Interleukin-15 is a cytokine that induces or enhances differentiation, maintenance, or activation of several T-cell subsets (including NK, NKT, Th17, Treg, and CD8+ memory cells) and also plays an important role in regulating visceral (intra-abdominal or interstitial) fat breakdown and myofibrillar protein synthesis (hypertrophy). It is also involved in modulating serotonergic activity in the brain by modulating the transmission of GABA and serotonin, which may be the basis for mood and memory disorders, as well as activity levels, sleep, and thermoregulation. Both anorexia nervosa (AN) and schizophrenia (SCH) represent two distinct and serious psychiatric disorders in which some of these symptoms may overlap and where neuroinflammation plays an important role which is yet to be precisely determined.

This article summarizes recent findings and highlights interleukin-15 as a possible link between anorexia nervosa and schizophrenia.

A review of the current literature in the field of psychoneuroimmunology.

In recent years, research has shown elevated levels of IL -15 in the serum of patients suffering from anorexia nervosa and schizophrenia.It is also interesting to note that IL -15 has structural similarities to IL -2, which previous studies have also shown to be elevated in patients with schizophrenia.

These associations, so far suggesting an important role of inflammation and its mediators, need further investigation in light of possible genetic overlap between anorexia nervosa and schizophrenia identified in genome-wide association studies (GWAS).

None Declared

The relevance of studying the clinical and immunological characteristics of prolonged and chronic endogenous manic and manic-delusional states is conditioned by their high prevalence, insufficient understanding of pathogenetic mechanisms, and the need to develop adequate therapeutic approaches.

To study the clinical and biological correlations between inflammatory markers of blood plasma, the severity of manic symptoms and psychopathological characteristics of patients with prolonged and chronic endogenous manic and manic-delusional states.

70 female patients aged 18 to 55 years (mean age 33.6±5.9 years) with prolonged and chronic endogenous manic and manic-delusional states within different nosologies (F31.1-2, F25.01, F25) were examined. Psychometric assessment was performed using the PANSS, YMRS, and GAF scales. The control group consisted of 55 mentally and somatically healthy women of the corresponding age.

Leukocyte elastase (LE) activity, α1-proteinase inhibitor (α1-PI) activity, and the autoantibody levels to astrocytic protein S-100B and myelin basic protein (MBP) were determined in blood plasma.

The increase in the level of immune system activation of different degrees (according to the complex of inflammatory and autoimmune markers) associated with the severity of the patient’s condition within the examined nosologies was revealed.

The highest level of immune activation, characterized by an increase in the activity of both LE and α1-PI (p<0.01), and the level of autoantibodies to S-100B and MBP (p<0.05), was characteristic of patients with chronic endogenous manic and manic-delusional states in the framework of schizophrenia. Manic symptoms within different nosologies had clinical features, however, no differences in the severity of these symptoms on the YMRS scale were revealed (p>0.05).

Positive correlations were found between LE activity and the PANSS subscale of general psychopathological symptoms (R=0.3, p=0.006) and the PANSS total score (R=0.3, p=0.03). The level of antibodies to S-100B correlated with the PANSS negative subscale score (R=0.3, p=0.04). A negative correlation was found between LE activity and the level of social functioning of patients according to the GAF scale (R=-0.3, p=0.02).

The immune profile of patients with prolonged and chronic manic and manic delusional states within endogenous psychiatric disorders is determined mainly by nosologic affiliation, which is also related to the clinical features of manic states.

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In recent years, there is a growing interest in microbiota and how certain dietary patterns affect our brain.

We know that diet has an important impact in physical and mental health. The mecanism that underlies is already unknown, but there is emerging evidence that diet modulates brain gut microbiota and has implications in mental problems.

The aim of this poster is highlight the importance of diet in mental health and the link with microbiota.

Review of recent literature about diet, microbiota and psychiatry. The studies were collected of the electronic databases PubMed.

New researches highlight the importance of adequate nutrition for mental health. Several studies link healthy diet with a minor risk of mental illnesses or with the improvement of depressive symptoms. Likewise, poor dietary habits could aggravate cognitive decline and increased risk of developing anxiety, depression or other mental illnesses.

It has been shown that a diet rich in fiber, polyphenols and micronutrients improve gut microbial composition and can reduce metabolic endotoxemia and neuroinflammation, and this has been associated with improvements in brain health. Also, prebiotic and probiotics have positive effects.

Therefore, dietary interventions could be a complementary therapeutic approach for patients with mental problems. This is what nutritional psychiatry focuses on.

Microbiota as a potential therapeutic target for mental illness is a hot topic in psychiatry, but also, its interaction with dietary change or the use of probiotics and prebiotics. This action is easy to implement in our clinical practice and could be part of a biopsychosocial treatment to improve or prevent some psychiatric disorders.

Nutritional psychiatry is a new field that needs to be developed and the knowledge in microbiota, diet and mental health could help. Hopefully, the research about this topic continues expanding.

None Declared

The studies on various groups of patients with schizophrenia revealed impairments in immune system, glutamatergic, and antioxidant systems contributing substantially in schizophrenia pathogenesis.

To search for links between the activities of platelet enzymes involved in glutamate and glutathione metabolism and monocytes’ subpopulation compositions in patients with schizophrenia and to identify possible correlations of the biomarkers with clinical data. Research objectives: determination of subpopulation ratio of monocytes; measurement of the activity levels of glutamate dehydrogenase (GDH), phosphate-activated glutaminase (PAG), glutathione reductase (GR) and glutathione S-transferase (GST) in blood platelets; search for correlations between these parameters and the scores by psychometric scales.

The study included 36 women aged 16-45 years with acute schizophrenia hospitalized in the Mental Health Research Centre with their current condition assessed as depressive-delusional. The control group consisted of 17 women 18-45 years old without somatic or mental pathology. GDH, PAG, GR and GST activities were measured by spectrophotometric methods, and numbers of monocyte subpopulations - “classical”, “intermediate”, “non-classical” - by flow cytometry. The Hamilton Depression Rating Scale (HAMD-17) was used to assess depression severity. The data was processed using the Statistica 8.0 software.

The detected changes in monocyte subpopulations’ composition towards the increase in the proportion of cells having a pro-inflammatory phenotype (CD14++CD16+ “intermediate”) indicated the activation of inflammatory reactions. Also, the activities of platelet enzymes of glutathione metabolism (GR and GST) were significantly decreased (p<0.05). Moreover, GDH and GST activities significantly correlated with the scores by HAMD-17 (r=0.40, p=0.022 and r=0.45, p=0.030, respectively). The results indicate the presence of pathological inflammatory process, the decrease in activities of glutathione antioxidant metabolism enzymes and a link to glutamate metabolism involvement (GDH) in the studied patient group.

The identified redistribution in the monocyte subpopulations’ composition and decrease in the activity of enzymes involved in glutamate metabolism and antioxidant system indicate the involvement of the immune, glutamate and antioxidant systems in the pathogenesis of schizophrenia and may reflect a functional interaction between these systems.

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• - Introduce the topic of the continuity of psychoses and its relevance in contemporary psychiatry.

• - Present authors as Henry EY, Jim van Os and Germán Berrios as key figures in the discussion on this topic, highlighting Ey, Dr. Jim van Os’s significant contributions to the understanding of the continuum of psychosis, Germán Berrios’s historical and cultural perspectives, and the importance of Bartolomé Llopis’s critical viewpoint. We also review the evolutionary approach about mental disorders as a keypoint in this discussion.

Analyzing and comparing the theses of Jim van Os, Ey, Germán Berrios, and Bartolomé Llopis’s critical perspective. about the continuum of the psychosis and the importance of this neverending question for its use in the clinical practice.

I will present a detailed literature review and a textual analysis of their writings.

• - Provide a brief description of Jim van Os’s theses highlighting his key ideas:

• - Dimensional Approach: promotes a dimensional approach to understanding psychosis, viewing psychotic experiences as continuous variables rather than categorical entities. This challenges the traditional diagnostic system.

• - Psychotic-Like Experiences: His research focuses on “psychotic-like experiences” (PLEs) in non-clinical populations, including mild hallucinations or paranoid thoughts.

• - Transdiagnostic Perspective: His work contributes to a transdiagnostic perspective, suggesting flexibility in diagnostic boundaries in psychiatry.

• - Next, introduce Germán Berrios’s theses on the same topic, emphasizing his historical and cultural perspectives and recognition of individual variability.

• - Finally, introduce Bartolomé Llopis’s critical perspective:

• - Llopis criticizes simplistic models of psychosis, arguing that they fail to capture the complexity of individual experiences.

• - He advocates for comprehensive assessments that consider not only symptomatology but also the unique contexts and histories of individuals.

• - While Ramón y Cajal is best known for his contributions to neuroscience and neuroanatomy, he did not directly apply Darwinian principles to his work in those fields. However He believed that an understanding of the evolutionary history of the brain and nervous system could provide valuable insights into their structure and function.

• - Highlight the potential for a more comprehensive and holistic approach to understanding and addressing psychotic experiences within an evolutionary context.

• - The relationship between the continuum of psychosis and evolutionism is a complex and multifaceted topic. It involves exploring how the concept of the continuum of psychosis, which suggests that psychotic experiences exist on a spectrum in the general population, may relate to evolutionary theories and perspectives on mental health. We will explain some key points to consider about this and the main psychiatrists whicha dealt with this question.

None Declared

Introduction: Research indicates that 2-8% of students exhibit ADHD symptoms, a condition impacting personal, social, and academic functionality (Kwon et al., 2018). A significant proportion encounter educational and socio-emotional challenges, often leading to academic disruptions; indeed, 11-21% of such students defer enrollment for two consecutive years (DuPaul et al., 2021). Studies have highlighted pronounced issues related to academic performance within this demographic (Henning et al., 2022). These findings emphasize the critical need for innovative interventions and a deeper understanding of ADHD’s impact on young adults in academic contexts.

To investigate challenges and evaluate supportive counseling approaches for students with Attention Deficit Hyperactivity Disorder (ADHD)”

This study utilized a qualitative approach, employing semi-structured interviews to understand the experiences and perspectives of university students with ADHD from across the country. The diverse sample comprised students from various academic disciplines and levels. Data were collected, ensuring participants’ comfort, and were analyzed using content analysis method, revealing insightful themes and patterns about ADHD’s impact in students’ quality of life and academic issues. The findings aim to contribute to a better understanding of ADHD

The results of the study highlight the significant academic and organisational difficulties faced by participants with ADHD. Many struggled intensely to maintain concentration in class, with distractions causing significant attentional lapses and increased anxiety. Procrastination was a recurring problem, leading to last-minute submissions and increased stress. Forgetting to complete academic tasks, such as course registration, had a cumulative negative impact on participants’ academic journeys. These findings highlight the complex challenges faced by people with ADHD in educational settings, and the need for comprehensive interventions. Addressing these multifaceted issues goes beyond academic accommodations and requires inclusive learning environments, counselling, peer support, and specialised faculty training to create a supportive ecosystem conducive to the success of individuals with ADHD.

This study highlights the multifaceted challenges, notably in concentration and task management, faced by individuals, presumably with ADHD, within academic settings. The reported struggles emphasize the urgent need for specialized interventions and support structures, focused on fostering concentration, effective task management, and administrative diligence. The insights provided are instrumental, guiding future research and intervention strategies aimed at addressing the identified needs and fostering an inclusive and supportive learning environment.

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A 21-year-old male presented to the emergency room due to strange behavior

Show how emotionally intense events can be a stress factor leading to dissociative or psychotic symptoms.

Case report and literature review

The patient is in Spain after having attended the meeting with the Pope at the World Youth Day in Portugal. He is an engineering student who, in the week prior to the trip, had high levels of stress related to exam time. He also explained that he had recently had conflicts with his partner. In the psychocopathological examination of the patient, a global insomnia of 3 days of duration stands out. In addition, a disorganized and disjointed speech focused on high concern that something bad could happen to his family and partner. In the interview he appears restless, nervous, with a perplexed contact. The patient’s companion says that he has been very worried and obsessed about his relationship with his partner, with constant doubts about asking her to marry him. It is decided to start olanzapine, receiving up to 15 mg per day. In the following interviews he shows better contact and a more organized speech.

It is known that emotionally intense situations can be a trigger for the development of psychotic symptoms. There are different manifestations of these stressful situations such as physical symptoms like fainting or but mental symptoms are also described such as dissociative amnesias, or less frequent as in this case psychotic symptoms. They are usually of sudden onset and early remission with good response to anxiolytics or antipsychotics.

None Declared

Presence of the disabled child in the family poses many challenges for their siblings, especially in adolescence. Children with disabled siblings often receive less attention from family and friends, experience a sense of injustice and anger towards sick siblings, as well as they are more likely to experience various somatic complaints and higher levels of depression and anxiety. However, research shows that resiliency could be a protective factor associated with the functioning of children and adolescents in certain life events, such as sibling’s disability, referring to good adaptation despite facing emerging adversities.

Therefore, the aim of the current study was to examine the role of resilience as a possible protective factor for the occurrence of internalizing and externalizing disorders in adolescents having disabled sibling.

175 diads of a healthy adolescent and one of its parents (N = 350) participated in the study. Participants were divided into two groups - 119 diads in the group with disabled sibling (Madolescent’s age = 16.70; SD = .66) and 56 diads in the group with a healthy sibling (M adolescent’s age = 16.64; SD = .75). The following measures were used in the study: Resilience Measurement Scale (SPP-18) and Child Behavior Checklist for Ages 6-18 (CBCL/6-18).

The results showed no statistically significant differences in any of the measured resilience factors (optimistic attitude and energy, persistence and determination in action, sense of humor and openness to new experiences, personal competences and a tolerance for negative affect), in adolescents with disabled sibling, comparing to the control group. However, adolescents with disabled sibling were found to have a significantly higher risk of the occurrence of both, externalizing and internalizing disorders compared to adolescents with healthy siblings. Furthermore, findings of the study also confirmed that personal competences and a tolerance for negative affect predicts lower risk of the occurrence of internalizing disorders in adolescents having disabled sibling.

Our findings highlights that resilience may have important role in reducing the risk of the clinical problems occurrence in adolescents having disabled sibling. Therefore, comprehensive psychological support enhancing their personal growth and competence should be provided in the above group.

None Declared

Treatment-resistant psychiatric disorders present a significant clinical challenge, often requiring trial-and-error approaches to find effective therapeutic interventions. Pharmacogenetic testing has emerged as a promising tool to guide medication selection and dosing, potentially reducing the time to achieve remission and alleviating the burden of persistent symptoms. However, the optimal timing and integration of pharmacogenetic testing into psychiatric practice remain underexplored.

Pharmacogenetic tests can identify individuals with genetic variants that may predict their response to psychotropic drugs, thus enabling a more personalized approach to treatment. Evidence suggests that early application of pharmacogenetic testing, particularly after the first failed medication trial, can substantially improve outcomes for patients with treatment-resistant disorders. Such timely intervention can inform drug choice and dosing, averting protracted periods of ineffective treatment and minimizing exposure to unnecessary side effects.

This review synthesizes current literature on pharmacogenetic testing in psychiatry, with a focus on its application in treatment-resistant mood disorders, schizophrenia, and other non-responsive psychiatric conditions. We examine the genetic polymorphisms that influence drug metabolism, efficacy, and the risk of adverse effects, particularly considering cytochrome P450 enzymes and receptor gene variations.

Pharmacogenetic testing holds significant promise in psychiatry, especially for treatment-resistant disorders, by aligning genetic profiles with medication selection to enhance therapeutic efficacy. While cost and access remain barriers, the benefits of early testing support its integration into standard care protocols. Further research is needed to establish clear guidelines and to expand the genetic targets relevant to psychiatric pharmacotherapy.

Adoption of pharmacogenetic testing after the initial treatment failure offers a pragmatic balance between the practical limitations of universal screening and the clinical imperative to alleviate the substantial morbidity associated with treatment-resistant psychiatric conditions.

None Declared

Premenstrual dysphoric disorder (PMDD) is prevalent, more severe than premenstrual syndrome(PMS), and a challenging disorder. The first line of treatment is pharmacotherapy. Non-pharmacological therapy includes aerobic exercise, consumption of complex carbohydrates and frequent meals, relaxation training, light therapy, sleep deprivation, and cognitive-behavioral therapy could be helpful

To our knowledge, there have not yet been any studies on this treatment option for PMDD with IBS

a case report

A lady suffering from PMDD and irritable bowel syndrome (IBS) did not respond to antidepressants, painkillers, and melatonin. She used to sit at home and in her room these days, waiting for the PMDD severity to decrease. Her condition reached remission after taking a small dosage of sulpiride and stopped on the last day of the period. The patient is satisfied with the result since concerns about antidepressants are addressed and avoided. This case provides a new approach to using low-dosage sulpiride temporarily every month in patients with both PMDD and IBS

Premenstrual dysphoric disorder is a challenging condition. The symptoms of PMDD are not continuous, and somatic symptoms are a significant component of both the diagnosis and the patient’s suffering. Choosing a suitable medication based on pros and cons contributes to successful treatment and patient satisfaction. This case provides a new approach to using low-dosage sulpiride in patients with both PMDD and IBS, but more studies are needed to confirm its efficacy and safety.

None Declared

Anatomical Therapeutic Chemical (ATC) indication-based classification system is the World Health Organization (WHO) drug classification system and it is widely used in clinical and researh practice, however there has been questions around the scientific base of this (1, 2). Neuroscience-based Nomenclature (NbN) has been developed by representatives from 5 international organizations, with specific expertise in psychopharmacology, to address the issues around neuropsychopharmacological drug classification and improve the focus on pharmacological domains and mode of action:

ECNP – European College of Neuropsychopharmacology

ACNP – American College of Neuropsychopharmacology

AsCNP – Asian College of Neuropsychopharmacology

CINP – International College of Neuropsychopharmacology

IUPHAR – International Union of Basic and Clinical Pharmacology

References:

1. Nutt DJ. Beyond psychoanaleptics - can we improve antidepressant drug nomenclature? [published correction appears in J Psychopharmacol. 2009 Sept;23(7):861]. J Psychopharmacol. 2009;23(4):343-345. doi:10.1177/0269881109105498

2. Zohar J, Stahl S, Moller HJ, et al. A review of the current nomenclature for psychotropic agents and an introduction to the Neuroscience-based Nomenclature. Eur Neuropsychopharmacol. 2015;25(12):2318-2325. doi:10.1016/j.euroneuro.2015.08.019

As NbN is a novel classification system that can be used as a teaching tool as well as for other purposes, we aimed to understand the experience, views and needs of the psychiatric trainees and early career psychiatrists who will shape the future of psychiatry, around drug classification systems.

The ethical clearance of the study was obtained from King’s College London. We prepared an online survey (https://forms.gle/FCSdVTFH4U5QNn5t8) with a multinational group of early career pscyhiatrists who met through the CINP and EFPT, and test-run the survey with a small group of psychiatric trainees. The online survey was then disseminated via emailing lists and groups of early careers psychiatrists as well as through social media.

At the time of this abstract submission, the data collection is ongoing. Results will include analyses of the experience with different drug classifcations systems, awareness, views and attainment of NbN, stratified according to the demographic data (country, careers status, main work setting).

The findings from this study will shed light on the views and needs of early career psychiatrists on the topic from clinical and academic aspects, a previously unexplored perspective on drug classification systems. The findings can inform the planning of various strategies to address areas to improve the use and teaching of these tools.

None Declared

Haematological alterations, especially in the red blood cell series, are a rare adverse effect of olanzapine treatment. A 64-year-old female patient with a diagnosis of long-standing schizophrenia was admitted to the psychiatric room for psychotic decompensation and leukopenia in control laboratory tests. She had a history of mild psoriasis, allergy to sulphonamides and infectious bursitis nine years earlier secondary to neutropenia due to clozapine. On previous admission, episodes of anaemia and neutropenia related to increased doses of olanzapine were observed. On current admission, a new episode of anaemia and neutropenia occurred with doses of up to 20 mg/day of olanzapine, hemoglobin levels of 63g/L ann neutrophil count of 0,8*10^9 neutrophils/l were detected.

Report a very rare but serious adverse effect in patients treated with olanzapine.

Haematological analysis were periodically carried out from 2009 to 2023.

A complete study was carried out with parameters of haemolysis, autoimmunity, a pharmacogenetic study and a myelogram.

The autoimmunity and haemolysis study excluded an autoimmune or haematological illness that could justify the haematological alterations.

The myelogram showed normal cellularity.

The pharmacogenetic study showed no relevant alterations.

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Image 2:

The case was classified as a non-immune haemolytic anaemia secondary to olanzapine and improved with withdrawal of the drug.

None Declared

Intranasal esketamine has been approved as a treatment for patients with treatment-resistant depression. We analyzed the results of its efficacy in 15 patients.

To evaluate the efficacy of intranasal Esketamine as a treatment in patients with treatment-resistant depression

Case series

For the last 8 months, since the treatment with intranasal esketamine was approved for resistant depression, we have treated 14 patients with this drug. Through this process, we followed a standardized method consisting in the following steps:

On the first esketamine session (DAY 1) the patient has to fill a CGI and a MADRS scale.

On the second esketamine session (DAY 7) the patient has to fill a CGI, a MADRS scale, a form about the level of satisfaction with the drug and a last form in which they can include the secondary effects.

On week 6 since the start of the treatment, the patient has to fill again a CGI, a MADRS scale, a form about the level of satisfaction with the drug and a last form in which they can include the secondary effects.

In the 6th month since the start of the treatment, the patient has to fill again a CGI, a MADRS scale, a form about the level of satisfaction with the drug and a last form in which they can include the secondary effects they have perceived.

We analyzed and compared all of the previous data and obtained the following results:

At day 7: 64% of the patients had a response in the form of improvement, of which 66% were feeling “slightly better” and 33% were feeling “better”.

At week 6: 71% of the patients had a response in the form of improvement, of which 50% were feeling “slightly better” and the other 50% were feeling “better”.

At month 6: only 28% of the patients completed the treatment; of which 100% had a response in the form of improvement: 50% were feeling “slightly better”, 25% were feeling “better” and 25% were feeling “far better”.

Although our data suggests that intranasal esketamine has been effective in short term depressive symptoms, we have yet no information about its medium and long-term efficacy or secondary effects. Nevertheless, other potential factors should be evaluated as they could affect the results in the long-term such as the difficulty in maintaining the treatment for more than 6 weeks.

In addition, the patients who experienced the most improvement according to our data were patients with a TAB diagnosis, so this could be an interesting research focus.

None Declared

Sodium oxybate, an effective treatment for narcolepsy-associated daytime sleepiness and cataplexy, has been extensively. Despite its therapeutic benefits, sodium oxybate is not without its risks, and adverse psychiatric effects have been documented. This case report highlights a rare manifestation of sodium oxybate-related secondary mania with psychotic symptoms in a patient with narcolepsy, emphasizing the importance of recognizing and managing such adverse events. Additionally, we provide a brief review of similar cases reported in the literature.

This report aims to describe the presentation, evaluation, and management of sodium oxybate-induced secondary mania with psychotic symptoms in a patient with narcolepsy. We also discuss the potential mechanisms underlying this adverse reaction and its clinical implications. Furthermore, we summarize findings from previous studies that have reported cases of secondary mania associated with sodium oxybate use.

We present the case of Mr. X, a 48-year-old male diagnosed with “Narcolepsy with cataplexy,” who had been receiving sodium oxybate treatment for 11 years. He was admitted to the hospital following a mild head injury and the emergence of a manic episode with psychotic features. Comprehensive clinical evaluation, including medical history, toxicology screening, and neuroimaging, was conducted.

Upon evaluation, Mr. X exhibited hyperactivity, restlessnes, grandiose delusions, paranoid delusions related to hospital staff, and decreased need for sleep. Notably, he had been consuming sodium oxybate excessively. Sodium oxybate was discontinued, and low-dose olanzapine was initiated. Within 24 hours, his manic and psychotic symptoms resolved. He admitted to overusing his medication, and his family reported a recent increase in his activity level. A review of the literature revealed similar cases of sodium oxybate-induced secondary mania with psychotic symptoms.

This case underscores the importance of vigilance for psychiatric side effects of sodium oxybate, particularly in patients with a history of substance abuse or potential overuse. Secondary mania associated with medications is a rare but significant clinical entity. Prompt recognition and intervention are crucial for patient safety and well-being. Further research is needed to elucidate the mechanisms underlying such reactions and to establish guidelines for their prevention and management.

None Declared

The patient is a 50-year-old female, with multiple admissions in the PICU. At her first admission, at the age of 30 she presented the following main symptoms :mutism, negativism, crying and loss of bladder and bowel control. After collecting her complete family history, it was determined that her mother and one of her brothers were diagnosed with mild intellectual disability. Concerning her childhood history, she presented with late milestones as an infant and toddler and difficulties throughout primary education. Little information concerning her adult life was given, since the patient remained mute during the entirety of her first hospitalization.

Determination of the efficacy of olanzapine in a patient with Phelan-McDermit syndrome with mild intellectual disability and psychotic symptoms such as auditory hallucinations, delusional ideas and disrupted behavior.

PANSS Test, intellectual capacity test, genetic testing.

PANSS Scale Score at the 1st day of admission:100

PANSS Scale Score at the last day: 79

Intellectual capacity test: mild intellectual disability

Genetic testing results: Phelan-McDermit syndrome

After 20 days, symptoms showed mild recession in responce to 20mg of olanzapine. In a period of 12 months, the patient showed no signs of relapse and she was not readmitted in the PICU.

None Declared

Neurological bladder is considered a functional disability that has a significant impact on the quality of life and psychological state of patients. Psychotropic drugs, in turn, can worsen the urinary dysfunction caused by this disease.

Our objective is to illustrate, through the case of a patient suffering from a neurological bladder decompensated by the treatment of a characterized depressive episode, the link between these two pathologies.

We report the case of Ms. M.W., aged 51, with a history of high blood pressure stabilized under nebivolol and a neurological bladder diagnosed 10 years ago with episodic pollakiuria, admitted to the psychiatric department for repeated suicide attempts. She had never used psychoactive substances and had no family psychiatric history. The patient presented depressive symptoms evolving for 5 months. The diagnosis of a characterized depressive episode with melancholic features was made and the patient was treated with sertraline. From the first intake of the drug, the patient presented acute urinary retention (UR) requiring the placement of a permanent bladder catheter. The urinary symptoms improved upon stopping the treatment. Sertraline was changed to olanzapine and escitalopram. The patient stopped the treatment after one month because of the worsening of urinary symptoms requiring the installation of a suprapubic catheter. The urinary problem, together with the cessation of treatment, were responsible for a worsening of psychiatric symptoms leading to multiple suicide attempts. Given the advanced stage of the neurological bladder demonstrated by the urodynamic tests, our patient was treated with paroxetine, quetiapine and oxazepam along with psychotherapeutic education. The evolution was characterized by improvement in psychiatric symptoms and the urinary symptoms were stable.

The lack of improvement after treatment discontinuation could be explained by an underlying neurological bladder manifesting with pollakiuria. The current literature on UR induced by psychotropic treatments is quite rare limited in case reports. This effect occurs especially when selective serotonin reuptake inhibitors (SSRIs) are prescribed in combination with other antipsychotics. Unlike first generation antipsychotics, atypical antipsychotics have muscarinic receptor antagonist properties which can induce UR. Among atypical antipsychotics, olanzapine has been shown to have the greatest antimuscarinic effects. Regarding SSRIs, they are associated with a lower risk of UR than other antidepressants and sertraline had the highest risk of UR.

SSRIs can induce UR particularly in combination with atypical antipsychotics. Coordination of care across multiple specialties and understanding the side effects of psychotropic medications can enable faster diagnoses and adequate management.

None Declared

Urine drug tests are commonly used in psychiatry settings, mainly for the purpose of screening for substance abuse and excluding drug-induced psychiatric disorders. When carefully interpreted, these tests offer critical information for clinical judgement. However, certain psychotropic medications can trigger false-positive results in common urine drug screenings. For example, aripiprazole has been reported to cause false-positive urine amphetamine test results, and haloperidol has been associated with false-positive urine drug tests for lysergic acid diethylamide (LSD). It is clinically significant to recognize some false-positive urine drug results and interpret certain results cautiously in clinical settings.

We present a case of false-positive urine drug screening for tricyclic antidepressant (TCA) in a patient on quetiapine and aim to highlight the importance of accurate result interpretation in urine drug tests.

Details of the case were described. Information was gathered based on medical records.

Mr. A, a 25-year-old construction worker, first presented at our hospital’s emergency room on a Saturday in January 2023. He was brought by the police because he was aggressive and mentioned his colleagues were monitoring him. Being a foreigner, he did not have any prior medical records in our hospital. Urgent blood tests were performed, and organic causes were ruled out. He was started on quetiapine and lorazepam in the emergency room and was then admitted to our hospital.

A urine drug test was ordered on the following Monday, the third day of his admission. Surprisingly his urine drug screening revealed positive results for TCA and benzodiazepines. Initially as the patient was psychotic and could not give reliable history, we considered a few differential diagnoses, such as schizoaffective disorder and major depressive disorder with psychotic features, based on the presumption that TCA had been prescribed by the psychiatrist in Mr. A’s home country. After further treatment, Mr. A became less psychotic and was able to share that he had a past psychiatric history of schizophrenia, but he had stopped antipsychotic medications four months ago.

This case report described a false-positive urine drug test for TCA while the patient was taking quetiapine. In this case, initially other diagnoses, such as schizoaffective disorder, were considered based on the incorrect assumption that patient was taking TCA.

False positive urine drug results can be confusing and misleading for clinicians. This report underscores the possibility of such false positives arising from quetiapine and emphasizes the critical importance of careful result interpretation.

None Declared

Lithium is one of the main drugs used in Bipolar Affective Disorder. However, it has a narrow therapeutic window, which requires close monitoring and progressive dose adjustment, according to serum levels, clinical response and the appearance of side effects. The term ‘SILENT’ explains descriptively persistent neurological sequelae related to lithium salt intoxication when symptoms persist for more than 2 months after stopping treatment. SILENT Syndrome is more common in females, at ages ranging from 21 to 77 years and is characterized mainly by avermian-type cerebellar disorder, persistent extrapyramidal syndrome, brainstem dysfunction and dementia of varying severity. It can also result in apraxia of the body, changes in the coordination and balance, dysarthria, as well as intentional and kinetic cerebellar tremor, involuntary movements of orofacial dyskinesias or resting tremor.

The authors intend to review the relevant and current literature in order to extend the knowledge about this condition and find the best conducts for clinical practice.

Non-systematic literature review.

Complications from the use of lithium known in the medical literature include mainly nephrotoxicity, endocrine alterations and neurotoxicity. The neurotoxic effects of lithium usually occur at high serum concentrations. However, they can also occur with lithium in the therapeutic range, and memory, attention and ataxia impairment may be some of the permanent sequelae. The etiopathogenesis is unclear, but demyelination has been detected in multiple brain regions, mainly in the cerebellum. The mechanism of lithium-induced cerebellar injury is believed to be mediated by the entry of calcium into the cells of this organ. The main factors that predispose to greater side effects and risk of toxicity are patients with decreased renal function, advanced age, use of diuretics, dementia, pregnancy, low sodium intake and physical illness with vomiting and/or diarrhea.

Lithium is a drug used mostly in affective disorders and given the narrow therapeutic window, it requires close monitoring in order to avoid side effects that can be permanent. In this way, it is important to review the factors that increase the lithium toxicity and make recommendations about it.

None Declared

The single-injection start regimen for aripiprazole once-monthly 400 mg (AOM 400) in patients with schizofrenia requires a single intramuscular injection in the gluteal or deltoid site and 14 days of concurrent oral therapy. Based on a population-pharmacokinetic model, the European Medicines Agency and Canada has recently approved a simplified starting strayegy of aripiprazole once a month with single-day regimen of two injections at separate gluteal and deltoid injection sites, together with a single 20 mg dose of oral aripiprazole on the 1st day.

The aim of the study is to evaluate the two injection start (TIS) regimen in inpatients in the Psichiatric Unit (SPDC) of the Hospital of Rimini.

We retrospectively reviewed medical records of patients, from February 2021 to April 2023, that have more than 18 years, who received the newly approved 2-injection start regimen as part of their standard care, evaluating if exist changes in clinical indicators, safety and tolerability of this regimen.

We valuated retrospectively the days of hospitalization after the aripiprazole 400 mg TIS and the number of emergency room access, analyzing the “repository of AUSL della Romagna” and discharge letters and the “CURE” program of the Psychiatric Service of Rimini.

We evaluated 24 patients from February 2021 to April 2023, 11 male (45,8%), 13 female (54,2%); average age 37,95, average lenght of stay in hospital was 11,75 days. 10 patients with diagnosis of psychosis/schizophrenia (41,7%), 6 patients with bipolar disorder (25%), 4 patients with personality disorder (16,6%), 2 patients with substance induced psychosi (8,3%), 1 patients with delusional disorder (4,2%), 1 patient with schizoaffective disorder (4,2%). 6 patients had the two-injection start regimen in 2021 (25%), 13 patients in 2022 (54,2), 5 patients in 2023 (20,8%); 20 patients did not have admission in hospital after the TIS (83,3%), 4 patients had 1 or more admission after the injection (16,7%). 3 patients (12,5%) had accesses in emergency-room after Abilify Maintena. 15 patients (62,5%) continue therapy; 9 patients (37,5%) had suspended the injection for drop-out or because of change of therapy not correlated at adverse effects (1 female patient had suspended treatment after the two-injections due to pregnancy). Just 1 patient that continue Abilify Maintena 400 mg had 2 accesses in the emergency-room.

The coadministration of 2 injections of 400 mg aripiprazole was not associated with safety concerns beyond those expected with a single-injection start regimen. From the study it appears that the long-acting therapy with Alibify Maintena 400 mg once-monthly helps to stabilize the patient to prevent hospitalization and accesses in emergency-room.

None Declared

Achieving successful stabilization in patients with mental disorders often requires the administration of multiple antipsychotic medications, with the increasing prevalence of clozapine in cases resistant to other treatments. Constipation emerges as a particularly troublesome side effect, gradually progressing into a chronic state of gastrointestinal dysfunction, often accompanied by recurrent episodes of paralytic ileus of varying severity. Prucalopride, a 5-HT4 agonist, selectively targets receptors within the intestinal system.This interaction induces muscular contractions and promotes chloride secretion. Literature suggest its potential efficacy in managing constipation induced by clozapine. In light of these observations, we designed and will conduct a randomized controlled trial to evaluate the effectiveness of prucalopride in alleviating constipation in patients who had shown limited responsiveness to conventional laxatives or other conservative treatments

The primary objective of this article is to present the methodology of a randomized control trial assessing the efficacy of prucalopride in the treatment of constipation among patients with mental disorders

The study will enroll 60 adult patients with mental disorders who will require more than two antipsychotic medications, including clozapine, for stabilization, and who will be experiencing constipation as a side effect

To ensure the validity of the study, the following additional inclusion criteria will be applied:

• - Patients will have no severe acute medical conditions

• - Patients will have no history of malignancy

• - Patients will have no severe respiratory or cardiac diseases

• - Patients will have negative results from an endoscopic evaluation of the large bowel, ruling out conditions such as irritable bowel syndrome, ischemic colitis, inflammatory bowel disease, or malignant neoplastic disease

Following the screening process, the patients will be randomly assigned to one of two treatment groups:

Prucalopride Group: Patients in this group will receive prucalopride for the treatment of refractory constipation

Conservative Treatment Group: Patients in this group will continue with conservative treatments.The treatment’s success will be determined based on specific endpoints:

• - Normalization of bowel movements, characterized by having more than five bowel movements per week

• - Resolution of symptoms related to gastrointestinal dysfunction, including pain, bloating, defecation difficulties, and paralytic ileus

Following the conclusion of the study, data from both groups will be meticulously collected and subjected to rigorous statistical analysis to identify differences in treatment outcomes between these two therapeutic approachs

The detailed findings will be presented in a forthcoming article

None Declared