Architecture is a particular art as well as a transversal science that evolves according to multiple variables that call upon, aesthetics, sociology, political science, technology, history, cultures, economy, tourism, as well as the satisfaction of human needs and the physical/psychological health. It addresses the four senses of human and it humbly configures man’s environment, constitutes the set or the framework in which he evolves and in which he becomes an actor, both overwhelming and magical as Aldo Rossi says (1981).

We aim through this review to show how does architecture affect human mental health wellbeing and what can we do to create a therapeutic architecture.

We comprehensively review the scientific literature using Pubmed database and other search platforms such as Google scholar to state the relationship between architecture and human mental health wellbeing and to delineate the meaning of architecture therapy in the field of mental disorders.

Our bibliographic research revealed that Architecture and mental health are directly linked and that the concept of therapeutic architecture or architectural therapy has been generated in 1984 by Roger Ulrich, Professor of Architecture at the Centre for Health Design in Sweden to designate the influence of the environment on the healing and recovery process of patients. In fact, Architecture has the ability to create meaningful spaces. Churches, mosques and cathedrals planned centuries ago are a testament to architectural wonders, as they evoke a sense of magnificence, royalty, glory, serenity and tranquility. The intriguing details of these spaces were meant to induce positive feelings and emotions and are considered architectural masterpieces to this day, as they continue to fascinate humans around the world. In the other hand, many studies showed the positive effect of nature (therapeutic horticulture) and exposure to the outdoors; towards distraction from stress and anxiety levels of patients in a Health care setup. Recent studies analyzed how Architecture and interior design (safety and security, noise and external stressors, space and interior layout, nature, lighting and atmosphere, art, community, etc…) are important not only for the well-being of patients in health care centers, but also for humans in general in their living environments.

Mental health is impacted by different aspects of architecture and design. Incorporating elements such as natural lighting, open floor plans, private and open community spaces, artwork, safety procedures, and nature/views of nature, provides a supportive environment for the mental well-being and the treatment of mental disorders.

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There is growing interest in the role of children’s play in supporting children’s mental health. Children’s opportunitities for play vary according to the space available to them for play, with more adventurous play happening outdoors (Dodd et al., 2021). The area close to children’s home, such as the street outside their home, can provide an important play space but, with increasing traffic, there has been a decrease in the use of local streets for play over the past generation or two. At the same time we have seen significant increases in children’s mental health problems.

Our objectives were: 1) to examine how trends in street play have changed over time; 2) to examine how children’s self-reported wellbeing is associated with their use of streets for play; 3) to examine how adult mental health is associated with their childhood street play experiences.

Working in collaboration with Save the Children and Play England, we surveyed a nationally representative sample of 1000 children and young people aged 6-16 years, 1000 adults aged 18+ and 1000 parents of children aged 6-16 years about children’s play in their local area and their memories of play during their own childhood. All participants also completed measures of wellbeing (children) or mental health (adults). Participants were recruited from Great Britian.

We found striking differences in the use of streets and local areas for play. For example, across all adults, 62% told us that they regularly played out in their street or area close to home as a child. In contrast 27% of children told us that they regularly play out now. By breaking down the proportion of participants who said they regularly played in their street or local area by their age group, their is a clear decline in outdoor street play over the past 70 years. We asked children about their wellbeing using the Stirling Children’s Wellbeing Scale. Children who said that they regularly played out in their street had higher levels of positive emotion but this was only true for children under 13 years. Adults who told us that they regularly played out in their street or area close to their home as a child had better mental health as adults (lower scores on the K6). Similarly, adults who told us that there was freedom for children to go and explore in the neighbourhood they lived in as a child had better mental health as adults.

Taken together these findings suggest that being able to play in the street or area close to home is linked to wellbeing during childhood and early adolescence and further, that having these expriences during childhood may be beneficial for mental health into adulthood. This indicates that when considering how to support the development of good mental health we should keep in mind the importance of children’s opportunities for play and the role that access to their local enviornment plays in supporting play.

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There are various ways people cope with life events. One can expect generalized positive or negative outcomes across various life domains, called dispositional optimism. This can be explained by attribution theory: how people explain past events, their causations, and outcomes. Understanding attribution styles is important to help people reframe current circumstances and improve mental wellbeing. Our hypothesis is that people of different religious groups may exhibit various levels of optimism and pessimism based on their values, teachings, and practices. Previous research has found that people of Christian faith, or those with a religious faith in general, look to their religion as a way of coping during life adversities. Certain religious practices such as prayers and Church gatherings have been found to improve mental health through increasing dispositional optimism. While the relationship between religiosity and mental health has been previously examined in different religious populations, there are few studies that focused on comparing this relationship across religions.

The objective of this scoping review is to understand the link between religiosity and mental health, focusing primarily on how people of the Christian religion demonstrate dispositional optimism or pessimism when coping with adverse life events, compared to other religious groups or atheists.

This scoping review included original peer reviewed study articles that studied mental health in terms of dispositional optimism or pessimism in people of Christian religion compared to other religious groups. This review used online databases, Ovid MEDLINE and PsycInfo, and used extraction tables to analyze the results of past research.

The results of this scoping review revealed that people of Christian religion, especially those high in religiosity, use their religion as a method of coping. This population also showed higher dispositional optimism compared to atheists or those that believe in other religions. However, when compared to other religions such as Buddhism and Muslim, Christian populations showed lower dispositional optimism.

It is evident that religious involvement is linked to aspects of mental health, but comparing the effects of different religions is still a topic of exploration that can be investigated further to allow deeper understanding of their similarities and differences, as well as the mechanisms by which religion can affect mental health. In this review, a gap in the body of knowledge regarding the relationship between religion and pessimism was revealed. Future research directions could include examining whether dispositional pessimism varies across religious groups, as it does not necessarily have a perfectly inverse relationship with optimism.

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Psychoneuroimmunology is a discipline that has emerged over the past decades as a broad interdisciplinary field that closely observes the relationship between the psychological state, the nervous system, the endocrine system, and the immune system. The natural aging process leads to alterations in the immune functions, involving lymphocyte dysregulation, and therefore leading to a higher risk of developing coronary artery diseases, infectious diseases or even cancer.

The aim of our inquiry is to evaluate the existing body of work with a focus on studies that observed the intricate connections between psychosocial factors and immunity.

We performed a systematic review on PubMed and a targeted literature search concentrating on all the factors involved in immunosenescence and their consequences.

The causality between emotional stressors (acute or chronic), lack of social support, adverse life events, coping mechanisms, personality traits, as well as endocrine changes and multiple age-related pathologies is often undeniable. Other relevant factors include nutrition, sleep, physical activity and substance use. As people grow older, they face a number of psychosocial stressors, such as retirement, social isolation, loss of independence, low income, a decrease in productivity and also somatic comorbidities. These factors, together with an age-related decline in immune function, can constitute not only a psychosocial disadvantage of the elderly, but also a risk factor able to trigger further deterioration of the immune system.

Age-associated alterations of the immune response represent a complex concept. Given that we are dealing with the phenomenon of aging in the general population, the field of psychoneuroimmunology can make a significant contribution in establishing the different mechanisms through which seniors can cushion the impact of stressors in regards to health and illness. Therefore, we can pave the way for an individualized approach and support for patients, as well as provide better therapeutic outcomes.

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Autoimmunity mechanisms involve many cells that produce inflammatory cytokines which damage different organs, like the brain. There is a relationship between neuropsychiatric diseases, such as psychosis, and autoimmune diseases. In this article we try to demonstrate that treating autoimmune diseases appropriately improves clinical evolution of patients with a first psychotic episode.

The purpose of this article is to emphasize the importance of a multidisciplinary approach to a first psychotic episode. It is very important to perform autoimmunity tests to rule out secondary psychoses, even more so if the patient does not respond correctly to treatment with antipsychotics, to improve his/her prognosis and quality of life.

We performed a literature search of PubMed database using the following MeSH terms: “Autoimmune Diseases” and “Psychotic Disorders”. 134 studies were published between 2017-2022. We selected the original papers that analyzed the association between autoimmune diseases and first psychotic episodes. Finally, 18 were selected.

In secondary psychoses, early diagnosis and treatment of the underlying pathology can lead to rapid improvement.

A multidisciplinary approach is necessary from the first moment that a FPE is diagnosed, even more so in middle-aged women.

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A lot of studies have determined the relationship between psychosis and autoimmune diseases. One of the classic examples is systemic lupus erythematosus and antiphospholipid syndrome.

Both are syndromes marked by a state of excessive inflammation and hypercoagulability, respectively. And psychosis is a frequent manifestation of these two diseases, so it is important to take it into account, because psychotic episode triggered by these diseases has a different therapeutic approach from that of primary psychoses.

To raise awareness about this fact, we present the clinical case of a 43-year-old woman, diagnosed with systemic lupus erythematosus and antiphospholipid syndrome, who went to the Emergency Department due to agitation and delusional ideation of harm.

Given that the patient presented a recent altered cranial MRI, the aforementioned pathologies and an acute and poorly systematized clinical onset, we referred her for admission to Internal Medicine due to suspicion of a psycho-organic syndrome of probable autoimmune origin.

After admission to Internal Medicine, corticosteroid treatment was prescribed. After three days, the symptoms remitted and the patient was discharged, starting outpatient follow-up.

It is important not to forget that psychotic symptoms may be due to causes other than merely psychopathological ones, and may belong to other aetiologies and, with it, other therapeutic attitudes.

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Mood Disorder (MD) affects more than 300 million people globally, and its etiology is unknown. In recently published data, MD has been correlated with inflammation and the immune system. Circulating monocytes have been proposed to play a role in the pathophysiology of depression.

To determine if there is a specific activation profile of monocytes in patients with MD that differentiates them from healthy control (HC).

Study Design: Case-control study matched by sex and age. The study was approved by IRB and carried out in three hospitals in Argentina.Participants between 18 and 55 years old from both genders, were evaluated by psychiatrists using the International Psychiatry Interview (MINI) to diagnose Mood Disorder (MD), and the Hamilton Depression Rating Scale (HADRS) to define active disease (AD), non-active disease (NAD) or healthy control (HC). The three monocyte subtypes were directly stained and analyzed in a drop of 100 uL of blood sample based on our validated monocyte cocktail including CD11b, HLA-DR, CD86, CD14 and CD16 expression by flow cytometry. To define normality Kolmogorov-Smirnov test was employed. A parametric T-test with Welch´s correction was employed for normal distribution and a non-parametric Mann Whitney test was used when comparing populations that do not pass the normality test.

The sample characteristics were shown in Table 1. Patients with AD (Hamilton >7) (n: 37), patients with NAD (Hamilton <7) (n: 38), and HC (n: 39) were recruited. The percentage of classical monocytes decreased in AD vs NAD (p=0.04), both AD, and NAD have significantly lower levels of classical monocytes than HC (****p<0.001) (Image 1). The percentage of intermediate monocytes is higher in AD vs NAD (p=0.05), both AD, and NAD have significantly higher levels of intermediate monocytes than HC (****p<0.001) (Image 2). The percentage of non-classical monocytes is higher in AD vs NAD (p=0.05), both AD, and NAD have significantly higher levels of non-classical monocytes than HC (****p<0.001) (Image 3).Table 1.

General characteristics of the sample

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While comparing percentages of three different monocyte subsets, clear differences in their distribution among the control and patient groups were appreciated. After comparing the subset frequencies between active patients (AD) and patients who were in remission (NAD), significant differences among the subsets were found although without reaching values of the HC, indicating that even patients in remission show an activated monocyte profile.

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Susac Syndrome (SS) is an immune-mediated endotheliopathy that mainly affects young women. It is characterized by the typical triad: subacute encephalopathy, retinal vaso-occlusive disease, and hearing loss. Encephalopathy symptoms are varied and include memory loss, psychiatric disturbances, cranial nerve disorders, seizures, and dementia. The syndrome is considered a rare but important differential diagnosis in various neurological, psychiatric, ophthalmological, and ear-nose-throat disorders.

Report a clinical case of SS to reflect on the relationship between psychiatric and neurological symptoms and on immune-mediated psychiatric symptoms.

Collection of clinical information from the patient described below. Review of the literature about SS.

A 21-year-old woman presented to the Psychiatry Emergency Department in November 2021 for complaints of sadness, anhedonia and emotional lability, with one month of evolution. She also had insomnia and confusional periods, so she stopped driving and quit her work as a storekeeper. She was given sertraline 50mg/day and trazodone 50mg/day. In the past two weeks, the patient had episodes of headache and vomiting, with 8 kg weight loss. She started a fever (38.5ºC) two days before observation. The patient had a prior history of depressive symptomatology four years earlier related to her father’s grief and her medical and surgical history was unremarkable. She was brought in a wheelchair by her mother and was using diapers because she was confined to bed for the past week. Objectively, the patient was somnolent, tearful and confused, with scarce speech and psychomotor slowing. No focal signs were found on neurological examination. Collaboration of Neurology was asked. Routine laboratory studies showed a slight increase in leucocyte count (12 500/mm3) and CRP (17mg/dL). Cerebrospinal fluid analysis showed 15 cells/uL and protein of 2.64 g/L. Cerebral MRI showed multiple striatocapsular periventricular lesions involving the thalamus, the left midbrain, and the medulla oblongata, as well as focal bilateral hemispherical and cerebellar subcortical lesions. The lesions presented high signal in T2 and showed restriction in the diffusion study. She was admitted to the Neurology inpatient department and treated with pulse methylprednisolone 1000 mg/day for five consecutive days, after which cognitive function improved. Ophthalmology observation found cotton-wool exudate and arteriolar interruption in the right eye, supporting the diagnosis of SS.

This syndrome represents the importance of diligent cooperation among different medical specialties to improve diagnosis-making, treatment and recovery. Psychiatric symptoms are frequent in neurological syndromes, so a high degree of suspicion is needed.

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Актуальность исследования накопления данных о исключении иммунологического статуса у больных с выраженными расстройствами желудочно-кишечного тракта (ФЖКТ), характерных непсихотических заболеваний легких.

изучение взаимосвязи и появление признаков иммунологического и психовегетативного статуса больных у ФЖИР

Проанализированы и рассчитаны результаты ПВА-обследования (тест MMPI) с иммунологическим статусом 57 больных (средний возраст 35,36 ± 14,43 года, мужчины-18, женщины-39) с ФАД в динамике с группой здоровых лиц 34 человека, среднего возраста 28 ,63±9,54 года

У больных с тревожной депрессией [средний профиль: пик по шкале 2 + ↑ 7-8 и ↓ 9 шкал] оценочное увеличение относительного значения Т-хелперов CD3+CD4+ (58,0 и 55,0% р = 0,015) при снижении относительного количества Т-цитотоксических лимфоцитов CD3+CD8+ (0,312 и 0,372, р=0,023; 14,0 и 19,0, р=0,001) соответственно, увеличение иммунорегуляторного индекса: Т-хелперы/Т-цитотоксические CD3+ CD4+/CD3+ CD8+ (4,143 и 2,600 , р=0,001); снижение относительного количества NK-клеток CD3-CD16+CD56+ (6% и 8%, р=0,01).

У больных с преобладанием соматизированной анестезии [ведущий пик по шкале 1]: основные выявлены в относительно сниженном CD3+ Т-лимфоцитов (53,0 и 60,0, р=0,001); снижение Т-хелперов: CD3+CD4+ (28,0% и 31,0%, р=0,001); повышение ЭКГ: CD3-СД16+СД56+ (34% и 26,0%, р=0,01; 1153 и 470, р=0,01) по сравнению со здоровыми людьми.

Выявленные изменения показателей иммунитета выявлялись в период обострения заболевания и носили транзиторный характер.

Анализ данных с позиций клинико-динамического выявления вклада иммунобиологических регуляторов организма в клиническое затяжное течение и участие иммунной системы в механизме реализации психоэмоционального контроля стресса. .

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Anti NMDAR encephalitis is a relatively common autoimmune encephalitis characterized by complex neuropsychiatric features and the presence of Immunoglobulin G antibodies against the NR1 subunit of the NMDA receptors in the central nervous system. It causes psychiatric features, confusion, memory loss and seizures followed by a movement disorder, loss of consciousness and changes in blood pressure, heart rate and temperature. Postpartum depression symptoms usually develop within the first few weeks after giving birth , but may begin earlier/during pregnancy / or later /up to a year after birth. They include: inability to sleep or sleeping too much, depressed mood or severe mood swing, difficulty bonding with your baby, withdrawing from family and friends, fatigue or loss of energy, feelings of shame, guilt or inadequacy, diminished ability to think clearly, concentrate or make decisions, anxiety and panic attacks, thoughts of harming yourself or your baby. Untreated may last for many months or longer.

Recent studies have highlighted the possibility that a subset of patients with first-onset severe psychiatric episodes might suffer from undiagnosed autoimmune encephalitis. The acute onset of severe atypical psychiatric symptoms in young female patients should raise the index of suspicion for anti-NMDA receptor encephalitis, particularly in the setting of neurological symptoms, including side effects of antipsychotic treatment.

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Creating a therapeutic environment is an interdisciplinary clinical and theoretical approach to psychiatric treatment in hospital settings, the basic idea of which is that the entire environment has therapeutic potential. Psychodinamic knowledge and understanding of the process as well as principles of body-oriented psychotherapy may be of great importance in the treatment of these patients in addition to the use of pharmacotherapy.

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Patients with systemic lupus erythematosus (SLE) have cognitive dysfunctions as a neuropsychiatric manifestation, associated with disabling symptoms. However, the presence of other medical or psychiatric comorbidities can delay or lead to a misdiagnose.

To present a case of a patient with diagnostic difficulty in the face of multiple medical and neurocognitive comorbidities.

Description of a case report.

19-year-old female, Mexican, unemployed, with incomplete high school, with medical history of preterm birth by cesarean at 30 weeks due to placenta previa, history of early puberty, 4 years evolution of focal epilepsy, 1 year evolution of hypothyroidism and mild depression.

She began her symptoms 4 years ago, characterized by an abrupt onset of memory disturbances, decreased concentration, poor academic performance, infantile behavior, need for affection, alternated with irritability periods, verbal and physical aggression, repetitive and erratic behavior. She went to multiple specialists with different therapeutic approaches without clinical improvement. In 2020, she was referred to our service for evaluation, evidenciating a mild depressive episode and psychotherapeutic treatment was started.

Mental and neurological examination without alterations, normal vital signs, at physical examination: malar rash, oral ulcers, alopecia. Labs: increased erythrocyte sedimentation rate, normocytic anemia, leukopenia, rest normal. An electroencephalogram was requested, without alterations. Simple brain MRI was performed (Figure 1).

Psychological (figure 2) and Neuropsychological tests (table 1) were performed, showing alterations in memory recall and inhibitory control.

Due to the symptoms presented by the patient, SLE was suspected, and rheumatology evaluation was requested, integrating a diagnosis of incomplete SLE, and started treatment. The patient presented symptomatic improvement in cognitive symptoms and systemic signs. Likewise, a genetic evaluation was requested, without meeting the criteria for a genetic syndrome. The patient continues with symptomatic improvement and multidisciplinary treatment.

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Neurocognitive alterations are one of the most frequent manifestations of neurolupus, although its diagnosis and treatment may be delayed in the absence of clinical suspicion, mainly in multi-comorbid patients.

In the case, the patient presented multiple diseases that can explain a picture of neurocognitive impairment, such as epilepsy, depression, hypothyroidism. However, in these cases, a multidisciplinary approach is imperative, requiring to rule out the different causes of the patient’s symptoms.

None Declared

Taking into account the role of the immune system in the pathogenesis of schizophrenia, it is important to study the peculiarities of innate immunity in the development of the disease. A special role in these processes belongs to monocytes, which play an integral role in the inflammatory reactions and perform regulatory and effector functions to other immunocytes.

To analyze the subpopulation composition of monocytes and other inflammatory markers in patients with schizophrenia

The study included 36 women with schizophrenia (F20, ICD-10) (30±12 years) in the acute stage of the disease and 20 healthy donors. Flow cytometry was used to determine the relative number of monocyte subpopulations. The activity of leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI) in blood was determined by spectrophotometric method. The level of autoantibodies to S100b and CRP concentration were assessed by ELISA.

A decrease in “classical” monocyte subpopulation (p=0.02) was accompanied by an increase in cells of the proinflammatory phenotype (p=0.03) “Transitional” and “non-classical” subpopulations did not differ from controls. A negative correlation was found between the proportion of “classical” monocytes with “transitional” and “intermediate” cells (r=-0.66 and r=-0.54, p=0.01). All inflammatory and autoimmune blood markers in patients were significantly elevated compared to controls (p<0.05).

The redistribution of the subpopulation composition of monocytes with an increase in “intermediate” subpopulation and an increase in other immune markers in the acute stage of schizophrenia serve as an additional link confirming the involvement of cellular immunity in the pathogenesis of the disease.

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Haloperidol is one of the first-generation antipsychotics which is used widely around the world and still has its place in psychotic disorders along with his documented antimanic properties.

It acts by blocking essentially dopaminergic receptors but also serotonergic and alpha-adrenergic receptors.

Haloperidol has many side effects, especially extrapyramidal symptoms. Oedema associated with haloperidol is a rare side effect.

The aim of this presentation is to describe the case of a young female who developed a rare side effect of haloperidol.

we conducted a review of literature on different data base about this side effect in order to discuss its potential underlying mechanisms.

Here we report a case of a 24-year-old female with the history of bipolar disorder type 1, and an allergy to chlorpromazine. She was admitted to our psychiatric department for a manic episode with psychotic features and was initially treated with 50 mg of Haloperidol in addition to 30 mg of valium per day. She developed pronounced oedema of the face and upper limbs after two weeks of treatment. All of the paraclinical examinations including blood cell count, liver function tests, renal function tests, serum electrolytes, ECG, urine test didn’t show any abnormalities. We solicited the opinion of both nephrology and pharmacovigilance and concluded to an allergic oedema.

The symptoms disappeared 10 days after the discontinuation of haloperidol which suggested a potential incrimination of this drug

As far as we know, there are very few reports of allergic oedema with haloperidol in the literature. Potential underlying mechanisms will be discussed.

Through this case study, we aimed to focus attention on this very rare but still possible side effect.

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In the past ten years, the use of mobile phones for text messaging has increased dramatically. This is due to its utility in communication and interactions in the professional and personal spheres. Recent studies have demonstrated that the usage of text messaging via smart phones for social networking has also contributed to the reduction of loneliness. However, excessive usage of mobile phones is linked to certain psychiatric morbidities. Textaphrenia is one of these newly emerging mental health issues.

The aim of this review is to analyze the effects of excessive use of mobile phones among young population.

Medical publications, studies, and specialized information on the subject were used to complete this work.

Researchers have shown a correlation between excessive cell phone use and personality traits like neuroticism, extraversion, low self-esteem,and impulsivity. In addition to sleep disturbances, anxiety, tension, and depressed mood are all symptoms that have been linked to unhealthy cell phone use. These symptoms have also been linked to abusive use of the internet. Moreover, the current investigation sheds light on the coexisting link that exists between problematic cell phone use and the use of substances like tobacco and alcohol.

The evidence suggests that excessive usage of smart phones for text messaging might lead to the development of psychological dependence and can interfere with daily tasks.

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The topic of apathetic depression remains insufficiently studied to date. This is due to the lack of unity of views on the definition of apathy and discrepancies in the definition of it’s phenomenological boundaries.

The study of the psychopathological features of endogenous apathetic depression, the development of a typology of apathetic depression based on differences in the structure of apathetic phenomena.

The study included 70 patients (31 male, 39 female) suffering from endogenous apathetic depression in the framework of affective diseases – recurrent depressive and bipolar affective disorder (25 cases) and schizophrenia (45 cases). Clinical-psychopathological and clinical-catamnestic methods were used.

Apathy in depressions differs in the disproportion of the representation of individual components of the apathetic syndrome. Based on the revealed differences, typological varieties of endogenous apathetic depressions were identified: with a predominance of a decrease in interests (30 cases, 42.9%); with a predominance of a decreased initiative (13 cases, 18.6%); with a predominance of a motivational decrease (27 cases, 38.6%). Last group, based on the degree of complicity of the adynamic component, was divided into apatheticadynamic and simple apathetic subtypes. Depression dominated by a decrease in interests was characterized by the predominance of the emotional component in the structure of apathy, consumatory anhedonia, but without loss of the ability to be involved in activities and volitional impairment. Depressions with a predominance of decreased initiative are characterized by the leading role of the cognitive component of apathy with the inability of patients to occupy themselves independently, with minimal severity of anhedonia and the formation of moral hypochondria phenomena. Depressions with a predominance of motivational decline are characterized by the dominance of the behavioral component of apathy with the loss of stimuli and motives for activity, anticipatory anhedonia, volitional deficit, with the inability to engage in any activities.

Apathetic disorders formed within the framework of endogenous depressions are characterized by heterogeneity, which is associated with an uneven representation of declining interests, the ability to show initiative and the motivational component of apathy.

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The diagnosis of the main psychiatric syndromes is still almost exclusively phenotypic and depends essentially of the recognition of characteristic signs and symptoms. The clinical evalution allows the formulation of a set of differential diagnoses, according to the pathological meaning of certain symptomatic patterns and combinations. Aside from the entire dependence on the clinical interview, there are still no complementary psychiatric diagnostic exams and it is also worth noting the absence of pathognomonic symptoms.

Through the presentation of the case of a patient with Bipolar Affective Disorder who manifests, during a manic episode, a Capgras delusion, we intend to approach the heterogeneity of the manifestation of some symptoms that tend to be specific of concrete psychiatric syndromes.

Clinical case presentation and non-systematic literature review using Pubmed plataform.

AB, female, 49 years old, diagnosed with Bipolar Affective Disorder. Hospitalized for a manic episode with dysphoric mood, increased energy levels and delusional activity of grandiose and persecutory content. During hospitalization, a Capgras delusion centered on the husband emerged: he was replaced by a stranger, I was able to detect him by smell.

Capgras delusion is a delusional misidentification syndrome characterized by the belief that someone close has been replaced by an imposter. Despite being a rare syndrome, vastly more common in schizophrenia, affecting about 73% of cases, it can also occur in other psychiatric conditions such as dementia syndromes and, less often, mood disorders (16.7%).

Additionally, there are several examples that demonstrate the versatility of psychiatric symptom occurrence in different diagnoses, with first-rank symptoms serving as an example. Described in 1959 by Kurt Schneider, they were considered specific symptoms of schizophrenia, assuming this diagnosis based on the recognition of only one symptom. Over time, its pathognomonic character has become extinct, and its detection in mood disorders and acute psychotic disorder is relatively common.

Another example is the overlap between depressive and anxious symptoms. In fact, anxiety symptoms occur in about 85% of patients diagnosed with depressive disorder and, in turn, the presence of depressive symptoms in about 90% of patients diagnosed with anxiety disorder. This evidence has allowed, over time, a review of the diagnostic criteria for these disorders, leading to a progressive blurring of the threshold between them.

Psychiatric diagnosis is still a delicate task, totally dependent on the clinical interview. The lack of analytical and imaging tests, as well as the absence of pathognomonic symptoms, constitute a particular challenge in diagnosis. For this reason, we highlight the importance of recognizing combinations and patterns of symptoms rather than the specificity of just one symptom.

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The semiological spectrum that encompasses musical imagery is a very confusing field, as it is often difficult to understand the nature of the underlying psychopathological phenomenon from the patient’s description.

The purpose of the authors is to explore reviewing, distinguishing and organizing the concepts such as Intrusive musical imagery, musical obsessions, musical hallucinations, pseudohallucinations and musical palinacousis.

A brief non-systematized review is presented, using the literature available on PubMed and Google Scholar.

Intrusive musical imagery (earworms, ohrwurms, or involuntary musical imagery) occur in more than 85% of general population, without pathology or ear disease. It involves the involuntary repetition of 15-30 seconds of a fragment of music/tune, persisting like a looping soundtrack, not being aversive.

Musical obsessions are a rare form of intrusive imagery, occurring either with other symptoms of Obsessive Compulsive Disorder or isolated (“The stuck song syndrome”). It is recurrent, persistent, intrusive, unintentional, time consuming and causes distress or functional impairment (although not as ego-dystonic and aversive as usually intrusive visual imagery are); preserved insight.

Musical hallucinations occur only in 0,16% in a general hospital; they can be linked to psychiatric diseases, but they are more common in neurological diseases (cerebral lesions, Parkinson’s disease, delirium, drug induced…). They are reported to with less controllability, less lyrical content, and lower familiarity, than other forms of inner music; are perceived to arise from an external source and are interpreted as veridical.

Musical Pseudohallucinations can arise after severe hearing loss, in hallucinogen intoxication and in psychotic or non-psychotic disorders (as dissociative states or in borderline personality disorder). They occur in inner/subjective space, but insight can fluctuate.

Musical palinacousis is associated with electroencephalogram and neuroimaging abnormalities, linked to structural brain pathology. There is perseveration (echoing) of an external auditory stimulus occurs after cessation of the stimulus.

A rash classification can lead to misdiagnosis (for e.g. interpreting obsessive symptoms as hallucinatory phenomena or rendering an organic pathology undiagnosed) and the institution of inappropriate therapy. It is important to carefully explore these musical imagery phenomena when patients present these complaints, taking some time to characterize them.

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A considerable number of patients with schizophrenia suffer from somatic passivity or delusions of control. So much so, that Schneider considered them as part of the first-rank symptoms.

In these cases, patients can think that feelings, impulses, thoughts, or actions are controlled or imposed by an external force.

The objective is to make a psychopathological description of this symptomatology, based on a case report with Anomalous bodily experiences.

In this study, we describe the case of a patient with disorder of self-experience. We have conducted a systematic review of the descriptions published to date, regarding this case.

We present the case of a 21-year-old patient who had gone to the emergency services three times for somatic pathology (described as dysesthetic and algic sensations in the throat, stomach and testicles).

In the psychopathological exploration, a delusional narrative is observed, as he refers that these sensations are being provoked by external people, with the aim of harming him.

The patient reports that these people are causing an increase in salivation in his salivary glands, for which he spits repeatedly.

He explains that these people can control his organs using an influencing machine, which in this case consists of a microchip implanted at the retroauricular area, from which they give orders and insult him at the same time.

In this case, a good symptom response was achieved with intramuscular Aripiprazole.

In the experiences of passivity, the patient experiences one event as if it were not his, but inserted into his self from the outside.

In the case of somatic passivity, there is a belief that there are external influences acting on the body. In this case, there was probably a kinesthetic hallucination coupled with an experience of passivity.

Similar to other published cases, this patient complained of being controlled and impaired by some form of contemporary technology. Delusions of control are often associated with delusional explanations about how thought or body can be controlled, in this case, through a microchip.

None Declared

According to World Alzheimer Report 2021, more that 55 million of people in the world suffer from dementia. And although age is the strongest known risk factor for dementia, dementia does not exclusively affect older people. Early onset dementia is defined as the onset of symptoms before the age of 65 years. Considering that people with early onset dementia are in the most productive period of their life and often exposed to stress, when the symptoms of depression or psychosis can appear linked to other psychiatric diagnose it is hard to think of dementia when it is in early stage.

We present a case of a woman at age of 55, mother of one child, widow, with secondary school degree, employed as textile worker.

She was already on psychiatric treatment for five years diagnosed at first as Mixed anxiety and depressive disorder and after that as Major depressive disorder, single episode, severe with psychotic features. Her past treatment include Sertraline up to 100mg per day or Escitalopram up to 10mg per day and Olanzapine up to 10mg per day. But her condition was worsening progressive with cognitive decline and during serial stressful events in the family (the death of her husband and severe corona virus infection of her son).

At present time she was hospitalized with psychotic symptoms, confusion, paranoid ideas and hallucinations, dysfunctional in everyday activities.

The neuropsychological testing showed global reduction in cognitive-behavior status. The results of extended laboratory tests were in normal range. Brain MRI showed global cortical reduction with more specified atrophy in fronto-temporal lobes bilateral. SPECT analysis showed significant hypoperfusion in both hemispheres in frontal, parietal and temporal lobes. Cerebrospinal fluid examination showed decresed level of beta-amyloid-42 (281,6 pq/ml).

The results confirmed the diagnose of dementia with early onset, but because of advanced stadium and insufficient family history it was not possible to make clinical diagonose of the type. Diagnose in the end of hospitalization was: Early onset dementia, M. Alzheimer frontal variant.

With the presented case we suggest that the clinicians need to be very careful in the cases of psychosis treated independently and explore the possibility that psychosis can be a symptom of Alzheimer desease. Our case suggest that we should consider the possibility of early onset AD in middle-aged patients whose first symptoms are depressive with psychotic features. In this respesct, psychiatris need to consider proper completion of AD diagnostic protocol including biomarkers analysis.

None Declared

CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) is a cerebrovascular disease, tht appears in 1.98/100,000. It´s caused by a mutation of the Notch3 gene and is characterized by accumulation of granular osmiophilic material in the middle layer of the small and median sized cerebral arteries.

Sypmtoms are migraine, recurrent cerebral ischemic episodes, dementia, neuropsychiatric disorders (anosognosia, character disorders, apathy and cognitive impairment). It usually appears between 30-60 years, although there is an important variability. There is no curative treatment, only palliative.

Clinical review of anosognosia and its presence in CADASIL disease.

Clinical case and literatura review.

We presented the clinical case of a 68-year-old man, who was diagnosed with CADASIL after a stroke 3 years earlier. In his family, his brother was diagnosed also with CADASIL. The patient had previously presented disturbances in impulse control (hyperorality) and important executive failures. He currently presented anosognosia, deficits in verbal memory, spatial perception and executive functions, in addition to behavioral alterations and apathy. Due to these deficits he was prohibited from certain activities (driving, hunting).

The patient was not aware of these deficits and becouse of his “no knowledge of his illness”, he disagreed with these prohibitions, so he showed rage and anger at the impotence of not understanding why certain actions are prohibited.

In the consultation, mnesic errors and in naming objects were also objectified, for which it was recommended to carry out cognitive stimulation on a daily basis. In addition, he presented failures of sphincter incontinence, especially of urine and occasionally also of the anal sphincter. He had previously had episodes of myoclonus or fasciculations.

A genetic study by massive sequencing confirmed the heterozygous presence of the pathogenic variant c.1819C>T p.(Arg607Cys) in the NOTCH3 gene, a CADASIL disease.

The anosognosia that many patients with CADASIL disease present constitutes a problem because it contributes to the delay in consultation and, therefore, the delay in the adequate diagnostic approach, therapeutic possibilities and family genetic counseling. Due in part to anosognosia, CADASIL is considered an underdiagnosed entity. Due to the lack of awareness and the consequent lack of recognition of the deficit, these people are often seen as stubborn and difficult to deal with by people in their immediate environment.

In addition, there is general difficulty in the rehabilitation process, since patients do not think the neccesity to be treated. This can generate frustration and despair both in their relatives and in the health personnel.

For all these reasons, both in anosognosia and in CADASIL disease, adequate psychological support is needed for both those affected and their families.

None Declared