Acute and transitory psychotic disorders comprise a polymorphous picture such as Leonhard’s cycloid psychoses, which alternate episodes of affective symptoms such as psychosis between two poles (anguish/happiness, incoherence/stupor, or akinesia/hyperkinesia).

To describe a case report of a 20-year-old man, in outpatient psychiatric follow-up, after debuting at age 18 with a severe depressive episode of endogenomorphic characteristics without psychotic symptoms, with subsequent complete remission. Two years after clinical stability, he required prolonged hospitalization due to polymorphous psychotic syndrome of abrupt onset in a context of previous continuous use of cannabis and cocaine. Suspicion towards parents, bizarre behaviors, rushing desires, unmotivated laughter, fixed gaze, bewilderment, anguish with a feeling of imminent death, alternates with euphoria and senseless purchases.

We present the case report of this patient with a mental examination of conscious, scattered attention with marked distractibility, confusion and experiences of strangeness, memory gaps, subjective sensation of well-being with tachypsychia, which fluctuates with thymic oscillations and alternates with episodes of marked indefinite anguish, intense anxiety with delusional fear of the death of him or his family. Little systematized ideas of reference and prejudice based on intuitions or delusional occurrences in their environment. Megalomaniac and religious-messianic ideation. No sensory perception disturbances. Disintegrated course of thought, with frequent illogical associations, ambivalence of thought, affectivity and psychomotricity. Motor restlessness and behavioral disorganization. Global insomnia. Judgment of reality and superior functions diminished. No auto/heteroaggressiveness.

Various psychoactive drugs were tested for two months, obtaining a response only with valproic acid 1500mg, pregabalin 450mg and olanzapine 15mg, presenting slow improvement in a situation of absence of consumption, with a predominance of symptomatic polymorphism, decreasing fluctuation between episodes of expansiveness and psychotic anguish, remitting disorganization and motility alterations, persisting poor awareness of the disease and cognitive complaints. He was referred for follow-up at the mental health center where his gradual recovery continued.

A differential diagnosis of polymorphous psychosis is proposed, compatible with a cycloid psychosis of the anxiety-happiness type with marked affective symptoms, precipitated by substance use.

Cycloid anxiety-happiness psychosis stands out for intense and fluctuating anxiety, oscillating with feelings of happiness, ecstasy, and placidity, mystical-religious delusions, and preoccupation with death, which may comprise a different psychotic debut.

None Declared

Recovery in schizophrenia is both widely accepted and commonly misunderstood. Researchers have described favorable outcomes for schizophrenia for the last 100 years. Nevertheless, many patients, relatives and clinicians view schizophrenia as a disease with an inevitable chronic course, as described by Kraepelin in 1889. The definition and measurement of recovery in schizophrenia have proven to be a difficult task. If defined by the remission of clinical symptoms, we have criteria that are operational, but is symptomatic remission sufficient to describe recovery? If looking at social recovery, outcomes related to recovery e.g., social life, employment or social engagement are not easily measured by reliable independent metrics. Thirdly, recovery can be described as a personal journey rather than a clinical endstate.

The aim is to present a historical and global overview of 100 years of research in recovery in schizophrenia.

We conducted a systematic review and meta-analysis. We included prospective studies with at least 20 years of follow-up on patients with a diagnosis of schizophrenia, and the studies must include face-to-face clinical evaluation. We examined outcome in three nested groups: ‘recovery’, ‘good or better’ (i.e., good and recovery), and ‘moderate or better’ (i.e., moderate, good, and recovery). We used random-effects meta-analysis and meta-regression to examine mean estimates and possible moderators.

The overview will start with Bleuler, who described that approximately one third have a good outcome, and end with the most recent meta-analyses on recovery in schizophrenia, presenting both data from our own research and others on the recovery of schizophrenia. Ultimately, we will discuss whether recovery have improved in the last 100 years.

It is a myth that schizophrenia inevitably has a deteriorating course. Recovery is certainly possible. Schizophrenia remains, however, a severe and complex mental disorder, exhibiting a limited change in prognosis despite more than 100 years of research and efforts to improve treatment.

None Declared

Brief Psychotic Disorder (BPD), defined according to the DSM-5 by the presence of delusions and/or hallucinations and/or disorganised speech persisting for at least one day and less than one month, the disturbance not being due to a bipolar disorder or a schizophrenia spectrum disorder or to the effect of a substance. Classically, the prognosis of a BPD is considered to be divided between restitution ad integrum (30%), progression to bipolar disorder (30%), progression to schizophrenia (30%) or repetition of the same form (10%).

The objectives of our study were to evaluate the evolutionary modalities after the first hospitalization for BPD after a follow-up of at least one year and to compare them with the data in the literature.

Our study was retrospective and descriptive. We reviewed the records of patients hospitalised in our department from 1 January 2014 to 31 December 2018 for a first BPD and assessed the subsequent course over a minimum period of one year.

We included 70 records of patients hospitalized. Twenty-five patients (35.71%) were lost to follow-up after their first hospitalisation. The remaining patients (64.29%) were divided into 3 groups according to the above-mentioned evolutionary modalities (recovery, recurrence of BPD, progression to schizophrenia, progression to bipolarity). Results were in favour of an evolution towards bipolar disorder (35.55%), towards schizophrenia (44.44%), a relapse of the BPD (4.44%), while 13.33% of the BPDs had no future after an aftercare of at least one year. In addition, one case of evolution towards a chronic delusional disorder of the persecution type was observed.

In the present study, our results tend to be in line with the law of one-third described by some authors despite a slight discrepancy partly explained by the limitations of our study. Although, the outcome of BPD remains unpredictable. The minimum five years of evolution are decisive in assessing the subsequent prognosis.

None Declared

Patients in psychotic relapse may exhibit violent behavior towards objects, themselves or others. These behaviors, although usually unconscious, are a common reason for hospitalization and a source of rejection and stigmatization by family and society.

The objective of this study was to evaluate the presence of aggressive behavior in relapsed inpatients with schizophrenia in the F psychiatry department at the Razi Hospital in Tunisia.

This was a descriptive, cross-sectional study of fifty male patients hospitalized for a psychotic relapse who were naïve or discontinuing treatment for at least two months. Patients were assessed using a semi-structured questionnaire and the Overt Aggression Scale (OAS).

The age of the patients included ranged from 17 to 65 years, with an average of 36.4±11.51 years. More than half of the patients were without occupation (58%, N= 29). For personnal history : Seven patients (14%) had attempted suicide ; Eight patients (16%) showed evidence of self-harm ; Thirteen patients (26%) had a history of arrests of which eleven (22%) were incarcerated.The OAS score ranged from to 0 to 35 with a mean at 9.7+/- 10.3. Twenty-seven patients were aggressive (54%).

Preventive strategies should focus more on predicting the aggressive potential of patients with schizophrenia and its socio-professional implication. Perhaps when using a less holistic approach to the disease and when approaching aggressive behavior as a symptom in its own right, we will be able to find other alternative options.

None Declared

Schizophrenia is characterised by a loss of contact with reality due to the presence in its symptomatology of a delusional and/or hallucinatory syndrome, also called positive symptoms and/or a dissociative syndrome, which reflects the negative component of the disease. Few studies suggest a probable link between testosterone and the symptomatic dimension of schizophrenia, but this subject remains poorly documented.

The purpose of this study was to describe Testosterone profile in male patients with schizophrenia who are naïve to antipsychotic treatment or have been off it for at least two months and to investigate the relationship between testosterone levels and disease severity.

This was a descriptive, cross-sectional study of fifty male patients hospitalized for a psychotic relapse who were naïve or discontinuing treatment for at least two months. Patients were assessed using a semi-structured questionnaire and The Positive and Negative Syndrome Scale (PANSS). A blood sample was taken to measure testosterone level.

The age of the patients included ranged from 17 to 65 years, with an average of 36.4±11.51 years. The PANSS score ranged from 50 to 195 with a mean of 116.76 +/- 31.817. Testosterone values ranged from 2.01 to 10.03 ng/ml with a mean of 4.74± 2.01 ng/ml. The majority had normal testosterone levels (94%) ; only 4% had high values and 2% had low values. A positive correlation was found between the positive component of PANSS and elevated testosterone (p=0.011). For the other subscales, no correlation with testosterone levels.

The present study is in favour of a testosterone aggravation of the mostly positive clinical signs of the disease in a significant way. Hormone assays could thus be a specific marker of certain patient profile with a particular evolution.

None Declared

In the last years there has been increasing evidence that inflammation and autoimmunity may play a role in the pathogenesis of schizophrenia.

Although the brain has been considered an immune-privileged site, we understand now that infections and inflammation interfere with the blood-brain barrier, making the brain vulnerable to antibodies, cytokines and infectious agents.

To understand the role of immune disfunction in schizophrenia pathogenesis, as well as the potential role of immunotherapy in its treatment.

We performed a narrative review of the evidence, using the following terms and their combinations “schizophrenia”, “autoimmunity” and “monoclonal antibodies”.

It is widely known that prenatal, perinatal and childhood exposure to infections, nutritional deficits and other environmental insults, acting on a background of genetic vulnerability, may lead to schizophrenia. In such cases, we can observe potent and enduring inflammatory responses, such as cytokines dysregulations.

State markers, including IL-1β, IL-6 and TGF-β have increased levels during exacerbation of symptoms and stabilized levels when antipsychotics are administrated. Trait markers, such as IL-12, IFN-γ and TNF-α have systematically increased levels in acutely and chronically ill patients, even during clinical stability.

Moreover, patients with schizophrenia have been showing abnormalities of the blood-brain barrier, signs of central nervous system inflammation and elevated autoantibody levels and reactivity.

Several autoimmune diseases are associated with schizophrenia, such as celiac disease, Graves’ disease and psoriasis. On the other hand, it is known since the 1950’s that schizophrenia has a negative association with rheumatoid arthritis.

There are case reports of people with psychosis that were treated with immunosuppressive agents (for concurrent autoimmune diseases) that showed improvement in their psychotic symptoms.

NSAIDs, immunomodulators and several monoclonal antibodies have been tested as potential treatments for schizophrenia. The results were conflicting but promising. It is suggested that not every patient with schizophrenia may benefit from these treatments. Ideally, treatment targeting the immune system should be provided in earlier phases of disease, such as in prodromal psychosis and first episode psychosis, because these are related to irreversible grey matter loss which causes cognitive decline.

Immune dysregulation may have an important etiological role in schizophrenia.

Hence, specific therapeutic approaches targeting the immune system may lead to new ways of treating and even preventing psychotic disorders.

Further investigation is necessary in order to provide more information on how aberrant antibody and cytokine production interferes with neuronal function and how it is expressed at the clinical level.

None Declared

The comorbidity between Schizophrenia and Obsessive-Compulsive Symptoms represents almost 25% of schizophrenic patients and it is believed that almost 12% match the diagnostic criteria for Obsessive-Compulsive Disorder. Some second-generation antipsychotics may worsen or even induce those symptoms, which makes the treatment of this patients a difficult challenge.

To assess the link between Schizophrenia and Obsessive-Compulsive Symptoms, to discuss the diagnostic challenges and treatment options. To present a clinical case report of a schizophrenic patient with Obsessive-Compulsive Symptoms, which improved with proper treatment.

We performed a non-systematic review of the existent literature with the keywords “Schizophrenia” and “Obsessive-Compulsive Symptoms”. Description of a clinical case report.

We present the case report of a male, 21 years old, single, diagnosed with Schizophrenia. In the past year, he was admitted twice in a psychiatric ward for persecutory and mystic delusions, which lead him to erratic behaviour. Since his adolescence he manifested repeated washing and compulsive cleaning associated with the fear of being contaminated with multiple diseases. Those compulsions worsened when he started being treated with antipsychotics. However, with therapeutic adjustments and with the introduction of an antidepressant we were able to control those symptoms.

Some antipsychotics may induce or even aggravate Obsessive-Compulsive Symptoms in psychotic patients. It is of extreme relevance to differentiate those symptoms as comorbid in Schizophrenia or if they existed prior to the first positive symptoms, since they can be representative of an Obsessive-Compulsive Disorder. Understanding this diagnostic and treatment complexity enables us to be more familiar with the development of Obsessive-Compulsive Symptoms in schizophrenic patients.

None Declared

Only two out of three patients diagnosed with First Episode Psychosis (FEP) achieve symptom remission after the administration of two different antipsychotics, illustrating the high prevalence of treatment-resistance in FEP. Of those, 84% are treatment-resistant since illness onset. Response to initial treatment is one of the main long-term illness course predictors. The only medication approved for treatment-resistant psychosis is clozapine and studies have demonstrated its superior antipsychotic effect among this drug class.

The aims of this communication are to describe a clinical case of FEP with symptom remission achieved only with clozapine and to review the literature regarding the pattern of clozapine use in FEP, the main difficulties of implementing it and its impact on the prognosis of this patients.

Relevant data from the patient’s medical record were collected. Pubmed database was searched using the terms “clozapine” and “first episode psychosis”.

A 50 year old woman without previous contact with psychiatric services was taken to the emergency room following behavioural disorganisation and heteroagressive conduct. Poisoning and referential delusions, as well as alienation of personal action and elementary auditory hallucinations were found and the patient was admitted in the psychiatric unit. She began treatment with Aripiprazole without therapeutic benefit and a switch to Paliperidone was made, with the same result. Clozapine was then titrated to a dose of 100mg/day, with resolution of all the positive symptoms mentioned above and she acquired total insight to the disease and need for treatment, being discharged with a diagnosis of schizophrenia. 9 articles, all from 2017 onwards, were collected from the Pubmed database.

There’s reluctance in prescribing clozapine in treatment-resistance FEP. This is evidenced by the mean number of antipsychotic prescribed before clozapine - 2.74 to 4.85 - as well as the delay on its prescription - 294 to 2447 days - and its prescription to only 16% in a cohort of patients with FEP. The main reasons for this hesitation are the serious, albeit rare, side-effects, such as agranulocytosis and myocarditis, as well as the difficulty in implementing it in community services, with mandatory weekly blood tests and very slow titration of the drug and treatment compliance issues, making it a very resource-consuming drug. However, in that same cohort, there was a significant reduction of the number of admissions, re-admissions and duration of hospitalisation, highlighting the need for earlier consideration in treatment-resistant FEP. The identification of treatment-resistance should then be proactive by the mental-health services, ensuring an earlier clozapine initiation with the goal of greatly improving the prognosis of these patients

None Declared

According to current diagnostic systems, affective symptoms do not represent a fundamental criterion for the diagnosis of DD. However, numerous studies have highlighted frequent comorbidity between DD and Mood Disorders and have elucidated the importance of the affective state in the development and persistence of delusions. Thus, some factor analysis studies have identified the existence of a depressive dimension in DD, suggesting a substantial psychopathological heterogeneity in DD. However, these important affective features have not evaluated from a phenomenological point of view and in their relationship with delusions.

The aim of the present study is to investigate the relationship between personality, trait affectivity and severity of delusions in patients with Delusional Disorder (DD).

Thirty-two outpatients affected by DD were administered the Structured Interview for DSM-IV-TR Personality Disorders (SIDP-IV), the Pathological Narcissism Inventory (NPI), the Positive and Negative Affect Schedule (PANAS) and the Psychotic Symptom Rating Scale (PSYRATS). Next, we analysed the prevalence of personality disorder in our sample of patients with DD and studied the correlations between the severity of delusions and the different affective variables. Finally, we obtained a multivariate explanatory model of the severity of the delusions.

The severity of delusions was directly associated with “Grandiose Fantasy” item of narcissistic personality and inversely related with the feelings of shame, fear and guilt. In the multivariate model, the feeling of shame was the only independent variable capable of accounting for the severity of the delusions, that, in in DD patients, would lie on an affective core of shame.Table 2.

Pearson correlation coefficient

The severity of delusional beliefs in DD patients would lie on an affective core of shame upon predisposing personality traits. These findings could help to develop a psychotherapeutic approach for delusional patients focused in the feeling of shame.

None Declared

It has been reported an inflammatory state in schizophrenia, with altered levels of some cytokines (Zhou et al. Cytokine 2021; 141:155441). Recent publications have shown the importance of IL- 33, a member of the IL-1 cytokine family which acts as an alarmin (Han et al. Neurosci Bull 2011; 27, 351-357). The role of this cytokine as a biomarker has been investigated in schizophrenia (Koricanac et al. Front Psychiatry 2022; 13, 925757). However, results are controversial. Some studies have not found significant associations between IL-33 and chronic schizophrenia (Campos-Carli et al. Compr Psychiatry 2017; 74 96-101), while other papers have reported increased levels (Kozlowska et. al. J Psychiatr Res. 2021; 138 380-387). In all these studies, levels of IL-33 were measured in a single daily measure, so that it has not been studied if IL-33 has changes during hospitalization.

To study the serum level of IL-33 at 12:00 and 00:00 hours in schizophrenia patients at admission and before hospital discharge.

Fifteen inpatients with diagnosis of paranoid schizophrenia according to ICD-10 criteria were studied. Patients were hospitalized at the University Hospital of the Canary Islands psychiatric ward because of an acute relapse. A total of four blood samples were taken from each patient: at 12:00 and 00:00 hours the day after admission and at 12:00 and 00:00 hours the day before discharge. Serum IL-33 levels were measured by ELISA techniques. Daytime and nighttime IL-33 serum levels at admission and discharge were compared using a non-parametric Wilcoxon signed-rank test.

In table 1 the results of the comparison of IL-33 at admission and discharge are presented. There is a significant reduction of IL-33 levels at 00:00 h. at discharge in comparison with the IL-33 levels at 00:00 h. at admission (p=0.028). No other statistically significant differences were observed.

The decrease of serum IL-33 at 00:00 at discharge compared to the 00:00 IL-33 serum level at admission points to the utility of this biomarker as a surrogate of brain inflammation.

None Declared

We present the case of a sixty-seven-year-old woman who is examined for the first time in the emergency room because of a nine-month clinical picture that involves psychotic symptoms. The patient exhibits persecutory delusions that started after she shared some private information on social media. These symptoms also entail emotional distress and behavioral disturbances. She has never experienced hallucinations, but she does present delusional interpretations of the environment. Her clinical history reveals abnormalities of premorbid personality, including paranoid and immature features.

(1) We will be carrying out a differential diagnosis of late onset psychotic symptoms. We will as well be exploring the concept of Paraphrenia and analyzing its differential features in order to stablish the most suitable diagnosis for the case.

(2) The relationship between abnormalities in premorbid personality and psychotic symptoms will be covered, reviewing the available literature on this matter, and relating it to the patient’s symptomatology.

A review of the patient’s clinical history will be carried out, considering her biography, the testimony of her family and the complementary tests performed during the hospitalization period.

A bibliographic review of the available scientific literature will also be developed involving disorders that could explain psychotic symptoms in the elderly, as well as the term Paraphrenia, which describes specific features in a psychotic episode but is not included in the diagnostic manuals.

(1) The symptomatology that our patient exhibits may be considered atypical given the late stage of its onset and its specific features.

(2) The case could be explained under the category of Delusional Disorder. From a psychopathological point or view, it could also fit under de diagnosis of Paraphrenia as described by Ravindran et al.

(3) Pathological personality traits were assessed in premorbid personality which included paranoid and immature features.

It could be useful to review the concept of the “paranoid spectrum” as proposed by some authors regarding some patient’s psychotic symptoms that don’t exactly fit any of the nowadays diagnostic categories. “Paraphrenia” could be understood as a distinct clinical entity for patients who show psychotic disorders but keep affective warmth and lack though deterioration and grossly disorganized behavior.

Most patients with late life paranoid psychoses have abnormal premorbid personalities, most usually of schizoid or paranoid type. There’s a decent amount of consensus in viewing the premorbid personality as having been abnormal as an early marker of impending psychosis.

Reformulating the way we approach diagnosis of psychotic symptoms of late onset could help us identify vulnerable patients on a premorbid stage and better classify and understand atypical entities.

None Declared

Ekbom Syndrome is a rare condition presenting as a uni-thematic delusional belief of parasitosis. Affected individuals are often socially isolated presenile females. The syndrome is characterised by kinaesthetic hallucinations of insect infestation with persistent pruritis. First described by Karl Ekbom in 1938, presentations are rare, often presenting initially to primary care and dermatological services. We report a case of an older adult female referred to Community Mental Health Team following multiple presentations to the primary care physician with subsequent diagnosis of Ekbom Syndrome.

To illustrate a rare case report of Ekbom Syndrome, managed successfully in the community in Ireland.

A retrospective case study. Data was reviewed from available psychiatric and medical records including laboratory testing.

A 69 year old Catholic Nun was referred to the CMHT for psychiatric assessment. The patient presented to the CMHT appointment as distressed. She reported a 15 year history with significant deterioration 4 months prior, of progressive symptoms of a ‘crawling and biting sensation’ all over her body, alongside intermittent anxiety related to the infestation. The patient acknowledged that she had visited her primary care physician on multiple occasions seeking resolution. On one occasion the patient brought a sample of the alleged parasites inside a small container, ‘matchbox sign’.

A professional pest control agency had recently been employed to decontaminate her bedroom in the parish house of which she is resident in. She described a rigid routined, daily washing of clothes. Medical history was significant for pituitary gland adenoma 30years prior, with pituitary excision twice secondary to visual disturbance and reoccurrence. She was on lifelong thyroid replacement with acceptable postoperative functioning.

The patient was commenced on Aripiprazole oral medication and received psychoeducation via Specialist Mental Health Nursing Outreach. Pimozide was deemed unsuitable due to presence of numerous cardiac risk factors. Physical and delusional psychopathology resolved in a trajectory fashion with aripiprazole titration. It was hypothesised that the patient had premorbid anakastic personality traits, exacerbated by the COVID19 pandemic prior to presentation.

Patients with delusional parasitosis can have complex medical and social histories and may present to psychiatry as a last resort. These clinical presentations can occur after periods of dermatological input and following extensive efforts to decontaminate their physical surroundings. Psychotic symptoms of Ekbom Syndrome may be effectively controlled with psychotropic therapy and patients benefit from psychoeducation about their rare disorder.

None Declared

Lateralization is the functional dominance of one of the dual organs of the body: eyes, arms, legs and even ears, during their spontaneous or purposeful actions. The handedness is influenced by many factors like geographic region, genetic and cultural factors as well as sex. The most used assessment for functional lateralization is hand dominance. When assessing foot and eye dominance, however, we find significantly higher left foot dominance as well as very strong left eye dominance in schizophrenic patients versus controls. We consider the explanation of this results is because in Bulgaria, during the communist regime (before 1990) left hand writing was under cultural pressure. Also handedness itself is influenced by other cultural factors as mentioned already. All of the above made us conclude that foot and eye dominance may assess much better the lateralization than hand dominance.

The aim of the study was to investigate the relaibility (internal consistency) of a combined Foot and Eye Dominance Scale in women- patients with schizophrenia and healthy subjects.

A sample of 94 women- scizophrenia patients and healthy controls were assessed with a Combined afaoot and Eye Dominance Scale. It consisted of two subscales Foot Dominance Subscale and Eye Dominance Subscale. The Foot Dominance Subscale included a modified Chapman & Chapman Foot Dominance Scale and a new Complex Task Scales with four foot tests, reflecting on complex tasks. The Eye Dominance Subscale included three eye tests. Scale reliability statistics (item-scale statistics, summary statistics for the items, Cronbach’s alpha), non-parametric Mann-Whitney test and Spearman’s rank correlation coefficient were used.

Considerable differences were found in the contribution of the single items to the Combined Foot and Eye Dominance Scale. Some items show greater means than other items (from 0,14 to 0,80), which suggested greater phenogenetic component and consequently greater contribution of these items to the total scale mean. The mean correlation between the items of the Combined Foot and Eye Dominance Scale was positive (0,32), indicating good internal consistency of the scale.

The Combined Foot and Eye Dominance Scale more strongly and objectively reflect leftedness and could be a more useful tool for the assessment of lateralization irrespectively of culture and nation. The Combined Scale allows cross-cultural worldwide equivalence to the different studies in different neuroontogenetic diagnoses with presumed abnormal cerebral asymmetry.

None Declared

Schizophrenia is a common chronic mental illness (1% of the general population) classified by the World Health Organization in the group of the 10 most disability causing diseases.

Despite its impact on social and relational functioning and the alteration of the quality of life, the sexuality of these patients is not always explored.

Evaluate the sexuality of patients with schizophrenia by comparing men and women followed in the "A" psychiatry department of Razi Hospital in Tunisia.

A descriptive cross-sectional study was conducted with 50 stabilized patients (25 men and 25 women) suffering from schizophrenia.

The research for sexual dysfunctions was carried out with the ASEX scale (Arizone Sexual Experience Scale) and CSFQ-14 (Changes in sexual functioning questionnaire) in their French version.

A correlation was used between these two scales in order to guarantee results’ conformity.

The sexual activity rate was 64.0% at the time of the study and 88.0% over a life span. These sexual activity rates were comparable between the two sexes.

The overall rate of sexual dysfunction was 68.7% of sexually active patients at the time of the study and concerned 72.2% of men and 64.3% of women, with no difference according to gender.

The different sexual dysfunctions were equally present in men and women, except for the dimension disorder: desire/interest, desire/frequency and arousal, which were more frequent in women.

The sexual aspect in patients followed for schizophrenia remains neglected by clinicians. It deserves better attention in order to optimize the overall care of patients and improve their quality of life.

None Declared

Folie a deux is a rare psychiatric disorder where an identical or similar mental disorder affects two or more individuals usually with close emotional ties. Management of patients with folie a deux may require multiple types of treatment including separation, family therapy and antipsychotics.

Narrative case of Folie a deux in 2 elderly sisters

Clinical case presentation through retrospective review of clinical notes

We present a case of 2 sisters living together of 76 and 74 years of age. The elder sister, Sister A, presented to Singapore’s Institute of Mental Health on October 2021 after she was referred from court for disturbed behaviour with more than 10 years history of paranoid delusions against their neighbours, eventually extending to strangers in general. She was admitted and stayed in hospital from October 2021 to February 2022. She was referred to community psychiatric services to perform home visits due to her unwillingness to attend subsequent follow ups after discharge. During these home visits, it was determined that her sister, Sister B, was displaying delusional thinking as well. Sister A was started on antipsychotics while Sister B was managed non-pharmacologically. After commencement of antipsychotics, Sister A showed good response with improvement of symptoms, while Sister B continued to display delusional thinking. Discussion was made with the next-of-kin of both sisters, their nephew, and the decision was made to continue to observe these symptoms and monitor for their resolution with continued treatment of Sister A. A multidisciplinary approach was also used to attempt to reintegrate them into society to rebuild trust in the public. Currently both sisters still report vague paranoia of strangers in general and a multidisciplinary team is involved in improving their symptoms further.

With this case report, we hope to raise awareness of the different methods that are useful in the management of Folie a deux along with the challenges faced when managing these cases.

None Declared

Lurasidon is a relatively new, second-generation antypsychotic drug with an interesting receptor profile. It is considered safe and has a low risk of side effects. This drug is effecitve in reducing the productive symptoms of schizophrenia, but also has a positive effect on negative symptoms and cognitive functions. It is a medicine with a multi-receptor mechanism of action: it mainly blocks dopaminergic D2 and serotonergic 5-HT2A receptors. According to the Summary of Product Characteristics, adverse reactions such as leucopenia, neutropenia and anaemia were too rare to estimate their frequency.

This study describes case of neutrocytopenia and leukocytopenia that are likely to be related to lurasidone and have resolved after discontinuation of this medicinal product. The aim of the article is to highlight the risk of using second-generation antipsychotics in patients and the occurence of blood cells disorders in particular neutrocytopenia.

An analysis of the medical history records were done to describe the case report.

39-years-old patient treated psychiatrically for 18 years, initially for mood disorders, irritability, behavioural disorders. In 2014 she was diagnosed with paranoid schizophrenia, herlast psychiatric hospitalization took place in 2021. The patient had a history of neutrocytopenia and leukocytopenia. In December 2020, the patient was admitted to the psychiatric ward on account of active aggression against her mother. She was discharged in January 2021 with the recommendation to take paliperidone intramusculary. Due to incomplete remission of psychotic symptoms, the patient received 37 mg of lurasidone since August 2021. The blood count, which was ordered upon admission to the Department of Psychiatric Rehabilitation, showed moderate neutrocytopenia. After discontinuation of lurasidone and the recommended supplementation, the results gradually improved and finally reached the normal range.

This case report shows the need for regular monitoring of blood cells parameters in patients treated with second generation antipsychotics, as there is a risk of neutrocytopenia or even agranulocitosis. If there is an obvious correlation, the dose should be reduced or switched to another medicinal product if possible and blood counts should monitored further.

None Declared

Patients suffering from schizophrenia have a higher risk of premature death. An unhealthy lifestyle contributes to increased risk of cardiovascular diseases, metabolic syndromes, suicides among them. In addition to the use of selected therapy with a restriction metabolic risk has become important to influence non-pharmacological factors such as proper diet, introducing the principles of a healthy lifestyle. A diet rich in fiber, the DASH diet, the Mediterranean diet may become beneficial in terms of lowering parameters metabolic, cardiovascular and immune related to premature mortality in schizophrenia.

Patients suffering from schizophrenia have a higher risk of premature death. An unhealthy lifestyle contributes to increased risk of cardiovascular diseases, metabolic syndromes, suicides among them. In addition to the use of selected therapy with a restriction metabolic risk has become important to influence non-pharmacological factors such as proper diet, introducing the principles of a healthy lifestyle. A diet rich in fiber, the DASH diet, the Mediterranean diet may become beneficial in terms of lowering parameters metabolic, cardiovascular and immune related to premature mortality in schizophrenia.

The objective of this study was to evaluate the influence of the lifestyle on the metabolic parameters in schizophrenia

In our study, we assessed the influence of diet, nutritional knowledge and lifestyle on parameters of metabolic syndrome (cholesterol, triglicerydes, glucose) in patients with schizophrenia.

In the results we have found positive co-relations between unhealthy diet and lifestyle and lack of knowledge on proper nutrition and increased parameters of metabolic syndrome.

Dietary intervention may become one of the therapeutic goals in schizophrenia.

None Declared

Acute laryngeal dystonia due to antipsychotics is an uncommon but potentially lethal form of extrapyramidal reaction. The initial symptoms may be subtle but progressively appear difficulties in phonation, stridor and dyspnea which are often life-threatening.

To describe a case of acute laryngeal dystonia and oculogyric crisis secondary to risperidone.

The present study is a case report of a patient admitted for schizophrenia who was presented a laryngeal dystonia and oculogyric crisis after being treated with 5mg risperidone. We also searched previously case reports, series and systematic reviews of laryngeal dystonia using a pubmed query.

A 30-year-old Caucasian woman who was admitted for schizophrenia presented rhinolalia, oropharynx paresthesias, mild dyspnea without stridor, and prolonged involuntary upword desviation of the eyes. All these symptoms started within 24 hours of starting risperidone 5mg per day. A laryngoscopy showed abnormal motion of the vocal cords that suggested laryngeal dystonia. Symptoms remitted after administration of intramuscular biperiden 4mg. Risperidone was later switched to olanzapine because of better psychomotor side-effect profile.

Laryngeal dystonia is a medical emergency requiring early diagnosis and immediate treatment. Anticholinergic agents should be carried out, without waiting for the results of complementary tests. The route of administration can be intramuscular or intravenous. This complication should be always kept into account when a patient is taking any antipsychotic, and remembered for the antipsychotic election in following treatments.

None Declared

Catatonia is a syndrome characterized by physical symptoms ranging from immobility to excessive motor activity. Besides being historically associated mainly with schizophrenia, it is widely known that it can be the expression of different psychiatric, neurological or medical conditions. The treatment of choice is benzodiazepines, indicating electroconvulsive therapy in refractory cases. Amantadine is considered a second-line therapy in setting when electroconvulsive therapy is not available.

To describe the case of a patient with treatment-resistant catatonic schizophrenia. Not having responded to benzodiazepines or electroconvulsive therapy, potentiation with amantadine was subsequently started.

Our patient presented at a psychopathological level; psychomotor inhibition, a perplexing attitude, and mute speech. At the motor level; ambitendency, indecision, automatic obedience, motor stereotypes, and facial grimaces. He did not present other alterations at the neurological level. Regarding complementary explorations, we performed neuroimaging and blood tests, which resulted all anodyne. With an alternative diagnosis, we considered that sequelae of a neuroleptic malignant syndrome could have produced the symptoms that he had suffered. Due to the persistence of the symptoms and their typical characteristics, catatonia was our first diagnostical impression. As treatment with benzodiazepines was ineffective, electroconvulsive therapy was started. No clinical improvement was observed. Given the refractoriness of the case, a review of the existing literature was carried out. We found reports of a good response to amantadine in similar cases. Amantadine was introduced up to a dose of 200mg.

After four weeks of treatment with amantadine at a dose of 200mg, the patient showed meager improvement at both psychopathological and motor level.

We find the case of a patient with long-term schizophrenia who is nowadays dependent on all daily living activities and requires sustained care.

None Declared

Forced medication is one of the most frequently used coercive measures in acute mental health units. It is a practice that can lead to physical, psychological and psychopathological consequences. Therefore, it is necessary to implement measures to reduce its use. In this sense, it is interesting to study the variables that can be associated with its use, and thus take measures accordingly.

This study attempts to identify the number of forced medication episodes between July 2017 and December 2018 treated in the catchment area of the Mental Health Service at Jerez Hospital. As a secondary objective, it pursues to identify the factors that conducted to the use of forced medication with the intention of being able to reduce the use of these measures.

A descriptive and retrospective study has been developed reviewing the total number of episodes of forced medication. Patients admitted and discharged from hospital between July 2017 and December 2018 treated in the Mental Health Service at Jerez Hospital. Data were extracted from medical records.

The total number of episodes of forced medication identified was 330. In these episodes, the average age was 41 years, with a predominance of 74% of the male gender. The most used route in the episodes was intramuscular (94.8%), in addition, more than 50% needed the association of two drugs, the most used were haloperidol and olanzapine. The 32.7% of the episodes also required the use of mechanical restraint and 44.2% required the presence of security service.

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We present the descriptive analysis of a further study currently been conducted in hour hospital which means to stablish predictive factors for the use of forced medication. We therefore intend to create patient profile, as well as new measures specifically directed to these factors with which to diminish the use of forced medication.

None Declared