Early Cerebrovascular Ultrasonography as a Predictor of Hemorrhagic Transformation After Thrombectomy

OBJECTIVES

To determine the predictive value of early transcranial color-coded sonography (TCCS) for intracranial hemorrhage (ICH) in patients with large artery occlusion (LAO) stroke of carotid circulation, who were submitted to endovascular therapy (EVT) with successful reperfusion.

MATERIALS AND METHODS

Retrospective study evaluating a cohort of consecutive stroke patients with LAO of the carotid circulation that were recanalyzed with EVT. We measured angle-corrected peak systolic velocities, end-diastolic velocities and mean flow velocities (PSV, EDV and MFV) of the symptomatic and asymptomatic middle cerebral artery (MCA). The ratio between MFV of the symptomatic MCA and MFV of the asymptomatic MCA (MCA-Ra) was calculated. Parenchymal hematoma in the 24 hours control CT was considered as ICH. Univariate associations and multivariate analyses were used to identify early independent predictors for ICH among TCCS findings.

RESULTS

We included 234 patients, mean age 72.5 (SD 12.6) years, 52.1% male. The mean time between recanalization and TCCS was 12.3 hours (range 3-22). Patients who developed postinterventional ICH showed a higher MCA-Ra (1.02 ± 0.26 vs 1.16 ± 0,21, p = 0.036). In multivariate analysis, only higher MCA-Ra remained independently associated with postinterventional ICH (OR: 6.778, 95%CI: 1.152-39.892, p = 0.034). A value of MCA-Ra ≥ 1,05 was associated with ICH, showing a sensitivity of 81.3% and a specificity of 65.9%; the AUC based of the ROC analysis was 0.688 (95% CI 0.570-0.806).

CONCLUSION

TCCS performed within the first 24 hours after stroke onset can help to predict hemorrhagic transformation in patients with LAO.

Different types of abstract concepts: evidence from two neurodegenerative patients

The observation of neurological patients showing selective impairments for specific conceptual categories contributed in the development of semantic memory theories. Here, we studied two patients (P01, P02), affected, respectively, by the semantic variant of Primary Progressive Aphasia (sv-PPA) and Cortico-Basal Syndrome (CBS). An implicit lexical decision task, including concrete (animals, tools) and abstract (emotions, social, quantity) concepts, was administered to patients and healthy controls.P01 and P02 showed an abolished priming effect for social and quantity-related concepts, respectively. This double dissociation suggests a role of different brain areas in representing specific abstract categories, giving insights for current semantic memory theories.

Foreign Language Processing Undermines Affect Labeling

Identifying emotional states and explicitly putting them into words, known as affect labeling, reduces amygdala activation. Crucially, bilinguals do not only label emotions in their native language; they sometimes do it in their foreign language as well. However, one's foreign languages are less emotional and more cognitively demanding than one's native language. Because of these differences, it is unclear whether labeling emotions in a foreign language will also cause downregulation of affect. Here, 26 unbalanced bilinguals were scanned while labeling emotional faces either in their native or foreign languages. Results on affect labeling in a foreign language revealed that not only did it not reduce amygdala activation, but it also evoked higher activation than affect labeling in a native language. Overall, foreign language processing undermines affect labeling, and it suggests that the language in which people name their emotions has important consequences in how they experience them.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s42761-021-00039-9.

NISAR-F SCORE: a simple risk stratification tool for patients implanted with cardiac resynchronization therapy

Funding Acknowledgements

Type of funding sources: None.

Introduction

Individualized estimation of prognosis after cardiac resynchronization therapy (CRT) remains challenging. Outcomes in this group of patients are influenced by multiple factors and a comprehensive and customized approach to estimate prognosis after CRT is lacking

Aims

To develop and validate a simple prognostic score for patients implanted with CRT (NISAR-F score), based on readily available clinical and echocardiographic variables to predict the combined endpoints of death or hospitalization in 24 months.

Methods

A single-centre retrospective study was conducted with inclusion of all consecutive patients who underwent CRT implantation between 2012 and 2019. Follow-up started after CRT implantation and ended upon death, hospitalization or 24 months after study entry. Survival analysis was performed using a multivariate Cox regression model, in order to analyze the effect on survival /hospitalization in 24 months of the following factors: age, gender, NYHA Class III-IV, ischemic heart failure, type 2 diabetes, arterial hypertension, dyslipidemia and ejection fraction < 21%. According to the analysis, points were attributed to each factor. Afterwards, the NISAR-F score was calculated for each patient, summing the points of each variable. The authors finally created ROC curves for the NISAR-F score to predict the occurrence of the combined endpoint in 2 groups of patients: CRT responders (ejection fraction increase of at least 10% after CRT implantation) and CRT non-responders. The statistical analysis was performed in SPSS.

Results

102 patients were included in the study (75.4% male, mean age 68 ± 10.46 years). 10(9.8%) of the patients were re-hospitalized and 8 (7.8%) died during the 24-month follow-up.  After calculating NISAR-F score for each patient, area under ROC curves were obtained. The analysis of the ROC curves allows us to confirm the good performance of the score created [responders group (AUC 0.812) vs non-responders (AUC 0.721)].

Conclusion The NISAR-F score is a useful tool to predict the combined endpoint (mortality and hospitalization in 24 months) after CRT implantation, in both responders and non-responders, revealing good performance of this new and simple score based only on clinical and echocardiographic variables.

Voltage bridge mapping in atrioventricular nodal reentry tachycardia ablation in adult population: results from a multicenter registry

Funding Acknowledgements

Type of funding sources: None.

Background

The presence of Low Voltage Bridge (LVB) in Atrioventricular Nodal Reentry Tachycardia (AVNRT) ablation has been described in children populations. Slow pathway ablations visualizing and targeting the LVB has been described to be safe and effective. However, the incidence of LVB in AVNRT ablation has not been widely explored in adult population.

Purpose

We aim to investigate the presence of LVB in adult patients (pts) undergoing AVNRT ablation, and the relationship between the LVB and the successful ablation site. We have also investigated the correlations between the Koch’s triangle (KT) anatomy and biophysical pts data.

Methods

The observational registry prospectively collected data of 165 pts. undergoing AVNRT ablation guided by 3D electroanatomical mapping system (EnSite - Abott, St Paul, MN) in 6 EP centers. Gender: 90F – 75M (55% - 45%) - Age: 57 ± 17 ys (min 15 – max 87) - Weight: 73 ± 15 kgs (min 42 - max 150)  Prior of ablation a voltage map of KT was created using diagnostic and ablation catheters.

We define as Type I LVB a clear, long area of low voltage within the KT between the CS ostium and the AV node with the base on the edge of the tricuspid annulus and Type II LVB a narrow low voltage channel between normal-voltage regions with the base on the edge of the tricuspid annulus.

The relationship between LVB and successful site was evaluated at the end of the procedure. KT anatomical data were correlated to gender, age and weight.

Results

The LVB was identified in 134 pts (81%) with a prevalence of type I (91 - 68%) over type II (33 - 25%). In 10 pts (7%) the LVB did not match type I nor type II. When an LVB was identified, the correspondence between the LVB and the successful ablation site was verified in 117 pts (87%). In addition, a shorter RF time was applied when an LVB was found (396s vs 298s; p = 0.03). Strong correlations between KT anatomy and biophysical pts data were not identified. The distance between His electrograms and the successful ablation site weakly correlated (ρ = -0.24, p < 0.01) with pts age suggesting a shortening in the distance with age progression.

Conclusion

The visualization of the Low Voltage Bridge may be a helpful tool to guide AVNRT ablation in a large cohort of pts; furthermore it is associated with reduced RF applications time. The KT characteristics are difficult to be predicted a priori according to patient gender, age or weight.

The impact of lipid profile in acute coronary syndrome: young patient vs old patient

Funding Acknowledgements

Type of funding sources: None.

Introduction

Several studies have suggested a relationship between dyslipidemia and atherogenesis, which displays a main role in the pathophysiology of Acute Coronary Syndrome (ACS).

Aim

To compare the lipid profile between younger (<55 years) and older (≥55 years) patients admitted due to ACS.

Methods

A single-centre retrospective study was conducted, with inclusion of all consecutive patients admitted in the Cardiology Department due to ACS. Several analytical parameters were evaluated, including total cholesterol (CT), HDL cholesterol (HDL), LDL cholesterol (LDL) and triglycerides (TG) and CT/HDL, LDL/HDL and TG/HDL ratios were calculated. All parameters are presented in mg/dL. Afterwards, comparison of these data between younger (age < 55 years, Group-A) and older (age≥55 years, Group-B) patients was done. Statistical analysis was performed with SPSS and a p value < 0.05 was considered statistically significant.

Results

1168 patients (70.1% male, mean age 69 ±12 years) were included in this study. 15.8% of patients were from Group-A. Mean levels of the analysed parameters were the following: CT 176 ± 55, LDL 111 ± 45, HDL 40 ± 12 and TG 137 ± 102. The following mean ratios were obtained: CT/HDL 4.6 ± 1.9, LDL/HDL 2.9 ± 1.4 and TG/HDL 3.8 ± 3.5. Comparison of the analysed parameters and calculated ratios is exhibited in table 1.

Conclusion

Overall, a worse lipid profile was observed in younger patients. This data reveals the role of dyslipidemia in coronary heart disease, which displays a main role in atherosclerosis at a younger age. This fact highlights the importance of adopting a healthy lifestyle and the adherence to primary and secondary prevention measures of cardiovascular events.

Lipid profile: young vs old patient Group A Group B Total Cholesterol 199 ± 44 170 ± 56 p < 0.001 LDL Cholesterol 128 ± 37 107 ± 46 p < 0.001 HDL Cholesterol 39 ± 10 40 ± 12 p = 0.307 Triglycerides 195 ± 189 125 ± 66 p < 0.001 CT/HDL 5.3 ± 1.5 6.8 ± 2.0 p < 0.001 LDL/HDL 3.4 ± 1.1 2.8 ± 1.4 p < 0.001 TG/HDL 5.6 ± 6.3 3.5 ± 2.5 p < 0.001

The effects of smoking and alcoholism in acute coronary syndrome

Funding Acknowledgements

Type of funding sources: None.

Introduction

Several studies have concluded that smoking increases mortality in patients with coronary disease. On the other hand, a J-shaped dose-effect curve has been used to describe the relationship between alcohol and cardiovascular mortality. According to the majority of studies, a moderate intake of alcohol is associated with a decrease in mortality, while an excessive alcohol intake appears to increase mortality.

Aim

To evaluate the effect of smoking and excessive alcohol intake in hospital mortality and 1-year mortality in patients hospitalized due to acute coronary syndrome (ACS).

Methods

A single-centre retrospective study was conducted, with inclusion of all consecutive patients admitted in the Cardiology Department due to ACS. Follow-up started after hospital admission and ended upon hospital death, death within the following 12 months or 12 months after study entry. Patients were divided in two groups: smokers (Group-A) and non-smokers (Group-B), to analyse the effect of smoking in hospital mortality and 1-year mortality. To analyse the effect of excessive alcohol intake, patients were also divided in other two groups: Group-C (excessive drinkers) and Group-D (non-excessive drinkers). Statistical analysis was performed with SPSS and a p value < 0.05 was considered statistically significant.

Results

1120 patients (68.9% male, mean age 69.12 ± 12.67 years) were included in this study. 20.5% were smokers and 3.2% had a previous excessive alcohol intake.

Between Group-A and Group-B, a statistically significant difference was observed in gender (93.1% male in Group-A vs 62.9% male in Group-B, p = 0.002), but not in age (p = 0.116). Hospital mortality rates in Group-A and Group-B were respectively 6.0% and 8.7% (p = 0.191) and 1-year mortality rates were 3.1% vs 5.1% (p = 0.239).

Between Group-C and Group-D, a statistically significant difference was observed in gender (94.4% male in Group-C vs 69.8% male in Group-B, p < 0.001), but not in age (p = 0.730). Hospital mortality rates in Group-C and Group-D were respectively 25% and 9.6% (p = 0.003) and 1-year mortality were 3.8% vs 6.6% (p = 0.577).

Conclusions

Smoking did not have a positive or negative effect in hospital mortality and 1-year mortality. However, excessive alcohol intake was associated with increased hospital mortality in this population.

Early detection of language categories in face perception

Does language categorization influence face identification? The present study addressed this question by means of two experiments. First, to establish language categorization of faces, the memory confusion paradigm was used to create two language categories of faces, Spanish and English. Subsequently, participants underwent an oddball paradigm, in which faces that had been previously paired with one of the two languages (Spanish or English), were presented. We measured EEG perceptual differences (vMMN) between standard and two types of deviant faces: within-language category (faces sharing language with standards) or between-language category (faces paired with the other language). Participants were more likely to confuse faces within the language category than between categories, an index that faces were categorized by language. At the neural level, early vMMN were obtained for between-language category faces, but not for within-language category faces. At a later stage, however, larger vMMNs were obtained for those faces from the same language category. Our results showed that language is a relevant social cue that individuals used to categorize others and this categorization subsequently affects face perception.

Pronoia or reverse paranoid delusion: A brief exploration into a conspiracy in your favour

Introduction

Pronoia is a neologism originally coined in 1982 to describe a state of mind that is, in essence, the positive counterpart of paranoia. It is characterized by feeling that the world is conspiring on behalf of the person experiencing pronoia.

Objectives

Brief literature review.

Methods

The authors review the available literature on pronoia and present a broad overview of its description and defining characteristics. An initial search utilizing key health journal databases revealed a scarcity in available documents, therefore a generalized search utilizing the search engine Google Scholar was performed with the term “pronoia”. Relevant articles obtained from the respective bibliographic references were also consulted.

Results

The primary outcome of this work is a summary of the available literature in order to build a more comprehensive understanding on pronoia. All relevant information was collated to form a cohesive description of the condition and its characteristics. We address a gap in the literature by offering a description of the lesser prevalent concept of pronoia.

Conclusions

Our results demonstrate a scarcity in the available literature describing the pronoia phenomenon when compared to its well-documented counterpart, paranoia. Further exploration into this topic is merited so as to close the gap on paranoia’s lesser-known positive counterpart. By signalling the existence of this concept, we strive to contribute to an increased identification of a concept that is many times underdiagnosed due to a lack of attention to its existence.

Disclosure

No significant relationships.

Electroconvulsive therapy as life-saving in an acute catatonic syndrome associated with bipolar disorder: A case report

Introduction

Catatonia is a neuropsychiatric syndrome characterized by an onset of a dysfunction in psychomotor activity and/or muscle tone, which may be associated with changes in consciousness, affect, and thinking. It is characterized by negativism, wax flexibility, catalepsy, mutism echolalia, ecopraxia, or stupor. It was first described in 1874 by Kahlbaum, who characterized it as specific motor disorder associated with different psychiatric disorders. Kraepelin and Bleuler restricted catatonia to a specific subtype of schizophrenia. However, the association between catatonia and other disorders, notably mood disorders, has been reinstated, including Bipolar Disorder. Its etiology is multiple and there are two severe forms: Neuroleptic Malignant Syndrome (NMS) and Malignant Catatonia (MC). These are syndromes that present high mortality, and the health professional should be aware of its etiology, signs, symptoms, evaluation and treatment.

Objectives

The aim of this work is to present a clinical case of MC, who was sustained by literature included on scientific platforms.

Methods

Case report

Results

It is essential to recognize the different clinical presentations of catatonia, taking into account that these are psychiatric alterations in which urgent intervention is justified. In the presented case, the use of antipsychotic medication has worsened the motor function and its suspension, associated with the introduction of lorazepam, resulted in a slight improvement. The electroconvulsive therapy was the last resort, fully succeeded.

Conclusions

The relationship between SMN and Catatonia/MC remains nuclear from a psychopathological and pathophysiological point of view. Nevertheless, there is general agreement that catatonia represents a very significant risk factor for NMS.

Disclosure

No significant relationships.

First psychotic episode as first manifestation of lyme disease: Case report

Introduction

Lyme disease (LD) is caused by the spirochete Borrelia burgdorferi (Bb) and has been reported to be associated with various psychiatric presentations.

Objectives

To report a case with LD and to highlight the importance of differential diagnosis in a first psychotic episode.

Methods

Case report and non-systematic review of the literature.

Results

A woman aged 31 was admitted to the psychiatric department, after a car accident with a mortal victim, due to a first psychotic episode with visual hallucinations, disorientation in time and space, persecutory and grandiosity delusions. She had a personal psychiatric history of obsessive-compulsive disorder and no previous admission to an inpatient Unit. On psychotropic drugs the condition failed to improve, and subsequently neurological symptoms developed. EEG abnormalities prompted a lumbar puncture. In the CSF a strong plasma cell reaction with atypical cells was observed. The enzyme immunoassay for Borrelia burgdorferi was positive and after treatment with penicillin the psychiatric and neurological signs and symptoms remitted. Screening assessment followed by a thorough history, comprehensive psychiatric clinical exam, review of systems, mental status exam, neurological exam and physical exam relevant to the patient’s complaints and findings with clinical judgment, pattern recognition and knowledgeable interpretation of laboratory findings facilitates diagnosis. Psychotropics and antibiotics may help improve functioning and prevent further disease progression.

Conclusions

LD is relatively rare, but awareness of the association between LD and neuropsychiatric presentations can improve understanding of the causes of mental illness and result in more effective prevention, diagnosis and treatment.

Disclosure

No significant relationships.

Falling into a burning ring of fire: A case of psychosis unmasking hidden neurosyphilis

Introduction

The first description of syphilis was made in Europe around the year 1493, and although perceived as a disease relegated to its historical importance, recent studies demonstrate that the prevalence of these infections is on the rise. Spanning decades after initial infection, 30% of affected individuals without treatment may develop tertiary syphilis, which includes neurosyphilis. Its notoriously “chameleon-like” presentation implies the necessity to not overlook neurosyphilis as a differential diagnosis in psychiatric settings.

Objectives

Case report study and discussion.

Methods

The authors present a case of affective and psychotic symptoms (including auditory and visual hallucinations and persecutory delusions) of rapid onset in a 61-year old woman without prior psychiatric history. A clinical investigation was conducted, which subsequently revealed a positive Venereal Disease Research Laboratories (VDRL) test. A lumbar puncture was performed and cerebrospinal fluid analysis confirmed neurosyphilis.

Results

Steady improvements in initial psychopathological manifestations were noted after completing recommended treatment for neurosyphilis. After discharge, the patient was medicated with an antidepressant and antipsychotic, demonstrating a complete return to baseline mentation and functionality on follow-up.

Conclusions

This case demonstrates the vital importance of considering syphilis in our differentials, especially due to the wide range of manifesting psychiatric symptoms. Although considered a disease of the past, this case reminds us that syphilis remains present in our society and its timely diagnosis and treatment can ameliorate the debilitating psychopathological manifestations of the disease. Due to the potential difficulties in identifying this great imitator, routine screening tests are still recommended in the psychiatric setting.

Angioedema with haloperidol - case report

Introduction

Haloperidol is a high-potency first generation antipsychotic and one of the most frequently used antipsychotic medications. It is a potent central antagonist of type 2 dopamine receptors, with low alpha 1 adrenergic activity and has no antihistamine or anti-cholinergic activity. It is a widely used drug with proven efficacy. Angioedema is a very rare side effect, occurring in <1% of cases.

Objectives

Case report and reflection on its etiology

Methods

A Pubmed search was performed with the MeSH terms “haloperidol” and “Anaphylactic reactions”. Relevant articles obtained from the respective bibliographic references were also consulted.

Results

The following case describes the development of angioedema in a patient with an acute confusional syndrome on the second haloperidol IM administration for symptomatic control of agitation. Angioedema has been reported as an adverse effect of various antipsychotics such as clozapine, risperidone, ziprazidone and chlorpromazine, however, resulting from haloperidol administration is rare.

Conclusions

In long-term formulations sensitization testing is especially important but a single prior administration is not sufficient, a second controlled administration is essential to avoid this kind of fatal reactions.

It’s never lupus: A case of atypical psychosis and neuropsychiatric lupus

Introduction

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease involving the production of autoantibodies with consequent involvement of multiple organ systems. Although not an uncommon condition, its pleomorphic neuropsychiatric manifestations imply consideration of SLE as a relevant differential diagnosis. As many as 50% of patients with SLE have neurological involvement throughout their disease course and it is associated with impaired quality of life, high morbidity and mortality rates.

Objectives

Case report study and discussion.

Methods

The authors present a case of a 50-year old woman without previous psychiatric history presenting to the psychiatric department with suicidal ideation in association with psychotic symptoms of rapid onset. She presented with various somatic symptoms including butterfly rash, alopecia, nail dystrophy and generalized myalgia and arthralgia. After conducting a thorough clinical investigation with subsequent unveiling of various alterations including those in the antibody panels and abnormal magnetic resonance imaging results, a diagnosis of neuropsychiatric lupus was established.

Results

Improvements in initial psychiatric symptoms were noted after completing pulse corticoid therapy for SLE with adjunct antipsychotic medication. On follow-up, the patient demonstrated a complete return to previous mental functioning with no reported relapses.

Conclusions

This case demonstrates the heterogeneous presentations that neuropsychiatric lupus can assume. The vast array of psychopathological signs and symptoms in SLE continue to exist as a significant diagnostic and therapeutic challenge. Timely identification resulting from a proactive approach in maintaining lupus as part of our differentials may prevent the significant morbidity and mortality commonly associated with the resultant central nervous system involvement in SLE.

Disclosure

No significant relationships.

Simulation of huntington’s disease in forensic psychiatry: Case report

Introduction

Huntington Disease (HD) is an autosomal-dominant, neurodegenerative disorder, with a progressive course, that typically involves a triad of cognitive, motor and psychiatric disorders. Its pathogenic mechanisms are not fully understood, although a faultily encoded version of the protein huntingtin—resulting from a cytosine-adenine-guanine (CAG) trinucleotide expansion in the HTT gene—has been shown to cause intracellular toxicity in neural tissue. Patients usually presents with prodromic psychiatric perturbances, such as depression, delusions or personality changes. Occasionally HD gives rise to criminal behavior.

Objectives

To understand HD clinical presentation and underlines the differencial diagnosis. We present a case of a 31-year-old male offender, whose mother was diagnosed with HD, and during his forensic-psychiatric evaluation, HD was considered, but not confirmed.

Methods

Case report.

Results

A 31-year-old male offender was under a forensic-psychiatric evaluation due to a crime of domestic violence, after he discovers that his wife had an affair. He reports previous personality changes and depression, and compares himself with his mother, stating she was diagnosed with HD due to psychiatric prodromic disturbances. He shows concern about having a disease, and was waiting for genetic test result. After a clinical evaluation, and despite a family history of HD and genetic suspicion, it was important to consider differential diagnosis. The case refers to a passionate crime, which attempted to simulate a HD, considering his genetic background.

Conclusions

Psychometrically identifiable features in HD appear to be important in the context of analyzing circumstances occasioning criminal acts, but the medical history is the most important part of the examination.

Disclosure

No significant relationships.

Clozapine in severe psychotic disorders: Balancing safety with efficacy

Introduction

Clozapine is a member of the dibenazepine class of antipsychotic drugs and has been designated an atypical antipsychotic drug. Clinical studies have shown that clozapine is effective in ameliorating the core symptoms, as well as the negative symptoms, in severe psychotic disorders and is therapeutically effective in treating about 30% of schizophrenic patients who are resistant to standard antipsychotic drugs.

Objectives

The goal is to review pharmacology, efficacy, and clinical use of clozapine, such as its side effects, and the benefit-to-risk ratio of this antipsychotic drug.

Methods

Non-systematic literature review based on scientific databases such as PubMed, using key words such as “clozapine”, “efficacy”, “side effects” and “resistant schizophrenia”.

Results

Clozapine was developed as the first atypical antipsychotic with activity for both the negative and positive symptoms of schizophrenia. The primary indications for clozapine are treatment-resistant psychotic disorder, defined as persistent moderate to severe delusions or hallucinations despite two or more clinical trials with other antipsychotic drugs, and patients who are at high risk for suicide. Concerns over a number of safety considerations are responsible for much of the underutilization of clozapine, such as agranulocytosis, metabolic side effects and myocarditis. These side effects can be detected, prevented, minimized and treated, but there will be a very small number of fatalities.

Conclusions

Awareness of the benefits and risks of clozapine is essential for increasing the use of this lifesaving agent.

Disclosure

No significant relationships.

Lithium in severe affective disorders: Balancing safety with efficacy

Introduction

Lithium has been one of the oldest substances used in psychiatric treatments and remains the first-line treatment for prevention of manic and depressive episodes of bipolar disorder (BD), but it has also a wide spectrum of side-effects.

Objectives

The goal is to review efficacy, and clinical use of lithium, such as its side effects, and its benefit-to-risk ratio.

Methods

Non-systematic literature review based on scientific databases such as PubMed.

Results

The first modern use of lithium was for the treatment of mania. Lithium has also proven useful in major depression, particularly for augmentation of antidepressants, for aggressive behavior and it has a specific antisuicide effect. Lithium’s prophylactic and antisuicidal effects are most unique. However, the use of lithium became problematic due to the serious toxicity since lithium also a narrow therapeutic index, with therapeutic levels between 0.6 and 1.5 mEq/L.

Conclusions

Awareness of the benefits and risks of lithium is essential for the use of this lifesaving agent. Lithium levels must be carefully monitored and lithium dosage adjusted as necessary.

Disclosure

No significant relationships.

Non bulimic shitty meal

Introduction

Coprophagia is a relatively rare phenomenon characterized by the ingestion of feces, and it is usually classified as a rare form of pica. It has been associated with multiple organic causes or mental disorders such as brain tumors, alcoholism, mental retardation, dementia, schizophrenia, depressive disorders or fetishism.

Objectives

Case report and reflection on its etiology

Methods

A Pubmed search was performed with the MeSH terms “Coprophagy” and “pica”. Relevant articles obtained from the respective bibliographic references were also consulted.

Results

A 56-year-old man with a history of psychiatric follow-up with a diagnosis of schizophrenia and cognitive impairment, assessed for behavioral changes such as cat feces intake. After possible organic causes were excluded, treatment with supportive psychotherapy and pharmacologically began with a selective serotonin reuptake inhibitor, fluoxetine, along with treatment for schizophrenia.

Conclusions

According to literature, coprophagia often occurs associated with other medical or neuropsychiatric conditions. Although the etiology, pathophysiology and management remains unclear, several pharmacologic treatments have been attempted with some degree of success. We describe a case of unusual behavior, coprophagia, associated with cognitive impairment and schizophrenia that responded favorably to fluoxetine although without complete remission, in order to contribute to a future nosological redefinition.

Disclosure

No significant relationships.

Ambivalence among intergenerational relationships in old age

Introduction

This study focuses on ambivalence among intergenerational relationships in old age.

Objectives

This study aims to analyze the perspectives of intergenerational relationships between older adults and adult children. For this purpose, a qualitative research was carried out, which analyzes these relations at a cross-national level.

Methods

Four hundred and twenty four older participants aged 65-97 years, were interviewed. Participants were of three different nationalities and lived in the community. All the interviews went through the process of verbatim transcription and subsequent content analysis.

Results

Two dimensions of generational ambivalence were revealed from the study; support and the conflict dimensions. Findings of content analysis produced six themes, which represent intergenerational relations between older adults and adult children: older adults-adult children interaction quality; family integration; care and support; definition of limits; distance and alienation; and communication difficulties.

Conclusions

This study highlighted the diversity of experiences in old age, in relation to intergenerational relationships and underlined the conflicting expectations from older adults in relation to their adult children.

Disclosure

No significant relationships.

Short communication: Iodine content in bovine milk is lowly heritable and shows limited genetic variation

Milk and dairy products are considered important sources of iodine in several countries. Despite this, there is a paucity of studies that have investigated sources of variation of milk iodine, especially on a large scale. So far, it is not clear if milk iodine content could be increased through breeding in dairy cattle. Recently, a mid-infrared spectroscopy prediction model has been developed for an indirect quantification of iodine content in cow milk, as it is a faster and less expensive method that allows the prediction at population level. The model has coefficient of determination and ratio of performance to deviation in external validation of 0.57 and 1.44, respectively, and it was used in the present study to predict the iodine content from historical milk spectral data to investigate phenotypic and genetic aspects in the Italian Holstein cattle. Based on the accuracy of the model, the prediction was interpreted as proxy for the real milk iodine concentration (IOD_P). The data set comprised 33,776 test-day records with IOD_P from 4,072 cows. Data of IOD_P were transformed through natural logarithm to achieve a normal distribution. The effect of parity, lactation stage, and month of sampling were investigated, and genetic parameters were estimated using a test-day repeatability animal model. Milk IOD_P decreased with parities and was the lowest in early lactation. Heritability of IOD_P was low (0.025) and it was positively genetically correlated with milk yield and negatively with fat content. Results suggested that it would be challenging to directly improve this trait through breeding strategies in dairy cattle, because IOD_P is mainly affected by temporary environmental factors and thus, cannot be easily improved through genetics. Although preliminary, findings of this study suggest that it would be more convenient to develop feeding and management strategies to drive milk iodine level than to put efforts and resources into breeding strategies. Further studies should validate IOD_P as an indicator trait of milk iodine content by improving reference data and estimating genetic correlation between predicted and measured values.