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Introduction: Ekbom syndrome also known as Morgellons syndrome or delirium of parasitosis is a psychiatric condition where the patient has the absolute conviction of being infested in spite of medical evidence. Patients may even mutilate themselves or apply toxic substances in order to get rid of these hypothetical organisms. Sometimes they bring samples of these hypothetical parasites to the office to prove their existence, which is known as the "matchbox sign", a pathognomonic finding. Objectives: The aim of this clinical case is to make visible the impact that this psychiatric condition can have on the patient's quality of life Methods: We present the case of a 40-year-old woman from Peru who was admitted to the otorhinolaryngology unit for injuries compatible with necrosis of the right pinna. When the patient was examined, scars were found on the lower limbs and back. The patient justifies the scratching lesions with the presence of pathogenic organisms, with no trace of them by the physician. Results: The patient was evaluated by psychiatry service during her admission in otorhinolaryngology, being diagnosed with Ekbom's delirium and starting treatment with 3 mL of Aripiprazole. Subsequently she was referred to the mental health unit where she left the follow-up until today. Conclusions: Different effective treatments have been described, among them pimozide, atypical antipsychotics and some SSRIs. However, the complexity of treatment arises when dealing with the irreducible idea that the patient has of being infested, refusing in most cases to receive psychiatric treatment. This can degenerate into major organic and psychological problems that turn the patient's life into a real hell, which often end up losing much of their daily functionality. The fact of empathizing with the patient and trying to elaborate a plan adjusted to the reality and needs of the moment, can help us to establish a good therapeutic bond that facilitates an early start of treatment and greater therapeutic adherence, enabling a significant improvement in their quality of life. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction: Erotomania, was described in 1942, is more common in women than in men, although the incidence is unknown. This syndrome is usually characterized by a young woman with the illusion that a man whom she considers to be of a higher social or professional position is in love with her. Developing an elaborate delusional process about this man, his love, his pursuit and total commitment to the idea. Two forms, pure or secondary, are described. As well as fixed or recurring 52-year-old female patient in outpatient follow-up with a diagnosis of schizophrenia with long-term follow-up, start of follow-up by a new therapist, in this context intensive follow-up is carried out in the event of the appearance of pharmacological secondary effects, pharmacological readjustment is carried out with good results. During the joint follow-up with nursing, the cessation of secondaryisms is confirmed and we are informed of the gradual appearance of overvalued ideas in relation to the new therapist, which are gradually structured in the form of erotomanic delirium that coincides with the cessation of follow-up by said therapist. Consultations in the emergency room occur on a couple of occasions due to mild behavioral alterations secondary to messages and communications that he reports receiving where said love is confirmed. Despite readjustments, there continues to be an increase in clinical symptoms due to abandonment of medication, finally producing serious alterations aimed at the search for said therapist, finally culminating in admission to the acute care unit for containment of said condition. Objectives: The objetives is the diferencial diagnosis, in this case symptoms could be classified as positive symptoms of schizophrenia, although it is its own nosological entity. Methods:. Results:. Conclusions: This patient represents a classic example of De Clerambault syndrome and is a faithful expression of the recurrent syndrome associated with delusions of grandeur, eroticism and jealousy. There have also been ideas of reference and agitated behavior associated with his delusional process. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction: Since its beginning in the 1970s in Wisconsin, Assertive Community Treatment (ACT), has been adopted by numerous hospitals worldwide. It improves outcomes for people who are most at-risk of psychiatric hospitalization. The main goal is to provide a global attention with a focus on promoting maximum autonomy and facilitating integration into society. In 2012, the Health Care Complex of Zamora, Spain, adopted this pioneering approach to Mental Health. The main efforts were focused on creating a community network for individuals with severe mental disorders. It embraced a biopsychosocial model of intervention aimed at facilitating patient recovery, giving them tools to create a new life project based on their own autonomy. Objectives: The primary objective of this study was to assess the progress of the Assertive Community Treatment (ACT) since its introduction at the Health Care Complex of Zamora, with a specific focus on analyzing the number of hospitalizations as the dependent variable. Methods: A quantitative analysis about psychiatry number of hospitalizations was conducted using the database of the Zamora's Psychiatry Hospitalization Unit. SPSS Statistics for Windows was used to calculate statistical values related to number of hospitalization. The dataset covers de period from 2010 to 2017. Results: The implementation of ACT has resulted in a significant reduction in hospitalizations reaching up to 75% in the Psychiatry Service of Zamora. It has been revealed a decrease from 17107 hospitalizations registered in 2011 to a total reduction to 4869 stances in 2013. A consistent trend in the reduction of hospitalizations has been observed (figure 1).A restructuration of the Hospitalization Unit was performed in order to implement de community model and reduce hospitalizations. Removal of more than 50% of the beds was developed.Besides, there has been implemented a community subunit with the objective of regaining their autonomy after a psychiatric exacerbation. Image: Conclusions: Getting hospitalized in a Psychiatry Unit can have many different socio-laboral consequences. The ACT model has demonstrated a significative reduction in hospitalizations and it has evolved into a support network dedicated the integration of individuals that are usually left behind by society. Moreover, it presents itself as a positive cost-benefit intervention.ACT allows us to envision a future with fewer hospitalization and greater integration of mental health patients into modern society. It is important to emphasize that the city of Zamora possesses unique characteristics that have facilitated the adaptation of this model. Not only are the rental prices for housing usually affordable, but the city's small size, which easy walking, allows for easy access to Community Mental Health resources and services. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction: Kambó is considered an "ancestral medicine" by the indigenous tribes of the western region of the Amazon. Objectives: Through this clinical case, the aim is to present the particularities of the symptoms and management of patients with consumption of not so common substances, such as Kambo or salvia divinorum, as well as the evolution that will occur in a patient with a previous diagnosis of a Depressive Episode. Methods: We present the case of a 23-year-old male, Gestalt therapy student. History of tobacco, THC, and recent use of salvia divinorum and Kambo. He began follow-up by psychiatry in a private setting three years ago due to a severe depressive episode, having required treatment with antidepressants, antipsychotics and benzodiazepines, and having been triggered by a serious assault. The episode is resolved and follow-up is discontinued. Family history of depressive syndrome and suicide. He resumed contact through the Emergency Department, requiring hospital admission due to symptoms compatible with a manic episode with psychotic symptoms. It begins with behavioral alterations and global insomnia that are related to the consumption of some substance, initially unknown to them, making the skin lesions they presented suspect the consumption of kambo. Results: We assess the risk of consuming these substances, which are sometimes used as alternative therapies, and especially in this type of patient, who is more vulnerable and perhaps seeks a way out of the problems they present. Conclusions: In our case, it triggered a manic episode with psychotic symptoms, which consisted of delusional ideation of mystical content accompanied by auditory hallucinations. The episode took about a month to subside, despite treatment. Subsequently, there have been more episodes with similar characteristics, and they have not been associated with the consumption of kambó, but have been linked to the consumption of "natural medicinal substances." Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction: Porencephaly is a neurological condition that can develop before or after birth, characterized by cysts located in any place inside the brain parenchyma, which generally are covered by plain walls and encircled by an atrophic crust. It generates a very variable clinic appearance, with severe cases of high disability and slight cases with a light neurological involvement, which also can go unnoticed until adulthood. The prevalence is unknow and the inheritance is autosomal dominant Male patient of 45 years diagnosed with porencephaly with cerebral palsy that affects left half and cognitive disability. His father reports an emerging defiant behavior, mutism and decrease of appetite from a week ago. No triggering stress factors are reported. Objectives: Show the importance of include in the differential diagnose hypoactive confusional syndrome. Methods: On urgent medical visit, male comes with ataxic gates which wasn't shown before. Inhibited attitude, semiflexed staring at floor, with sparing and monosyllabic speech answers, verbalizing discomfort and personal concern. Sleep-wake rhythm disruptions. Results: Blood tests and drug screening shows no abnormalities Cranial CT: Without acute lesion Urinary infection observed. Conclusions: It is important to make complementary test to exclude organic frames which could justify acute-subacute psychopathology. In this case, diagnosis was acute confusional syndrome, however, most known presentation is the hyperactive one which include motor hyperactivity, inappropriate behavior or disorganization and alterations of sensory perception. Hypoactive must always be considered, which is the concluding diagnosis in this case. [ABSTRACT FROM AUTHOR]

Introduction: Delirium is one of the most frequents cognitive disorders in the hospitalized patients. Some studies reveals 20-40% of the hospitalized patients older than 60 years present this disorder during residence, leading them to ask for a psychiatry consult. It's cause is organic and multifactorial. The start is acute and has fluctuating course defined by disturbances in attention, memory and orientation, together with perceptual abnormalities. Objectives: Differential diagnosis between delirium and dementia through clinic case:. Methods: Patient with 61 years old is admitted in neurosurgery because of multiple cerebral secondary hemorrhages caused by cranioencephalic traumatism. Consultation done due to agitation and disorientation episodes, hallucinations and fluctuation levels of consciousness and attention. No psychiatric background. Alcoholism suspect. We suspect an acute delirium and initiate haloperidol and quetiapine with a partial response. Family member refers behavioral disorder and memory failures moths before the trauma. His speech is perseverant, about the past and in some occasion confabulatory. Results: Analysis: sodium 130: Hyponatremia can justify delirium; Cranial Ct: acute contusive hemorrhage foci in right temporal hemisphere, subdural right hematoma; Liaison Neurology: suspected alcoholic dementia. They referral to external consultations for study. Conclusions: Delirium may syndromically resemble other disease or can appear concomitant thus it is necessary a differential diagnose to make a correct approach. Dementia has a progressive course, stable, without consciousness disturbances, less affected attention and finally, and disorientation appears in late stages. [ABSTRACT FROM AUTHOR]

Introduction: Shared psychotic disorder or Folie a deux is an unusual mental disorder characterized by the transfer of delusions between two or more people who have a close relationship. An individual (inductor or primary) who suffers from a psychotic disorder, influences one or more individuals (induced or secondary). Delusional disorders or schizophrenia are the most commonly diagnosed disorders in the inductor individual. Objectives: The objective of this study is to describe the clinical characteristics of an unusual entity such as shared psychotic disorder. Methods: Description of a clinical case of shared psychotic disorder of a family treated in the emergency room during confinement. Results: 47-year-old woman, goes to the emergency room with her husband. No psychiatric history. Both the patient and her husband verbalize delusions of harm and surveillance from neighbors. They also report that two of their children hold this belief. The mother, unlike the rest of the cohabitants, presents disqualifying auditory hallucinations. Her husband decides to take her to the emergency room because he finds her distressed, "between two realities" and aggressive when she is confronted about hallucinations. We start treatment with oral paliperidone in the mother and a subsequent follow-up, and a total remission of symptoms in all cohabitants. Conclusions: As in other mental disorders, the correct diagnosis and subsequent referral are essential. The separation of the inductor individual from the induced one is useful for the correct management of this disorder. With timely intervention and a regular follow-up, the Folie a deux has a good prognosis. [ABSTRACT FROM AUTHOR]

Introduction: Excessive daytime sleepiness, hypnagogichypnopompic hallucinations, sleep paralysis, and cataplexy are symptoms associated with narcolepsy. It is not uncommon to occur co-morbidly between narcolepsy and psychiatric disorders. This association is poorly understood. Recent findings indicate that anxiety disorders also are associated with typical symptoms of narcolepsy. Objectives: Study of the comorbidity between narcolepsy and psychiatric disorders, like anxiety, through a clinical case. Methods: A 21-year-old female patient with no psychiatric history who consulted due to anxiety and panic attacks related to poor narcolepsy control. Debut of the neurological disease during adolescence with frequent cataplexy attacks that condition their daily activity and generate avoidance behaviors and agoraphobia. Results: The patient complained of poor quality of sleep and reported a large number of different types of situations (eg, surprise, embarrassment) associated with cataplectic events. Treatment with SSRIs first and bupropion with pregabalin later was partially effective. Recent studies suggest efficacy of vagus nerve stimulation. Conclusions: Anxiety disorders, especially panic attacks and social phobias, often affect patients with narcolepsy. Anxiety and mood symptoms could be secondary complications of the chronic symptoms of narcolepsy. Recent studies have shown that narcolepsy is caused by defective hypocretin signaling. As hypocretin neurotransmission is also involved in stress regulation and addiction, this raises the possibility that mood and anxiety symptoms are primary disease phenomena in narcolepsy. Recent studies suggest that vagus nerve stimulation could be potentially useful in the treatment of resistant depressive and anxiety disorder and it is not a contraindication in patients with narcolepsy. [ABSTRACT FROM AUTHOR]

Introduction: Even when sharing etiologic factors, the incidence of DM-1 is low in patients with schizophrenia. Both diseases can lead to cognitive impairment, but its difficult to define its origin. 33 years old male, with DM-1 and schizophrenia referred to Therapeutic Community for psychotic symptomatology control, cannabis consumption withdrawal, improvement of self-care and hipoglycemia control reach Objectives: Nowadays toxic abstinent and adequate consciousness of disorder. Remarkable persistence of hallucinations both auditive and visual, mostly shown as delirium, pharmacologic treatmentrefractary. During last months, he shows excessive absentmindedness, recent memory failure and verbal declarative memory and psychomotor slowdown Analysis: unbalance glycosylated hemoglobin. MR: cortical-subcortical atrophy, very shocking his age. Endocrinology follow up it was decided to stablish an insulin pump, so metrics were regulated. Methods: Neurological profile of the patient (deficit and slowdown attention capability) aggravation of symptoms according to glycaemia and disturbances in image test could lead to vascular origin. Attention deficit and excessive focus are symptoms of schizophrenia, but they are shown in the beginning, they tend to stabilize during years. Verbal declarative memory disruptions can be produced in both disorders Results: Better glycemic control and changed to Lurasidone 37mg and Cariprazine 3mg objecting higher reactivity and less absentmindednes Conclusions: Cognitive impairment in DM is frequent in adults with severe and long evolving hypoglycemic episodes Regardless of its origin, the cognitive impairment in schizophrenia leads to serious impact in functional and pragmatic areas Further investigation will allow us to quantify the magnitude of cognitive effect in metabolic control so according strategies could be developed. [ABSTRACT FROM AUTHOR]

Introduction: Depressive disorders (Dd) in childhood have a prevalence about 1-2%. Sometimes depression may be underdiagnosed with the risk of complications: comorbidity, chronicity or development of psychiatric diseases in adulthood. Although children often do not show a clear sad mood, they usually presents irritability as a cardinal symptom. Other common symptoms in children's depression are lack of attention, difficult of concentration and impulsivity. These symptoms actually could define as well an Attention Deficit and Hyperactivity Disorder (ADHD), highly prevalent in schoolaged children (5-7%). Objectives: -To deep into diagnosis and evolution of depressive disorder in primary school-aged children (7-12 years-old). -To contrast clinical evidence about specific aged-symptoms observed in the boy and follow-up until remission. Methods: -Case study. Graphic description of diagnosis path and treatment in a 8-years-old boy suffers from depression. -Clinical case attended in Mental Health Unit, ambulatory consultation (outpatient). -Diagnosis tools: Clinical examination, family interview, evaluation tests and school psychopedagogical assessment. Results: -Treatment methods: psychotherapy, psychopharmacology and theater. -Specific depressive symptoms depends on childhood stages (*chart by ages). -Pharmacological treatment used: psychostimulants, benzodiazepines and antidepressants. -Efficacy of monotherapy with Fluoxetine 20mg/day 6-months. -Importance of individual psychotherapy and group activities 12-months. -Episode resolution and functional recovery 15-months. Conclusions: Variability of symptoms in children's depression can be confused with other psychiatric disorders like decreased school performance (ADHD), that may make diagnosis difficult. Sometimes, both disorders coexist, especially when the mood disorder is secondary to academic problems caused by ADHD. Early diagnosis and continued follow-up in specialized units is necessary to avoid progression and complications of Dd. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19pandemic presents symptomatic heterogeneity, so the differential diagnosis is even more relevant and more in patients with mental disorders. COVID-19 is a new disease that is under study and affects people over 65 with the greatest severity worldwide. The most frequent psychiatric symptoms are behavioral disturbances and confusional syndrome among those affected. Objectives: The objective is to demonstrate the importance of differential diagnosis in patients with psychiatric symptoms and covid-19. Methods: Patients aged 71 and 77, admitted to psychiatry. They present drowsiness that alternates with episodes of psychomotor agitation in which they verbalize fear of the coronavirus. Personal history: bipolar disorder and schizoaffective disorder. Psychopathological exploration: Spatial-temporal disorientation, uncooperative, fluctuating state of consciousness, verborrheic, salty and incoherent speech at times. Dysphoric mood. Psychomotor restlessness predominantly at night, verbal heteroaggressiveness. Negative to ingestion due to odynophagia. Sensory-perceptual alterations and nihilistic delusions "the virus has killed me, I'm already dead." Upon admission, they present a cough and fever and are treated with azithromycin and dexamethasone for suspected COVID-19. Complementary tests: chest X-ray bilateral pleural effusion. Cranial CT: Diffuse cortical and subcortical brain parenchyma retraction pattern. PCR positive coronavirus. Results: After overcoming the infection and with psychopharmacological treatment the confusional syndrome remitted. Conclusions: Confusional syndrome can present with different psychiatric symptoms, so the differential diagnosis is very important and even more so in patients older than 65 years who present somatic pathologies or acute infections. The differential diagnosis of confusional syndrome is key to adequate treatment and favor the prognosis. [ABSTRACT FROM AUTHOR]

Introduction: Meningioma is a slow-growing benign tumor arising from meninges, usually asymptomatic. Meningiomas may be primarily present with mood disorders, psychosis, memory disturbances, personality changes, anxiety or anorexia nervosa, but frequently it presented with neurologic signs due to mass effect. Prevalence rates for meningiomas are variable and range from 50.4/100,000 to 70.7/100,000. Female incidence is about three-fold the male incidence, with the largest difference observed between 30 and 59 years. Although there may be an association between some tumor locations and psychiatric symptoms, it is difficult to predict the symptoms based on the location or vice versa. Objectives: Show the importance of complementary test due to discard organic anomalies that could justify symptomatology. Methods: A53 years old singlewoman with no history of psychiatric disorder or drug abuse. The patient came to urgencieswith his family due to behavior disorder, anxiety and insomnia in the lastmonth. In the examination presents disorganized behavior with rituals, and thoughts abnormalities, including though blocking and irrational laughers inconsistent with the mood. Strange speech behaving suspiciously and hyperalert. Hyporexia and weight loss of 10kg Results: Blood tests, serologies, drug screening shows no abnormalities Craneal MRI: pineal/tentorial border meningioma BDI: 9 IPDE: correlation to histrionic behaviorWedecide an involuntary hospitalization due to lack of diagnosis and patient unconsciousness of her mental condition. We initiate treatment with paliperidone 6mg/24h, lorazepam 1mg/8h and lormetazepam 2mg/24h. Conclusions: The posibility of cerebral tumours as the cause of developing first psychotic episode and the importance of cerebral scaner in middle ages. [ABSTRACT FROM AUTHOR]

Introduction: Raynaud's phenomenon is a recurrent vasospastic alteration that reduces peripheral blood flow due to cold or emotional stress. During attacks, colour changes occur in distal limb areas. Serotonin reuptake inhibitors, psychostimulants and atypical antipsychotics, such as aripiprazole and risperidone, may be related to this phenomenon. It usually starts about two weeks after the start of treatment and remits after its suspension. Objectives: Alert about an uncommon side effect and its treatment through the description and analysis of a clinical case. Methods: Patient woman of 60 years, history of schizoaffective disorder. She was hospitalized in the acute unit for psychotic decompensation. She presented important psychomotor agitation, dysphoria and divagatory speech with delusional content of prejudice. No hallucinations. During hospitalization, it started treatment with aripiprazole 15 mg with good response and rapid remission of symptoms. After two weeks, it maintained psychopathological stabilization in a revision consultation. However, she presented erythroderma and cyanosis in fingers of both hands in relation to cold and crushing. Results: Analytical without significant findings. Vascular surgery and rheumatology discarded pathology. Aripiprazole is replaced by oral paliperidone. She had good treatment tolerance and maintains clinical stability after several months since the change of antipsychotic. She haven't submitted a new Raynaud. Conclusions: The rapid remission of the Raynaud phenomenon after the suspension of treatment with aripiprazole and the absence of pathological findings of complementary tests performed, orients towards a probable side effect of the antipsychotic treatment. [ABSTRACT FROM AUTHOR]

Introduction: Use of cannabis is a growing problem internationally and its relation inducing psychosis is also a growing public health concern. It leads to significant impairment, including emotional distress, difficulty communicating, and other debilitating symptoms. Objectives: In this case report, we discuss a patient with no previous history of psychotic symptoms, presenting with first-episode psychosis in the context of progressive, acutely worsening, psychotic thoughts and behaviors following prolonged use of cannabis. Methods: 26-year-old patient, male with no past psychiatric history or hospitalizations, who was admitted in psychiatric emergencies of local hospital with a first-time psychotic episode in the context of cannabis consume. This patient presented paranoid ideation, bizarre delusional thoughts, paranoid auditory hallucinations, persecution delusions with his neighbors, insomnia with 0-2 hours of sleep per night, affecting his activities of daily living. His affect was guarded, suspicious, and perplexed with apparent slowed cognition The patient had no known drug or environmental allergies, bloods labs were normal except urine toxicology positive for cannabinoids and normal head computerized tomography scan. Results: During the two-week, the patient was treated with oral olanzapina 5 mg at bedtime and discontinuation of cannabis use, with significant improvement, with resolution of paranoid ideation, abnormal thought processes, and insomnia. The strong response to olanzapine as an initial treatment may indicates the use of an effective antipsychotic for cannabis-induced psychosis. Conclusions: We should be aware of the possibility of cannabisinduced psychotic delusions, paranoia, and distorted thoughts, in order to identify and treat this condition. [ABSTRACT FROM AUTHOR]

Aboriginal and Torres Strait Islander culture is the oldest living culture in the world, dating over 60,000 years. An understanding of the complexity and richness of Aboriginal and Torres Strait Islander cultures, including the relationship between land and health, is still yet to be fully realised and as a result this people suffer ongoing social and health inequalities. These inequalities contribute to higher rates of ill health and a 17-year life expectancy gap between Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander Australians. Aboriginal and Torres Strait Islander Australians report higher levels of psychological distress compared with other Australians, with 77 percent reporting experiencing at least one major stressor in the past 12 months, the most common stressor being the death of a family member or close friend (42%). Particularly in rural and remote Australia, have higher rates of depression, substance abuse, co-morbidity and post-traumatic stress disorder. However, Aboriginal and Torres Strait Islander Australians do not access community and outpatient mental health services at a level that is commensurate with their need. In contrast, hospitalisation rates for mental health-related causes involving specialised psychiatric care are almost twice the rate, and for mental health-related causes without specialised psychiatric care are around three times higher, compared with non-Aboriginal and Torres Strait Islander Australians and death rates from ‘mental and behavioural disorders’ are much higher for Aboriginal and Torres Strait Islander Australians than for non-Aboriginal and Torres Strait Islander people. [ABSTRACT FROM AUTHOR]