently and inadequately prescribed. Using multivariate analysis, we found a significant association between low access to psychiatric care and: being masculine, having had more than two children, having had personal life events (in particular chronic somatic diseases), and having had no history of mental illness or of psychiatric hospitalization. It appears that chronic somatic diseases are frequently associated with psychiatric diseases, and the association worsens the prognosis of the two disorders. However, even if employees with mental disorders associated with chronic somatic diseases are unfit for work, many of them do not have access to mental health care and only have care by a general practitioner. ConclusionMore than half of French Public Sector employees referred to the Departmental Medical Board of Martinique for a medico-administrative decision relevant to sick leave due to mental diseases, had low access to specialized psychiatric care. By identifying barriers to care and reasons for not seeking specialized mental health care, we would be able to prevent disability claims and days off work (predicting malaise in the workplace and health-related limitations). Our results demonstrate the need to strengthen existing partnerships, and thus enhancing cooperation between public psychiatric sectors and primary healthcare players, facilitating access to mental healthcare and decreasing the stigma about mental disorders.

Chest pain in a pediatric emergency department: clinical assessment and management reality in a third-level Portuguese hospital.

Background:Chest pain in children and adolescents is a common complaint in the emergency department (ED), being mostly benign. A thorough patient history and physical examination should be enough in most cases for its proper management. Regarding non-cardiac chest pain, anxiety plays an important role.Methods:Retrospective analysis of all admissions in a pediatric ED of a Portuguese third-level hospital with a chief complaint of chest pain between January and December 2018. Chi-square test was used to compare different etiologies, considering a significance level of 5%.Results:A total of 798 visits were included: 53.6% girls, 80.8% adolescents (mean age: 13years old). According to the Pediatric Canadian Triage and Acuity Scale, 77.7% was prioritized as level IV: less urgent; 65.3% reported associated symptoms including dyspnea (31.8%), cough (18.2%), and palpitations (16.1%). In physical examination, 45.5% had alterations: 62.8% with chest wall tenderness. Further investigation was done in 84% of patients: 62.4% electrocardiograms (altered in 14.7%), 52.6% chest radiographies (altered in 17.1%) and 8.9% cardiac biomarkers (altered in 12.7%). The 3 main causes of chest pain were musculoskeletal (33%), idiopathic (24.4%) and psychogenic (21.6%), with 1.1% of cardiac etiology. Less than 3% needed hospital admission and 18.9% were oriented to an outpatient consultation. 7.1% readmissions reported. When compared to other causes as a group, psychogenic chest pain presented a statistically significant association with female sex, adolescence, psychiatric antecedents, previous stressful event, and normal physical examination. Of these, <30% were oriented to a pedopsychiatry/psychology consultation.Conclusions:Opposing to the low priority level in triage, benign diagnosis found, and low hospital admissions, there was a high percentage of complementary diagnostic tests performed with few altered results. In psychogenic chest pain there was a low postdischarge referral. The authors highlight the importance of clinical algorithms to reduce unnecessary tests performed and readmissions and improve orientation and follow-up, particularly in psychogenic etiology.

Psychosis developed on a travel to china – a case report

IntroductionPsychosis it is a serious medical condition that could happen to anyone while travelling, even without a prior history of mental illness. Some psychotic episodes during travel likely are brief psychotic disorders. This is a poorly understood subject that seems to have an increasing incidence.ObjectivesThis work aims to present a clinical case of a patient who developed psychotic symptoms on her visit to China, and to provide a brief update review of this subject.MethodsWe describe a case based on patient’s history and clinical data. We also searched and reviewed cases on “travel” AND “psychosis” and “tourist” AND “psychosis” using PubMed® database.ResultsWe report the case of a 41-year-old woman without psychiatric antecedents or substance use who developed psychotic symptoms during a travel to China. Symptoms resolved completely soon after returning to Portugal and admission to the psychiatric emergency service where an antipsychotic treatment was initiated. Psychosis in tourists typically occur in destinations with strong symbolic or mystical connotations and in individuals who travel alone for several days. The most common symptoms are hallucinations, delusions, ideas of reference and agitation. Most patients improved and returned to previous functioning.ConclusionsTo improve the knowledge of travel-related psychosis it is important to identify the cases and the associated biological and clinical factors, later on it may be possible to identify the predictive factors of these psychosis. Further research are necessary to establish a possible association between brief psychotic episode and travel to China, as reports for tourists to Jerusalem and to Florence.DisclosureNo significant relationships.

The role of social cognition skills and social determinants of health in predicting symptoms of mental illness

Social factors, such as social cognition skills (SCS) and social determinants of health (SDH), may be vital for mental health, even when compared with classical psycho-physical predictors (demographic, physical, psychiatric, and cognitive factors). Although major risk factors for psychiatric disorders have been previously assessed, the relative weight of SCS and SDH in relation to classical psycho-physical predictors in predicting symptoms of mental disorders remains largely unknown. In this study, we implemented multiple structural equation models (SEM) from a randomized sample assessed in the Colombian National Mental Health Survey of 2015 (CNMHS, n = 2947, females: 1348) to evaluate the role of SCS, SDH, and psycho-physical factors (totaling 17 variables) as predictors of mental illness symptoms (anxiety, depression, and other psychiatric symptoms). Specifically, we assessed the structural equation modeling of (a) SCS (emotion recognition and empathy skills); (b) SDH (including the experience of social adversities and social protective factors); (c) and classical psycho-physical factors, including psychiatric antecedents, physical–somatic factors (chronic diseases), and cognitive factors (executive functioning). Results revealed that the emotion recognition skills, social adverse factors, antecedents of psychiatric disorders and chronic diseases, and cognitive functioning were the best predictors of symptoms of mental illness. Moreover, SCS, particularly emotion recognition skills, and SDH (experiences of social adversities, familial, and social support networks) reached higher predictive values of symptoms than classical psycho-physical factors. Our study provides unprecedented evidence on the impact of social factors in predicting symptoms of mental illness and highlights the relevance of these factors to track early states of disease.

The Role of Social Cognition Skills (SCS) and Social Determinants of Health (SDH) in Predicting Symptoms of Mental Illness

Background: Social factors, such as social cognition skills (SCS) and social determinants of health (SDH), may be vital for mental health, even when compared with classical psycho-physical predictors (demographic, physical, psychiatric, and cognitive factors). Although major risk factors for psychiatric disorders have been previously assessed, the relative weight of SCS and SDH in relation to classical psycho-physical predictors in predicting symptoms of mental disorders remains largely unknown. Methods: In this study, we implemented multiple structural equation models (SEM) from a randomized sample assessed in the Colombian National Mental Health Survey of 2015 (CNMHS, n=2,947) to evaluate the role of SCS, SDH and psycho-physical factors (totaling 17 variables) as predictors of mental illness symptoms (anxiety, depression and other psychiatric symptoms). Specifically, we assessed the structural equation modeling of (a) SCS (emotion recognition and empathy skills); (b) SDH (including the experience of social adversities and social protective factors); (c) and classical psycho-physical factors, including psychiatric antecedents, physical-somatic factors (chronic diseases), and cognitive factors (executive functioning). Findings: Results revealed that emotion recognition skills, social adverse factors, past medical history of psychiatric disorders, the presence of chronic diseases and cognitive functioning were the best predictors of symptoms of mental illness. Moreover, SCS, particularly emotion recognition skills, and SDH (experiences of social adversities, familial and social support networks) reached higher predictive values of symptoms of mental illness than classical psycho-physical factors. Interpretation: Our study provides unprecedented evidence on the impact of social factors in predicting symptoms of mental illness and highlights the relevance of these factors to track early states of disease. Funding Statement: AI is partially supported by CONICET, CONICYT/FONDECYT (Regular 1170010 and 1171200), FONDAP (15150012), the INECO Foundation, PICT (2017-1818 and 2017- 1820), the Inter-American Development Bank (IDB), the Global Brain Health Institute (GBHI), GBHI ALZ UK-20-639295, and NIH/NIA R01 AG057234. This study has been partially supported by Colciencias Colombia and the Ministerio de Salud Colombia, Grant 762-201. Declaration of Interests: The authors declare neither competing financial interests nor other conflicts of interest. Ethics Approval Statement: The study was approved by the institutional ethics committee.

Somatic delusional disorder in a patient with idiopathic normal pressure hydrocephalus

Background: The delusional disorder represents one of the most difficult psychiatric disorders in terms of treatment and management because of the beliefs and convictions presented by the patient, the absence of insight and also the treatment-resistance. Of these, the somatic delusion or the hypochondriac delusion represent that situation in which the patient presents the conviction that certain parts of his body doesn`t work properly and that some parts of its have exaggerated or diminished dimensions or they present various unpleasant olfactory and tasteful features. One of the specificities of this disorder is represented by the non-bizarre character of the delusion in contrast to the others bizarre delusions specific to schizophrenia but which the patient supports without a doubt in contrast to the somatoform disorder. (1) Purpose and methods: The purpose of the presentation is to highlight the evolution of such a somatic delusion disorder and the challenges met throughout the diagnosis and investigation processes corroborating the brain changes we found with the prognosis of the current disorder. Description of the case: D.E. is a 64 years old woman presenting in our clinic having in her psychiatric antecedents only one admission until now and which presents a delusion somatic disorder consisting of T8-T10 located vertebral-thoracic hyperalgesia accompanied by depressive mood with anhedonia, high-intensity anxiety and abulia. The patient argues that she suffered a thoracic-lumbar trauma by falling from the same level 8 years ago and since then the somatic complaints appeared. All this time the patient underwent three surgeries located at the vertebra-thoracic level, without a consistent improvement of the symptoms. At the cerebral computerized tomography performed in our clinic is highlighted a normal pressure hydrocephalus. Following psychotropic treatment and various inter-clinical consultations the patient exits our service with an improved affective status and a still maintained but low-intensity somatic delusion. Conclusions: It is necessary that the somatic delusion disorder be strictly differentiated by the somatoform disorder and the major depressive disorder with somatic complaints. Also, the differential diagnosis of the possible somatic etiologies must be taken into account. In this regard the psychiatric interview and the brain changes highlighted paraclinically may be essential in the diagnosis and the future evolution of the psychiatric disorder.

Determinants of suboptimal medication adherence in patients with a major depressive episode.

Major Depression (MD) is often a chronic condition requiring a long-term pharmacologic treatment. Despite the efficacy of antidepressants, the medication adherence in those affected is usually very poor. In this scenario, further research concerning drivers of suboptimal adherence is needed. We aimed to explore medication adherence in patients with a MD episode, and to identify sociodemographic, clinical (psychiatric antecedents, comorbidities, medication, pain, and medication side effects), and psychosocial factors (negative life events, childhood trauma, and attitudes to medication) related to adherence status. The Medication Adherence Rating Scale (MARS) was completed by 370 patients at hospital admission. Participants were divided into groups of optimal and suboptimal adherence based on the medication adherence behavior score (MARS's factor 1), and were compared with respect to the study variables. Twenty-nine percent of participants (n=107) were found to be optimally adherents to their medication (score=4/4). Compared to optimally adherents, suboptimally adherents (71%) presented a significantly higher depression severity, more psychiatric hospitalizations, suicidal ideation, physical pain, negative medication side effects, and antecedents of emotional maltreatment. Suboptimally adherents also had less favorable attitudes toward medication and were less in a relationship than optimally adherents. Multivariate analyses showed that depression severity, suicidal ideation, and physical pain increase the probability of belonging to the suboptimal adherent group. These results suggest a vicious circle in which more vulnerable patients are less adherent to medication, which could worsen the clinical picture maintaining, in turn, low adherence. More efforts are needed to develop interventions aiming to improve medication adherence in MD patients.

Impact of oil recession on community mental health service utilization in an oil sands mining region in Canada.

This retrospective clinical audit compared changes in community mental health service utilization before and during an economic recession in an oil sands region in Canada which was characterized by a doubling of unemployment rates and poor economic outlook. Sociodemographic descriptors, psychiatric antecedents, clinical characteristics and follow-up care were compared before and during the recession for newly assessed patients in community mental health clinics located across a Northern Alberta oil mining region. Data were collected retrospectively as part of a clinical audit process and then analysed with descriptive statistics, cross-tabular univariate analyses with chi-square tests using SPSS version 20. A total of 1,465 patients were included. Sociodemographic factors disproportionately elevated during the recession included male sex, Caucasian ethnicity, own home ownership, higher levels of education and unemployment. More patients seeking mental health care were already taking psychotropic medications (e.g. antipsychotics, benzodiazepines and stimulants). At the same time, disproportionately fewer patients engaged in substance abuse or had a prior formal history of mental health problems. The referral reasons during recession were less likely to be associated with substance abuse or mood concerns and more likely for 'other' reasons. The patients seeking psychiatric help during a recession were disproportionately likely to be diagnosed with personality disorders and 'other' less common diagnostic categories and less likely to suffer from mood or trauma-related diagnoses. Referrals for counselling and social services were also disproportionately more common during the recession. This study provides a comprehensive description of longitudinal patterns of mental health service utilization before and during a recession. The findings provide important evidence for policy and planning decisions to encourage resource allocation to help promote accessibility of the most needed community mental health resources.

BASIC EMOTIONS, EXECUTIVE FUNCTIONS AND SOCIAL COGNITION IN PATIENTS AFTER STROKE

Alterations in executive functions (EF) constitute a common cognitive sequel, affecting up to 75% of patients with stroke. Previous investigations have found alterations in tasks of Theory of Mind (ToM) and empathy. Numerous studies have described alterations in the facial recognition of basic emotions (FRBE). However, there is little evidence on the presence of alterations in FRBE and social cognition, and their relationship with EF in this type of patients. We included 24 patients from Santa Catalina Neurorehabilitación Clínica with diagnosis of lobar ischemic stroke with an evolution time of 3 - 12 months. Patients with aphasia, visual perception deficit, fluctuations in the state of consciousness, or psychiatric antecedents were excluded. 17 patients completed these requirements and were able to complete the neurocognitive assessments and social cognition tasks. Control group: For the FRBE tests, 23 subjects were included, without neurological diseases. Instruments: General Diagnostic Battery: California Verbal Learning Test, Semantic Verbal Fluency, Boston Vocabulary, Complex King Figure, Symbols and Digits Test, Analogies, Matrices, Vocabulary, Digits and Adult Intelligence Scale Cubes Design WAIS III. Executive Function Tests: Wisconsin Card Sorting Test, Trail Making Test, FCR Copy Strategy, Reverse digits, phonological fluency. Tests of Social Cognition: Theory of the Mind (TOM): Reading of the Mind in the Eyes (RME), Faux Pas (FP), False belief (FB) of first and second order. Making of social decisions: Game of Dice Task (GDT). FRBE Battery: 60 photographs were selected based on the work of Calder et al. Three tasks were assembled, of 60 sheets each for basic emotion: joy, sadness, anger, disgust, fear and surprise. 92% of the patients presented alterations in at least two of the three tasks of FRBE. 75% showed alterations in TOM tasks. 42% showed alterations in GDT. 85% of the patients showed alterations in at least two EF tasks. Although the heterogeneity locations of the ischemias, most of the patients presented alterations in FRBE, TOM and EF. Disturbance for both the comprehension and expression of emotional and affective states are very frequent in this population, causing socially inadequate responses, deteriorating their rehabilitation process and quality of life.

Characterization of Patients Assessed in Community Mental Health Clinics in a North- Western Canadian Municipal Region: Patient Profile, Sex Differences, and Follow-Up Referral

Aims: To characterize the sex-specific differences in the demographic and clinical profile as well as psychiatric antecedents, and follow-up referral for new outpatient psychiatric patients in Fort McMurray. Methods: Information on a new patient data assessment tool was compiled as part of a clinical audit process between 1st January 2014 and 31st December 2014. Results: Overall, 677 patients were assessed over the 12 month period, comprising 261 (38.6%) males. The mean age for all the patients was 35.67 (SD=13.02). There were statistically significant differences between male and female patients in respect of all the demographic and social characteristics as well as psychiatric antecedents. 249 (36.8%) patients had primary Depressive disorders. With odds ratios ranging between 4.02 and 7.11, outpatients diagnosed with substance related disorders, personality disorders and trauma/stressor related disorders were about 4.5, 5.5, and 7 times respectively less likely to be offered follow-up appointments after their initial assessments compared to patients who had a primary depressive disorder controlling for other variables in a logistic regression model. Conclusion: By better understanding the outpatient profile and their clinical background, we are able to better understand the potential antecedents associated with greater need for quality psychiatric services.

Psychotic episode in a patient with antiphospholipid syndrome – case presentation

A 22-year-old pacient, without psychiatric antecedents, treated in the “Prof. Dr. Al. Obregia” Clinical Hospital, Clinical Psychiatry VIII Section, in December 2017, presented for psychomotor agitation, complex auditory hallucinations, solilocvia, mystical delusional ideation, social withdrawal, bizarre behaviour, and hypnic disorders. The symptoms started approximately one month before, and accentuated progressively. We will focus on the characteristics of the debute (psychotic episode) of a rare autoimmune disease, such as antiphospholipid syndrome, and also on the patient’s prognosis.

Mefloquine Long Half-Life is Associated with Sustained Psychiatric Side Effects: A Case Report

Background: Psychiatric side effects of mefloquine, an antimalarial drug, are well known (agitation, depression and suicidal ideation, psychosis with paranoia and hallucinations). Case Presentation: We report the case of a 30-year-old man without psychiatric antecedents, who developed acute psychosis and depression with suicidal ideation after five weeks of treatment with mefloquine. The symptomatology decreased rapidly a few days later, under antipsychotic drug (olanzapine) and benzodiazepines (lorazepam) and the treatment doses were diminished after one week. However, three weeks later, the same symptomatology reappeared and the treatment doses of both psychotropic drugs had to be increased once again. The antidepressant escitalopram was also introduced. Three months were necessary to definitively suppress the psychotropic drugs. Plasma mefloquine clearance was monitored by a validated liquid-chromatography mass-spectrometric method and confirmed the very long half-life of the drug, which is estimated at 14.5 days. Conclusions: The pathophysiological mechanisms of these psychiatric side effects probably involve a toxic limbic encephalopathy. Mefloquine is highly lipophilic and may accumulate in the limbic system. In conclusion, due to the very long half-life of mefloquine, psychiatric symptoms can persist for weeks, necessitating an appropriate psychotropic treatment. Chronic symptoms resulting from permanent neurotoxicity may also occur.

Caractérisation des premiers épisodes de schizophrénie à partir de bases de données administratives de santé jumelées

Schizophrenia (SCZ) is a severe chronic disease associated with significant functional impairments. Prior to a diagnosis of SCZ, some nonspecific symptoms may occur (i.e., anxiety, insomnia, depressive symptoms) and may progress into psychosis. While these may be attenuated or not of sufficient severity for psychosis, many will seek help for these symptoms. Understanding the predictors of SCZ remains a considerable challenge for clinicians. Thus, several studies have been conducted to explain the different premorbid trajectories of psychosis. Though, no consensus has been established on the prediagnostic characteristics of patients with SCZ and remains a matter of debate, especially for women and older patients. Hence, our study aims to clarify the psychiatric characteristics of patients from Quebec preceding their first episode of SCZ and address the influence of age and sex. To do so, we used administrative databases from the RAMQ (Physician billings) and MED-ÉCHO (hospital registry in Quebec) between January 1996 and December 2006; 98% of about 7.5 millions of inhabitants are registered with the universal health plan. It recorded 24,883 men and women over the age of 18 diagnosed with a first episode of SCZ between the years 2004 and 2007. Different psychiatric antecedents by groups of age and sex are reported by cumulative frequency. The sample comprised of 53% men. Approximately, 50% and 36% were diagnosed with SCZ by psychiatrists and family physicians respectively. Patients aged from 30 to 54 represented most of the sample; over half of men and women were first diagnosed after 30 years old. Those with no antecedents accounted for 65% of the sample, while overall 35% had at least one ICD-9 diagnosis, specifically and in descending order manic depressive psychosis, depressive disorder, and drug use disorder. In women under 30, anxiety, depressive disorder and adjustment disorder were more frequent. Whereas amongst men under 30, substance use disorder was the most common antecedent, followed by anxiety. Considering the total population coverage, these findings are interesting as they draw a representative global portrait of the population with SCZ before their diagnosis according to their age group and sex. This project recalls the importance of examining the first psychotic episodes to possibly intervene early in the course of the disease by addressing depressive disorders, anxiety disorders and substance use.

ADHD in Tunisian Adolescents: Prevalence and Associated Factors

Objective: The aims of the study were to determine the prevalence of ADHD in a population of high school students and to explore the factors associated with this disorder. Method: This was a cross-sectional study that had included 447 high school students. The diagnosis of ADHD was made by the Adult ADHD Self-Report Scale translated in Arabic language. The sociodemographic and clinical characteristics were evaluated by a preestablished questionnaire. The self-esteem was assessed by the Rosenberg Self-Esteem Scale. Results: The prevalence of ADHD was 18.1%. The logistic regression analysis showed an association between the diagnosis of ADHD and the bad relationships with parents (odds ratio [OR] = 16.43; p < 10-3), the presence of personal psychiatric antecedents (OR = 12.16; p < 10-3), internet misuse (OR = 2.39; p = .014), and maltreatment antecedents (OR = 3.16; p = .009). Conclusion: The prevalence of ADHD in this study was one of the highest prevalence reported. The factors associated with ADHD may have diagnostic and therapeutic implications.