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Introduction During the course of COVID-19 pandemic, The respiratory system is the most commonly affected while many neuropsychiatric manifestations of the disease have been observed. Objectives Emphasize the importance of eliminating the diagnosis of covid 19 infection in a pandemic context face to first episode psychosis. Methods Presentation of case report Results A 29-year-old woman unemployed married with no personal medical history and with psychiatric family history. She wasn’t exposed to subject with covid 19 in her family circle. She was admitted in psychiatric care for acute behavioural disorders during five days. On physical examination: she was afebrile, eupneic and tachycardiac. Oxygen saturation was 96% and blood pressure was 100/50 mmHg. Specialized neurological examination was normal and cerebral CT scan was without abnormalities. At the psychiatric interview she was extremely agitated. She was distressed her speech was incoherent. She had auditory and visual hallucinations and a multi-thematic delirium. One day after her admission she died suddenly, the autopsy found positive RT PCR covid test and bilateral basal pneumonia. Conclusions In individuals presenting with new-onset psychosis in areas endemic to COVID-19, consideration should be made for neuropsychiatric manifestations of Covid 19 from where the importance to push the explorations and to test the patients. Disclosure No significant relationships.

Introduction Tuberous sclerosis is a multisystem genetic disorder. It is associated with significant psychiatric comorbidity mainly autistic disorders, hyperkinetic disorders, depression and anxiety. It is rarely associated with psychosis and bipolar disorder. Objectives To describe the case of a 34-year-old male with concomitant diagnosis of bipolar disorder and tuberous sclerosis. Methods Case report based on clinical records. Brief literature review using articles searched in the PubMed/MEDLINE database using the terms “tuberous sclerosis”, “bipolar disorder” and “neuropsychiatric”. Results The patient presented at our Emergency Department 3 years ago with a mixed episode with psychotic symptoms with 1 month of duration. Prior history of two hypomanic episodes, but no depressive episodes. High baseline functionality. Sporadic use of alcohol and cannabis. No family history of psychiatric or neurological diseases. Diagnostic work-up showed no relevant results, aside from small calcifications in brain CT. He was admitted to our ward and medicated with aripiprazol (titrated up to 30 mg), leading to full remission of the clinical picture. The patient was referred to our outpatient clinic and stayed with medication for 1,5 years. One year after, he presented a sudden episode of mutism and perplexity with quick remission. The EEG wielded no relevant results. New brain CT showed signs of tuberous sclerosis. He was referred to Neurology and subsequent assessments, including brain MRI, led to the fulfilment of clinical criteria for tuberous sclerosis. Conclusions This case illustrates the possibility of concomitant diagnosis of bipolar disorder and tuberous sclerosis. The possible association between these disorders is discussed. Disclosure No significant relationships.

Introduction Gerstmann syndrome is a rare neurological disorder that consist primarily of 4 neuropsychological signs that include acalculia (impairment in performing calcultaions), digital agnosia (dificulty discriminating their own fingers), agraphia (impairment or dificulty to write by hand); and left-right disorientation (impairment of distinguishing left from right. Objectives Presentation of a case report of a patient with Gertsmann syndrome secondary to breast cancer metastasis. Methods We analyze the case of a 79 years-old female with a history of breast cancer in remission, with a severe depressive episode of 8 months of evolution, dysphoria, apathy, decrease in the ability to carry out basic activities of daily life, acute personality changes and sleep disruption. 15 days previous to the first examination the patient suffers gait disturbances, falling from her own height, memory impairment, suicide ideation and nomination aphasia. Results At the examination we encounter digital agnosia, acalculia, agraphia, right-left disorientation, right hemiparesis. MRI are taken founding 3 tumor lesions in the left and right frontal lobe, 2 solid lesions with a necrotic appearance in the right parietal lobe, one of them in the angular gyrus of the parietal cortex. CT scan found a solid tumor-like lesion in the left pulmonary apex. CA-125 antigen 429.5 U/mL. She was sent to continue her treatment with oncology, receiving radiotherapy. Conclusions The psychiatric abnormalities secondary to Gerstmann syndrome make the relatives of this patient seek psychiatric care, requiring multidisciplinary work to reach an accurate diagnosis. Gerstmann syndrome is a rare neurological condition that can mimic lots of other clinical pictures. Disclosure No significant relationships.

Introduction The delusional misidentification syndromes (DMS) are uncommon but fascinating neuropsychiatric disorders. One particularly intriguing form of DMS is called the mirror sign or mirror delusional misidentification (MDM). Objectives We aim to present a case on MDM and a review on MDM and its correlation with neurological lesions. Methods Non-systematic review of the literature and case report. Results A 72 years old patient was admitted to the emergency department with disorientation, behavioral changes and persecutory delusional ideation. The patient was also unable to recognize his face in the mirror, claiming to be his son. On neuroimaging tests, the patient presented with moderate diffuse cortical-subcortical cerebral atrophy associated with mild diffuse cortical cerebellar atrophy, as well as atheromatous calcifications in carotid siphons. In the MDM, the patient treats the mirror image as separate from the self. It is commonly seen in patients with dementia. Unlike Capgras syndrome, MDM is typically associated with neurological illness, particularly with neurodegenerative conditions. Findings on neuroimaging have shown a pattern of right hemisphere cortical and subcortical lesions. the most common findings included the following: generalized or localized atrophy on Magnetic Resonance Imaging, ventricular dilatation on Computed Tomography scan, and slowing on Electroencephalography. Conclusions Mirror delusional misidentification differs from other forms of DMS as it is seen exclusively in patients with neurological disease. While right hemisphere dysfunction appears to be a requirement for MDM, patients with this condition do not show consistent enough neuroimaging findings to allow for a localization within the right hemisphere. Disclosure No significant relationships.

Introduction Although defined heterogeneously within the literature apathy is classified as a multidimensional deficit with emotional, behavioral, and cognitive domains in which there is a decrease in self-motivated/goal-directed activity. Recently conceptualized as a syndrome but lacking a universal screening tool. Objectives Review current knowledge on apathy and its best therapeutic approach. Methods Non-systematic review of literature through search on PubMed/MEDLINE following the terms “apathy”and“psychiatry”. Results Apathy is amongst the most frequent symptoms of dementia and highly prevalent across different forms and stages of dementia, including mild cognitive impairment (MCI) as well as other neurodegenerative and psychiatric disorders such as Parkinson’s disease (PD), Schizophrenia, Depression and Brain Injury. Individuals with apathy have higher frequencies of cognitive impairment and are less likely to be compliant/respond to treatment for comorbid illnesses. Apathy reduces quality of life, increases mortality and leads to caregivers distress - often identified as the most burdensome symptom. Once treatment should favor dopaminergic neurotransmission, psychostimulants were considered. Methylphenidate showed encouraging results as well as dopamine agonists but both with limited evidence. Atypical antipsychotics(APs) seem beneficial compared to typical APs. Antidepressants did not improve symptoms and may even worsen them. Previously reported benefits of acetylcholinesterase inhibitors (AChEIs) were not replicated in recent studies except for rivastigmine in PD. Nonpharmacological interventions are also important. Conclusions Apathy occurs frequently in a broad range of neuropsychiatric conditions and considering its impact on patients´ quality of life more studies are needed to find an efficient treatment. A consensus regarding definition and screening tools would allow a better approach. Disclosure No significant relationships.

Introduction Anorexia nervosa (AN) is a chronic psychiatric disorder resulting from abnormal eating habits with a high prevalence (0.5%). AN involves genetic and epigenetic factors supporting that AN is a metabo-psychiatric disorder. One candidate gene for AN, validated by meta-analyzes, is BDNF which encodes the brain-derived neurotrophic factor. BDNF negatively modulates the central control of food intake and its injection in rodents induces weight loss and anorexia. In humans, we observed an association of its functional variant Val66Met/rs6265 and electrodermal response to images of thinness suggesting an association between rs6265 and a reward effect of weight loss in AN. Objectives This work study the impact of the functional polymorphism at risk rs6265, epigenetic variations in DNA methylation of BDNF gene and consequences on the concentrations of BDNF in AN patients. Methods DNA was isolated from 24 AN patients and 48 controls. DNA methylation was measured for sites spanning the BDNF gene using Infinium HumanMethylation450 BeadChip technology. The genotyping of rs6265 was performed by Taqman-SNP assay. The BDNF was dosaged by ELISA from plasmas. Results We observe that several sites are significantly hypermethylated in AN patients compared to controls. AN patients show significantly higher BDNF levels than controls. Finally, this BDNF concentration is significantly higher in AN carrying the risk Met66 allele. Conclusions This work demonstrates the effects of genetic and epigenetic variations of BDNF, which could constitute relevant diagnostic biomarkers of AN, and their likely consequences in the pathophysiology of AN. This work was supported by the Nestlé Foundation. Disclosure No significant relationships.

Introduction Parkinson’s disease (PD) is a neurologic degenerative condition with complex neuropsychiatric manifestations which can be challenging to manage and greatly impact quality of life and prognosis. Objectives The description of this case aims to highlight the complex interaction between PD, drug-abuse and impulse control disorder (ICD). Methods Clinical information was obtained through patient interviewing and medical records consulting. A literature review on the topic was conducted. Results We report the case of a 52-years-old male with PD diagnosed at the age of 45, presenting with rigidity of right limbs and freezing of gait. He had a history of multiple substance-abuse: hashish, heroin and cocaine, with cessation of all substances by the age of 40. The patient responded well to antiparkinsonian medication initially, but needed frequent adjustments and developed ICD secondary to dopamine agonists, presenting pathological gambling and hypersexuality. At 47 he restarted using cocaine stating that it diminished the motor symptoms. Motor symptoms worsened and became partially responsive to medication. Pharmacologic options were limited due to ICD. He developed dopamine dysregulation syndrome, abusing dopaminergic drugs and requesting multiple prescriptions. Deep brain stimulation surgery was proposed, but the patient was deemed unfit for the procedure after two separate psychiatric evaluations, mainly because of behaviour and social problems in relation to sustained cocaine abuse and personality disorder. Attempts to stop drug abuse were unsuccessful despite several interventions by addiction psychiatry. Conclusions Co-occurrence of PD, substance-abuse and personality disorder poses as a therapeutic challenge conditioned by pharmacological iatrogenesis and behavioural disturbances, requiring a multidisciplinary and individualized approach. Disclosure No significant relationships.

Introduction Huntington’s Disease (HD) is an autosomal dominant, neurodegenerative condition with a prevalence of 10.6-13.7 per 100,000, caused by the trinucleotide CAG (cytosine, adenine, guanine) repeat expansion in the HTT gene. HD is characterized by a range of motor, cognitive, and psychiatric symptoms, the latter of which usually manifest prior to the onset of motor or cognitive disturbances. Amongst psychiatric symptoms, changes in personality are most common, followed by depression. Psychosis has a higher prevalence in those with early-onset HD. Objectives This case report aims to demonstrate an apporach to the management of neuropsychiatric disturbances in HD as well as expose the need for development of an evidence-based apprach to treatment. Methods PubMed was searched for the criteria Huntington’s Disease AND Psychosis, with a secondary search for Management of Psychosis in Huntington’s Disease. Results The patient is a 54-year-old male with no psychiatric history and reported past medical history of Huntington’s Disease, diagnosed one month ago. He was brought to the Psychiatric ED due to agitation and disorganized behavior at home. On admission, he demonstrated disorganized behavior, grandiose delusions, neurocognitive deficits, and reported auditory hallucinations. With the initiation of tetrabenazine and risperidone his psychiatric symptoms improved and he was able to be discharged to a long-term care facility. Conclusions Literature is scarce regarding treatment of psychiatric manifestations of HD. We catered our approach towards safe and effective symptoms management in a multidisciplinary manner. Further research is required to reach an evidence-based consensus as well as develop specific guidelines for managing psychiatric conditions related to HD. Disclosure No significant relationships.

Introduction Darier-White disease (DD) is a rare genodermatosis of dominant autosomic inheritance characterized by the keratinization of epidermis, nails and mucous membrane. It leads to the formation of papules and brown hyperkeratotic plaques, mainly in seborrheic areas. The disease is associated with a mutation on the ATP2A2 gene, mapped in the 12q23-24 chromosome. There is known a relationship between DD and neuropsychiatric diseases, such as bipolar disorder, depression and schizophrenia. Objectives To discuss the relationship between DD and neuropshychiatric disorders. Methods We report the case of a patient with diagnosed schizophrenia, alcohol and cannabis dependence who presented skin lesions. Results The physical exploration of our patient revealed cutaneous lesions and we pointed the diagnostic towards DD. Afterwards, a cross-consultation was done with the dermatology experts. During the physical exploration, the patient shows confluent hyperkeratotic papules, dominant on the sides and center of back and hands, together with nail injuries (see images). The diagnostic was confirmed through anatomic pathology. The patient was treated with 10 mg/day of Acitretin together with emollients twice a day, which improved the patient clinical status and signs. The patient remained stable at a psychiatric standpoint. After 3 years of treatment, the patient keeps the same medication but with a reduced dose of 5 mg/day, with a 70% decrease of the initial hyperkeratotic lesions. Conclusions Previous studies concludes that mutations in the ATP2A2 gene, in addition to causing DD, confer susceptibility to neuropsychiatric features.These case report highlight the need for clinicians to asses and recognize neuropsychiatric symptoms in DD. Disclosure No significant relationships.

Introduction: Despite the unclear nature of catatonia, the treatment response of catatonia to benzodiazepines is widely known for its typical, dramatic recovery. The neurobiological correlates of this phenomenon regarding specific receptors and neurotransmitters are unclear, as are the potential treatment options. This is important to consider when the most commonly recommended treatments of catatonia with Lorazepam or Electroconvulsive Therapy (ECT) are unavailable or unsuccessful. In this report, we describe a case of severe, malignant catatonia and psychosis mostly unresponsive to Lorazepam during two different hospitalizations, but with eventual return to baseline after successful treatment with Valproate. Objectives: - To describe a unique case of malignant catatonia that was unresponsive to Lorazepam - To illustrate the potential utility of Valproate as an alternative treatment strategy for catatonia Methods: This is a case report. Results: A 19-year-old Hispanic male presented to our hospital initially with family reports of severe and sudden depression with bizarre behavior. Prior to this admission, the patient had been discharged recently from another tertiary hospital following a 2-week admission for severe catatonia. Chart review from that admission scored the patient's Bush-Francis Catatonia Rating Scale (BFCRS) at 16, which remained mostly unchanged after numerous additional intramuscular doses and standing oral doses of Lorazepam, with a reduction of BFCRS the next day of only 2. During the patient's admission at our hospital, the patient endorsed bizarre, guilt-related delusions, and his catatonia was more severe and malignant with a BFCRS of 19, with tachycardia and diaphoresis. The patient was initially given a total of seven doses of a mix of intramuscular and oral Lorazepam (total 18mg), with a minimal 2-point reduction in BFCRS. As ECT was unavailable, Lorazepam was discontinued in favor of a trial of oral Valproate 500mg twice daily, and after his catatonia subsided (with a serum level of 60.8), he was started on oral Risperidone 0.5mg once at night, titrated up to 3mg twice daily, and eventually returned to baseline as confirmed by his family members. Conclusions: The treatment of catatonia with Lorazepam is usually reliable and has been found to be up to 80% effective, but when the recommended use of benzodiazepines and ECT fail or are unavailable, there are few studies exploring the viability of alternative treatment options. With the use of Valproate, previous studies have shown it can treat even severe catatonia (KrÜger, J Neuropsychiatry 2001; 13:303-304), or can actually be its cause (Lauterbach, Neuropsychiatry, Neuropsychology, and Behavioral Neurology. 1998 Jul;11(3):157-163). As such, this case report highlights the importance of exploring alternative treatments for catatonia, including Valproate, in order to better tailor the management of this unique syndrome. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction A meta-analysis by Gürsel et al. (2018) found altered functional connectivity in OCD patients within and between default mode (DMN), salience (SN), and frontoparietal networks (FPN), as well as evidence for aberrant fronto-striatal circuitry. Objectives Testing the replicability of meta-analysis rsfMRI findings in OCD patients. Methods We measured functional connectivity during resting-state fMRI in a sample of OCD patients (n=24) and controls matched for age and sex (n=33). The CONN toolbox implemented in SPM was used to perform seed-to-voxel analysis using 30 seed regions based on the previous meta-analytic findings. Results OCD patients showed reduced functional connectivity between SN and DMN compared to controls, replicating previous findings. We did not observe significant group differences of functional connectivity within the DMN, SN, or FPN. The strongest finding consisted of altered connectivity between DMN and SN to the visual network. OCD patients showed reduced functional connectivity between the left lateral parietal seed (LPl) and the inferior lateral occipital pole left (iLOCl) compared to controls. Furthermore, the LPl was found to be hyperconnected with the right superior lateral occipital cortex (sLOCr) and the right precuneus. This finding was positively correlated to OCD symptom severity, especially compulsions. Conclusions Our findings replicated partly the meta-analysis findings, specifically reduced connectivity between SN and DMN. Using seeds based on the meta-analysis, we identified aberrations between the SN and, in particular, the DMN to the visual network. This raises the question about the visual system’s involvement in OCD symptoms and the abnormal connectivity of a unimodal region to the multimodal DMN. Disclosure No significant relationships.

Introduction Traumatic brain injury (TBI) is a leading cause of morbidity and mortality, giving rise to a variety of neuropsychiatric syndromes associated with great functional impairments, chronic disability and poor quality of life. Depending on diagnostic criteria, 20-90% of victims of TBI develop at least one neuropsychiatric manifestation in the first month, and about 40% present at least three symptoms during three months, with higher incidence in females. Survivors of TBI are at increased risk for development of severe, long-term psychiatric disorders. The aetiology of these disturbances remains unclear. Objectives To review current knowledge on the neuropsychiatric consequences associated with TBI. Methods Non-systematic review of literature through search on PubMed/MEDLINE database for publications up to 2020, following the terms “traumatic brain injury” and “neuropsychiatry”. Results Although the experience of neuropsychiatric symptoms may be temporary and may resolve in the acute period, many patients with TBI can experience psychopathology that is persistent or that develops in the post-acute period, regardless of injury severity. These symptoms can involve personality changes, psychosis, major depression, generalized anxiety disorder, post-traumatic stress disorder, maladaptive social behaviours, poor disability adjustment, reduced coping skills and cognitive impairment. Evidence remains insufficient to conclude the role of TBI-related neuropathological consequences in the development of post-TBI neuropsychiatric disorder. Non-organic factors are also implicated in its generation and maintenance. Conclusions Neuropsychiatric sequelae are common following TBI. Several of these syndromes are amenable to treatment. Further investigations are required to better understand the mechanistic aetiology of these conditions and the effectiveness of therapeutic modalities.

Introduction Wilson’s Disease is a rare, autosomal recessive disorder related to disturbances of copper metabolism. Its clinical picture includes hepatic, neurologic, psychiatric, and systemic manifestations. Psychiatric symptoms are frequent over the course of this disease and can be found in up to a quarter of patients at presentation. Successful treatment for Wilson’s Disease can be achieved using anti-copper agents. Objectives We aim to review the literature regarding the psychiatric manifestations of Wilson’s Disease. We also include brief considerations about their management. Methods We performed an updated review in the PubMed database using the terms “Wilson’s Disease” and “Psychiatric manifestations”. The included articles were selected by title and abstract. Results Psychiatric manifestations, including psychosis, mood disorders, personality disorders and cognitive impairment are common in Wilson’s Disease and can be the initial symptoms of this condition. The diagnosis of Wilson’s Disease in people presenting with psychiatric symptoms heralds special considerations in psychopharmacology since this population has a higher risk of hepatic impairment, epilepsy, and extrapyramidal side effects. Conclusions Psychiatric symptoms are common in Wilson’s Disease and can be its presenting clinical features. Missing the diagnosis of Wilson’s Disease can stall an efficient treatment and lead to inadequate patient management.

Introduction Olfactory hallucinations have been described since the 19th century as a particular, often unpleasant smell at the beginning or during the spell. The olfactory cortex are involved in temporal lobe epilepsy. Objectives The aim was analyze the relationship between the olfactory hallucinations and the previus diagnosis of epilepsy. Methods In this study, we present a clinical case and review the current literature showing the relationship between smell and epilepsy. Results A 69-years-old woman, with a medical history of epilepsy, went to the emergency department describing a recent episode of seizure, self-limited in time, after a sensation of an unpleasant smell in bed. A medical history of osteoarthritis, cholecystectomy and essential tremor is described. No unknown drug allergies. The neurological examination shows dysarthric speech, tremor in the right upper limb, isochoric and reactive pupils, preserved sensitivity and strength, and a positive Romber’s sign. The physical examination, blood test and vital signs were normal. The head CT scan showed signs of ischemic leukoencephalopathy, without acute ischemic or hemorrhagic lesions. The patient was medicated with 1000 mg of valproate daily, which was suspended a month ago due to an alteration in liver transaminases. Treatment with diazepam 10 mg daily was prescribed and referred for consultation. The sense of smell changes over time for anormal aging process, affecting abilitiesto detect, identify and discriminate odors.Several neurodegenerative diseases presentcertain alterations that help us determine yourorigin and progression (Vaughan and Jackson, 2014). Conclusions Olfactory auras occurs before a seizure of the temporal lobe. Repeated stimuli in limbic regions can produce changes in the piriform cortex, with increased excitability and in epileptic discharges. Disclosure No significant relationships.

Abstract Background Apathy is a very common behavioural and psychological symptom across brain disorders. In the last decade, there have been considerable advances in research on apathy and motivation. It is thus important to revise the apathy diagnostic criteria published in 2009. The main objectives were to: a) revise the definition of apathy; b) update the list of apathy dimensions; c) operationalise the diagnostic criteria; and d) suggest appropriate assessment tools including new technologies. Methods The expert panel (N = 23) included researchers and health care professionals working on brain disorders and apathy, a representative of a regulatory body, and a representative of the pharmaceutical industry. The revised diagnostic criteria for apathy were developed in a two-step process. First, following the standard Delphi methodology, the experts were asked to answer questions via web-survey in two rounds. Second, all the collected information was discussed on the occasion of the 26th European Congress of Psychiatry held in Nice (France). Results Apathy was defined as a quantitative reduction of goal-directed activity in comparison to the patient's previous level of functioning (criterion A). Symptoms must persist for at least four weeks, and affect at least two of the three apathy dimensions (behaviour/cognition; emotion; social interaction; criterion B). Apathy should cause identifiable functional impairments (criterion C), and should not be fully explained by other factors, such as effects of a substance or major changes in the patient's environment (Criterion D). Conclusions The new diagnostic criteria for apathy provide a clinical and scientific framework to increase the validity of apathy as a clinical construct. This should also help to pave the path for apathy in brain disorders to be an interventional target. [ABSTRACT FROM AUTHOR]

Abstract Aims Absent or delayed help-seeking is considered to aggravate the immense personal and societal burden caused by mental disorders. Therefore, we cross-sectionally examined rates and clinical and sociodemographic moderators of early help-seeking for current clinician-assessed non-psychotic mental problems/disorders in the community. Methods Altogether, 2683 individuals of the Swiss Canton Bern (16–40 years old, response rate 63.4%) were interviewed by telephone for current axis-I problems/disorders using the Mini-International Neuropsychiatric Interview, for psychosocial functioning using the Social and Occupational Functioning Assessment Scale, and for help-seeking for mental problems. Results In total, 1122 (41.8%) reported mental problems. Of these, 769 (68.5%) affirmed any one screening question and 353 (31.5%) fulfilled criteria for any current axis-I disorder, and 396 (35.3%) reported any lifetime help-seeking (28.3% sought help in the past and 7.0% were in current treatment). In path analyses, current help-seeking was associated mainly by type and number of mental problems/disorders mediated by functional impairment, in addition to older age, no current partner, and past treatment. Conclusion Our cross-sectional data indicate a gap in help-seeking for mental problems/disorders. The relationship between number of mental problems/disorders and help-seeking mediated by functional impairment confirm that individuals commonly do not seek help until problems are severe enough to cause problems in occupational and psychosocial functioning, driving the already immense costs of mental disorders. Thus, campaigns promoting early help-seeking, including early diagnostic clarification of and support for subthreshold mental problems in terms of an indicated prevention, should focus on psychosocial functioning, aside from signs of mental illness. [ABSTRACT FROM AUTHOR]

Background Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease that has a wide variety of physical manifestations, including neuropsychiatric features. Bipolar disorder (BD) is a chronic, episodic illness, that may present as depression or as mania. The objective of this study was to investigate the association between SLE and BD using big data analysis methods. Methods Patients with SLE were compared with age- and sex-matched controls regarding the prevalence of BD in a cross-sectional study. Chi-square and t -tests were used for univariate analysis and a logistic regression model was used for multivariate analysis, adjusting for confounders. The study was performed utilizing the chronic disease registry of Clalit Health Services medical database. Results The study included 5018 SLE patients and 25,090 matched controls. BD was found in a higher prevalence among SLE patients compared to controls (0.62% vs. 0.26%, respectively, P < 0.001). BD patients had a greater prevalence of smokers compared to non-BD patients (62.5% vs 23.5%, respectively, P < 0.001). In a multivariate analysis, smoking and SLE were both found to be significantly associated with BD. Conclusions SLE was found to be independently associated with BD. These findings may imply that an autoimmune process affecting the central nervous system among SLE patients facilitates the expression of concomitant BD. [ABSTRACT FROM AUTHOR]

Background There is considerable evidence that white matter abnormalities play a key role in the pathogenesis of a number of major psychiatric disorders, including schizophrenia, bipolar affective disorder, and obsessive-compulsive disorder. Few studies, however, have compared white matter abnormalities early in the course of the illness. Methods A total of 102 children and adolescents participated in the study, including 43 with early-onset schizophrenia, 13 with early-onset bipolar affective disorder, 17 with obsessive-compulsive disorder, and 29 healthy controls. Diffusion tensor imaging scans were obtained on all children and the images were assessed for the presence of non-spatially overlapping regions of white matter differences, a novel algorithm known as the pothole approach. Results Patients with early-onset schizophrenia and early-onset bipolar affective disorder had a significantly greater number of white matter potholes compared to controls, but the total number of potholes did not differ between the two groups. The volumes of the potholes were significantly larger in patients with early-onset bipolar affective disorder compared to the early-onset schizophrenia group. Children and adolescents with obsessive-compulsive disorder showed no differences in the total number of white matter potholes compared to controls. Conclusions White matter abnormalities in early-onset schizophrenia and bipolar affective disorder are more global in nature, whereas children and adolescents with obsessive-compulsive disorder do not show widespread differences in FA. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: 22q11.2 deletion syndrome (22q11.2DS) and Williams syndrome (WS) are common neurogenetic microdeletion syndromes. The aim of the present study was to compare the neuropsychiatric and neurocognitive phenotypes of 22q11.2DS and WS. Methods: Forty-five individuals with 22q11.2DS, 24 with WS, 22 with idiopathic developmental disability (DD) and 22 typically developing (TD) controls were compared for the rates of psychiatric disorders as well as cognitive executive and visuospatial functions. Results: We found that while anxiety, mood and disruptive disorders had an equally high prevalence among individuals with 22q11.2DS, WS and DDs, the 22q11.2DS group had the highest rates of psychotic disorders and the WS group had the highest rates of specific phobia. We also found that the WS group demonstrated more severe impairments in both executive and visuospatial functions than the other groups. WS and 22q11.2DS subjects had worse Performance-IQ than Verbal-IQ, a feature typical of non-verbal learning disorders. Conclusion: These findings offer a wide perspective on unique versus common phenotypes in 22q11.2DS and WS. [Copyright &y& Elsevier]

The present study aimed to determine whether any gender-related difference exists concerning oxidative stress parameters in a population of 231 subjects, and if these changes might be related to gender-associated differences in major depressive disorder (MDD) or bipolar disorder (BD) vulnerability. This is a case-control nested in a population-based study. The initial psychopathology screen was performed with the Mini-International Neuropsychiatric Interview and the diagnostic was further confirmed with the Structured Clinical Interview for DSM-IV. Blood samples were obtained after the interview and the oxidative stress parameters such as uric acid, advanced oxidation protein product (PCC) and lipid hydroperoxides (TBARS) were determined. Our results indicated a higher prevalence of MDD and BD in women when compared to men. In addition, significant gender differences were found in the levels of PCC (0.27±0.27 vs. 0.40±0.31nmol CO/mg protein, men vs. women, respectively; P =0.02) and uric acid (4.88±1.39mg/dL vs. 3.53±1.02mg/dL, men vs. women, respectively; P =0.0001), but not in TBARS (0.013±0.01nmol/mg of protein vs. 0.017±0.02nmol/mg of protein, men vs. women respectively; P =0.243). After sample stratification by gender, no association was found between oxidative stress parameters and clinical diagnosis of MDD and BD for women (P =0.516 for PCC; P =0.620 for TBARS P =0.727 for uric acid) and men (P =0.367 for PCC; P =0.372 for TBARS P =0.664 for uric acid). In this study, women seem more susceptible to oxidative stress than male. However, these gender-based differences do not seem to provide a biochemical basis for the epidemiologic differences in mood disorders susceptibility between sexes. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To compare mental health of 136 young adults without neurosensory handicaps born with low birthweight (LBW, birthweight less than 2000g) with 132 adults with normal birthweight (NBW). Method: A cohort of moderate LBW and NBW young adults were assessed with the Mini-International Neuropsychiatric Interview (MINI) at 19 years and the Children Assessment Schedule (CAS) at 11 years of age. Results: At 19 years of age, 44 out of 136 (32%) LBW young adults were diagnosed with a psychiatric disorder compared to 10% NBW (OR: 2.8; 95% CI: 1.1, 4.5, P =0.02). Among the LBW young adults, affective-, anxiety-, ADHD- and antisocial personality disorders were most common, and nine subjects (20%) had more than one diagnosis. Of 97 LBW subjects examined both at 11 and 19 years of age, 54 (56%) were mentally healthy though out adolescence. This was half as many as for controls (OR: 0.6; 95% CI: 0.3 to 0.9). Conclusion: Moderate LBW was associated with an increased risk of psychiatric disorders in young adulthood. Only half of LBW young adults stayed healthy throughout adolescence. [Copyright &y& Elsevier]

Abstract: Objective: To investigate the frequency of bradykinesia in patients with obsessive-compulsive disorder (OCD) and to see whether patients with OCD who also have bradykinesia display distinctive neuropsychological and neuropsychiatric features. Methods: We studied 23 antipsychotic-free patients with OCD and 13 healthy controls. Bradykinesia was assessed with section III of the Unified Parkinson Disease Rating Scale. The Wechsler Adult Intelligent Scales-Revised (WAIS-R) was used to assess the Full Scale IQ and to measure visuospatial, visuoconstructional ability and psychomotor speed/mental slowness. Results: Of the 23 patients with OCD studied, 8 (34%) had mild symptoms of bradykinesia. No relationship was found between bradykinesia and the sociodemographic variables assessed but this motor symptom was significantly associated with the severity of compulsions. Patients with bradykinesia differed from those without: they had a higher frequency of repeating compulsions, and lower IQ scores, performance scores, and WAIS-R subtest scores for similarities and picture completion. No significant differences were found between patients without bradykinesia and healthy controls in any test. Conclusions: Clinical assessment of motor symptoms in adult patients with OCD often discloses mild bradykinesia sometimes associated with repeating compulsions and poor WAIS-R performance scores. [Copyright &y& Elsevier]

Abstract: Objective: To assess the feasibility, patient and clinician acceptability and test-retest reliability of the Mini-International Neuropsychiatric Interview (MINI) used by non-psychiatrists in an acute psychiatric ward. Method: Of 268 consecutive patients included in a cross-sectional study, 176 (66%) completed MINI, and were compared to patients not interviewed. Patients and clinicians were questioned about the interview, using Visual Analogue Scales (VAS). For 38 patients, test-retest reliability was assessed with Cohen''s kappa and observed agreement. Results: MINI was not feasible for all patients. Among factors associated with not being interviewed were early discharge, psychosis, substance use and involuntary admissions. Although evaluations by patients and clinicians completing the postinterview questionnaire varied, MINI was generally perceived as being useful and feasible. Psychotic symptoms were associated with a less positive experience with MINI for both patients and clinicians. In the test-retest analyses, kappa values indicated excellent agreement for six diagnoses, fair to good for six and poor for seven, whereas observed agreement was 75% or above for all disorders. Conclusion: Among patients admitted to an acute psychiatric ward willing and able to complete the interview, MINI was well accepted by patients and clinicians, and has moderately good test-retest reliability. [Copyright &y& Elsevier]

Abstract: There is wide acknowledgement that apathy is an important behavioural syndrome in Alzheimer''s disease and in various neuropsychiatric disorders. In light of recent research and the renewed interest in the correlates and impacts of apathy, and in its treatments, it is important to develop criteria for apathy that will be widely accepted, have clear operational steps, and that will be easily applied in practice and research settings. Meeting these needs is the focus of the task force work reported here. The task force includes members of the Association Française de Psychiatrie Biologique, the European Psychiatric Association, the European Alzheimer''s Disease Consortium and experts from Europe, Australia and North America. An advanced draft was discussed at the consensus meeting (during the EPA conference in April 7th 2008) and a final agreement reached concerning operational definitions and hierarchy of the criteria. Apathy is defined as a disorder of motivation that persists over time and should meet the following requirements. Firstly, the core feature of apathy, diminished motivation, must be present for at least four weeks; secondly two of the three dimensions of apathy (reduced goal-directed behaviour, goal-directed cognitive activity, and emotions) must also be present; thirdly there should be identifiable functional impairments attributable to the apathy. Finally, exclusion criteria are specified to exclude symptoms and states that mimic apathy. [Copyright &y& Elsevier]

Abstract: The insular cortex is located in the centre of the cerebral hemisphere, having connections with the primary and secondary somatosensory areas, anterior cingulate cortex, amygdaloid body, prefrontal cortex, superior temporal gyrus, temporal pole, orbitofrontal cortex, frontal and parietal opercula, primary and association auditory cortices, visual association cortex, olfactory bulb, hippocampus, entorhinal cortex, and motor cortex. Accordingly, dense connections exist among insular cortex neurons. The insular cortex is involved in the processing of visceral sensory, visceral motor, vestibular, attention, pain, emotion, verbal, motor information, inputs related to music and eating, in addition to gustatory, olfactory, visual, auditory, and tactile data. In this article, the literature on the relationship between the insular cortex and neuropsychiatric disorders was summarized following a computer search of the Pub-Med database. Recent neuroimaging data, including voxel based morphometry, PET and fMRI, revealed that the insular cortex was involved in various neuropsychiatric diseases such as mood disorders, panic disorders, PTSD, obsessive-compulsive disorders, eating disorders, and schizophrenia. Investigations of functions and connections of the insular cortex suggest that sensory information including gustatory, olfactory, visual, auditory, and tactile inputs converge on the insular cortex, and that these multimodal sensory information may be integrated there. [Copyright &y& Elsevier]

Introduction: Stroke is one of the most common diseases in the emergency department, being the second most common cause of death and the fourth leading cause of disability worldwide. Neuropsychiatric manifestations following stroke have been reported, most commonly depression. Psychotic symptoms subsequent to stroke are rare and usually associated with poor outcomes and high mortality. Despite that, they are often underestimated, undiagnosed, and thus remaining undertreated. Objectives: Brief description of a clinical case of poststroke psychosis, followed by a review of the different neuropsychiatric outcomes secondary to stroke. Methods: Non-systematic review of literature collected from online medical databases under the keywords "stroke", "cerebrovascular disease", "neuropsychiatry" and "poststroke psychosis". Results: The authors report a case of an organic psychosis in a 72-year-old male with history of right hemisphere stroke ten months prior to admission in the psychiatric inpatient unit of Hospital Garcia de Orta. He presented with a two-month picture of gradual behavioural changes in the form of sexual disinhibition, irritability, persecutory and jealousy delusions, associated with heteroaggressivity directed at family members and neighbours. No cognitive changes were described by the family. After antipsychotic therapy (risperidone titrated up to 3 mg/day), progressive clinical improvement was observed, with full remission of psychotic symptoms, euthymic mood and recovered insight at discharge. Conclusions: Neuropsychiatric outcomes following stroke are common and seriously impact quality of life. Poststroke psychosis typically occurs a few months after stroke, suggesting a window for early diagnosis and prompt treatment, which can reduce the morbidity and improve the quality of life of these patients. [ABSTRACT FROM AUTHOR]

Introduction: Huntington Disease (HD) is a hereditary dominant disease with the typical triad: chorea, dementia and psychiatric disorders (depression and delusion), whose treatment is basically symptomatic Objectives: To understand HD clinic based on its neuropsychopathology, guiding an essay to shed light on a psychopharmacology choice according to the symptoms. Methods: A clinical series of two HD patients admitted to a psychiatric hospital in different times (2015, 2019) with an aggressive disruptive behavior because of delusional cognitions and depression, comparing their clinical evolution each other (including psychopathological exams and neuropsychological test) with different therapeutic possibilities (covering antipsychotic and antidepressant) according with a recent bibliographic review. Results: Psychopathological exam reveals both celotypic erotomaniac delusional cognitions conditioning violent behaviors focused in family environment; neuropsychological test reveals both cognitive impairment with similar score (WAIS III and IV, attached document) and depression; therapeutic possibilities in bibliographic review still not agree in gold standard drug, though it is generally accepted the use of atypical neuroleptics and ISRS. In our series both are with paliperidone LA, but in the second case, clozapine addition shows better results in psychosis, as well as the change of a classic ISRS for vortioxetine shows better results in depressive mood, also objectifying an improvement of motor symptoms. Conclusions: While bibliography doesn't point a specific drug for the psychiatry clinic in HD, in our clinical series we detected an improvement of delusion and depression symptoms linked to a chorea amelioration using clozapine and vortioxetine, nevertheless, more studies are needed to confirm this hypothesis. [ABSTRACT FROM AUTHOR]

Introduction: Olfactory hallucinations have been described since the 19th century as a particular, often unpleasant smell at the beginning or during the spell. The olfactory cortex are involved in temporal lobe epilepsy. Objectives: The aim was analyze the relationship between the olfactory hallucinations and the previus diagnosis of epilepsy. Methods: In this study, we present a clinical case and review the current literature showing the relationship between smell and epilepsy. Results: A 69-years-old woman, with a medical history of epilepsy, went to the emergency department describing a recent episode of seizure, self-limited in time, after a sensation of an unpleasant smell in bed. A medical history of osteoarthritis, cholecystectomy and essential tremor is described. No unknown drug allergies. The neurological examination shows dysarthric speech, tremor in the right upper limb, isochoric and reactive pupils, preserved sensitivity and strength, and a positive Romber's sign. The physical examination, blood test and vital signs were normal. The head CT scan showed signs of ischemic leukoencephalopathy, without acute ischemic or hemorrhagic lesions. The patient was medicated with 1000 mg of valproate daily, which was suspended a month ago due to an alteration in liver transaminases. Treatment with diazepam 10 mg daily was prescribed and referred for consultation. The sense of smell changes over time for anormal aging process, affecting abilitiesto detect, identify and discriminate odors. Several neurodegenerative diseases presentcertain alterations that help us determine yourorigin and progression (Vaughan and Jackson, 2014). Conclusions: Olfactory auras occurs before a seizure of the temporal lobe. Repeated stimuli in limbic regions can produce changes in the piriform cortex, with increased excitability and in epileptic discharges. [ABSTRACT FROM AUTHOR]

Introduction: A meta-analysis by Gürsel et al. (2018) found altered functional connectivity in OCD patients within and between default mode (DMN), salience (SN), and frontoparietal networks (FPN), as well as evidence for aberrant fronto-striatal circuitry. Objectives: Testing the replicability of meta-analysis rsfMRI findings in OCD patients. Methods: We measured functional connectivity during restingstate fMRI in a sample of OCD patients (n=24) and controls matched for age and sex (n=33). The CONN toolbox implemented in SPM was used to perform seed-to-voxel analysis using 30 seed regions based on the previous meta-analytic findings. Results: OCD patients showed reduced functional connectivity between SN and DMN compared to controls, replicating previous findings. We did not observe significant group differences of functional connectivity within the DMN, SN, or FPN. The strongest finding consisted of altered connectivity between DMN and SN to the visual network. OCD patients showed reduced functional connectivity between the left lateral parietal seed (LPl) and the inferior lateral occipital pole left (iLOCl) compared to controls. Furthermore, the LPl was found to be hyperconnected with the right superior lateral occipital cortex (sLOCr) and the right precuneus. This finding was positively correlated to OCD symptom severity, especially compulsions. Conclusions: Our findings replicated partly the meta-analysis findings, specifically reduced connectivity between SN and DMN. Using seeds based on the meta-analysis, we identified aberrations between the SN and, in particular, the DMN to the visual network. This raises the question about the visual system's involvement in OCD symptoms and the abnormal connectivity of a unimodal region to the multimodal DMN. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality, giving rise to a variety of neuropsychiatric syndromes associated with great functional impairments, chronic disability and poor quality of life. Depending on diagnostic criteria, 20-90% of victims of TBI develop at least one neuropsychiatric manifestation in the first month, and about 40% present at least three symptoms during three months, with higher incidence in females. Survivors of TBI are at increased risk for development of severe, long-term psychiatric disorders. The aetiology of these disturbances remains unclear. Objectives: To review current knowledge on the neuropsychiatric consequences associated with TBI. Methods: Non-systematic review of literature through search on PubMed/MEDLINE database for publications up to 2020, following the terms "traumatic brain injury" and "neuropsychiatry". Results: Although the experience of neuropsychiatric symptoms may be temporary and may resolve in the acute period, many patients with TBI can experience psychopathology that is persistent or that develops in the post-acute period, regardless of injury severity. These symptoms can involve personality changes, psychosis, major depression, generalized anxiety disorder, post-traumatic stress disorder, maladaptive social behaviours, poor disability adjustment, reduced coping skills and cognitive impairment. Evidence remains insufficient to conclude the role of TBI-related neuropathological consequences in the development of post-TBI neuropsychiatric disorder. Non-organic factors are also implicated in its generation and maintenance. Conclusions: Neuropsychiatric sequelae are common following TBI. Several of these syndromes are amenable to treatment. Further investigations are required to better understand the mechanistic aetiology of these conditions and the effectiveness of therapeutic modalities. [ABSTRACT FROM AUTHOR]

Introduction: Wilson's Disease is a rare, autosomal recessive disorder related to disturbances of coppermetabolism. Its clinical picture includes hepatic, neurologic, psychiatric, and systemicmanifestations. Psychiatric symptoms are frequent over the course of this disease and can be found in up to a quarter of patients at presentation. Successful treatment for Wilson's Disease can be achieved using anti-copper agents. Objectives: We aim to review the literature regarding the psychiatric manifestations of Wilson's Disease. We also include brief considerations about their management. Methods: We performed an updated review in the PubMed database using the terms "Wilson's Disease" and "Psychiatric manifestations". The included articles were selected by title and abstract. Results: Psychiatric manifestations, including psychosis, mood disorders, personality disorders and cognitive impairment are common in Wilson's Disease and can be the initial symptoms of this condition. The diagnosis of Wilson's Disease in people presenting with psychiatric symptoms heralds special considerations in psychopharmacology since this population has a higher risk of hepatic impairment, epilepsy, and extrapyramidal side effects. Conclusions: Psychiatric symptoms are common in Wilson's Disease and can be its presenting clinical features. Missing the diagnosis of Wilson's Disease can stall an efficient treatment and lead to inadequate patient management. [ABSTRACT FROM AUTHOR]

Introduction: Tourette Syndrome (TS) is a chronic disorder characterized by tics. The Diagnostic and Statistical Manual of Mental Disorders lists the most used criteria, and focuses on these motor and vocal phenomena. However, patients may have other associated features or comorbidities: impulsivity, depression, anxiety, obsessive-compulsive disorder, attention-deficit hyperactivity disorder, among others. We present the case of a patient who was hospitalised for two weeks and explore his psychopathology. Objectives: Discuss the psychopathology and comorbidities of TS through the analysis of a clinical case. Methods: Description of the case and literature review using Pubmed. Results: We present the case of a 34-year-old male who was admitted at our Acute Inpatient Ward due to depressive symptoms along with anxiety, suicidal ideation and hetero-aggressive outbursts. He had been diagnosed in infancy with Tourette syndrome, but in adulthood had poor treatment and follow-up adherence. Exploration of the history led to an understanding of the development of depressive symptoms, and other problems were gradually unearthed as well. His tics were predominantly motor, and was impulsive is his actions, being unable to keep up a regular job. He also had a fetishistic disorder: he had no sexual encounters with women, deriving sexual excitement and pleasure from the observation, recording (through photographs) and cataloguing of women's nails. This was a growing encumbrance in the family and in the patient's life, leading to discordance. Conclusions: Tourette is a neuropsychiatric syndrome that encompasses more than just tics. Being able to understand the various shades of this disorder is useful to adequately help these patients. [ABSTRACT FROM AUTHOR]

Introduction: Anti-NMDA receptor encephalitis was first described in 20071. 80% of the patients diagnosed are female with initial presentation of psychiatric symptoms2. Early detection and treatment is important as probability of full recovery decreases with disease progression3. Objectives: Presentation of a case of unusual psychiatric symptoms in a patient with Anti-NMDA receptor encephalitis. Methods: Case report. Results: A 33-year-old foreign woman with no past psychiatric and medical history, presented with acute change in behaviour, auditory hallucinations, paranoid delusions, poverty of speech, psychomotor retardation and poor oral intake. She was tried on two different antipsychotics. Two weeks later, she developed fever, tachycardia, neck stiffness and also generalised seizures and oro-facial dyskinesia. Cerebrospinal fluid examination was positive for NMDA receptor antibodies. She received steroids and intravenous immunoglobulins, but developed ileus due to autonomic dysfunction and hypokalaemia. She also required tracheostomy and naso-gastric tube feeding. Upon family's request, she was discharged to her home country. Conclusions: Initial suspicion of anti-NDMA receptor encephalitis should be raised and early auto-immune workup performed in patients presenting with acute onset of psychosis especially in young females with no past medical or psychiatric history. References Dalmau et al. Paraneoplastic anti-NMDAR encephalitis associated with ovarian teratoma. Ann Neurol. 2007;61(1): 25-36. Maat et al. Psychiatric phenomena as initial manifestation of encephalitis by anti-NMDAR antibodies. Acta Neuropsychiatr. 2013: 25(3): 128-136 Dalmau et al. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2011;10(1):63-74. [ABSTRACT FROM AUTHOR]

Introduction: Hypomelanosis of Ito is (HI) is a rare neurocutaneous disorder characterized by the presence of hypopigmented lesions following the lines of Blaschko, which can be associated with central nervous system (CNS), ocular, dental, musculoskeletical and genitourinary manifestations. CSN symptomatology is the most common extracutaneous manifestation described. It involves intellectual disability, psychomotor development retardation, epilepsy and autism. (Figure 1). Objectives: Our objetive is to describe and analyse the clinical case of a 23 years old male with HI and psychotic symptoms. We also aimed to reach a well defined psychiatric diagnosis. Methods: Clinical case was analysed. Blood test, brain scan and electroencephalogram were done. Wechsler Adult Intelligence Scale IV (WAIS-IV), Boston Aphasia test and Autism Diagnosis Observation Schedule-2 (ADOS-2) Module 4 were administered. We also conduct a literature review about HI and diagnostic complexity between schizophrenia and autism. Results: Blood test, brain scan and electroencephalogram showed no disturbances. WAIS-IV score was 110 (average). At Boston Aphasia test, pragmatic language impairments were detected. Results of ADOS-2 Module 4 showed an autism diagnosis. Conclusions: Organic causes of psychosis and autism should be ruled out in HI patients. Our patient showed thought blocking, stereotiped movements and isolation which were mistakenly categorized as part of a psychotic episode until an autism diagnosis was given. Abnormal thought processes are common in individuals with Autism Spectrum Disorder, but at least 1 month of prominent delusions or hallucinations is required before a diagnosis of schizophrenia is made. [ABSTRACT FROM AUTHOR]

Introduction: Today, studies on pediatric acute-onset neuropsychiatric syndrome (PANS), including pediatric infection-triggered neuropsychitric disorder (PITAND) and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS), are scarce (Calaprice et al., 2017). These disorders represent true clinical entities where is still debated because the data available to describe a characteristic phenotype are still controversial (Gamucci et al., 2019). Objectives: The aim of this study is to describe the clinical, neuropsychological and biochemical aspects of patients with symptoms suggestive of PANS. Methods: Description of three clinical cases of children diagnosed with PANDAS and PITAND treated in child and adolescent psychiatric unit (Infantil Mental Health Unit) between 2011 to 2019. Results: All of patients presented, abruptly, ritualized behaviors, egodistonic obsessive thinking, irritability, emotional lability and separation anxiety. Also, motor tics were observed in one of the patients and another child had night terrors. They were ages between 8 and 10 years. One of the patients was previously diagnosed of autism. All of children had pharyngotonsillitis weeks prior to diagnosis, as well as elevated anti-streptolysin O antibody (ASLOs) titers and pharyngeal smears positive for SBHGA or Haemophilus influenzae. They were treated with beta-lactam antibiotics, SSRIs and low doses of risperidone. Conclusions: The PANDAS or PITAND diagnosis is currently controversial. However, series of cases with onset or exacerbation of characteristic symptoms in the context of a high tract infection support the existence of this neuropsychiatric syndrome and that it is necessary to continue investigating. [ABSTRACT FROM AUTHOR]