Although schizophrenia and anorexia nervosa are very different disorders, when they occur in the same patient it can be difficult to distinguish whether the alterations in body image are due to psychotic symptoms or correspond to a comorbid eating disorder. It is also relevant to know how they can interact with each other.

Presentation of a clinical case of anorexia nervosa in the context of a patient with a previous diagnosis of paranoid schizophrenia.

Bibliographic review of the relationship between schizophrenia and alterations in the perception of body image by searching for articles in Pubmed.

We present a 48-year-old woman who resides with her mother and a sister. Diagnosed with paranoid schizophrenia and eating disorder. She had previously been admitted to hospital twice. Since 2004, she has been followed up in mental health consultations. The patient reports constant weight changes. A year ago she began to feel overweight and began to restrict her intake and to exercise, having lost 20 kg. She reports psychotic symptoms in the past, that she now denies. Various scales show moderate impact of weight on personal perception of psychosocial adjustment, an impulse to thinness and a significant distortion of body image, perceiving herself as heavier than she is and wishing she was lighter.

In schizophrenia, confusion in bodily experiences and states is not uncommon. The possible interactions between the symptoms of schizophrenia and anorexia nervosa complicate the adequate care of these patients. Further research on comorbidity of these two disorders is necessary.

The WHO warned that the COVID-19 pandemic could have psychiatric consequences such as elevated levels depression, increased alcohol and drug use, and other behaviours that exert a strong influence on health. In Latvia a state of emergency was announced on March 12th, was extended twice and lifted on June 10th.

To estimate the prevalence of depression and distress in the general population of Latvia and association with substance use during the state of emergency.

The nationwide representative online study in the general population of Latvia was conducted in July 2020 during three week period. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to determine the presence of distress/depression. The structured questionnaire to determine psychoactive substance use was applied. Proportions of independent variables across the study groups were compared using Chi-square test.

The study sample included 2608 respondents. The prevalence of depression and distress was estimated at 5.7% (95%CI 4.92 – 6.71) and 13.5% (95%CI 6.85 – 8.91), respectively. Patients with depression (28% vs. 7.4%, p <0.001) and distress (30.9% vs. 7.4% p <0.05) smoked more tobacco compared to respondents without distress/depression. Those with depression or distress were significantly more likely to consume more alcohol during the emergency state than people without depression or distress (14.0% and 17.7% vs. 6.6%, p <0.001). The changes in the use of other psychoactive substances in those who had depression or distress were not statistically significant.

Preparing support systems to mitigate mental health consequences is needed urgently.

Corpus callosum agenesis (CCA) is a rare congenital disorder in which there is a partial or complete absence of the corpus callosum. Within the framework of an anatomoclinical approach to schizophrenia, a few studies have focused on its association with neurological disorders, including CCA.

In this perspective, we report a rare case of an adolescent with intellectual disability, with whose complete CCA was revealed by a recent-onset schizophrenia.

A case report and literature review.

The teenager M.A. is from a first degree consanguineous marriage. He had no family history, no special habits and no history of seizures. Since early childhood, he had had a psychomotor acquisition delay and relationship difficulties that tended to worsen later. At school, he was teased by his peers and failed 4 times in different rows. At the age of 15, he dropped out of school. Verbal and physical aggressiveness, soliloquy, unmotivated laughter and vague ideas of persecution suddenly appeared, hence his psychiatric consultation one month later. Neuropsychological tests indicated current low Intelligence Quotient (60). Brain imaging revealed complete ACC (see Figure 1). He was diagnosed with schizophrenia and put on antipsychotic treatment at adequate doses and durations, with poor therapeutic response.

Our observation provides additional support for neurodevelopmental models of schizophrenia, and confirms literature data indicating that severe structural brain abnormalities would lead to early onset psychotic symptoms which are often refractory to pharmacological treatments

Adherence to antiretroviral therapy is a key factor in predicting the success or failure of treatment. Data suggest that the status of mental health and especially depression of people living with HIV can affect adherence to antiretroviral therapy.

The purpose of this study was to assess the mental health status of people living with HIV, to record adherence to antiretroviral therapy and to investigate whether mental health affects adherence to antiretroviral therapy.

A cross-sectional mixed observational correlation study in a sample of 112 HIV-positive individuals was conducted. The Simplified Medication Adherence Questionnaire (SMAQ) was used to assess adherence to antiretroviral therapy, the Beck Depression Inventory (BDI) was used to assess depression, and the WHOQOL – BREF tool was used to assess mental health.

The results of the study showed that 58.93% of patients were found to be non-adherent to antiretroviral therapy. Furthermore, according to the BDI scale, 10.7% of patients experienced marginal clinical depression, 10.7% experienced moderate levels of depression and 2.7% experienced severe or very severe levels of depression. Further, people living with HIV had a moderate level of mental health (M = 3.40, SD = 0.58).

Our study showed that a high percentage of people living with HIV are non-adherent to antiretroviral therapy. Factors that are possibly associated with decreased adherence are mental health and especially depression. Psychological support for people living with HIV and anti-depressant prevention programs could increase adherence to antiretroviral therapy.

Rarely, thyroid cancer can lead to hyperthyroidism. The link between dysthyroidism and psychiatric symptoms is well established, but cases of psychosis associated with hyperthyroidism are rarely reported in the literature.

Identifying psychosis secondary to hyperthyroidism caused by a secreting tumor through a case and literature review.

We report the case of a patient with thyroid suspect tumor and chronic psychosis. We performed a literature review based on a PubMed search with the following keywords: “dysthyroidism psychosis”.

Mr. S,32, with a personal psychiatric history of chronic psychosis evolving since 4 years, without notable pathological history, was hospitalized in psychiatry for psychomotor instability, verbal hetero-aggressiveness, subtotal insomnia and refusal of treatment. The psychiatric examination revealed the presence of a chronic delusional syndrome with a theme of persecution, mysticism,and an interpretive, intuitive and hallucinatory mechanism, without dissociative syndrome. The somatic examination objectified a cachectic patient with a bilateral symmetrical non-impulsive exophthalmos, a goiter with a thrill on palpation, dysphonia and sinus tachycardia.A laboratory workup revealed inflammatory syndrome, collapsed TSH (<0.05 mU / L) and an increased T4 to 37 pmol / L. Cervical ultrasound showed a strongly suspect left lobar heteronodular goiter and poorly structured peripheral lymphadenopathy (TI-RADS 4-B). Sedative diazepam therapy was started with antithyroid therapy and a beta blocker. The evolution was quickly favorable. The patient is referred for surgical treatement.

The severity of the hyperthyroidism,neoplastic origin, the improvement in psychotic signs with antithyroid treatment are arguments in favor of the thyroid origin by thyroid neoplasia.

Children with acute brain damage make up a large group of patients who require multi-stage rehabilitation. Rehabilitation requires the creation of special conditions for psychiatric care and psychological and pedagogical correction of the consequences of severe damage to the nervous system.

To identify the options for mental activity during the restoration of the level of consciousness in children after acute severe brain damage.

210 children under the age of 18 with severe brain damage (traumatic brain injury, hypoxia, hydrocephalus). Clinical-psychopathological, pedagogical methods were used; additionally diagnostic scales, questionnaires.

4 groups were formed: 1st 37 (18%) patients had manifestations of mental activity with physical, cognitive and social capabilities in the minimal consciousness “+” (a- / hyperkinetic mutism with emotional reactions, understanding of addressed speech); 2nd 67 (32%) - manifestations of physical and cognitive abilities with minimal consciousness “-” (a- / hyperkinetic mutism without reactions); 3rd 95 (40%) - only the manifestation of physical capabilities at the exit from the vegetative status. 4th 11 (10%) - a low manifestation of mental activity in the form of physical capabilities with a vegetative status.

4 variants of mental activity in children after acute severe brain damage have been identified: from minimal involuntary reactions or their absence in vegetative status to voluntary actions according to the instructions of an adult in minimal consciousness “+”. Taking into account the variability of mental activity helps to differentiate the methods of psychiatric and psychological-pedagogical assistance in the recovery of children already in the early stages of rehabilitation.

Dermatitis artefacta (DA) is a condition whereby self-induced skin damage is the means used to satisfy a desire to assume the sick role.

To describe clinical evaluation, diagnosis, treatment and evolution of an 15 years-old woman with DA.

Retrospective review of clinical records, including dermatology, psychiatry and Pathology.

A 15-year-old woman, who come to the Child Psychiatry consultations derived by the Dermatology Service, which is attended by the appearance of multiple bullous lesions throughout the body. Since August, the patient has reported a worsening of her mood, with feelings of loneliness and vital emptiness, with somatic and psychic anxiety referred. In the Dermatology office, she does not recognize self-infliction and the patient is derived to psychiatry consultation and solicited a skin biopsia. In the psychiatric interview, she recognizes that burns occur with a deodorant spray. She admitted doubts about her sexuality for months, claiming to be homosexual for the first time. When she burns, feels pleasure and relief. At the exploration: She wears a gay pride flag bracelet. Expressionless attitude. Cold contact. Approachable. Slightly collaborative. Without major affective disorders. No somatic anxiety, nor psychic. Short speech, impoverished language. Personality traits Cluster B and C. •Salamanca Questionnaire: Dependent personality, and in the background anxiety and histrionic. •Plutchik Impulsivity Scale: 14. •Toronto Alexithymia Scale: 64

The prognosis of the condition is variable, but it has been shown that resolution of the underlying psychosocial stressor leads to improvement. Multinucleated keratinocytes, a pathognomonic lesion of cryodermatitis artefacta, are discovered in the Pathology.

Burning mouth syndrome (BMS) is a chronic condition characterized by a burning sensation of the oral cavity and is often associated with taste disturbances and xerostomia.

To study the psychotropics as part of the possible etiologies of this síndrome.

A 67-year-old woman complained of burning pain in the tongue and oral mucosa, taste disorder, and sensory impairment. Slight improvement after treatment with Gabapentine 300mg (1-0-0). The pain is constant, with sharp characteristics. Improves when eating, the ability to taste is preserved. Subsequently, treatment with 2% lidocaine rinse (3-4 times / day) is tested, with temporary pain relief. Lorazepam 1mg (1-0-0), without improvement. Patient in follow-up by the Neuropsychiatry consultation for 3 years, due to major depressive disorder in treatment with Quetiapine 100mg (0-0-1).

In the first consultation the treatment is modified, adding Duloxetine 60 mg (1-0-0) and Alprazolam 0.5mg (1 / 2-1 / 2.0), and reducing the dose of Quetiapine to 75 mg and then 50mg. In the subsequent consultation, one month later, she only manages to reduce the neuroleptic dose by half, without noticing clinical improvement. After two months, she has completely removed the quetiapine, and completely disappearing the burning mouth sensation, improving his affective clinic in the same way.

There are a large number of drugs that produce xerostomia, in intimate relationship with the burning mouth. Among those we can find antihistamines, neuroleptics, antihypertensives, and benzodiazepines. In many cases, correcting or eliminating these etiologic agents does not improve or stop the initial symptoms, but sometimes, it does.

According to our national data based on PREDATORR study, the point prevalence of diabetes mellitus in Romania was 11.6 % in adults between 20 and 79 years old. Unequivocally, type 2 diabetes mellitus is highly correlated with psychological and personality factors.

The objective of our research was to evaluate the frequency of type D personality in patients suffering from type 2 diabetes and its influence on angiopathic complications.

A cross-sectional study was conducted in 173 patients with type 2 diabetes who were self-assessed by using Beck Depression Inventory I, STAI-Y scale and DS 14 scale for detection of type D personality.

Both depression (p = 0.012) and state and trait anxiety (p = 0.019 and 0.023 respectively) scores were significantly higher in diabetic patients with type D personality compared with non-type D diabetic patients. Lower limb complications were more frequent in non-type D personality diabetics (p = 0.018) while diabetic retinopathy and diabetic polyneuropathy (p = 0.004 and p = 0.010 respectively).

The presence of type D personality has a supplementary negative impact on type 2 diabetic patients’ affectivity and emotions. On the one hand, the more frequent microangiopathic complications in type D personality diabetic patients confirm that diabetes, at least in part, is an endovascular disease. On the other hand, some factors such as pro-inflammatory biomarkers may be more expressed in type 2 diabetic patients with concomitantly type D personality than those without this type of personality, leading to premature microangiopathic complications.

The prevalence of chronic liver diseases (CLD) is over 30 million people worldwide, they are associated with significant health care costs, loss of productivity of patients, and has a significant impact on the quality of life associated with health.

The research objective was to determine current views on the psychological state of patients with CLD.

A qualitative and quantitative analysis of the content of scientific Ukrainian and English literature published from 2014 to 2020, which sets out different views on the psychological state of patients with chronic liver diseases using the PubMed and Google Scholar databases. Only concept analysis, meta-analysis, and systematic reviews published in English, presented in the scientific literature were included.

The information on the peculiarities of the psychological state of patients with CLD was generalized. Based on the research, we can conclude that this group of patients is characterized by low mood, chronic fatigue, low level of social adaptation, increased anxiety, and reduced efficiency.

Studies by different scientists from different countries agree that patients with chronic liver disease are characterized by the above symptoms. Some emphasize psychoneurophysiology and associate these symptoms with chronic inflammation, which occurs as liver damage progresses. Other researchers suggest that it is due to the quality of life of these patients and the severity of the disease. However, the scientific community has yet to find out what exactly caused this.

We present the case of a 19-year-old female patient treated in our hospital due to an outburst of persistent vomiting. The patient had a diagnosis of Cyclic Vomiting Syndrome (CVS), a year before the diagnosis the patient had been labeled as a somatizer and admitted into the department of psychiatry. Given her psychiatric record and the fact that CVS is a rare diagnosis we were consulted on arrival.

CVS is an infrequent disorder of unknown etiology which shares similarities with migraine headaches. It is characterized by episodes of vomiting followed by periods of remission without active symptomatology with no organic pathology to account for the symptoms. Epistemic injustice (EI) is defined by Miranda Fricker as “a damage done to someone in their capacity as a knower”. She defined two forms of EI: testimonial and hermeneutical injustice.

A case report is presented alongside a review of the relevant literature regarding CVS and epistemic injustice.

On arrival at the emergency department she tried explaining her condition, but her testimony was disregarded on the basis of her psychiatric record. It was only after the on-call psychiatrist explained the condition when she received the appropriate abortive treatment, after which she was admitted to the internal medicine department where she was followed by the liaison psychiatrist.

CVS is a disabling disease still unknown to most clinicians in spite of the increasing quality evidence about its identification and treatment. The case highlight how cases of newly identified disease can suffer from testimonial and hermeneutical injustice.

Literature on childhood Functional Neurological Disorders (FNDs) is spare. Clinical presentations are vaguely characterized and often misdiagnosed in younger ages. Their main neurological features enrol: Psychogenic non-epileptic seizures (PNES), Functional movement disorders (FMDs), sensory alterations, cephalgia and feeding problems.

The study was aimed to better characterize the childhood population of FND, because of they represent an emerging challenge for clinicians, giving its higher presentation in the younger age and the difficulties of an early and differential diagnosis as well as an effective management.

Our study retrospectively examined the characteristics of 82 FNDs children and adolescents (8 to 16 y.o.; 13 males; 29 females) referred as neurological inpatients of an urban academic neuropsychiatric department, from 2014 to 2019. Three main clinical aspects were analysed: type and pattern of symptoms manifestations (DSM-5 criteria); Life Events; family functioning.

FND accounted for 2% of 5-years consultations of neurological inpatients (M: F=1:2). The clinical presentation was characterized in 70% by pattern of co-expressed neurological symptoms: FMDs (9.5%); PNES (12%); dizziness/lipothymia (12%); paraesthesia/anaesthesia (16%). Generalized pain was associated in 38% of the reported patterns while cephalgia in 44%. Sleep disorders were reported in 40%. Previous psychiatric diagnoses were uncommon (2 out 82). Antecedent stressors were identified in 97% of patients for personal illness history and in the 93% for chronic illness in the family anamnesis. Family problems were in 25% of cases.

Our data contributes to better characterize the childhood population of FND, describing clinical patterns of presentation, highlighting putative antecedent stressors and risk factors

Current epidemiological data on the pandemic prevalence of HIV in the world expand the boundaries of the problems associated with the threat of unpredictable spread of infection and the frequency of mental disorders that accompany HIV infection.

Somatogenic mental disorders are determined by the fact that the central nervous system (CNS) is one of the reservoirs for HIV. HIV is indirectly a neurotropic virus and can cause associated neurocognitive impairment (HAND)

In study were used clinical-linguistic examination method for determining linguistic markers for mental disorders in HIV patients who did not receive specific antiviral therapy.

As a result, it was found that 50% of HIV-infected patients not suffering from addiction syndromes or surfactant abuse have mental disorders, which are characterized mainly by disorders of adaptive reactions and mild cognitive impairment. 57.7% of HIV-infected people who do not use surfactants showed a high level of social adaptation. For patients who do not use surfactants, and who have undergone a commission examination before starting ART, the leading psychopathological syndromes are anxiety, anxiety-hypochondria. 44.2% of patients did not have obvious psychopathological symptoms.

Structure of emotional experiences was revealed in patients who recently learned about the burden of a serious chronic disease with the corresponding fear of death and self-stigmatization. Identified linguistic markers are additional signs that can be used by physicians and psychiatrists to diagnose both cognitive impairment and emotional impairment in patients with HIV infection.

No significant relationships.

Metabolic syndrome (MS) is associated with an increased risk of developing a cognitive vascular disorders and dementia.

The associations of cognitive disorders (CD) with components of methabolic syndrome (MS) such as : body mass index, lipid spectrum, arterial hypertension and glucose level (GL) in middle age subjects were study.

The 271 patients with MS according IDF criteria, (aged 30 – 60 years) were examend. Current mild cognitive impairment (MCI) was confirmed by psychodiagnostic interview according to the criteria of ICD-10. All patients passed through: MMSE test, Cognitive Failures Questionnaire, Wechsler memory scale, Symbol Coding and Category Fluency test. Level of blood glucose and plasma indicators of lipid spectrum were assessed in the blood samples with «Abbott» kits. To assess the results the NCEP criteria were used.

All 271 subject were divided into 2 groups, group A – with CD and/or MCI (212 subjects) and the group B -without affective disorders (49 subjects). Using the Mann-Whitney test significantly strong connection between high levels of total cholesterol (TC), cholesterol low density lipoprotein (LDL-C), lipoproteins of very low density (VLDL), the GL and MCI in group A were obtained. Optional subjects with sings of PH, MS and MCI had a fairly high level of VLDL and LDL-C in comparison with subjects without MCI.

The meaning of the relationship between metabolic syndrome and mild cognitive impairments in middle-aged people is in increasing in the level of LDL and VLDL that can provoke MCI in middleage subjects with MS.

Kleine-Levin Syndrome (KLS) is an extremely rare disorder of unknown etiology. It affects mainly male adolescents and is thought to follow a relapse-remitting course. During episodes of illness, a wide array of neuropsychiatric symptoms may present and a psychiatric diagnosis might be incorrectly made.

We aim to review the literature on the clinical manifestations of KLS, as well as the current evidence regarding this disorder’s management.

We performed an updated review in the PubMed database using the terms “Kleine-Levin Syndrome”. The included articles were selected by title and abstract.

KLS usually presents with recurrent episodes, lasting days to weeks, of severe hypersomnia, cognitive impairment, major apathy and derealization, among other neuropsychiatric symptoms. Although it was previously thought that complete normalization occurred between episodes, recent evidence suggests that around one third of patients have mild cognitive impairment and there are alterations in brain blood flow during the asymptomatic periods. During episodes of illness, management comprises environmental measures as well as drug therapy. Corticosteroids and amantadine have been successful in stopping episodes and lithium may be useful in a preventative role, however, there are no randomized controlled trials focusing on KLS treatment.

KLS remains an elusive entity since it is an extremely rare disorder with unclear etiology, course, and no consensual treatment. Further research is warranted in this area, namely randomized controlled trials. It is important for the practicing psychiatrist to be aware of this illness in order to recognize it and adequately manage it.

Wilson’s Disease is a rare, autosomal recessive disorder related to disturbances of copper metabolism. Its clinical picture includes hepatic, neurologic, psychiatric, and systemic manifestations. Psychiatric symptoms are frequent over the course of this disease and can be found in up to a quarter of patients at presentation. Successful treatment for Wilson’s Disease can be achieved using anti-copper agents.

We aim to review the literature regarding the psychiatric manifestations of Wilson’s Disease. We also include brief considerations about their management.

We performed an updated review in the PubMed database using the terms “Wilson’s Disease” and “Psychiatric manifestations”. The included articles were selected by title and abstract.

Psychiatric manifestations, including psychosis, mood disorders, personality disorders and cognitive impairment are common in Wilson’s Disease and can be the initial symptoms of this condition. The diagnosis of Wilson’s Disease in people presenting with psychiatric symptoms heralds special considerations in psychopharmacology since this population has a higher risk of hepatic impairment, epilepsy, and extrapyramidal side effects.

Psychiatric symptoms are common in Wilson’s Disease and can be its presenting clinical features. Missing the diagnosis of Wilson’s Disease can stall an efficient treatment and lead to inadequate patient management.

Over the past decades, immunotherapy treatments have been a revolution to many chronic diseases with encouraging results in clinical outcomes and quality of life. The use of monoclonal antibodies has yielded a great variability in terms of clinical efficacy and tolerability although it’s believed the incidence of psychotic symptoms is low (0,1-0,4%).

To review the effects of monoclonal antibodies on psychosis.

Review of literature using PubMed database. A total of 16 studies were included.

The targeted molecules by monoclonal antibodies may determine the risk of psychosis. While those who target TNF-alfa seem to have a reduced risk of psychosis (such as Infliximab, Adalimumab, Certolizumab and Golimumab), monoclonal antibodies who modulate lymphocytes may have a greater risk of psychosis namely Natalizumab, Belimumab, Basiliximab and Daclizumab, which seems to correlate to evidence of alterations in lymphocyte subsets in groups of patients with first psychotic episode and schizophrenia. Some seem to have positive correlation with psychosis namely monoclonal antibodies who have a supressing effect on the immune system, especially those who target adaptative immunity and those who are used in autoimmune diseases (vs oncologic conditions). It is unknown if delusions prevail over hallucinations or vice-versa. Despite the paucity of evidence, these findings corroborate the variability regarding the psychiatric effects of immunotherapy.

The available literature reports a low prevalence of psychotic symptoms associated with the use of monoclonal antibodies but it highlights the importance in knowing the immune mechanisms involved in psychotic disorders. Greater research is needed to correctly assess that risk.

Some research suggests that mental health problems can be brought on by the stress of having unexplained symptom. In non-western cultures especially, psychological distress is often communicated through multiple somatic complaints. The biopsychosocial model takes into consideration all factors affecting health and disease, supporting the integration of biological, psychological and social factors in the assessment and treatment.

In our study we assess prevalence of alexithymia as a potential psychopathological attribute manifesting as unexplained somatic symptoms

196 patients aged 18 to 60 with unexplained physical symptoms for at least three months, after collection of demographic data, medical and psychiatric history, were subject to Arabic version of the following scales : patient health questionnaire PHQ-15 to assess severity of somatic symptoms, patient health questionnaire PHQ-9 to assess depressive symptoms, generalized anaxiety disorder GAD-7 to assess general anxiety disorder symptoms and Toronto Alexithymia scale TAS to assess alexithymia

90% of ours ample were female patients, 49,5% showed alexithymia, 27,6% were borderline alexithymic and 23% had no alexithymia. Patients with unexplained physical symptoms showed moderate to high depressive symptoms in 81,1% of the sample, moderate to severe anxiety symptoms in 73,5%. Severity of somatic symptoms as assessed by PHQ-15 were significantly highly correlated to scores for Alexithymia (TAS), depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7) p<0,001

Alexithymia is prevalent among patients with unexplained physical symptoms. This later population has high prevalence of depressive and anxiety symptoms that go with the severity of somatic manifestations

We present the case of an 82-year-old patient who was treated by our liaison psychiatry unit after a suicide attempt through prescription-drug overdose. The patient had been diagnosed with Parkinson’s disease (PD) ten years prior to his admittance and was being treated with carbidopa/levodopa and non-ergot dopamine agonists.

Impulse control disorders and depression are the most prevalent neuropsychiatric manifestation of PD. According to several sources, this symptomatology is underdiagnosed and undertreated, causing helplessness and distress to patients and their caregivers. Likewise, the accumulated evidence suggests that certain drugs can contribute to the appearance of the aforementioned symptoms.

A case report is presented alongside a review of the relevant literature regarding the neuropsychiatric manifestations in the context of PD and the diagnosis and treatment of these symptoms.

During his treatment, ropinirole was removed while quetiapine was progressively administered (up to 150mg/day). Carbidopa/levodopa regime was increased causing visual hallucinations and delusional jealousy. A careful balance between antiparkinsonian and antipsychotic medication needed to be achieved before discharge.

Neuropsychiatric manifestations in the context of PD are more prevalent than what was thought in the past. Certain medications, particularly non-ergot dopamine agonists could potentially contribute to the onset of these symptoms. Moreover, these manifestations can be underdiagnosed due to the stigma or social burden imposed upon family and / or caregivers. It is important that recent advances in the understanding of non-motor symptomatology of PD could permeate clinical practice to achieve an adequate identification and treatment of these symptoms.

Primary hyperparathyroidism (PHPT), usually caused by a parathyroid adenoma, is characterized by a pathologically high secretion of parathyroid hormone and consequent hypercalcemia. PHPT has a high prevalence among elderly patients and might be responsible for neuropsychiatric symptoms.

We aim to report the rare manifestation of acute psychosis accompanying a PHPT diagnosis, and to discuss the neurobiological relationship between hyperparathyroidism, hypercalcaemia and neuropsychiatric symptoms.

We present a clinical case based on patient’s history and clinical data, along with a literature review on PHPT neuropsychiatric symptons.

We present the case of a 68-year-old man diagnosed with PHPT in November 2019. He was brought up to psychiatric evaluation for the first time in May 2020 upon behavioral changes (aggressiveness and bizarre rituals). The patient described the sensation of burns scattered throughout the body since January 2020, felling anxious and frightened, sleeping poorly and progressive social isolation. He presented delusional ideas of mystical and paranoid content. No significant cognitive impairments were found. The patient’s psychosis was partially responsive to atypical antipsychotics. He’s waiting for surgery. Hypercalcaemia might manifest as mood disorders, cognitive changes and rarely as acute psychosis. Although there is not yet a clear mechanism to explain it, high calcium levels seem to cause neurotoxicity and neurotransmission dysfunction. Restoration of normal calcium levels tend to resolve neuropsychiatric symptoms, but in PHPT parathyroidectomy is usually recommended.

Neuropsychiatric symptoms are responsible for great disability, and demand an organic in-depth investigation. A multidisciplinary team approach must always be considered in the management of such conditions.