IntroductionOver the past decades, immunotherapy treatments have been a revolution to many chronic diseases with encouraging results in clinical outcomes and quality of life. The use of monoclonal antibodies has yielded a great variability in terms of clinical efficacy and tolerability although it’s believed the incidence of psychotic symptoms is low (0,1-0,4%).Objectives To review the effects of monoclonal antibodies on psychosis.MethodsReview of literature using PubMed database. A total of 16 studies were included.ResultsThe targeted molecules by monoclonal antibodies may determine the risk of psychosis. While those who target TNF-alfa seem to have a reduced risk of psychosis (such as Infliximab, Adalimumab, Certolizumab and Golimumab), monoclonal antibodies who modulate lymphocytes may have a greater risk of psychosis namely Natalizumab, Belimumab, Basiliximab and Daclizumab, which seems to correlate to evidence of alterations in lymphocyte subsets in groups of patients with first psychotic episode and schizophrenia. Some seem to have positive correlation with psychosis namely monoclonal antibodies who have a supressing effect on the immune system, especially those who target adaptative immunity and those who are used in autoimmune diseases (vs oncologic conditions). It is unknown if delusions prevail over hallucinations or vice-versa. Despite the paucity of evidence, these findings corroborate the variability regarding the psychiatric effects of immunotherapy.ConclusionsThe available literature reports a low prevalence of psychotic symptoms associated with the use of monoclonal antibodies but it highlights the importance in knowing the immune mechanisms involved in psychotic disorders. Greater research is needed to correctly assess that risk.
IntroductionElectroconvulsive therapy (ECT) is considered a gold-standart treatment of severe and treatment-resistant depression. Lack of response to ECT often causes distress in psychiatrists regarding the next therapeutic decisions.ObjectivesTo present a case report of a patient with psychotic depression with partial response to ECT.MethodsClinical interviews and review of literature using the Pubmed platform.ResultsThe authors present a case of a 60 year-old woman admitted for severe depressive episode with psychotic symptoms. Due to lack of response to multiple antidepressive and antipsychotic treatments, 15 sessions of ECT were performed with improvement of behavioral and psychotic symptoms. However, endogenous depressive symptoms with functional impairment persisted. It was then initiated Bupropion 300mg/day resulting in vast improvements on drive, energy and activity levels with restored functionality. Previously to ECT, Bupropion was not considered a valid option due to the psychomotor restlessness that was present. This case exposes the limitations of ECT and the therapeutic conundrums that arise when there is partial response. The symptoms expressed in the patient after ECT course correlate with deficits in noradrenergic and dopaminergic pathways that are involved in endogenous depression. The use of Bupropion, with its effect on noradrenaline and dopamine receptors, may offer a therapeutic lifeline in these cases.ConclusionsECT still stands as a gold-standart for severe depressive disorder, especially when several psychopharmacological therapies have failed. In cases of partial response to ECT, the neurobiological correlates of clinical presentation can guide the therapeutic management towards improved outcomes.DisclosureNo significant relationships.
IS MANCHESTER TRIAGE ADEQUATE TO PSYCHIATRIC EMERGENCIES? AN OBSERVATIONAL DESCRIPTIVE STUDY OF A PORTUGUESE HOSPITAL BACKGROUND Triage in portuguese emergency departments is conducted using the MTS 1 . Psychiatric assessments focus on assessing the level of danger presented to others or the level of severity of impairment to social functioning 1-3 . Current medical triage scales focuses on medical and surgical presentations, such as the MTS, present insufficient data that proves its validity and reliability in psychiatric emergencies 2.4 .
To conduct a review of the existing literature regarding the established treatments for female sexual dysfunctions (FSD) and the novel pharmacological approaches that have been studied as well its clinical effectiveness.
IntroductionDelusional disorder is a mental illness in which delusions are the dominant symptom. Delusional disorder is not well studied relative to other psychotic disorders - it is poorly understood in practically every aspect of its nature, including cause, phenomenology, prevalence, comorbidity, course, treatment, and prognosis.ObjectivesTo study the clinical and sociodemographic characteristics of individuals admitted for inpatient treatment with the diagnosis of delusional disorder, in particular the adherence to treatment.MethodsRetrospective observational study of inpatient treatment of patients with delusional disorder diagnosis between january 1st2007 and 31th december of 2017 in the Psychiatry Service of CHUSJ. Follow up of 2 years from discharge. Data collected included sociodemographic characteristics and clinical features. Descriptive analysis of the results was performed using SPSS (v.26).ResultsIn the period of time analyzed, 152 hospitalizations were identified, corresponding to 114 patients: 38.2% male and 62.8% female. The average age was 58 years. 3 months after discharge: 65% of patients were going to the medical appointments, which dropped to 60% in 6 months, 55% in 12 months, 53% in 12 and 24 months. Regarding adherence to the treatment: 65% of patients were still adherent to medication in 3 months time, 55% in 6 months, dropping to 50% in a year and to 48% in 2 years. There is a relation between involuntary discharge and adherence to consultations and medication.ConclusionsA cardinal characteristic of delusional disorder, conviction that one is not mentally ill, contributes complexity to the treatment challenges and profoundly affects the therapeutic relationship.
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