Misophonia: Analysis of the neuroanatomic patterns at the basis of psychiatric symptoms and changes of the orthosympathetic/ parasympathetic balance

Background/Aim

Misophonia is a disorder characterized by reduced tolerance to specific sounds or stimuli known as “triggers,” which tend to evoke negative emotional, physiological, and behavioral responses. In this study, we aimed to better characterize participants with misophonia through the evaluation of the response of the autonomic nervous system to “trigger sounds,” a psychometric assessment, and the analysis of the neurological pathways.

Materials and methods

Participants included 11 adults presenting with misophonic disturbance and 44 sex-matched healthy controls (HCs). Following recently proposed diagnostic criteria, the participants listened to six “trigger sounds” and a “general annoyance” sound (baby crying) during a series of physiological tests. The effects were examined through functional magnetic resonance imaging (fMRI), the analysis of heart rate variability (HRV), and of galvanic skin conductance (GSC). The fMRI was performed on a 3T Scanner. The HRV was obtained through the analysis of electrocardiogram, whereas the GSC was examined through the positioning of silver-chloride electrodes on fingers. Furthermore, the psychometric assessment included questionnaires focused on misophonia, psychopathology, resilience, anger, and motivation.

Results

Participants with misophonia showed patterns of increased sympathetic activation in response to trigger sounds and a general annoyance sound, the low frequency (LF) component of HRV, the sympathetic index, and the number of significant GSC over the threshold, where the amplitude/phasic response of GSC was higher. The fMRI analysis provided evidence for the activation of the temporal cortex, the limbic area, the ventromedial prefrontal/premotor/cingulate cortex, and the cerebellum in participants with misophonia. In addition, the psychometric assessment seemed to differentiate misophonia as a construct independent from general psychopathology.

Conclusion

These results suggest the activation of a specific auditory-insula-limbic pathway at the basis of the sympathetic activation observed in participants with misophonia in response to “trigger and general annoyance sounds.” Further studies should disentangle the complex issue of whether misophonia represents a new clinical disorder or a non-pathological condition. These results could help to build diagnostic tests to recognize and better classify this disorder. The relevance of this question goes beyond purely theoretical issues, as in the first case, participants with misophonia should receive a diagnosis and a targeted treatment, while in the second case, they should not.

Anxiety, Stress and Depression in COVID-19 Survivors From an Italian Cohort of Hospitalized Patients: Results From a 1-Year Follow-Up

Background

Mental health-related symptoms can persist over time beyond the most common respiratory clinical features of COVID-19. A recent meta-analysis underlined that mental health sequalae may be relevant for COVID-19 survivors and reported the following prevalence rates: 20% for post-traumatic stress disorder, 22% for anxiety, 36% for psychological distress, and 21% for depression. In the context of a multi-disciplinary follow-up project, we already investigated the mid-term (4 months) psychiatric outcomes in a sample of COVID-19 survivors. Patients were re-assessed after 1-year since hospital discharge.

Methods

Follow-up conducted after 1 year involved 196 individuals recovered from COVID-19. Patients were assessed with a multi-disciplinary approach; including both a clinical interview performed by an experienced psychiatrist, trained in the use of the Mini-International Neuropsychiatric Interview (MINI) to assess the presence of anxiety, stress, and depressive symptoms and the following self-administered questionnaires: Beck Anxiety Inventory, Beck Depression Inventory-II, Resilience Scale for Adults, Impact of Event Scale, and COVID-19 Peritraumatic Distress Index (CPDI).

Results

Anxiety (p < 0.0001) and depressive (p < 0.0003) symptoms registered at the clinical interview showed a significant improvement from the 4 to 12-months follow-up. Logistic regression model showed that female gender (p = 0.006), arterial hypertension (p = 0.01), obesity (0.04), anxiety (p < 0.0001), and depressive (p = 0.02) symptoms at 4-months follow-up were associated with persistence of anxiety symptoms at 12 months. At logistic regression analysis female gender (p = 0.02) and depressive symptoms at 4-months follow-up (p = 0.01) were associated with depressive symptoms after 12 months.

Conclusion

Severity of the disease in the acute phase, in this study, was not a determining factor in identifying subjects at risk of developing clinically relevant anxiety and depression as a consequence of COVID-19 disease. Findings from the logistic regressions suggest that the factors most affecting depression and anxiety in COVID survivors after 12 months were female gender, the presence of anxiety and depression after 4 months and some physical symptoms, not necessarily COVID-related. Impact of infection and consequent hospitalization for COVID-19 did no longer represent a relevant issue for depressive symptoms, compared to other general factors.

Mid-term Psychiatric Outcomes of Patients Recovered From COVID-19 From an Italian Cohort of Hospitalized Patients

Background: Although the usual primary clinical manifestation of Coronavirus disease (COVID-19) is respiratory, several non-respiratory symptoms have been described, including neuropsychiatric ones. The aim of this study was to investigate the mid-term mental health outcomes in patients recovered from COVID-19, 3-4 months after discharge from the University Hospital Maggiore della Carità, Novara, Italy. Furthermore, we investigated the possible association of the mid-term mental health consequences of the COVID-19 infection with patients' clinical current status, persistent physical impairment and severity of acute phase of the disease. Methods: Prospective study involving 238 individuals recovered from COVID-19. In the context of a multi-disciplinary approach, patients' assessment included both a clinical interview performed by an experienced psychiatrist, trained in the use of the Mini-International Neuropsychiatric Interview to assess the presence of anxiety and depressive symptoms and self-administered questionnaires: Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Resilience Scale for Adults (RSA), Impact of Event Scale (IES). Results: At the psychiatric assessment 32.9 and 29.5% of participants showed anxiety and depressive symptoms, respectively. Changes in appetite and sleep patterns emerged for 15.6 and 31.2% of patients. According to the self-administered questionnaires, 7.1% of participants had moderate-severe anxiety levels (BAI), while 10.5% had mild to severe depression (BDI-II). Twenty-six (11%) participants were referred to further psychiatric consultation. Psychiatric symptoms showed no correlation with acute COVID-19 severity; in our sample patients with depressive symptoms at the clinical interview, as well as those with mild to severe levels of depression according to BDI-II scores, had lower forced expiratory volume in the 1st second (FEV1) values than those without and greater odds for persistent, poor tolerance for physical efforts. Conclusions: As could be expected, an approach including both a psychiatric interview and the use of self-administered questionnaires is likely to capture the psychiatric outcome of patients recovered from COVID-19 better than questionnaires alone. Anxiety and depressive symptoms at follow-up had no correlation with the severity of COVID acute manifestations, but rather with ongoing and persistent physical symptoms. Further studies and longer follow-up duration will allow a better understanding of the complex relationship between residual physical symptoms, quality of life and psychological health.

Respiratory and Psychophysical Sequelae Among Patients With COVID-19 Four Months After Hospital Discharge

IMPORTANCE

Although plenty of data exist regarding clinical manifestations, course, case fatality rate, and risk factors associated with mortality in severe coronavirus disease 2019 (COVID-19), long-term respiratory and functional sequelae in survivors of COVID-19 are unknown.

OBJECTIVE

To evaluate the prevalence of lung function anomalies, exercise function impairment, and psychological sequelae among patients hospitalized for COVID-19, 4 months after discharge.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study at an academic hospital in Northern Italy was conducted among a consecutive series of patients aged 18 years and older (or their caregivers) who had received a confirmed diagnosis of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection severe enough to require hospital admission from March 1 to June 29, 2020. SARS-CoV-2 infection was confirmed via reverse transcription-polymerase chain reaction testing, bronchial swab, serological testing, or suggestive computed tomography results.

EXPOSURE

Severe COVID-19 requiring hospitalization.

MAIN OUTCOMES AND MEASURES

The primary outcome of the study was to describe the proportion of patients with a diffusing lung capacity for carbon monoxide (Dlco) less than 80% of expected value. Secondary outcomes included proportion of patients with severe lung function impairment (defined as Dlco <60% expected value); proportion of patients with posttraumatic stress symptoms (measured using the Impact of Event Scale-Revised total score); proportion of patients with functional impairment (assessed using the Short Physical Performance Battery [SPPB] score and 2-minute walking test); and identification of factors associated with Dlco reduction and psychological or functional sequelae.

RESULTS

Among 767 patients hospitalized for severe COVID-19, 494 (64.4%) refused to participate, and 35 (4.6%) died during follow-up. A total of 238 patients (31.0%) (median [interquartile range] age, 61 [50-71] years; 142 [59.7%] men; median [interquartile range] comorbidities, 2 [1-3]) consented to participate to the study. Of these, 219 patients were able to complete both pulmonary function tests and Dlco measurement. Dlco was reduced to less than 80% of the estimated value in 113 patients (51.6%) and less than 60% in 34 patients (15.5%). The SPPB score was suggested limited mobility (score <11) in 53 patients (22.3%). Patients with SPPB scores within reference range underwent a 2-minute walk test, which was outside reference ranges of expected performance for age and sex in 75 patients (40.5%); thus, a total of 128 patients (53.8%) had functional impairment. Posttraumatic stress symptoms were reported in a total of 41 patients (17.2%).

CONCLUSIONS AND RELEVANCE

These findings suggest that at 4 months after discharge, respiratory, physical, and psychological sequelae were common among patients who had been hospitalized for COVID-19.

Group Activities to Promote Early Rehabilitation in an Acute Psychiatric Ward: A Relationship-Based Approach Focusing on Movies

Our Psychiatry Institute has a long-standing tradition of providing training in the importance of relational and emotional skills and helping relationships. Here we describe techniques that are routinely used on our psychiatric ward (Maggiore della Carità Hospital, Novara, Italy) to promote early rehabilitation of acute psychiatric inpatients. We focus on the Cinema group, which is typical of our approach to informal, therapeutic group activity. Targeting social and relational issues as adjunct to treatment as usual is useful in acute settings and can begin at an early stage of hospitalization. Our intervention is designed to improve patients' coping strategies, relational and communication skills, and overall quality of life.

Alexithymia, recognition of facial emotion and inference in patients with Eating Disorders (ED) or Substance Abuse Disorders (SAD)

Alexythimia is a psychological construct characterized by difficulty describing emotions and distinguishing them from somatic components of the emotional activation. Patients with eating disorders (ED) or substance use disorders (SAD) commonly present also impairment of recognition of facial expressions and deficits in social inference. Patients with ED and SAD may present impulsiveness, difficulty in emotion-focused coping skills, and search for a concrete relief from psychological suffering. The purpose of study is to compare the ED, SAD and healthy controls (HC), in several variables, including Alexythimia, empathy, and ability to recognize emotions, social inference. Thirty-two patients with ED, 27 patients with SAD and 31 HC were recruited between September 2016 and April 2016 at the psychiatric ward of Novara Hospital, nursing home of Nebbiuno and the nursing home of Viverone. We administrated to patients the same battery of tests, composed by Toronto Alexithymia Scale-20 (TAS-20), Facial Emotion Identification Test (FEIT), the awareness of Social Inference Test (TASIT), temperament and Character Inventory (TCI), Interpersonal Reactivity Index (IRI), Symptoms Checklist-90 (SCL-90). The two clinical groups showed differences in TAS, FEIT and TASIT, highlighting Alexythimic tracts, difficulty in recognizing emotions and deficit of social inference, compared to HCs. The TCI and SCL-90 have also highlighted the common psychopathological characteristics and temperamental in patients with ED and SAD. Alexythimia is particularly represented in patients with ED and SAD, and could represent a maintenance factor, together with deficits in emotions recognition and social inference. The similarities between ED and TD seem to suggest the possibility of shared core features.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Comparison between patients with depressive disorders and healthy controls in resilience and coping skills

Introduction

Resilience in the psychiatric field, it is defined as the ability to recover from perceived adverse or changing situations through a dynamic process of adaptation. This process is influenced by personal characteristics, family and social resources and is expressed by positive coping skills. It is well known that resilience has an inverse relation with depression, however, the specific role of resilience in disorders like depression, personality disorders and psychosis is not fully understood.

Objectives

Compare differences in resilience and coping skills in a sample of patients with depressive disorder in acute phase versus healthy controls.

Methods

We are conducting a cohort study to the date we recruited 82 inpatients admitted in our psychiatric ward. The data have been gathered from the 1st December 2014 and they will continue to be collected until the 1st December 2016, the healthy controls are represented by 67 subjects with similar socio-demographic features.

Inclusion criteria are: diagnosis of depressive disorders or dysthymia according to DSM-IV-TR diagnostic criteria, age > 18 years, proper understanding of Italian language, willingness to give written informed consent. We compared them with healthy controls with similar socio-demographic features.

Patients’ assessment includes the following tests:

– Resilience Scale for Adults (RSA);

– Brief-COPE Scale (Brief-COPE);

– Statistical analysis will be performed using SPSS for Windows, 21.0 (Armonk, NY: IBM Corporation).

Results

Data collection is still ongoing.

Conclusions

From a preliminary analysis of data, we assume that the levels of resilience and coping of our patients is reduced compared with controls, however the recruitment during the acute phase could significantly influence final results.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Resilience and attempted suicide in depressed patients

Introduction

Among the patients, 6.6% with past-year major depressive disorders attempt suicide in their life. Resilience (the ability to respond positively to adversity) and coping strategies (the ability to manage living stresses) may be protective factors against suicide ideation and behavior. A study conducted on 100 abstinent substance dependent patients suggested that suicide attempters had significantly lower resilience scale scores. Other authors demonstrated that intrinsic religiosity, resilience, quality of life were associated with previous suicide attempts in depressed patients.

Aim

To examine the correlation among resilience, coping strategies and sociodemographic and clinical characteristics in depressed patients.

Methods

From December 1st 2014 to December 31st 2015 we recruited inpatients and outpatients aged > 18 years with a diagnosis of depression (current or past). At baseline, patients were assessed with Montgomery Asberg Depression Rating Scale, Resilience Scale for Adult and Brief-COping with problems experienced; sociodemographic and clinical characteristics were gathered. Follow-up was conducted after 1 year in order to assess the possible presence of further depressive episodes and suicide attempts. Analysis was performed with SPSS.

Results and discussion

Data collection are still ongoing; results and implications will be discussed. We expect to find higher attempted suicide rates in patients with lower resilience and less coping strategies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The Psycho-geriatric Patient in the Emergency Room (ER) of the Maggiore della Carità Hospital in Novara

Introduction

Due to population aging, the health system will face increasing challenges in the next years. Concerning mental disorders, they are major public health issues in late life, with mood and anxiety disorders being some of the most common mental disorder among the elderly. For this reason, increasing attention has to be paid to the evaluation of the elderly in psychiatry emergency settings.

Objectives

To evaluate the socio-demographic and clinical features of over 65 patients referred to psychiatric consultations in the ER of “Maggiore della Carità” Hospital in Novara, in a 7 years period.

Aims

The analysis of the characteristics of the study sample could be potentially useful in resource planning in order to better serve this important segment of the general population.

Methods

Determinants of ER visits for over 65 patients referred to psychiatric evaluation were studied retrospectively from 2008 to 2015.

Results

Elderly patients made up 14,7% (n = 458) of all psychiatric evaluation in the ER (n = 3124). About two thirds (65,9%) were females and one third were males (34,1%). The mean age of patients recruited was 75.11 years. The majority of subjects (68.6%) presented without a diagnosis of Axis I according to DSM-IV. The other most frequent diagnosis was “cognitive disorders” (11.4%) and “mood disorders” (10.9%).

Conclusions

The large proportion of patients without a diagnosis of Axis I, could be related to the misunderstanding of the psychosocial aspects of aging. Preliminary results highlight the importance of research on this topic, considering population aging and the impact of mental disorders in late-life.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Vortioxetine versus citalopram in treating major depressive disorder (MDD)

Introduction

Citalopram is a widely used antidepressant (AD), indicated for the treatment of Major Depressive Disorder (MDD), with a high and Selective Serotonin Reuptake Inhibitory action (SSRI), good efficacy and safety profile. Vortioxetine is a novel multimodal antidepressant compound, with a mixed action on Serotonin (both 5-HT agonism and antagonism). Its clinical efficacy has been established in several short and long term trials; furthermore it proved effective at mitigating cognitive dysfunction, which is addressed to as one of the main causes of social impairment in MMD patients.

Objectives

To evaluate the relative efficacy and safety of Vortioxetine versus Citalopram, in patients suffering from MDD.

Aims

To assess whether Vortioxetine effectiveness and tolerability are comparable to those observed for previous antidepressants.

Methods

The main outcomes were efficacy (variance from baseline to 1 month) in the Montgomery-Åsberg Depression Rating Scale (MADRS) and Hamilton Rating Scale for Depression (HAM-D) and tolerability (adverse events). Changes in cognitive performance were assessed using the following specifics tools: Digit symbol substitution test (DSST), Trail Making Test A (TMT-A) and Hopkins Verbal Learning Test-Revised (HVLT-R).

Results

Data collection is ongoing. According to Literature we expect to find a significant number of MDD patients on Vortioxetine to achieve a reduction in depressive symptoms from baseline, to report poor adverse events and to increase their cognitive performance.

Conclusion

As shown by recent literature, Vortioxetine might be an effective option in treating MMD with particular focus on cognitive dysfunction.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Marchiafava-Bignami Disease with frontal cortex involvement and late onset, long-lasting psychiatric symptoms: a case report

AIMS

To describe the case and management of a patient with Marchiafava-Bignami Disease (MBD) with frontal cortical lesions, no specific symptom at first referral to the Emergency Room, and late onset of atypical psychiatric symptoms.

METHODS

We report the case of a 44-year-old patient with a history of chronic alcohol abuse, eventually diagnosed with MBD.

RESULTS

Magnetic Resonance showed lesions in the splenium and the body of corpus callosum and bilateral lesions of the frontal cortex. The patient showed late-onset atypical psychiatric symptoms which were drug resistant.

DISCUSSION

The case we describe seems to support the existing few ones describing cortical involvement in MBD, which suggest that this is associated with a poorer prognosis. Psychiatric symptoms may be challenging to treat because of drug resistance.

CONCLUSIONS

The involvement of psychiatrists together with neurologists and radiologists, with a consultation-liaison approach proved important for the achievement of diagnosis and of the most appropriate management and treatment for this patient.

Suicide attempters: Clinical characteristics and management

Background

Suicide attempts, defined as self-inflicted, potentially injurious behaviors with a nonfatal outcome, and with evidence of intent to die are extremely prevalent. Literature suggests that suicide is more common among males, while attempted suicide is more frequent among females. Depression, mental disorders, substance use disorders and history of suicidal behavior are important risk factors for suicide: the risk of suicide attempt is 3 to 12 times higher in psychiatric patients than in the general population.

Aim

The aim of our study was to compare severity of depressive symptoms in a sample of suicide attempters with a diagnosis of bipolar and related disorders or depressive disorders and in a sample of sex- and diagnosis-matched patients who do not commit a suicide attempt. The severity of attempted suicide and the suicidal risk in the hospital will be assessed as well.

Material and methods

We collected a sample of inpatients who committed a suicide attempt during 2015. For each attempter, we selected another sex- and diagnosis-matched patient with no history of attempted suicide. Socio-demographic and clinical characteristics of the sample were gathered. Assessment included: Montgomery-Asberg Depression Rating Scale (MADRS) for severity of depressive symptoms in both groups, Suicide Intent Scale (SIS) for the severity of attempted suicide and the suicidal risk with a nurse assessment for suicide.

Results

Data collecting is still ongoing. We expected to find more severe symptoms in patients who attempted suicide. Clinical implication will be discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Who is a survivor of suicide loss? A systematic review

Introduction

Death by suicide stuns with soul-crushing surprise, leaving family and friends not only grieving the unexpected death, but confused and lost by this haunting loss. The underlying structure of grief for survivors of suicide loss appears complicated.

Aims

The purpose of this study consists in reviewing literature data about survivors of suicide, especially exploring the few informations emerged by researches on the role of psychiatrist as “survivor”.

Methods

A PubMed search was conducted using combinations of the following keywords: survivors suicide or bereavement suicide or suicide psychiatrists and randomized.

The search was conducted through September 10, 2015, and no conference proceedings were included.

Results

Bereavement following suicide is complicated by the psychological impact of the act on those close to the victim. It is further complicated by the societal perception that the act of suicide is a failure by the victim and the family to deal with some emotional issue and ultimately society affixes blame for the loss on the survivors. This individual or societal stigma introduces a unique stress on the bereavement process that in some cases requires clinical intervention.

Conclusions

Suicide bereavement seems to be different from natural loss. Clinicians may react to a patient's suicide both on a personal and professional level, with emotions such as loss of self-esteem or blame. This grief somehow nullifies the core of a helping relationship and may imply a more conservative management of future patients or even avoiding to accept suicidal patients for treatment. Support interventions have been proposed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Dermal reactivity and resilience in a sample of depressed patients

Background

Mental disorders are considered a risk factor for suicide: for example, the lifetime risk of suicide is estimated to be 4%–8% in people with mood disorders. The literature suggests that a history of suicide attempts is significantly related to electrodermal hyporeactivity and that patients with violent suicide attempters exhibit faster habituation of the electrodermal response to repeated neutral tones than patients with non-violent attempts. The impact of depressive symptoms on suicidal ideation may be moderated by resilience. Resilience refers to the ability to maintain o regain mental health despite experiencing adversity. In bipolar and depressive disorders, resilience may influence severity of episodes, frequency of relapse and response to treatment.

Aim

The objective of our study was to assess the possible correlation among attempted suicide, resilience and dermal reactivity in a sample of depressed patients.

Methods

We recruited patients with depressive disorders and bipolar depression; data about socio-demographic, clinical features, severity of attempted suicide and suicidal risk were gathered. Patients filled in the Resilience Scale for Adult (RSA). Moreover, for each patient we performed the Edor test in order to assess dermal reactivity.

Results

Data collection is still ongoing. We expect to find lower levels of resilience in those patients who are hyporeactive and attempted suicide. Moreover, we hypothesize that suicide attempts in the group of hyporeactive patients would be characterized by planning and greater severity. Clinical implications will be discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Clinical Characteristics Associated with Suicide Attempts in Clinical Settings: A Comparison of Suicidal and Non-Suicidal Depressed Inpatients

INTRODUCTION

Both psychiatrists and psychiatric nurses are involved in the psychiatric management of suicidal inpatients. One-to-one observation by qualified nurses and the accommodation of the patient in a room close to the infirmary are usually recommended. Suicidal risk should be reassessed periodically to check response to treatment.

AIM

To compare the severity of depressive symptoms in depressed inpatients admitted after an attempted suicide and those admitted for any other reason and to assess the severity of suicide attempts and the management of suicidal risk in clinical settings.

MATERIALS AND METHODS

We divided the sample into two subgroups: patients with a diagnosis of depression admitted because of a recent suicide attempt and depressed patients with no recent history of attempted suicide. Socio-demographic and clinical data were gathered; assessments included the Montgomery-Asberg Depression Rating Scale and the Nurses' Global Assessment of Suicide Risk (NGASR).

RESULTS

Forty-six patients were recruited over a 1-year period: 20 were admitted to the hospital following a suicide attempt; the other 26 had not attempted suicide and were admitted for other depression-related reasons. Multivariate analysis revealed a correlation between use of antidepressants and recent attempted suicide. Attempting suicide was not related to the severity of depressive symptoms. In the recent suicide attempt subgroup, NGASR suicide risk levels were lower at discharge than at admission. Patients with a recent history of attempted suicide had a higher number of suicide attempts in their clinical history than patients with no recent history of attempted suicide.

CONCLUSION

There were no correlations between psychiatric diagnosis, severity of depressive symptoms, and recent suicide attempt. Antidepressant therapy protected against suicide attempts. History of suicide attempts was one of the best predictors of recent attempted suicide. A more thorough understanding of the complex phenomenon of suicide and the reasons for suicidal behavior is needed.

The effectiveness of a new approach using movies in the training of medical students

INTRODUCTION

The use of movies in medical (particularly psychiatric) education has been often limited to portraits of mental illness and psychiatrists. The Psychiatric Institute of the Università del Piemonte Orientale has a longstanding tradition of working with/on movies according to a method developed by Eugenio Torre, using dynamic images as educational incitements. Our aim is to describe the preliminary results on the impact of this intervention in medical students.

METHODS

The cinemeducation project lasted 6 months, and included 12 meetings. Forty randomly selected participants were assessed with: Attitudes Towards Psychiatry Scale (ATP-30), Social Distance Scale (SDS), Interpersonal Reactivity Index (IRI), and Toronto Alexithymia Scale (TAS), both at baseline and after 6 months, when the workshop was concluded.

RESULTS

A significant increase was found in the ATP-30 score, and a reduction of the SDS and IRI-Personal Distress scale scores.

CONCLUSIONS

Informal feedback from participants was strongly positive. Preliminary results from the assessment of participants are encouraging. Students' attitudes towards psychiatry and ability to tolerate anxiety when experiencing others' distress improved, while stigma decreased. The evocative power of movie dynamic images, developed in the group and integrated with the help of the group leader, can enrich students' knowledge, both from a cognitive and emotional standpoint.

Creutzfeldt-jacob disease with psychiatric presentation (CJD) : A case report

Introduction

CJD is a neurodegenerative disease with a rapid onset characterized by progressive dementia, myoclonus and also cerebellar, pyramidal and extrapyramidal signs. It is caused by an increased loss of neurons due to the abnormal conformation of a membrane protein.

Case report

A 69 year-old woman was admitted to Psychiatry with a clinical picture characterized by psychomotor agitation, disorientation, confusion, confabulation, false ricognition, circumstantiality, perseveration, logorrhea and dysphoria. She presented no alterations of sense-perception. Her psychiatric history was silent. The neurological examination showed no focal neurological deficits and the first EEG was nonspecific. She became progressively more confused, with subsequent drowsiness with psychomotor agitation, aimless buste, disorganization and visual hallucinations. She started treatment with quetiapine (200 mg/die) and lorazepam (4 mg/die) without benefit. The second EEG was characterized by triphasic waves with diffuse projection. MRI angiography revealed the presence of diffuse cortical ribbon hyperintensity of gray matter. CSF examination showed positivity of 14/3/3 protein and a TAU protein value greater than 16000 pq/ml allowing diagnosis of CJD.

Conclusions

We emphasize the importance of a correct differential diagnosis in patients with psychiatric symptoms and rapidly progressive dementia unresponsive to therapy.