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ObjectiveInfection by the Zika virus is a Public Health Emergency of International Concern as defined by the World Health Organization. Resolution no. 72, issued by the Collegiate Board of the Brazilian Health Surveillance Agency (ANVISA) on March 30, 2016, made ZKV testing mandatory prior to procedures involving germ cells and tissues. This paper aims to discuss the aforementioned Resolution from the standpoint of evidence and cost-effectiveness of the measures taken within the first two months of mandatory testing.MethodsThe medical staff at the clinic looked into the steps needed to comply with the new rules and checked laboratories in the city to perform the tests with their lead times and costs, health insurance refunds, data maintenance capabilities, how to contact patients, decision-making processes in ongoing cases, deadlines for implementation, in addition to exchanging ideas with other clinics and gathering information from the guidelines being produced. A SWOT analysis was performed.ResultsA total of 152 tests were performed within the first two months of mandatory testing, in five different clinical situations: one previously symptomatic woman with a negative PCR test before starting the cycle; two asymptomatic women had positive IgM (1.3%) and negative PCR tests on days 25 and 60; one husband enrolled as a suspect with a negative RT-PCR on day 13 and another untested suspected case; a couple decided to have their oocytes cryopreserved because the husband's test result was not available on pickup day. The mean cost of USD 200 per couple is equivalent to 1.2 day of the stimulation protocol. The staff worked more efficiently and was able to respond promptly to the increased demand for ZKV testing; however, the tests failed to reassure patients of the safety of the procedure and increased costs.ConclusionThe testing requirement for asymptomatic patients prior to ART should be reviewed.

A dissociative fugue occurs when an individual with dissociative amnesia wanders away from their familiar surroundings, maintaining self‑care and apparently normal behavior to observers, lasting from hours to months in a row. New identities can be assumed and even organized travel can occur. While dissociative amnesia by itself may have a prevalence of around 7.2%, dissociative fugue is a rare entity, with unknown prevalence, and there are few reports in the literature. In this article, we describe a case of dissociative fugue in a 34‑year old woman that lasted eight months. Dissociative amnesia with fugue remains an interesting topic for further research since it can present a diagnostic challenge, there are currently no evidence‑based pharmacological treatments and prognosis varies greatly between patients.

Introduction The capacity for lying is a common human phenomenon with evolutionary explanations, in which one seeks to deceive usually to avoid harmful or undesired consequences. The spectrum of lies is vast and varies from the content to the motivation. Pathological lying has the potential to affect mental evaluations thus motivating an important discussion regarding this behaviour. Objectives The authors aim to explore the psychopathological concept and spectrum of pathological lies, from their underlying motives to their implications and challenges in psychiatric diagnosis with recourse to a clinical case example. Methods A review of pertinent literature on the topic with focus on that which is most relevant to the theme was included. The authors present the clinical case of a middle-aged female who presented with mythomania which included the fabrication of having attempted murder. Results The literature demonstrates a relationship between compulsive lying and personality disorders. Head trauma and other central nervous system issues may also play a role. Some traits may facilitate the detection of deception, such as dramatic and unmotivated constructs with a positive self-portrayal. The clinical case description correlates the personality factors associated with mythomania, namely antisocial personality disorder, differing from the typical presentation as her fabrications portrayed her negatively. Conclusions The implication of pathological lying is that it may interfere with mental assessment thus altering, by way of deception, the psychiatric evaluation as lies may be difficult to detect upon a first evaluation. The psychiatrist should be alerted to the possibility of fabrication when dealing with a patient with predisposing factors. Disclosure No significant relationships.

IntroductionThe first description of syphilis was made in Europe around the year 1493, and although perceived as a disease relegated to its historical importance, recent studies demonstrate that the prevalence of these infections is on the rise. Spanning decades after initial infection, 30% of affected individuals without treatment may develop tertiary syphilis, which includes neurosyphilis. Its notoriously “chameleon-like” presentation implies the necessity to not overlook neurosyphilis as a differential diagnosis in psychiatric settings.ObjectivesCase report study and discussion.MethodsThe authors present a case of affective and psychotic symptoms (including auditory and visual hallucinations and persecutory delusions) of rapid onset in a 61-year old woman without prior psychiatric history. A clinical investigation was conducted, which subsequently revealed a positive Venereal Disease Research Laboratories (VDRL) test. A lumbar puncture was performed and cerebrospinal fluid analysis confirmed neurosyphilis.ResultsSteady improvements in initial psychopathological manifestations were noted after completing recommended treatment for neurosyphilis. After discharge, the patient was medicated with an antidepressant and antipsychotic, demonstrating a complete return to baseline mentation and functionality on follow-up.ConclusionsThis case demonstrates the vital importance of considering syphilis in our differentials, especially due to the wide range of manifesting psychiatric symptoms. Although considered a disease of the past, this case reminds us that syphilis remains present in our society and its timely diagnosis and treatment can ameliorate the debilitating psychopathological manifestations of the disease. Due to the potential difficulties in identifying this great imitator, routine screening tests are still recommended in the psychiatric setting.

IntroductionLyme disease (LD) is caused by the spirochete Borrelia burgdorferi (Bb) and has been reported to be associated with various psychiatric presentations.ObjectivesTo report a case with LD and to highlight the importance of differential diagnosis in a first psychotic episode.MethodsCase report and non-systematic review of the literature.Results A woman aged 31 was admitted to the psychiatric department, after a car accident with a mortal victim, due to a first psychotic episode with visual hallucinations, disorientation in time and space, persecutory and grandiosity delusions. She had a personal psychiatric history of obsessive-compulsive disorder and no previous admission to an inpatient Unit. On psychotropic drugs the condition failed to improve, and subsequently neurological symptoms developed. EEG abnormalities prompted a lumbar puncture. In the CSF a strong plasma cell reaction with atypical cells was observed. The enzyme immunoassay for Borrelia burgdorferi was positive and after treatment with penicillin the psychiatric and neurological signs and symptoms remitted. Screening assessment followed by a thorough history, comprehensive psychiatric clinical exam, review of systems, mental status exam, neurological exam and physical exam relevant to the patient’s complaints and findings with clinical judgment, pattern recognition and knowledgeable interpretation of laboratory findings facilitates diagnosis. Psychotropics and antibiotics may help improve functioning and prevent further disease progression.ConclusionsLD is relatively rare, but awareness of the association between LD and neuropsychiatric presentations can improve understanding of the causes of mental illness and result in more effective prevention, diagnosis and treatment.DisclosureNo significant relationships.

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IntroductionCoprophagia is a relatively rare phenomenon characterized by the ingestion of feces, and it is usually classified as a rare form of pica. It has been associated with multiple organic causes or mental disorders such as brain tumors, alcoholism, mental retardation, dementia, schizophrenia, depressive disorders or fetishism.ObjectivesCase report and reflection on its etiologyMethodsA Pubmed search was performed with the MeSH terms “Coprophagy” and “pica”. Relevant articles obtained from the respective bibliographic references were also consulted.Results A 56-year-old man with a history of psychiatric follow-up with a diagnosis of schizophrenia and cognitive impairment, assessed for behavioral changes such as cat feces intake. After possible organic causes were excluded, treatment with supportive psychotherapy and pharmacologically began with a selective serotonin reuptake inhibitor, fluoxetine, along with treatment for schizophrenia.ConclusionsAccording to literature, coprophagia often occurs associated with other medical or neuropsychiatric conditions. Although the etiology, pathophysiology and management remains unclear, several pharmacologic treatments have been attempted with some degree of success. We describe a case of unusual behavior, coprophagia, associated with cognitive impairment and schizophrenia that responded favorably to fluoxetine although without complete remission, in order to contribute to a future nosological redefinition.DisclosureNo significant relationships.