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.

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.

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

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.

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

No significant relationships.

Recently there has been renewal in interest of psychedelic research. Classic psychedelics such as lysergic acid diethylamide (LSD), psilocybin and mescaline act pharmacologically as agonists at the 5-HT2A receptor. The entactogens like methylenedioxymethamphetamine (MDMA), acts as a serotonin, dopamine and noradrenaline agonist. All of these drugs are potential candidates in the treatment of multiple psychiatric illnesses.

The authors intend to review the literature on the clinical application of psychedelic drugs in psychiatric disorders.

Non-systematic review of the literature.

In recent clinical trial the psychedelic is given with psychotherapeutic input. In a supportive setting, psychedelics produced immediate and significant anti-depressant and anxiolytic effects that were endured for several months. Randomized clinical trials support the efficace of psilocybin in the treatment of depression and those with anxiety and depression symptoms provoked by life-threatening cancer. There have also been studies showing efficacy in both alcohol and tobacco dependence. When administered safely LSD can reduce anxiety and have anti-addictive property. Randomized clinical trials support the efficacy of MDMA in the treatment of PTSD. Psychedelics were well-tolerated, few adverse effects have been reported. The most common adverse effects were transient anxiety, short-lived headaches, nausea and mild increases in heart rate and blood pressure, with no persisting adverse effects. Serious adverse events, such as persistent psychosis and suicidality, have not been demonstrated.

Psychedelics appear to be effective in multiple psychiatric disorders and are well-tolerated, although further evidence is required, to better see they therapeutic potential.

No significant relationships.

Depression (MDD) is a serious mental illness, which greatly affects the quality of life of patients. Nowadays, the clinical diagnosis of MDD lacks sufficient objective basis, and the effect of drug treatment is unsatisfactory. Therefore, biomarkers are very important for the risk prediction, classification, diagnosis and prognosis of MDD.

Research progress of metabonomics of blood endogenous small molecules in depression

Metabonomics is a newly developed discipline after genomics and proteomics, and is an important part of system biology. Metabonomics provides a new approach to explore the etiology, mechanism, prognosis and screening potential biomarkers of MDD. Blood contains almost all the small molecule metabolites in the body. The changes of metabolites in blood can represent the changes of metabolites in other body fluids. Moreover, this sample is easy to obtain and has less trauma, so it is the most common biological sample in clinical detection.

At present, there are many studies on the metabonomics of endogenous small molecules in MDD blood, which provides the possibility for further screening of MDD related biomarkers.

In this paper, the research progress of related biomarkers in MDD blood is reviewed.

No significant relationships.

This is a presentation of the FEP of a 23 y.o. patient. The patient had a Duration of Untreated Psychosis (DUP) of 6 months and Duration of Untreated Illness (DUI) of six years. The therapeutic response and the adverse effects of Paliperidone are being described.

To investigate the tolerance of Paliperidone in a patient with FEP.

The patient was assessed regularly by the psychiatric team consisting of a CT doctor and one General Adult Consultant. Appropriate psychological assessments and investigations took place.

Upon admission the patient appeared guarded. She also presented with weight loss and dehydration. Initial PANSS score was 173, positive subscale 41. The patient was initially treated with monotherapy 6mg of Paliperidone. However, the heart rate was around 100 bpm culminating as high as 156 bpm. The ECG indicated sinus tachycardia. The patient presented with serious EPSs and diarrhea. Simpson-Angus Scale score 10. Metoprolol 25mg was prescribed twice a day. The clinical team proceeded in cross titration replacing Paliperidone with Olanzapine. A brain CT scan was also performed, unremarkable. After 10 days of therapy the PANSS score reduced to 102, positive subscale 21.

Initial sinus tachycardia is a common adverse effect of Paliperidone. However in this case the tachycardia was refractory in time even after the 7th day, making an alternative SGA trial necessary.

No significant relationships.

The development of original drugs - new generation GABAA receptor modulators (GABAAR), with an anti-alcohol orientation, non-addictive and stimulating detoxification processes, makes it possible to increase the effectiveness of therapy and reduce the cost of treatment.

Study the mechanism of interaction between m-Cl-BHU and GABAA - receptor

Molecular docking was performed to study the molecular docking of m-Cl-BHU with at the binding site of the target protein GABAAR.Radioreceptor studies were carried out using [3H] flunitrazepam binding with synaptosomal receptors in the cerebral cortex of Wistar rats in experimental alcoholism under the influence of therapy with m-CL-BHU. Kinetic parameters (T1/2, Clt, MRT, MET, AUC) of a model substrate - antipyrine were determined in the saliva of healthy volunteers and alcoholic patients.

IResults of molecular docking (Schrödinger program (Glide) showed: m-CL-BHU (meta-chlorobenzhydryl urea) is complementary to the benzodiazepine GABAAR. Binding energy is low) (scoring (GScore) -11.14 kKal/mol); m-CL-BHU interacts with key amino acids at the α1γ2 interface: Tyr159, Tyr209, H101 Phe77 and is characterized by a high degree of model fit - dG insert: 0.741 Binding of [3H] flunitrazepam to the benzodiazepine site of GABAAR in rat brain in experimental alcoholism, who received 14 days of m-CL-BHU at 100 mg/kg /day, increased in receptor affinity. Changes in the kinetic parameters (T1/2, Clt, MRT, MET, AUC) of a model substrate - antipyrine in the saliva of healthy volunteers and alcoholic patients using Galodif (m-CL-BHU) at 300 mg/day 21 days

m-CL-BHU - GABAA receptor modulator with an alternative mechanism of action

No significant relationships.

Hiccups are an involuntarily powerful spasm of the diaphragm, followed by a sudden inspiration with a closure of the glottis. Hiccups lasting longer than one month is termed intractable hiccups. Intractable hiccups can be caused by structural or functional disturbances of the medulla, afferent or efferent nerves to the respiratory muscles or metabolic and endocrine disorders, drugs, general anaesthesia and emotional problems.

Authors present a case report about curing a patient of intractable hiccups using baclofen along with literature review.

A case report along with literature review forms the basis of discussion.

A 30-year female diagnosed with schizophrenia stable on 2mg risperidone for 3 years presented to the outpatient department with complain of intractable hiccups for 6 months. Frequency of hiccups was around 10-12 times per minute and continued throughout the day leading to significant socio-occupational distress. patient had been receiving medical treatment for last 4 months for the same including Metoclopramide, chlorpromazine along with trying breath holding and drinking cold water but symptoms persisted. Her ECG, chest X-ray, complete blood counts were unremarkable, CT scan of brain was normal. Patient was started on baclofen 10mg thrice daily. Within 1-week patient had dramatic response and complete remission was achieved in 2 weeks.

Beclofen is effective in hiccups because it is an analogue of GABA, that decreases excitability and inhibits the hiccup reflex, which reduces synaptic transmission. Baclofen is used to treat hiccups, and can be used either as a first-line treatment or if patient does not respond to other medications.

No significant relationships.

Mr. X, a 39-year-old man presented to us with a history of alcohol use from the last 12-15 years in a dependence pattern with tolerance, uncomplicated withdrawal symptoms and salience. He was detoxified, given parenteral thiamine supplements and oral lorazepam to reduce withdrawal symptoms. He was contemplating to quit alcohol and thus about 4-5 days after his detoxification, tablet acamprosate 1998 mg/day was added, in three divided dosages. He was discharged after 10 days and had no withdrawal signs or cerebellar deficits. In the next follow-up after two weeks, he reported to be abstinent from alcohol, but now complained of new onset coarse tremors and excessive salivation. He had no other extra pyramidal or cerebellar symptoms, no hepatic or renal dysfunction and no neurological deficits. The Patient had a drooling score of 6 on Drooling Severity and Frequency Scale(DSFS).

Acamprosate and naltrexone are the only two drugs approved by the US Food and Drug Administration for achieving abstinence in patients with Alcohol Dependence Syndrome. Acamprosate is well tolerated and has a few drug interactions. It has a comparatively benign side effect profile which includes diarrhea, intestinal cramps, itching, dizziness, muscle weakness, headache, flatulence, nausea, anxiety, and insomnia. Here we report hypersalivation and coarse tremors as unusual side effects of acamprosate.

Cross-sectional

Here we report hypersalivation and coarse tremors as unusual side effects of acamprosate.

The probable mechanism responsible for this is thought to be acamprosate induced decrease in dopamine release in ventral tegmental area due to diminished glutamate activity.

No significant relationships.

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.

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

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

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.

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.

No significant relationships.

Clozapine is a second-generation antipsychotic indicated in treatment-resistant schizophrenia. Patients taking clozapine are likely to experience an increase in salivation or sialorrhea. Clozapine‐induced sialorrhea (CIS) may lead to sleep disturbances or aspiration pneumonia. Treatment options include locally administered anticholinergic medication with atropine ophthalmic drops applied sublingually.

To review the current evidence for the effectiveness, safety, side effects and dosage of sublingual application of atropine in reducing or resolving of CIS.

Systematic review. Data were obtained from PubMed/Medline, EMBASE, PsycINFO, Cochrane Plus, Trip Database, Science Direct and Scopus searches of English-language articles, without restriction for date of publication and study design, reporting the sublingual use of atropine in the treatment of CIS. Large clinical studies with appropriate statistical methods and recruited adults were preferred.

12 selected articles (of 458 references) consisted entirely of case reports and case series. A total of 29 patients with CIS were reported, of whom 24 responded favorably to sublingually administered atropine drops 1% (1-2 drops a day). One limitation of its utilization is the dose-related dry mouth, which can be addressed by lowering the number of drops administered. CIS can occur at different clozapine doses, in various stages of treatment.

The reviewed articles suggest that the use of sublingual atropine is a promising local treatment for CIS. Oral anticholinergic and alpha-2 agonist medications have been used to treat CIS with variable efficacy, but can cause systemic anticholinergic side effects. Further experimental research is needed.

No significant relationships.

Depression is one of the most prevalent mental illnesses, leading to important personal distress and economic consequences. Treatment is long, often involving psychotherapy and pharmacological treatment, and relapses are frequent. Used mostly for treatment of mood disorders and alcohol dependence, drugs such as lysergic acid diethylamide (LSD) were studied in the 1950’s and showed therapeutic promise in attenuating depressive symptoms. However, in the 1960s all major psychedelic research programs were ended. Recently, there is a renewed research interest in these drugs, considering its antidepressant potential.

To review current knowledge on the therapeutic uses of psychedelic drugs such as LSD in depression disorders.

Review of the most recent literature regarding the therapeutical potential of psychedelic drugs such as LSD in depression disorders. The research was carried out through the UptoDate, PubMed, MedLine, ScienceDirect and SpringerLink databases, using the terms “LSD”, “psychedelic drugs” and “depression disorders”, until December 2020.

As in past scientific studies, data of recent clinical research shows that the use of LSD relieves distress concerning death, particularly in terminally ill oncologic patients, and addictions including alcoholism and nicotine. There is more limited data concerning the use of classic hallucinogens to treat depression and anxiety disorders.

Although research has shown many of the neurobiological and psychological effects of classic hallucinogens on humans, the studies that have been completed to date are not sufficient to establish clinically relevant effects. Despite further research is needed, the outcomes are encouraging, and larger, well-designed, placebo-controlled trials are now underway or being planned.

No significant relationships.

The development of an extrapyramidal syndrome (EPS) is assumed to be a potential and important consequence of organophosphate poisoning (OP). Even though its causal relationship is firmly established, the information available in the literature regarding the orientation to be given is scarce, and its approach remains shrouded in a significant degree of uncertainty. Catatonia, as a neuropsychiatric condition, may present a marked overlap with the set of extrapyramidal symptoms developed after OP. Does the overlap between the symptoms seen in catatonia and in EPS make differential diagnosis fundamental or does it have no relevance in relation to the approach to be established?

To discuss the therapeutic approach to be implemented in the extrapyramidal symptoms resulting from OP and reflect on the overlap between catatonia and EPS.

Presentation of a clinical case and review of the literature.

A 50-year-old woman with major depressive disorder developed a condition marked by exuberant extrapyramidal symptoms 3 weeks after OP. Significant stiffness, tremor, dysphagia and facial hypomimia were some of the symptoms observed. Therapy was started with amantadine 100mg daily, with complete resolution of the symptoms after 5 days. Follow-up revealed reversal of extrapyramidal symptoms, in the absence of any neuroimaging changes or any other neuropsychiatric manifestations.

The possible overlap between catatonia and EPS is remarkable. The two conditions, regardless of their differentiation, may benefit from an identical approach using dopaminergic drugs. The use of amantadine, even in low doses, may be an option in the rapid reversal of extrapyramidal symptoms resulting from OP.

No significant relationships.

Future firefighters are selected and trained to perform well under pressure and stress.

The research is focused on the experimental study of fire cadets’ memory capacity under stress.

The study follows Solomon Four Group Design with two variables: stress stimuli (exposure/non-exposure), fire cadets (n=50)/civilian students (n=40). Two series of The Digit Span Test measurements (DST) were performed. Heart rate, EMG, systolic wave amplitude, pulse transit time were measured during the experiment to determine the respondents’ stress levels.

Memory capacity in fire cadets under stress (n=30) significantly increased (Wilcoxon match-pairs rank test, р = 0.001; 1st DST series, neutral stimuli: M=6.53, SE=0.17, SD=0.96; 2st DST series, stressful stimuli: M=7.3, SE=0.21, SD=1.16), the obtained effect size was medium (Cohen’s d = 0.7232). There was no significant change in memory capacity in civilian students under stress (n=20, Wilcoxon test, р=0.452; 1st DST series, neutral stimuli: M=6.78, SE=0.23, SD=1.02; 2st DST series, stressful stimuli: M=6.7, SE=0.23, SD=1.04). Moreover, there was no significant change in memory capacity in fire cadets that were not under stress (n=20, Wilcoxon test, р = 0.628; 1st DST series, neutral stimuli: M=6.88, SE=0.16, SD=0.70; 2st DST series, neutral stimuli: M=6.78, SE=0.16, SD=0.73). Systolic wave amplitude in the stress-exposed groups changed more pronouncedly in students (Mann–Whitney test, z=-2.131; p = 0.033) compared to cadets.

In most of the fire cadets, moderate stress exposure resulted in a memory capacity increase.

No significant relationships.

Future firefighters are trained and selected for a job requiring the ability to perform well under high stress and time pressure.

The research is focused on the experimental study of fire cadets’ cognitive performance indicators (speed/accuracy) under stress.

The study follows Solomon Four Group Design with two variables: stress stimuli (exposure/non-exposure) and participants’ background (50 male fire cadets; 50 male civilian students). Stress stimuli consisted of emergencies’ photos, audio, videos. ECG, EMG, systolic wave amplitude, pulse transit time were measured during the experiment to determine the respondents’ stress levels. The cognitive reflection test (CRT) was performed. Mann-Whitney U-test, Spearman’s rank correlation coefficient were used.

There were no differences between students and fire cadets in CRT time (p=0.515, students: 118.1±38.6 sec, cadets: 143.5±78.1 sec) and accuracy (p=0.246, students: 1.2±0.9, cadets: 1.4±0.9). Fire cadets in the stress exposure group (mean time=122, mean accuracy=1.22) performed CRT significantly faster (p=0.039) than non-exposed cadets (mean time=166, mean accuracy=1.56). The accuracy difference was insignificant (p=0.206). Fire cadets with prior emergency work experience (n=30, mean time=159.7, mean accuracy=1.6) were no different from other cadets (n=20, mean time=159.7, mean accuracy=1.1) both in time (p=0.289) and accuracy(p=0.07). The performance difference between civilian student groups was insignificant (exposure: mean time=123, mean accuracy=1.32; non-exposure: mean time=113, mean accuracy=1.06).

Stress exposure enhances fire cadets’ CRT performance (in speed, but not in accuracy). Emergency work experience did not contribute to this effect, which could be explained by the self-selection effect (since only people inclined to emergency work choose to become a firefighter).

No significant relationships.

We present the case of a 34-year-old female patient with no prior psychiatric record who was treated in our outpatient department due to persecutory delusions of recent onset. The patient had a history of refractory temporal epilepsy since adolescence and underwent a temporal lobe resection 4 month prior to the appearance of her symptoms.

Temporal lobe resection is a well-established technique to treat refractory temporal lobe epilepsy in which psychotic symptoms are an infrequent complication; the most frequent being cognitive sequelae, visual field defects and depression. According to several sources, this symptomatology may be underdiagnosed and undereportend and there have been a number of case reports and series of cases which describe the aforementioned entity.

A case report is presented alongside a review of the relevant literature regarding cases of secondary psychosis after brain surgery.

During her treatment we administered olanzapine up to doses of 7.5mg per day because of the risk of reducing the convulsive threshold. We observed a marked improvement and the disappearance of the delusions. The dose of olanzapine has been maintained for a year with no important side-effects and without a relapse in symptoms.

Psychotic symptoms as a complication of temporal lobe resection may be more frequent than what was thought in the past. It is important to study this phenomenon more in-depth because the symptoms may remain undetected and present worse outcomes given that there are effective treatments which could ameliorate the condition.

No significant relationships.

Electroconvulsive therapy (ECT) remains a valuable treatment for major depression with psychotic symptoms. However, it is necessary to pay special attention when there is a history of fractures.

Through the description of the following clinical case, we will emphasize the importance of screening for vertebral fractures within ECT and the different procedures that must be taken if that occurs.

We undertook a narrative literature review by performing a search on PubMed for English-written articles. The query used was “Electroconvulsive Therapy” AND “Vertebral Fractures”.

A 71-year-old woman was admitted with an episode of psychotic depression. Basic tests were performed and were all normal. After not responding to pharmacologic treatment, she was referred for ECT. The patient had a full recovery after 4 weeks of biweekly sessions. She was discharged and proposed for maintenance ECT. However, she started complaining of back pain after falling and did an X-ray and CT scan which revealed fractured L1 and L2. It was suggested conservative treatment with a Jewett orthosis. Within this period, the ECT was suspended and after a 4-week treatment, the fracture was consolidated. As there was no risk of neurological compression, the treatment was restarted with the same dosage of succinylcholine, and it was achieved complete muscular relaxation. The patient fully recovered without any orthopedic sequel.

Electroconvulsive therapy can be safely performed after conservative treatment of vertebral fractures, if special attention is provided to complete muscular relaxation. For this effect, the dosage of succinylcholine can be adjusted.

No significant relationships.

Electroconvulsive therapy (ECT) is considered a gold-standart treatment of severe and treatment-resistant depression. Lack of response to ECT often causes distress in psychiatrists regarding the next therapeutic decisions.

To present a case report of a patient with psychotic depression with partial response to ECT.

Clinical interviews and review of literature using the Pubmed platform.

The authors present a case of a 60 year-old woman admitted for severe depressive episode with psychotic symptoms. Due to lack of response to multiple antidepressive and antipsychotic treatments, 15 sessions of ECT were performed with improvement of behavioral and psychotic symptoms. However, endogenous depressive symptoms with functional impairment persisted. It was then initiated Bupropion 300mg/day resulting in vast improvements on drive, energy and activity levels with restored functionality. Previously to ECT, Bupropion was not considered a valid option due to the psychomotor restlessness that was present. This case exposes the limitations of ECT and the therapeutic conundrums that arise when there is partial response. The symptoms expressed in the patient after ECT course correlate with deficits in noradrenergic and dopaminergic pathways that are involved in endogenous depression. The use of Bupropion, with its effect on noradrenaline and dopamine receptors, may offer a therapeutic lifeline in these cases.

ECT still stands as a gold-standart for severe depressive disorder, especially when several psychopharmacological therapies have failed. In cases of partial response to ECT, the neurobiological correlates of clinical presentation can guide the therapeutic management towards improved outcomes.

No significant relationships.

Since the declaration of the national lockdown in Spain on March 14th until the publication of the SEPB recommendations on May 11th, most of the ECT-U closed or drastically reduced their activity.

To present our non-stop management of an ECT-U during the first two months of COVID-19 lockdown in Spain.

We retrospectively analysed the time between sessions, the clinical, pharmacological and electrical data records of maintenance patients (m-ECT) and compared them with their own records in the two-month period prior to COVID-19. We analysed the length of admission, clinical, pharmacological and electrical records in hospitalized patients (i-ETC) and compared them with patients from the entire year prior to COVID-19 paired by age, sex and diagnosis.

The ECT-m programme included 17 patients: we postponed the ECT in 8 patients; 1 patient was hospitalized and 8 patients continued normally. The time between m-ECT increased by 8.37±4.89 days (p=0.018) without relapse. During the COVID-19 period, we performed ECT-i in 14 patients without new infections. In i-ECT the duration of admissions increased by 22.1 ±1.2 days (p=0.006), the load increased by 81.53 ±87.8 mC (p=0.027) and the time of the electrical seizure decreased by 7.9 ±9.2 seconds (p=0.037).

The modifications that reach a statistical significance are explained by the readjustment of the ECT-U, with no clinical significance. With the appropriate measures, neither m-ECT nor i-ECT were discontinued. Thus we maintained adequate patient management.

No significant relationships.

Postictal suppression (PSI) is considered a key feature for ECT’s outcomes because higher values have been correlated with clinical efficacy. However, little is known about the demographic factors influencing this parameter.

To analyze the influence of sex, age, diagnosis and treatment phase on ECT efficacy measured with PSI value.

3251 ECT sessions were performed on 182 patients during two years at a university hospital. PSI was retrospectively analyzed comparing it according to sex (male, female), age, main diagnosis (major depressive disorder [MDD], bipolar disorder [BD], schizoaffective disorder [SZA], schizophrenia [SCZ]) and treatment phase (acute [a-ECT], continuation [c-ECT], maintenance [m-ECT]).

PSI values were 69.76 % (SD 17.05) in women and 70.72 % (SD 16.81) in men without differences between sexes (F=0.979; p=0.607). PSI was correlated with age (r=-0.058; p=0.031). MDD PSI was 70.01 % (SD 16.88), for BD it was 69.48 % (SD 17.00), for SZA it was 68.62 % (SD 17.39), and for SCZ it was 70.73 % (SD 17.18), without differences between diagnosis (F=1.085; p=0.141). According to treatment phase, PSI in the a-ECT was 72.26 % (SD 16.43), in the c-ECT it was 67.83 % (SD 17.53), and in the m-ECT it was 68.47 % (SD 17.02), without differences between phases (F=0.901; p=0.915).

Although there exist statistically significant association between age and PSI it is a negligible correlation with no clinical relevance. Thus, we conclude that neither sex nor age, nor diagnosis, nor treatment phase seem to influence PSI to a relevant degree.

No significant relationships.

The standard anaesthetic for electroconvulsive therapy (ECT) in our hospital methohexital was no longer available from the beginning of 2019. A change to alternatives became necessary. We initially decided on thiopental and than switched to propofol after the suspicion of increased occurrence of cognitive deficits due to thiopental narcosis was expressed by clinicians.

This retrospective study provides a comparison of the two narcotics in terms of side-effects and seizure parameters.

We performed a retrospective data collection from our clinical database and identified a total of 64 patients (w=60.9 %, m=39.1 %) got either thiopental (n=35) or propofol (n=29) for ECT narcosis.

The mean age at the beginning of the ECT series was 56.0 years (20-82, SD 17.8, median 57.5). The groups did not differ in terms of age distribution. On average the depressive episode lastet for 9.0 months (SD 11.5, median 6.0) with no difference between the two groups. The mean EEG seizure time was significantly shorter in the propofol group (28.1 sec; 95%-CI: 23.8-32.4) than in the thiopental group (38.3 sec.; 95%-CI: 34.3-38.3). The mean EMG seizure activity was also shortler in the propofol group (12.0 sec.; 95%-CI: 8.0-15.0) compared with the thiopental group (21.5 sec.; 95%-CI: 18.3-24.8). The ECT series was interrupted due to cognitive side-effects in 20 cases. The majority of these cases (n=17) concerned the thiopental group, compared to 3 cases in the propofol group.

Propofol narcosis in ECT was assiosiated with worse seizure parameters, whereas thiopental narcosis was associated with increased risk of cognitive side-effects.

No significant relationships.

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.

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

Case report

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.

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.

No significant relationships.