Psychiatric Presentations Research Articles

Cerebral Brain Abscess Mimicking Psychiatric Presentation in an HIV-Positive Patient With Post-traumatic Stress Disorder and Bipolar Disorder: A Case Report

Cerebral Brain Abscess Mimicking Psychiatric Presentation in an HIV-Positive Patient With Post-traumatic Stress Disorder and Bipolar Disorder: A Case Report

Assessing emergency physicians' competency gaps in caring for acute psychiatric emergencies: a comparative analysis of self-perceived confidence and performance against training program expectations

BackgroundThe increasing trend of patients with mental health conditions seeking emergency care is a global phenomenon. Numerous studies have emphasized the importance of emergency physicians' ability to recognize and manage psychiatric emergencies, both for patient well-being and societal safety nets. With the growing demand for emergency care related to mental health conditions, it is crucial to assess whether emergency physicians possess sufficient confidence and capabilities to adapt to these changes. Against this backdrop, our study aimed to explore the factors influencing emergency physicians' management of acute psychiatric emergencies and to critically evaluate whether current training programs adequately align with societal expectations for psychiatric emergency care.MethodsA cross-sectional survey, disseminated online by the Taiwan Society of Emergency Medicine, targeted 936 attending physicians and 449 residents in 43 Resident Review Committee approved training hospitals in winter 2021. The questionnaire covered participant demographics, skill requirements, and confidence in managing acute psychiatric patients independently. Statistical analyses included descriptive statistics, chi-square tests, medians (IQRs), and Wilcoxon rank-sum tests.ResultsOut of 229 participants, 63.8% were attending physicians, and 81.7% were affiliated with medical centers. Psychiatrists led 69.9% of emergency psychiatric training curricula, and 66.8% reported that their clinical psychiatric training outcomes were assessed by psychiatrists. Clinical seniority, training hospital level, and the average number of patients with an acute psychiatric presentation seen in a daily shift influenced physicians' self-reported confidence in managing acute psychiatric patients independently. Medical center training improved capability in managing psychiatric emergencies in the elderly, while encountering a higher average number of patients with an acute psychiatric presentation seen in a daily EM shift was associated with better performance, especially in managing specific populations.ConclusionsOur nationwide study highlights how clinical seniority, training hospital level, and patient volume per shift influence emergency physicians' confidence in managing acute psychiatric patients. However, there remains room for improvement, particularly in addressing the needs of specific patient populations. These findings underscore the importance of refining training curricula to bridge these gaps and enhance the quality of psychiatric emergency patient care.

Seven Identities Co-existing, A Noteworthy Manifestation of Complex Childhood Trauma: A Case Report

Background Childhood trauma increases the risk for psychiatric disorders such as Dissociative Identity Disorder (DID), Other Specified Dissociative Disorder (OSDD), Depersonalisation/Derealisation disorder (DDD), Post-Traumatic Stress Disorder Dissociative Type (D-PTSD), and Borderline Personality Disorder (BPD). Children who experience prolonged stress, trauma, or abuse during developmental years of growth and change have a wide range of outcomes. Case Presentation We report a case of a 22-year-old female with a significant history of physical abuse and sexual assault who initially presented to the hospital for suicidal ideation with a stated plan. During the patient’s stay at the hospital, we encountered two of the six alternate identities of the patient. The patient revealed she experiences all 7 identities (her true self plus 6 alters) in parallel, recalls the events of each alter, and can intermittently switch between identities; all rare features of dissociative disorders. Conclusion Given our patient’s extensive history of trauma, previous psychiatric diagnoses, and current dissociative presentation, we conclude that a diagnosis of OSDD and defence mechanisms of dissociation and regression may be appropriate. The patient was discharged with clomipramine for Obsessive-Compulsive Disorder and mood, lurasidone for mood, mirtazapine for mood, insomnia, and appetite stimulation, clonidine for nightmares and Postural Orthostatic Tachycardia Syndrome (POTS), fludrocortisone for POTS, gabapentin for Generalized Anxiety and fibromyalgia, and levothyroxine for hypothyroidism, and counselled to follow up with an outpatient therapist specialising in trauma. This case highlights the impact that childhood physical, sexual, and emotional trauma can have on one’s psychiatric presentation and the complexity of diagnosing dissociative presentations in an inpatient psychiatry setting.

Nonseizure Response to ECT in Older Adults with Bipolar Depression on Bumetanide

Abstract: Psychiatric presentations in older adults are complicated by chronic comorbidities, polypharmacy, and older age-related psychosocial changes. This case report discusses an unusual treatment response to ECT in a 75-year-old man with chronic bipolar disorder. There was no seizure activity on EEG and upon direct observation in 3 out of 7 ECT sessions. After an in-depth medication review of its impact on ECT, we propose that bumetanide could likely have contributed to the nonseizure response. Bumetanide was proposed as a potential antiepileptic agent, but the evidence for its effect on ECT is sparse. A proportion of older adults receiving ECT are likely to be on this FDA-approved diuretic for cardiovascular comorbidities. This case highlights the need for further studies to test for ECT-modifying of bumetanide.

A - 143 Organic Psychiatric Disorders Due to Frontal Lobe Neoplasms

Abstract Objective This current study seeks to explore the presentation of psychiatric disorders as a preliminary symptom in individuals who suffer from frontal lobe neoplasms. Data Selection The primary sources of information for this literature review were Google Scholar, PubMed, ScienceDirect, and the National Institute of Health (NIH). Search terms included frontal lobe tumors/neoplasms, primary brain tumors, psychiatric/psychological, acquired disorders, and pseudo-depression/mania. This search was limited to articles published in English from January 2014 to December 2023. Inclusion criteria were studies that focused on frontal lobe tumors and psychiatric manifestations as a result of illness. Exclusion criteria were studies older than nine years or studies that explored traits of psychiatric illness (i.e., aggression) as opposed to a psychiatric diagnosis. Data Synthesis Frontal lobe neoplasms, accounting for a significant percentage of PTBs, have been found to impact the psychological well-being of patients, leading to a range of psychiatric manifestations that may appear before physiological symptoms. These include mood disorders (i.e., depression, manic episodes), psychotic episodes, and personality disorders. Due to the complexities of the frontal lobe, these manifestations are not linearly linked to frontal lobe lesions. Conclusion This study’s findings advocate for a multidisciplinary approach to treatment, emphasizing the need for neuropsychological evaluations pre- and post-tumor resection. It calls for heightened awareness among clinicians to consider organic causes behind psychiatric presentations, especially in atypical cases or when traditional treatments fail. Ultimately, this research contributes to a deeper understanding of the neuropsychiatric consequences of frontal lobe neoplasms and paves the way for more targeted and effective interventions.

National study comparing psychiatric presentations among migrants and citizens in Qatar

Arab countries host 10 % of the global migrant population, yet research on the mental health of migrant workers within this region is notably lacking. Addressing this gap, our study marks the inaugural nationwide investigation into psychiatric conditions among migrant workers compared to native Qatari citizens in an inpatient setting. Employing a retrospective cohort methodology, we scrutinized psychiatric presentations among two cohorts: migrant workers (cohort 1) and Qatari nationals (cohort 2) admitted to psychiatric inpatient facilities in Qatar. Our sample comprised 150 migrant workers and 138 Qatari inpatients, with a predominance of males in both cohorts and mean ages around 34–35 years. The median length of hospitalization was 13 days for migrant workers and 14 days for Qatari patients. Qatari inpatients exhibited a higher prevalence of prior psychiatric history and comorbid physical conditions. The primary diagnosis upon discharge for approximately one-third of patients in both groups was schizophrenia spectrum and other psychotic disorders, with bipolar disorder representing roughly one-quarter of cases in each cohort. Notably, migrant workers demonstrated a higher incidence of depressive disorders, trauma, and stress-related conditions, while Qatari patients were more frequently diagnosed with substance use disorder and displayed aggressive behaviors.

Climate Change and Aging: Implications for Psychiatric Care.

We reviewed recent evidence regarding the impact of climate change (specifically, high ambient temperatures, heatwaves, weather-related disasters, and air pollution) on older adults' mental health. We also summarized evidence regarding other medical problems that can occur in aging adults in connection with climate change, resulting in psychiatric manifestations or influencing psychopharmacological management. Older adults can experience anxiety, depressive, and/or posttraumatic stress symptoms, as well as sleep disturbances in the aftermath of climate disasters. Cognitive deficits may occur with exposure to air pollutants, heatwaves, or post-disaster. Individuals with major neurocognitive disorders and/or preexisting psychiatric illness have a higher risk of psychiatric hospitalizations after exposure to high temperatures and air pollution. There is a growing body of research regarding psychiatric clinical presentations associated with climate change in older adults. However, there is a paucity of evidence on management strategies. Future research should investigate culturally appropriate, cost-effective psychosocial and pharmacological interventions.

COVID-19 and psychiatric disorders among young people: a cross-sectional study.

During the COVID-19 pandemic, a significant rise in mental health issues was observed. Particularly, children and adolescents have shown a higher risk of developing mental disorders than adults. This study aimed to describe the evolving features of the requests for psychiatric emergency interventions during the COVID-19 pandemic in young people. We conducted a cross-sectional study comparing the number, characteristics, and symptoms of people aged between 12 and 18 years old attending one Emergency Department (ED) for psychiatric issues, considering three different periods: T0 (8 March 2019-7 March 2020), T1 (8 March 2020-7 March 2021), and T2 (8 March 2021-7 March 2022). Total admissions were 220: 99 (45%) during T0, 40 (18.1%) for T1, and 81 (36.8%) for T2 ( P < 0.001). A significant decrease in the mean age from T0 to T1 was found ( P < 0.01). Admissions for psychomotor agitation decreased, while admission due to anxiety disorder and nonsuicidal self-injury raised significantly ( P < 0.05), as for first psychiatric presentation ( P < 0.01). Regarding substance use, a significant reduction was observed ( P < 0.05). The rates of eating disorders ( P < 0.001) and early insomnia ( P < 0.01) increased from T0. These findings highlight the worsening of psychiatric symptoms in the young population during the COVID-19 pandemic.

Rituximab Therapy for Adult Refractory Systemic Lupus Erythematosus with Neurological and/or Psychiatric Presentations: A PRISMACompliant Meta-Analysis

Rituximab (RTX) is used off-label for refractory cases of systemic lupus erythematosus (SLE) with extrarenal activity, including neurological and/or psychiatric (N/P) presentations. However, evidence from randomized controlled trials is limited. This study aimed to conduct a pooled analysis of the effectiveness and safety of RTX therapy for adult refractory SLE with N/P manifestations. Electronic searches in PubMed, Epistemonikos, and ICTRP databases and statistical analysis were conducted in May 2023. Electronic searches identified 20 studies (25 reports). A total of 59 patients (53 females; 90%) were included, with a mean age of 33.5±10.6 years and a median disease duration of 3.5 years (range, 0.08 to 25.0) who were followed up post-RTX therapy for a median time of 12 months (range, 3.0 to 46.2). The rate of clinical response (partial or major) was 90% (95% CI, 83 to 96) (n = 57 patients). A third of responders relapsed after a median time of 9.5 months (range, 3.0 to 33.0). Pooled pre-RTX/post-RTX scores for Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) (n = 13) were 19±15/7±5 and for neurological British Isles Lupus Assessment Group (BILAG) (n = 29) were A/D (13), A/C (5), B/D (7), B/C (2), and A/A (2). Patients without mood disorder had a higher chance of clinical response {relative risk (RR) 1.4 (1.03 to 1.48)}. Patients who benefited the most from RTX therapy were those with psychosis (a higher chance of major clinical response; RR 1.9 (1.02 to 2.34)), without acute confusional state (a lower chance of relapse; RR 0.08 (0.006 to 0.791)), and with disease duration <3 years (a lower chance of relapse; RR 0.18 (0.014 to 0.992)). Infection rate during treatment was 33% (7/21). RTX therapy had good effectiveness. The pooled evidence for safety outcomes was limited and of low certainty.

Hashimoto encephalopathy: a literature review and case report with comprehensive neuropsychological evaluation

Objective: Hashimoto’s encephalopathy (HE), a rare immune-mediated disorder, manifests as altered mental state, cognitive and psychological dysfunction, seizures, and myoclonus. Little is known, however, about the neuropsychological profiles of individuals with HE due to the sparse amount of research. This report overviews HE, summarizes findings from available published neuropsychological evaluations, and details neuropsychological examinations of a 57-year-old White woman with a confirmed HE diagnosis evidencing persistent neuropsychological impairment at two discrete timepoints. Method: An extensive literature search was conducted on PubMed and Google Scholar for studies including neuropsychological evaluations of HE cases. Our neuropsychological evaluation included chart review, diagnostic clinical interview, performance-based neurocognitive assessment, and measures of personality and psychopathology. Results: Our assessment revealed a largely subcortical pattern of neurocognitive impairment and impactful neuropsychiatric symptoms that, together, significantly impacted the patient’s quality of life and functional status. The patient’s performance improved during a six-month re-evaluation within the domains of cognition, psychological functioning, and functional independence. Conclusions: This article highlights the complexity and possible long-term sequela of HE. Complex medical history (including autoimmune disorders) and psychiatric presentation at onset may be factors related to longer-term cognitive dysfunction. Neuropsychology and psychology can serve important and unique roles in assessing long-term functioning and response to treatment in such cases.

A Cross-Sectional Review of HIV Screening in High-Acuity Emergency Department Patients: A Missed Opportunity.

Emergency department (ED) patients requiring immediate treatment often bypass a triage process that includes HIV screening. In this study we aimed to investigate the potential missed opportunity to screen these patients for HIV. We conducted this cross-sectional study in a municipal ED over a six-week period between June-August 2019. The patient population in this study arrived in the ED as a pre-notification from prehospital services or designated by the ambulance or walk-in triage nurse as requiring immediate medical attention. Medical student researchers collected demographic data and categorized patients into three clinical groups (trauma, medical, psychiatric). They documented the patient's eligibility for HIV screening as determined by a physician and confirmed that the patient met criteria of clear mental status, controlled pain, stable vital signs, and ability to contribute to a medical history and physical examination. The student researchers did this at initial presentation and then again during the patient's ED stay of up to eight hours. The study outcomes measured the percentage of total patients within each clinical group (trauma, medical, psychiatric) able to engage in the HIV screening process upon arrival and during an eight-hour ED stay. On average, 700 patients per month are announced on arrival via overhead page, indicating that they require immediate medical attention. During the six-week study, 205 patients (approximately 20% of total) were enrolled: 114 trauma; 56 medical; and 35 psychiatric presentations. The average patient age was 53; 60% of patients were male. Niney-eight (48%) patients were eligible for HIV screening within an eight-hour ED stay; 63 (31%) were able to be screened upon initial presentation and 35 (17%) in the first eight hours of their ED visit. Within medical and trauma subgroups, there was no significant difference in the proportion (36%) of patients that could be screened upon presentation. Among the psychiatric presentations, only five (14%) were able to be screened during their hospital stay. Triage protocols for high-acuity medico-surgical patients resulted in a missed opportunity to screen 48% of patients for HIV. Acute psychiatric patients represented a particular missed opportunity. We advocate for universal HIV screening, facilitated through electronic best practice advisories and a modified triage tailored to higher acuity patients. Implementing these changes would ensure that HIV screening is not overlooked in high-acuity ED patients, leading to early detection and timely interventions.

Assessment of Patients' Referral Patterns with Complaints of Self-harm and Aggression in the COVID-19 Era

Background: Due to the high transmission rate of COVID-19, the high prevalence of the disease, the high mortality rate, and its effects on mental health, we aimed to assess the current status of psychiatric symptoms. Methods: In this observational study, we have assessed various psychiatric presentations and disorders before and after the COVID-19 pandemic within the same time limit. Data have been obtained from the psychiatric interview performed by an attending physician in psychiatry. Results: The following features have been observed after the pandemic: increased depressed mood, irritability, crime trend, physical violations, personality disorders along with improved family support, and decreased suicidal ideation. No significant difference has been observed in the rate of response to psychotherapy and psychiatric medications before and after the time of the pandemic. Conclusion: Increased physical threat and aggression, substance use, and symptoms of psychosis were more frequently observed in the time of the pandemic. The physical threat was mainly committed by younger patients with psychiatric illnesses.

Psychiatric Emergencies in Perinatal Women: A Retrospective Analysis

Objective: The perinatal period represents a critical juncture in a woman's life marked by profound emotional, social, and physical changes. During this phase, there is a propensity for the exacerbation of pre-existing psychiatric symptoms or the emergence of new ones. Notably, there is often an uptick in psychiatric emergencies and presentations to emergency psychiatric departments among women in the perinatal period. This study aimed to retrospectively evaluate women accessing emergency psychiatric departments during pregnancy and the postpartum period, focusing on their presenting complaints, diagnoses, clinical trajectory, and factors influencing the decision for inpatient treatment. Material and Method: A retrospective review was conducted on the records of 11,419 women aged 18 to 45 who sought care at the Psychiatric Emergency Department of Bakirkoy Prof.Dr. Mazhar Osman Research and Training Hospital Hospital between July 2015 and July 2016. Results: Among them, the records of 163 women who were either pregnant or within one year postpartum were analyzed. Of the women accessing services during the perinatal period, 46% were pregnant, while 54% were in the postpartum phase. Additionally, 38.7% of these women presented to the psychiatric department for the first time. Distress and anxiety emerged as the most common reasons for seeking help. Interestingly, no significant differences were observed between the pregnancy and postpartum periods regarding presenting complaints and clinical progression. However, the incidence of psychotic disorders was notably higher during the postpartum period compared to pregnancy. Through logistic regression analysis involving pregnancy status, presenting complaints, and diagnoses, it was determined that the nature of the presenting complaint significantly influenced the decision for inpatient treatment. Notably, scepticism, agitation, and suicidal ideation were identified as the most prevalent complaints among women who required inpatient care. Conclusion: Mental health challenges during the perinatal period not only jeopardize the well-being of the woman but also impact the health of the infant. Detecting and addressing emergent psychiatric issues during this phase are pivotal for timely intervention and preventive measures.

Proposal for a Mechanistic Disease Conceptualization in Clinical Neurosciences: The Neural Network Components (NNC) Model.

Clinical neurosciences, and psychiatry specifically, have been challenged by the lack of a comprehensive and practical framework that explains the core mechanistic processes of variable psychiatric presentations. Current conceptualization and classification of psychiatric presentations are primarily centered on a non-biologically based clinical descriptive approach. Despite various attempts, advances in neuroscience research have not led to an improved conceptualization or mechanistic classification of psychiatric disorders. This perspective article proposes a new-work-in-progress-framework for conceptualizing psychiatric presentations based on neural network components (NNC). This framework could guide the development of mechanistic disease classification, improve understanding of underpinning pathology, and provide specific intervention targets. This model also has the potential to dissolve artificial barriers between the fields of psychiatry and neurology.

Eating Disorder and Other Psychiatric Hospitalizations in New Zealand During the COVID-19 Pandemic.

An unprecedented rise in eating disorder presentations has been documented in several countries during the COVID-19 pandemic. We explored this phenomenon by analyzing nationwide psychiatric admissions over 5 years, controlling for demographic variables. We retrospectively analyzed all hospitalizations in New Zealand with a primary psychiatric diagnosis from 2017 to 2021, using Poisson regression to calculate admission rates by diagnosis, before and during the pandemic. Using Fisher's exact test and Poisson modeling, national data were validated against a manually collected sample of eating disorder admissions. Eating disorder admissions rose significantly during the pandemic (RR 1.48, p < 0.0001), while other diagnoses remained unchanged or decreased slightly. Anorexia nervosa in 10 to 19-year-old females drove increases, with persistent elevations noted in the 10-14 age group. Pandemic-associated increases were more striking for Māori (RR 2.55), the indigenous Polynesian population, compared with non-Māori (RR 1.43). Eating disorder hospital presentations increased during the COVID-19 pandemic, while other psychiatric presentations to hospital remained relatively unchanged. Possible drivers include disrupted routines, barriers to healthcare access, altered social networks, and increased social media use. Clinical services require additional resources to manage the increased disease burden, especially in vulnerable pediatric and indigenous populations. Ongoing monitoring will be required to establish the time-course of pandemic-related clinical demand.

The familiarity of Romanian psychiatrists with anti-N-methyl-D-aspartate receptor encephalitis: findings from a web-based survey study.

Psychiatrists are often the first to be consulted in patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. Thus, they need to be aware of clinical features, differential diagnoses, and treatment options for this condition. In this study, we aimed to investigate the familiarity of Romanian psychiatrists with anti-NMDAR encephalitis. We recruited psychiatrists from Romania and conducted a cross-sectional observational study by using a web-based survey. The survey was completed by 111 psychiatrists, of whom 47 (42.34%) were specialists, while 64 (57.66%) were trainees. The median length of training for specialists was ten years (interquartile range - IQR 9.5), while for trainees it was 2.5 years (IQR 3). In total, 31 (27.93%) psychiatrists encountered a case of anti-NMDAR encephalitis, with no significant difference between specialists and trainees. 31 (27.93%) psychiatrists were either unaware of the disorder or only knew its name, while 77 (69.37%) had knowledge of an outline of it. Only 3 (2.7%) psychiatrists had comprehensive knowledge of the disorder. Respondents with a higher awareness level had undergone significantly longer training (p=0.014). Unsurprisingly, having encountered a case significantly influenced awareness levels (p<0.001). There were no significant differences between specialists and trainees regarding specific knowledge about anti-NMDAR encephalitis. However, higher awareness levels and having encountered a case significantly influenced answer accuracy for questions regarding psychiatric presentation and epidemiological features. Our study indicates that Romanian psychiatrists have suboptimal knowledge of anti-NMDAR encephalitis, highlighting the need for improved awareness of this disorder.

The longitudinal dispositions of people diagnosed with adjustment or severe stress disorders

BackgroundAdjustment and stress-related disorders are prevalent among psychiatric service users. Despite their prevalence, little is known about their prognosis. To reduce that gap, the present article documents the service use and diagnostic outcomes of people with adjustment or stress-related disorders presenting at Singapore’s largest psychiatric emergency department.MethodsAdministrative data from 2014 to 2021 was retrieved to follow a group of 683 service users whose first-ever psychiatric presentation in 2014 warranted a diagnosis of adjustment or stress-related disorder. People were grouped a priori depending on whether different diagnoses were recorded within 7 days, 9 months, after 9 months or not at all. Survival curves characterized conversion to other diagnoses and engagement with healthcare services. Service use outcomes include the number of hospitalizations, outpatient appointments, emergency department visits, and prescriptions.ResultsSixty-one percent (n = 417) never received another diagnosis over the 8-year period. This group used emergency services most and received the most pharmacotherapy shortly after their first visit. Of those who received another diagnosis, depression, personality disorders, and psychotic disorders were the most common. Those who received another diagnosis within 7 days (n = 70, 10%) received it on their first day of hospitalization (IQR 1–1), making the most use of inpatient services. The group who received another diagnosis within 9 months (n = 105, 15%) did so after 42 days (IQR 26–84) and had the highest relative number of deaths. Those who received another diagnosis after 9 months (n = 91, 13%) did so after 1,134 days (IQR 613–1,823) and had the longest period of engagement but made the least use of any psychiatric service, potentially suggesting a group whose early index diagnosis heralded vulnerability to future disorders.ConclusionsA large group of service users with acute stress or adjustment disorders will likely never be given another psychiatric diagnosis and appear to disengage following an initial period of high-intensity service use. The group that received a different diagnosis after the 9-month mark had prolonged contact with services but low intensity of service use and may represent a target for preventative intervention to help them improve their stress-managing skills and avoid developing other disorders.

Police-referred psychiatric emergency presentations during the first and second wave of COVID-19 in Berlin, Germany: a retrospective chart review

BackgroundLiterature on psychiatric emergency services (PES) presentations during the COVID-19 pandemic showed heterogeneous results regarding patients brought in by police (BIBP). This is the first study primarily focusing on patients BIBP in a PES during the COVID-19-period.MethodsCase documentation records during the first and second wave of the COVID-19 pandemic in a PES in Berlin, Germany were analyzed using descriptive data analysis and binomial logistic regression analysis to detect factors that predict presentations BIBP.Results5440 PES presentations: 20.4% BIBP during the first wave vs. 16.3% during its control period; second wave: 17.6% BIBP vs. 14.9% during its control period. In both waves, absolute increases in presentations BIBP were seen compared to control (p = .029, p = .028, respectively). COVID-19-period was a predictor for presentations BIBP during the first and the second wave. The following factors also predicted presentations BIBP: younger age, male gender, aggressive behavior, suicide attempt prior to presentation and diagnosis of psychotic or substance use disorders; depressive disorders were negatively associated.ConclusionsDuring the two first waves of the COVID-19 pandemic, there was an increase in presentations BIBP in a PES in Berlin. Regression analysis shows that the pandemic itself was a predictor of presentations BIBP. The underlying factors of this association need to be further elucidated in future research. Additionally, general factors predicting PES presentations BIBP are reported that replenish the present literature.

Psychiatric Presentation of a Severe Vitamin B12 Deficiency Associated with Biermer’s Disease: A Case Report

Psychiatric Presentation of a Severe Vitamin B12 Deficiency Associated with Biermer’s Disease: A Case Report

A Study to Determine How Frequently Patients Are Admitted to Acute General Hospitals With Psychiatric Presentations and Whether Acute Medics Feel Confident in Managing Such Cases

A Study to Determine How Frequently Patients Are Admitted to Acute General Hospitals With Psychiatric Presentations and Whether Acute Medics Feel Confident in Managing Such Cases