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Introduction: A 34 year old man was referred to our unit for psychiatric evaluation. His psychomotor development was normal until the age of 12, when he started showing progressive loss of cognitive skills and finalized motor activity. Symptoms rapidly worsened and by the age of 20 his language and motor skills were severly compromised. Starting at age 17 he had been treated with both 1st and 2nd generation antipsychotics which did not lead to any changes in symptoms. Family history was negative for psychotic or neurological disorders. The mother had alcohol abuse disorder and the younger sister was diagnosed with generalized anxiety disorder. Method: At the time of our evaluation patient was receiving 10mg of Olanzapine. He was vigilant and passively cooperative to examination; he displayed physical immobility, waxy flexibilitas, stereotyped behaviour, camptocormia, echolalia, blunted affect and automatic and repetitive behaviour. Thought content was difficult to evaluate but he denied hallucinations or delusional thoughts. Results: BP was normal, as well as brain MRI and PET. Screening for Wilson''s disease, metabolic diseases and fragile X Syndrome were negatve. DAT scan was also performed and showed no abnormalities. Medication withdrawal didn’t lead to any changes in his status. Conclusions: The patient''s symtoms fulfill the criteria for drug resistant Catatonic Schizophrenia. However the early onset of symptoms, the rapid deterioration of cognitive abilities, the early and extensive motor imparment and the complete resistance to drug treatment make this an interesting case for discussion about differential diagnosis. [Copyright &y& Elsevier]

Introduction: We describe a case of OCD and movement disorders associated with anti basal ganglia antibodies. Methods: A 17 year old patient was referred to our unit in February 2010 because of movement disorder. He denied personal or family history of psychiatric disorders and substance abuse other that occasional cannabis use. His symptoms had began 6 months earlier when he started presenting intrusive thoughts associated with various compulsions such as complex arm and leg movements and bizarre postures: he was treated with Olanzapine and Sertraline which lead to partial improvement of symptoms but he self-discontinuated the medication in january 2010. Upon admittance in february 2010 the patient showed obsessive thoughts associated with bizarre postures and upper limb complex movements. Results: He was treated with 100mg of Clomipramine which lead to partial regression of symptoms. Autoimmunity screening was performed revealing anti neuron specific enolase and anti pyruvate kynase antibodies. The patient was treated with Desametasone which did not lead to any improvement. Conclusions: Anti neuron specific enolase and anti pyruvate kynase antibodies are directed against antigens specifically expressed in the basal ganglia. According to literature data these autoantibodies can be associated with movement disorders and OCD and we hypothesize that our patient''s symtptoms were caused by autoimmunity. Although cortison was not successfull, recents reports in scientific literature have shown that other non psychopharmacological treatment, such as plasmapheresis, or IV immunoglobulins could be effective in similar patients: we are considering this as our next treatment option. [Copyright &y& Elsevier]

Introduction: We describe a rare case antithyroid drug induced hypothyroidism leading to an acute psychotic episode. Method: A 39 year old woman complaining of anxiety was referred to our day hospital unit in september 2010. Her symptoms began a month earlier and she denied any past personal or family history of psychiatric disorders except for an acute psychotic episode in august 2010. She diagnosed with hyperthyroidism in june 2010 and was started on medication with 30mg of methilmazole. Two weeks later she started to feel confused, and she developed auditory and visual hallucinations as well as persecutory delusionsn and she was hospitalized in a psychiatric facility. Upon admittance lab work indicated severe hypothyroidism (TSH 87uI/L)and high total cholesterol. Antythiroid medication was suspended and the patient was started on antipsychotic medication with 10mg of haloperidol. Results: Four days later the patient dysplayed a complete remission of symtpoms. She self discontinuated the antipsychotic medication one week after discharge and showed no sign of psychotic symptoms. Thyroid function was later revaluated and indicated mild hypethyroidism, for which methilmazole 10mg was prescribed. In october 2010 the patient was evaluated in our unit and showed no sign of psychotic symptoms or anxiety. Conclusions: Although very few cases of methilmazole induced psychosis are reported, based on the patient''s history, on the doses of medication that were prescribed, on the lab work and on the onset, evolution and remission of her symptoms we hypothesize that the psychotic episode was drug induced. [Copyright &y& Elsevier]

Objectives: Our goals were to evaluate if the presence of severe delusions negatively affects insight, regardless of diagnosis, and whether or not patients gain insight into their delusions when using a third person perspective. Methods: 92 delusional patients with psychotic and psychotic mood disorders were asked to speak about their delusions and were evaluated by means of the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms (SAPS and SANS). They were then asked to state whether they thought what they said was believable for them and for the interviewer. After two weeks 79 patients were evaluated with the same scales and listened to a tape where their delusion was re-enacted. They were then asked to state if what they heard was believable for them and for the interviewer. Results: 12 patients thought their delusions was unbelievable for the interviewer at first interview, and 17 patients did the same after the second interview; 4 patients stated what they heard from the tape after the second interview was unbelievable both for them and interviewer. Patients with better insight (patients who stated their delusion was not believable) had a lower SAPS score, a lower item delusion score and a significant improvement of item delusion score at second interview Conclusion: Several patients gain partial insight when using a third person perspective. The severity of delusions negatively affects insight, regardless of the patient''s diagnosis. [Copyright &y& Elsevier]

Objectives: To estimate the prevalence of depressive symptoms in patients affected by subclinical hypothyroidism by means of Hamilton Rating Scale for Depression (HAM-D) and Montgomery-Asberg Depression Rating Scale (MADRS); to assess which depressive symptoms are prevalent in our population, with references to the factorialization of HAM-D by Cleary and Guy (1977); to verify whether levothyroxine replacement therapy alone can induce total remission of depressive symptoms. Methods: The study enrolled 63 patients affected by subclinical hypothyroidism undergoing follow-up at the endocrinology service of San Paolo Hospital in Milan. All patients underwent an evaluation by means of HAM-D and MADRS scales and serum TSH, free T4, free T3, TPO-Ab and Tg-Ab levels were measured. Results: We estimated a prevalence of depressive symptoms in our population of 63.5%. Concerning the qualitative assessment of psychiatric disturbances in the population we considered, our results showed that the most frequent symptoms were part of four factors, according to the Cleary and Guy factorialization of HAM-D: these factors are representative of anxiety and somatisation (factor I), cognitive impairment disturbances (factor III), psychomotor retardation (factor V) and sleep disorders (factor VI). Levothyroxine replacement therapy alone wasn’t effective in inducing total remission of depressive symptoms. Conclusions: This study suggests the importance of a psychiatric evaluation in patients affected by subclinical hypothyroidism. [Copyright &y& Elsevier]