Interferon alpha is a cytokine with antiviral and antineoplastic action, which is commonly used for treatment of Hepatitis C and B, malignant melanoma, Kaposi's sarcoma, kidney cancer and certain hematologic diseases. It is well-known some of its neuropsychiatric symptoms such as depressive symptoms, cognitive impairment, chronic fatigue, dysphoria and anxiety, but there are also other less common like mania, psychotic symptoms and suicide risk that have been reported. These symptoms interfere in the quality of life very significantly, which at the end can affect treatment adherence.We report a case of a 33-year-old man who was taken to the emergency department by his family referring nervousness, irritability, verbose, and insomnia during the last 5 days. The patient had not psychiatric history. He was diagnosed with a malignant melanoma stage III A a year ago which required to start interferon alpha treatment.Patient and family tell that symptoms began after forgetting last interferon dose. In the psychopathology exploration, we could observe mood lability, delusion ideas of prosecution, which includes his entire family and autorreferentiality. In the emergency room the blood test, urine drug test and CT were normal.During the admission, and in collaboration with the Oncology service, it was agreed the reintroduction and maintenance of interferon combined with olanzapine up to 30 mg/day and clonazepam up to 6 mg/day, which resulted in the resolution of symptoms in two weeks.Disclosure of interestThe authors have not supplied their declaration of competing interest.

During late 19th and early 20th century neuropsychiatrists began to identify common behavioral and cognitive disturbances in epilepsy, but it is not until 1973 that Norman Gestchwind described the basics of what we know as Gestchwind syndrome. This syndrome includes the triada of hyper-religiosity, hypergraphia and hypo/hypersexuality and it was mainly associated with temporal lobe epilepsy. Moreover, it is well known the association between epilepsy and psychotic symptoms, the so-called schizophrenia-like syndrome, which can lead us to a false diagnosis of schizophrenia. We report a 44-year-old man who was brought to the hospital with delusional ideation of prosecution and reference in his work environment with important behavioral disruption, as well as delusional ideation of religious content. He had a diagnosis of schizophrenia since he was 18-years-old and personal history of generalized tonic-clonic convulsions in his twenties. During the admission, he recovered ad integrum very rapidly with low doses of risperidone, but referred recurrence of déjà vu episodes. After reviewing his patobiography and past medical history, we identified the presence of hypergraphia, hypersexuality and a profound religious feeling, fulfilling the criteria for Gestchwind syndrome, in the context of which was later diagnosed as chronic epileptic psychosis. It is very important a careful approach to the patobiography and personal history. Also, we should include classic differential diagnosis such as Gestchwind syndrome, as they can lead us finally to the correct diagnosis, which in this case meant not only a different treatment but also a better prognosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ObjectiveThe aim of our study is to outline the demographic characteristics of the patients with a diagnosis of personality disorder that come to the ED. A second objective is to find specific risk factor for this type of patients.MethodsWe selected patients that came to the ED with the diagnosis of personality disorder, between October 2015 and February 2016. Data analysis was conducted using SPSS software. Chi2 test and t-Test were used as appropriate. A P-value < 0.05 was considered statistically significant.ResultsSixty-eight of the 402 patients that were attended in the ED met the criteria of personality disorder; 44.92% of these patients presented with suicidal ideation or attempt. We found in the use of drugs, statistically significant differences between men and women, using drugs all the men with a personality disorder that came to the ED except one. The most frequent reason for consult were anxiety, conduct alterations, suicidal ideation, and suicidal attempt, being these consultations the 77%.ConclusionAnxiety and suicide risk are the most common reasons for a personality disorder patient to go to an ED. We have to be even more careful due to the high rate of suicide conducts in these patients. Also, it is important to think of drug use and dual pathology when assessing these patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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