ONLY IN DREAMS: a case report of sleep deprivation psychosis

Introduction

Sleep is essential for an adequate neurobiological functioning, being implicated in several cognitive functions. Even in healthy individuals, sleep deprivation can lead to a number of psychopathological changes, including perceptual distortions, hallucinations and delusions. Thus, the resulting clinical picture may be similar to a psychotic disorder.

Objectives

To present a clinical case of psychotic symptomatology induced by sleep deprivation.

Methods

Patient’s clinical file consultation and literature review using the search engine Pubmed® and the keywords: “sleep deprivation”, “sleep loss” and “psychosis”.

Results

We present the case of a 41-year-old woman with a history of an episode of mood changes with psychotic symptoms that was preceded by a period of total insomnia. No psychotropic drugs since then and no relapses. In May 2020, she was admitted in psychiatry department due to clinical picture composed by significant psychomotor slowing, drowsiness, slowed speech, verbal visual, tactile and auditory hallucinations accompanied by grandiose delusions. These symptoms were preceded by total insomnia with one week of duration. In the hospital was administered quetiapine 100mg and lorazepam 2.5mg to aid in the recovery of sleep deprivation and concomitantly aripiprazole 15mg was prescribed. The patient presented a rapid and significant clinical improvement. Currently, it is without any type of medication and without psychopathological changes.

Conclusions

The clinical picture present in this case report was triggered after a significant period of sleep deprivation. Thus, it illustrates the role that sleep has in the development of psychiatric symptomatology, sometimes difficult to differentiate from psychiatric disorders.

Disclosure

No significant relationships.

Catatonia and dementia: a case report

Introduction

Catatonia is a neuropsychiatric disorder characterized by motor, behavioral and autonomic changes. It is associated with several psychiatric disorders, including dementia. Catatonia is an underdiagnosed syndrome, so it is important to draw attention to it. Here, we review a case of a patient admitted to our psychiatric department with a clinical presentation compatible with catatonia. After proper treatment, further assessment revealed dementia.

Objectives

This work aims to describe a case of catatonia in a patient with dementia.

Methods

Bibliographic research using Pubmed®. Clinical file consultation and patient interviews.

Results

Catatonia is a disorder that was already been described as part of several types of dementia. We present a 69-year-old female patient, admitted to our psychiatric department with clinical presentation compatible with catatonia. To admission, she presented some typical complications resulting from long immobility such as pressure ulcers and nutritional deficiencies. During the hospitalization, she developed a urinary infection and there was the need to tube feeding. She was treated with benzodiazepines and improved. Further assessment revealed dementia.

Conclusions

Catatonia in dementia is not uncommon, although it is an underdiagnosed syndrome, and when treated early and properly it has a good prognosis.

Disclosure

No significant relationships.

Role of migration in the development of a first episode of psychosis

Introduction

Currently, there is scientific evidence supporting the relationship between socio-environmental factors and the onset of a first episode of psychosis (FEP). In this context, the phenomenon of migration, seen as a negative life experience, may become an important risk factor in developing a psychotic disorder (PD). In Europe, the impact of this phenomenon is growing and, therefore, it’s necessary to provide a proper answer to these individual’s mental health problems.

Objectives

Identify which phases of this migration process are most important in the development of a FEP and what are the more significant socio-environmental factors in each phase.

Methods

Bibliographic research in Pubmed database using the terms “Migration” and “First Episode Psychosis”.

Results

Research confirms that migrants have a 2 to 3-fold increased risk of developing a PD. This risk will be even higher in the refugee population. Pre- and post-migration factors demonstrated to be more important than factors related with the migration process itself. In the pre-migration phase highlight factors like the lower parental social class and a previous trauma. In the post-migration phase highlight factors like discrimination, social disadvantage and a mismatch between expectations and reality.

Conclusions

Literature is unanimous in considering migrant status as an independent risk factor for the development of FEP, possibly due to the outsider’s role in society. Thus, despite the growing interest in Biological Psychiatry, this work demonstrates that socio-environmental factors are very preponderant in the development of these disorders and because of that further investigation is still necessary.

Disclosure

No significant relationships.

“Walking with myself by my side” - non-medical use of Ketamine

Introduction

Ketamine, synthesized in 1962 as phencyclidine derivate, is denominated a “dissociative anesthetic” because of its side-effects, such as dissociative episodes and psychotic-like symptoms, which have limited its applicability on clinical practice. Otherwise, in the last decades the non-medical use of ketamine has been growing and today is one of the most popular illicit substances consumed between adolescents and young adults.

Objectives

Increasing the knowledge and understanding of the factors related to crescent use of ketamine and the experiences and consequences associated to its consumption.

Methods

Clinical interview with patients diagnosed with ketamine use disorder and bibliographic research in Pubmed database using the terms “Ketamine use” and “Ketamine addiction”.

Results

Pat et al. (2002) describes a clinical case of a young male, diagnosed with substance use disorders, specifically alcohol and cocaine use disorders, that started a treatment with ketamine. After the treatment, pleasant depersonalization experiences contributed to the development of patient’s ketamine dependence. Other patient’s reports confirm the association of ketamine use with psychedelic effects and dissociative episodes and pointed these effects as main reason for its consumption.

Conclusions

The adverse effects that limited the medical use of ketamine are the same that promote its utilization with recreational purposes by adolescents and young adults in parties and nightclubs. About the ketamine dependence, the literature is scarce and doesn´t clearly identify a physical withdrawal syndrome, pointing only to a serious psychological dependence. Thus, with the crescent non-medical use of ketamine, it’s urgent to develop an intervention plan directed to this problem.

Disclosure

No significant relationships.

Dissociation and emotional dysregulation in pathological personalities related to the fear of SARS-COV-2: a case report

Introduction

The COVID-19 pandemic represented a serious strain on the mental health resilience worldwide. Implementation of restrictive rules implied the disruption of social networks, eliciting emotional exhaustion and intense response to fear. This was amplified by media spread of panic and fake news, representing risk factors for post traumatic stress disorder (PTSD). Fear can be dangerous, especially accounting premorbid psychopathological vulnerability, such as pathological personality traits. Emotional dysregulation increases fear levels, mediated by the relationship between emotional dysregulation and lack of tolerance.

Objectives

Clinical case presentation of patient who developed dissociative and behavioral symptoms following COVID-19 infection. Bibliographic research.

Methods

Bibliographic research using Pubmed®. Clinical file consultation and patient interviews.

Results

Heightened psychophysiological reactivity can result from the persistent fear experienced during a traumatic event and repeated memories related to it, leading to a sensitization of the response to fear. We present 57 year-old female patient, admitted to the COVID ward after trying to escape from home isolation due to positivity to COVID-19. In the hospital setting she developed dissociative symptoms, trying to escape from the ward and infect other people.

Conclusions

Intense fear responses to COVID-19 are likely explained by poor emotion regulation capacities as well as dissociative mechanisms. Studies have shown that this pandemic was experienced as a real traumatic event and some studies have found that it may lead to the development of PTSD. Pathological personality is positively related to PTSD symptoms, attributable to higher levels of mood instability, cognitive/perceptual disorders, interpersonal dysfunctions and negative affection.

Disclosure

No significant relationships.

Anorexia Nervosa and Gender Dysphoria: A Clinical Case

Introduction

Eating disorders (ED) and gender dysphoria (GD) are associated with a change in body perception. Therefore, body dissatisfaction plays a common and central role in these disorders. In GD, body image concerns are related to the features of the biological sex. In ED, body dissatisfaction comes from a distorted perception of weight and body shape and plays an important role in the development and maintenance of the psychopathology.

Objectives

To present and discuss the clinical case of a patient with a previous diagnosis of GD who presented with a clinical condition suggesting a restrictive anorexia nervosa (AN).

Methods

Patient´s clinical files consultation and literature review using Pubmed and the keywords: eating disorders and gender dysphoria.

Results

We present the case of a 25-year-old patient who was living in a shelter for victims of domestic violence and was admitted for severe restrictive AN. The patient was discharged after 40 days and medicated with sertraline, diazepam and olanzapine, as well as her previous medication (hormonal therapy): cyproterone, finasteride, estradiol, oxybutynin.

Conclusions

Although studies on this subject are still scarce, there has been some progress and the literature recognizes the coexistence of these conditions. However ED symptoms in patients with GD could have a different meaning: they may represent a dysfunctional coping strategy adopted to block features of the biological sex. Therefore health professionals may take a more holistic approach to body image. Additional studies will be necessary, allowing the establishment of cause-consequence interactions between weight loss and psychopathology related to GD.

Disclosure

No significant relationships.

Pseudohypoparathyroidism type I-b with neurological involvement is associated with a homozygous PTH1R mutation

Pseudohypoparathyroidism type 1b (PHP1b) is characterized by hypocalcemia, hyperphosphatemia, increased levels of circulating parathyroid hormone (PTH), and no skeletal or developmental abnormalities. The goal of this study was to perform a full characterization of a familial case of PHP1b with neurological involvement and to identify the genetic cause of disease. The initial laboratory profile of the proband showed severe hypocalcemia, hyperphosphatemia and normal levels of PTH, which was considered to be compatible with primary hypoparathyroidism. With disease progression the patient developed cognitive disturbance, PTH levels were found to be slightly elevated and a picture of PTH resistance syndrome seemed more probable. The diagnosis of PHP1b was established after the study of family members and blunted urinary cAMP results were obtained in a PTH stimulation test. Integration of whole genome genotyping and exome sequencing data supported this diagnosis by revealing a novel homozygous missense mutation in PTH1R (p.Arg186His) completely segregating with the disease. Here, we demonstrate segregation of a novel mutation in PTH1R with a phenotype of PHP1b presenting with neurological symptoms, but no bone defects. This case represents the extreme end of the spectrum of cognitive impairment in PTH dysfunction and defines a possible novel form of PHP1b resulting from the impaired interaction between PTH and PTH1R.