Delusional infestation (DI), also known as delusional parasitosis or Ekbom syndrome, is a rare disorder, characterised by fixed belief that the skin, body or immediate environment is infested by small pathogens, despite the lack of any medical evidence for it.

To describe and discuss two clinical cases of DI, in order to show two different ways of presenting in this entity.

Two case report and non-systematic review.

We present the case of a 76-year-old woman, without psychiatric history, with an DI with 5 years of evolution, referred to a psychiatric consultation by a dermatologist. The second case, is a 41-year-old woman with a history of multiple substance use disorder, with an DI with a month of evolution, who resorted to the emergency department. DI is not a single diagnostic entity. The classic form, as represented in the first case,is a primary form, which develops without any known cause or underlying disease, corresponding to a persistent delusional disorder. However, about 60% of patients have secondary forms of DI, in the context of substance misuse, some medications or in the course of physical or psychiatric diseases (e.g. stroke, delirium, dementia, depression, schizophrenia).

DI can occur as a primary delusional disorder or secondary to several other medical conditions. An in-depth clinical history is essential in order to make the correct diagnosis. A multidisciplinary approach is also important, to exclude any possible organic etiology, not forgetting that many patients may turn to other medical specialities first.

No significant relationships.

Since Ancient Times, Man has tried to analyze the passage of time, looking for repetitions, relating them to space to build a notion of a mechanical and chronological time. The idea and problem of time play a central role in both modern philosophy and psychiatry. Many authors contributed to the notion of “lived time” and placed the focus on how time is lived and perceived by the individual. Even though the notion of “time assimilated in space” has an important role in psychiatric nosology, the “lived time” has a psychopathological impact and is a field of study and debate.

This work aims to acknowledge the relevance of the experience of temporal structures (past, present and future) and how they relate to psychopathology.

We did a non-systematic literature revision in the main databases.

Phenomenological psychopathology has been profoundly interested in the philosophical discussions on the nature of time and its relation with the subject’s experience and condition. For instance, the melancholic experience, the maniac experience and the schizophrenic experience constitute changes in how time structures are perceived and lived by the individual.

Temporality has drawn attention to researchers from many different areas of study, having as of this day many approaches possible. It is important to know those contributions and conceptualizations in order to improve as a clinician.

No significant relationships.

Traumatic experiences has a key role on the mental health of individuals. Turkish Armed Forces has been involved in various combat in and out of the country over the years. Individuals who are able to find meaning after a negative life events are better overcome their issues and return to their positive functioning. Unhealthy attachment styles has been observed more in clinical samples than healthy attachment styles.

The aim of this study was to investigate the predictive role of attachment styles and meaning in life on psychiatric symptoms among wife of military personel who lost their lifes.

74 women who lost their husband in combat to the study. Their age was between 21 and 74, with the mean of 46.93. 60 (75.9%) participants had a child when they lost their husband. 63 (79.7%) of them hasn’t been married again. Brief Symptom Inventory, Meaning in Life Scale and Relationship Scales Questtionnare were used to collect the data. Five different regression analysis was conducted.

Finding meaning in life, dismissing and preoccupied attachment sytles predicted depression (R2= 51.8%). Finding meaning in life and fearful attachment styles predicted anxiety (R2= 46.2%). Finding meaning in life and fearful attachment styles predicted negative identity (R2= 51.1%). Finding meaning in life and dismissing attachment styles predicted hostility (R2= 50.4%) and somatization (R2= 57%).

Meaning in life has a protective role in the development of any psychopathologies whereas insecure attachment styles are risk factor.

No significant relationships.

Delusional Disorders with Religious Content (DDRC) require careful study concerning their prevalence, psychopathological heterogeneity and the risk of destructive behavior.

To classify the clinical forms of DDRC

By clinical-psychopathological, follow-up and statistical approaches 2523 cases of patients with mental disorders who received inpatient care in a state clinic for year were analyzed; in 225 cases of total 2523 delusional disorders in schizophrenia (ICD-10: F20.0, F20.01, F20.02) were diagnosed.

The comparative analysis of delusional disorders (225 cases, 100%) with religious (70 cases -31.1%) and non-religious content (155 cases - 69.9%) revealed prevalence of DDRC in non-believers (p <0.01). Delusional destructive behavior occurred in 47.1% of 70 cases in patients with DDRC (15% of total 225).

The predominant content of DDRC (among the Delusions of Possession, Sinfulness/guilt, Messianism, Manichaean and the End-world Delusions) was the Delusions of Possession - 36.8%. Psychopathological heterogeneity of DDRC was identified and specific types of DDRC were described.

DDRC is associated with the development of massive psychopathological symptoms and significant severity, and often accompanied by various forms of destractive behavior. This circumstance requires constant and careful management of these patients, collection of their religious history and asks for specific therapeutic approaches.

No significant relationships.

Diagnostics of Apocalyptic variant of end-world Delusion with Religious Content (ADRC) in schizophrenia is related with insufficient exploration and recognizability, despite the severity of the state, social risks and resistance to psychopharmacotherapy.

To define psychopathological and phenomenological features of ADRC in schizophrenia, to identify the clinical dynamics of delusional disorders due to specifics of the delusional behavior, and to develop diagnostic and prognostic criteria.

28 patients with ADRC in schizophrenia were examined (ICD-10: F20.0, F20.01, F20.02). Clinical-psychopathological and statistical methods were applied.

Delusional ideas of end-world, Apocalyptic variant, occurred in the structure of affective-delusional state (acute sensual delusion with fantastic content). Two types of ADRC were identified: with the predominance of acute sensory delusions of perception and with the predominance of visual-figurative delusions of the imagination. These types differed in the severity and depth of psychotic manifestations and in the specifics of a delusion formation, were characterized by the mono- or polythematic delusional disorders.

Cases of ADRC differ both in the clinical-psychopathological specifics of delusional constructions, and in the socio-behavioral aspect. Among these cases, there is a high risk of delusional destructive behavior, with auto-aggressive, suicidal attempts and hetero-aggressive behavior. In cases with ADRC the strong persistence of delusional pseudo-religious beliefs occurs, with the refusal of any medical and psychological assistance, as well as implication of socially dangerous acts associated with the spread of delusional ideas and their induction of religiously inclined persons, which leads to the emergence of pathological pseudoreligiosity (distortion of traditional canonical religious views).

No significant relationships.

One of the central debates in the psychiatric community is the difficulty in distinguishing Dissociative Identity Disorder (DID) from Borderline Personality Disorder (BPD). The fact that core symptoms of these pathologies such as emotional dysregulation, alterations in sense of Self, amnesia, depersonalization, self harm, hearing voices, difficulties in maintaining relationships, are symptoms that feature in both disorders can lead physicians to a misdiagnosis, thus depriving patients with DID of adequate treatment.

To report a complex clinical case of a DID patient initially misdiagnosed as BPD.

Clinical case report.

A 45-year-old Caucasian woman with a history of childhood intrafamilial sexual abuse and domestic violence, substance use disorder, autolesionistic and suicidal behaviour with an active diagnosis of BPD presented to our ambulatory mental health care service. A more thorough examination revealed a history of emotional and affect dysregulation, depersonalization, amnesia, intrusive traumatic memories and nightmares with affective, cognitive, and sensorimotor aspects, persistent negative Self-perception. Auditory verbal hallucinations were also present described as inner space with commentary and derogatory nature with one of them being a child voice. The diagnosis of tertiary structural dissociation and DID was finally made when three Apparently Normal Personalities emerged with several Emotional Personalities, authorising for cautious partial pharmacological washout and initiation of three phase-orientated treatment approach.

DID is more common than is assumed and the overlap of core symptoms with other disorders can lead to a misdiagnosis. A careful clinical interview and evaluation of symptoms is mandatory to a correct DID diagnosis with a consequent appropriate therapy.

No significant relationships.

Delusional Syndrome of Possession in schizophrenia (DSPS) is insufficiently explored. Although it characterized by significant severity of clinical state and resistance to psychopharmacotherapy, and may be accompanied by high social risks.

To carry out clinical and psychopathological differentiation of DSPS and to define its personalized diagnostic and prognostic criteria.

66 patients with DSPS were observed (F20.0, F20.01, F20.02 according to ICD-10) by psychopathological, psychometrical and statistical methods.

Persistent delusional conviction of patient in invasion of certain «spiritual being» (demonic or divine) inside of the body and soul is the specific core of DSPS. The psychotic episode with DSPS has similar pattern with paranoid syndrome of Kandinsky–Clérambault. Although, the structure of the syndrome is varying, and characterized by predominance of hallucinatory or delusion symptoms. According to these varieties two different types of DSPS were identified, which were observed in continuous or paroxysmal course of disease. The forms of destructive delusional behavior were also different for both of these types.

Delusional Syndrome of Possession in schizophrenia (DSPS) is complex and diverse phenomenon, due to religious content of delusional disorders, which occurs in specific psychopathological structure of psychotic state. This fact may cause controversy both in psychiatric practice and in religious communities. So, the obtained data could be important for social and treatment predicting, as well as for pastoral counseling.

No significant relationships.

The term pathological pseudoreligiosity (PPR) has been chosen for description of mental disorders with religious content (MDRC), accompanied with distortion of acceptance and assimilation of religious convictions, and with significant changes in patient’s religious behavior and way of life.

To assess the entire spectrum of mental pathology with religious content and relate it to the depth of mental disorder.

857 patients (300 males, 557 females), with religious worldview and mental disorders were observed with psychopathological and follow-up methods.

The pathological pseudoreligiosity was detected in 326 patients – 38%. Follow-up period estimated mean 9,5 years. Next mental disorders with religious content were identified and described. Specific PPR types were correlated with register of the depth of mental disorder (K. Schneider):

Management and treatment of patients suffering from MDRC with pathological pseudoreligiosity requires a particular approach. The consideration must be given to religious content of mental disorders and to clinical specifics of these disorders.

No significant relationships.

INTRODUCTION-OBJECTIVES. Similar to philosophy (regina-scientiarum) is psychiatry fundamental-discipline for all-medical&social sciences. Immanuel KANT: Primus inter pares of ARISTOTELES&PLATON considered over 200years ago physiological and pragmatic anthropology-[1]. Social physiology is given-[3-4]. Consideration of social-psychopathology in German-justice-[2].

REFERENCES. [1]-Kant,I: BdXI,371-393, BdXII,399,625-638:Suhrkamp-TB-Wiss. [2]-Neu,E/Michailov, M.Ch/Welscher,U/et-al.: 2a.-FISP-2018-Beijing/Philos (1348-50,1373-4,1420); 2013-Athens Abstr.Book(AB):464-5/503-4/766; 2008-Seoul-ProcVol.4: 101-108/195-214/229-237; 2003-Istanbul:273-281; IVR-2019-Luzern (Law), Progr-Book p.116. 2b.-EPA-2020-Madrid, Eur.Psychiatry 63S, EPP0834/5+EPV0581/1470; EPA-2019-Warsaw, 56S,S689; EPA-2018-Nice, 48/S1, S623&567&662. 2c.-WPA-2021-Bangkok (in-press). 2019-Lisbon, E-Poster WCP19-2137/-1822/-1839. 2018-Mexico-City, Abs.-Book WCP18-0584/-0625/-0643/-0654. 2011-Buenos-Aires, AB:PO1.200. [3]-Glasachev,O: Sechenov Physiol.J 80/no5, 1994,p.139-143 (Russian), ref. in English. [4]-Seeley,T.D: Social-Physiology Honey-Bee, Book-1996.

[5]-Daily-journal-“tz”-München, esp. every Tuesday 2016-2019: reports on Res.-Houses,e.g. 14.02.2019, 15.02.17, 06.12.16/p.10, 18.10.16/p.10, 17.11.2020/p.6. Süddt.Zeitung-München no172/p.30,2017. Mü.-Merkur:16.11.2020/p.32; 19.11.2020/p.29. FAZ:20.10.2019/p.53; 16.11.2020/p.21. BUROW,P: Justiz am Abgrund&Ein Richter klagt an. GNISA,J, Präs.-Dt.Richterverein: „Ende der Gerechtigkeit“, Herder-2017. SCHLEIF,T/Amtsrichter: Buch „Urteil: ungerecht“, zeit-online 24.10.2019. Hans-Jochen&Liselotte VOGEL:„Mehr Gerechtigkeit“, 2019 „Wohn-Irrsinn“(Enteignungen). ZANTKE,S (Richter-Amtsgericht-Zwickau): TV-Programm„Auf einen Blick“ Nr.47,2018,S.24. [6]-Luetge,Ch et-al.(ed): Experimental-Ethics, Palgrave-Macmillan 2014. [7]-Pegoraro,R/Vatican: «Arzt&Christ» 38:3-55,1992.

RESULTS Prominent German experts for justice: Patrick BUROW, Jens GNISA/President Law-Association/Germany, Torsten SCHLEIF/Amtsrichter, Hans-Jochen VOGEL/Ex-Minister, Stephan ZANTKE/Richter reflect in their books fundamental-criticism of German justice [5]. Inst.-Ecol.-Med./IUM investigated psychopathology of juridical-offices&law-court in Munich (Amtsgericht). Analysis suggests presence of symptoms for pseudologia-phantastica, psychopathy, cyclophrenia (esp.mania),etc. conc. observations on many persons (n>30).

CONCLUSION. Juridical situation in Germany demonstrates contradiction to human-rights (EU-CHARTA, art.1-8/25-26/33-35), ignoring moral-philosophy, related to human obligations/I.Kant-[1], experimental ethics/Ch.Luetge et-al.-[6], medical personnel/R.Pegoraro-[7]. Only paradigm change in law-policy incl. enlarged implication of moral philosophy-theology, psychiatry-psychology, social philosophy in juridical eduction & practices could counteract disastrous juridical situation in Germany and on global level, supporting UNO-AGENDA21 for better education-health-ecology-economy (see 2.).

No significant relationships.

Ayahusca has potential therapeutic beneffits.

Expose the potential beneffits of ayahuasca from neuropharmacology and clinical existing evidence.

A literature review was carried out in the databases pubmed, clinical key and texts of scientific dissemination.

There´s scientific literature about the potential therapeutic use of ayahuasca in dependencies, anxiety symtoms and depression, near death experiences and terminal illnesses. Possible benefit is postulated in impulsivity and personality disorders. It induces an introspective state, triggered by thoughts, emotions and autobiographical memories, which promotes reflection on personal issues, allowing new perspectives on certain life issues. It is common for users to describe it as analogous to a psychotherapeutic intervention. 5HTA2 agonists stimulate the expression of genes that encode transcription factors such as c-fos, egr 1, egr 2 and brain-derived neurotrophic factor (BDNF), which influence neuronal plasticity and are associated with cognitive aspects such as memory and attention. MAOIs and 5HT2A agonism have anxiolytic and antidepressant effects. Sigma -1 agonism promotes neuroplasticity. Decrease and remission in the consumption of alcohol and cocaine has been reported in patients with abuse and dependence. There has been significant decrease in depressive symptomatology, in observational studies, cases and controls and double blind compared with placebo. Improvement in different domains measured with mindfulness scales, similar to those observed in meditators, suggests an association between mindfulness techniques and experiences with ayahuasca.

There is existing evidence about potential therapeutical uses of ayahuasca. More studies are needed with biger samples, to establish it´s clinical use.

No significant relationships.

Stimulants are considered the mainstay of treatment for attention-deficit/hyperactivity disorder (ADHD), and most patients are put on a long-term regimen with these psychostimulants. However some children treated with psychostimulants have reported psychosis as an adverse effect.

Understand the capacity of psychostimulant medications to induce psychotic symptoms and determine the frequency of such reactions in adolescents and young adults.

Non-systematic review of the literature in English, through research in PubMed. Additionally, a clinical case is exposed, which was treated at the psychiatric inpatient unit of the Tamega e Sousa hospital center.

Some patients, including some with no identifiable risk factors, can develop drugrelated signs or symptoms of psychosis or mania, such as hallucinations, at usual doses of frequently used ADHD drugs. Age of onset of psychosis can be significantly earlier in individuals with a history of stimulant use. In our clinical case, a young man of 18 years, previously diagnosed with ADHD, was medicated with atomoxetine two months prior being admitted to our psychiatric unit. There was no reported history of a similar psychiatric condition, and no risk factors were identified. At admission, he had bizarre behavior, with allucinatory activity and delusions of persecution. Atomoxetine was suspended and started oral antipsychotic, with improvement of symptoms and stabilization of the clinical condition.

In adolescents and young adults with ADHD undergoing stimulant therapy, any psychotic symptoms or mood changes need to be carefully assessed at regular intervals by the physicians and the caregivers, in order to observe change in the symptoms.

No significant relationships.

The need for preventive mechanisms in psychiatric pathology has been raised, therefore authors talk about primary, secondary and tertiary prevention. However, this emphasis on those preventive aspects has tended to ignore an essential part: quaternary prevention.

Reflecting the importance of avoiding ignoring iatrogenic forms of psychopathology by studying a clinical case and reviewing available literature.

We will present a clinical case of a patient with residual schizophrenia who undergoes an escalation of pharmacological interventions that lead to functional deterioration after initiating behavioral alterations. We will also review available literature about quaternary prevention.

M. is an institutionalized patient who was taking a combination of three neuroleptics, anxiolytics and stabilizers for the treatment of behavior problems such as heteroaggressiveness. When the patient was referred to psychiatry consultations after being hospitalized, he could not move, had lost sphincter control and had serious communication problems. However, treatment was suspended and only one neuroleptic was maintained. The patient regained sphincter control and kept a residual but communicative delusional speech.

It is important to see how sometimes we can get into therapeutic escalation without correcting the underlying problem by focusing on a symptom, because behavioral alterations will persist regardless of pharmacological treatment changes. Sometimes clinical fluctuations make us confuse basal state and decompensation, ignoring the fact that we lack the way to modify the course. Authors believe that a rational approach to treatment should take into account the balance between potential benefits and side effects applied to an individual patient.

No significant relationships.

Lorazepam is a benzodiazepine derivative that is globally used for the therapy of anxiety and insomnia.

The objective of our work was to show that Lorazepam can be a cause of unexpected liver injury even though it is a rare entity.

We reported the case of a patient who had a Drug-Induced Liver Injury (DILI) under Lorazepam. We performed a literature review based on a PubMed search with the following keywords: “Lorazepam,DILI”.

A 20 year-old-Tunisian woman was hospitalized in the psychiatry department of the hospital of Nabeul in Tunisia for a brief psychotic episode.She had a DILI under Olanzapine, Chlorpromazine and Lorazepam, which conducted us to interrupt her treatments except for the Lorazepam(5mg/day). The hepatic tests went back to normal even under Lorazepam. Few days later, the liver enzymes increased again to reach very high levels. Extensive workup was negative for other causes of liver injury, including viral hepatitis A, B, C and E.; capillary electrophoresis of serum proteins was normal; Exhaustive immunological tests were performed searching for auto immune hepatitis(anti-smooth muscle antibodies, anti-LKM1, anti-LC1, anti-SLA/LP) primary biliary cholangitis(anti-mitochondrial antibodies, anti-GP210, anti-sp100) and other antibodies like antinuclear antibodies were negative. Liver biopsy showed polymorphic inflammatory infiltrate including some eosinophilic polynuclear cells and rare vaguely epitheloid macrophages, with necrotico-inflammatory foci in the lobules, all of which were consistent with DILI. Lorazepam was discontinued and within 10 days her liver enzymes decreased and completely normalized.

Lorazepam, with an unknown action mechanism, can be a cause of DILI.

No significant relationships.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous drug reaction characterised by both systemic and cutaneous clinical manifestation with a mean latency period of 3.9 weeks.

To underline the importance of an early diagnosis of DRESS SYNDROME.

We reported a case of carbamazepine induced DRESS syndrome with atypical chronology of manifestations.

A 43-year-old man with no previous known medical history was admitted in psychiatry. He experienced a relapse of schizoaffective symptoms. In the last three years, the patient was treated by Valproic acid as a mood stabilizer. Because of the unavailability of this molecule, carbamazepine was prescribed in combination with antipsychotics. Three days later, the patient developed a high fever, hypotension, a pruritus, a facial oedema, a skin rash associated to lymphadenopathy. Laboratory findings showed a lymphopenia, eosinophilia and elevated liver chemistries. In order to define the case, RegiSCAR scoring system was used, and our case is categorized as probable with a score of five. Carbamazepine was discontinued upon clinical manifestationsand the patient was treated with systemic antihistaminic treatment associated to methylprednisolone with a good outcome. After 3 weeks, clinical and biological improvement were noted.

Despite the absence of a delayed onset, typically between 3 weeks and 3months, we can diagnose dress syndrome 3 days after carbamazepine intake. This case highlights that psychiatrists should be aware of the risk of early onset dress syndrome associated with carbamazepine and they should monitor for warning symptoms from treatment initiation.

No significant relationships.

Therapeutic effect of Qinghuanling on negative symptoms and cognitive function of schizophrenia

To evaluate the therapeutic effect of Qinghuanling on cognitive impairment in schizophrenia, and to provide basis for clinical medication.

24 male patients with schizophrenia were randomly divided into study group and control group. The study group was given quetiapine fumarate combined with Qinghuanling, and the control group was given quetiapine fumarate. The positive and negative symptom scale (PANSS) and adverse event response scale (TESS) were evaluated regularly.

The PANSS score of the study group was significantly lower than the control group from 6th week (64.10 ± 7.64 vs 72.31 ± 11.16; 51.60 ± 7.40 vs 63.23 ± 7.08, P < 0.05). Among them, the score of negative factor in the study group was significantly lower than that in the control group at the end of 6 and 8 weeks (2.16 ± 0.40 vs 2.75 ± 0.38; 1.65 ± 0.42 vs 2.38 ± 0.43, P < 0.01); the score of cognitive factor in the study group was significantly lower than that in the control group at the end of the 8th week (1.87 ± 0.20 vs 2.12 ± 0.27, P < 0.05). Compared with before treatment, PANSS score and symptom cluster factor score of the two groups were significantly decreased from the 2nd weekend to the 8th weekend (P < 0.05).

The combined use of Qinghuanling can significantly improve the therapeutic effect of schizophrenia, especially for the symptom cluster score of negative factors and cognitive factors, with high safety.

No significant relationships.

Eslicarbazepine Acetate, a novel anti-epileptic drug has been approved as monotherapy in focal onset seizures, with/without secondary generalization in adults. Eslicarbazepine has many advantages over older anti-epileptic drugs and is useful in patients of new onset focal epilepsy.

Aim of our study was to determine the efficacy and safety of Eslicarbazepine Acetate, observe its well-tolerated use and monitor adverse effects in newly diagnosed patients of focal epilepsy.

Study was done at Department of Psychiatry, Teerthanker Mahaveer University, Moradabad. A total of 30 newly diagnosed cases of focal epilepsy between 18-60 years of age were studied for 6 months, using a Semi-structured Interview and Liverpool Adverse Events Profile.

Majority of patients were males (58%), between 21-30 years. Patients with partial/focal seizures (63%) were more common than those of generalized seizures (37%). Majority of the participants had 1-2 episodes of focal seizures weekly(48%), while some had almost daily(32%). Majority were on Eslicarbazepine Acetate 800 mg in two divided doses daily (64%), while the others received 1200 mg in three divided doses(32%). The mean Liverpool Adverse Events Profile score initially was 28.34 ± 6.28 which significantly improved after 4 weeks treatment to 22.80 ± 4.35 (p < 0.05). The improvement in newly diagnosed focal seizures patients was significantly more than other patients (p < 0.05). No major side effects were observed.

Eslicarbazepine Acetate as a monotherapy is effective in treating focal epilepsy. Better results of this drug are found in newly diagnosed focal epilepsy patients.

No significant relationships.

Glucagon-like peptide-1 (GLP-1) is an endogenous peptide that stimulates insulin secretion and decreases glucagon secretion. The use of GLP-1 receptor agonists (GLP-1RA) showed efficacy reducing the weight and glucose levels in patients with and without type 2 diabetes. This effect was also associated with a decreased risk of major cardiovascular events.

Our aim is to review the role of GLP-1RA in psychiatric patients at cardio-metabolic risk due to antipsychotics treatment.

We reviewed articles published in PubMed using the keywords: “GLP-1” “glucagon like peptide” “antipsychotics” and “psychiatry”.

The number need to treat (NNT) to achieve clinical meaningful weight loss was 3.8. GLP-1RA treatment was also associated with greater reductions in body mass index, fasting glucose, HbA1c and visceral fat. This effect is true for antipsychotic treatment in general and for those on clozapine and olanzapine in particular. Overall, the GLP-1RA are well tolerated with nausea being the most common related adverse effect. Other variables such as age, sex, psychosis severity, nausea or any adverse drug reaction did not affect the weight loss.

Studies showed a promising role in the management of antipsychotics induced weight gain, particularly in clozapine and olanzapine treated patients. Although these promising results, the route of administration, with a daily or weekly subcutaneous injection, and the GLP-1RA associated financial costs, can be viewed as important factors which can limit the wide use of this type of treatment in psychiatric patients.

No significant relationships.

Levetirazetam is an antiepileptic drug with psychiatric adverse reactions. It includes psychosis, paranoia or hallucinations. The frequency is less than 1%.

To describe and study a case of Psychosis produced by Levetirazetam

Retrospective review of clinical records and complementary test, including psychiatry, electrophysiology and neurology. Diagnosis schales such as Salamanca Questionnaire were used as suport.

A 42-year-old woman diagnosed with tuberous sclerosis and undergoing treatment with levetirazetam acudes to the emergency department for behavioral disorders. She has presented an episode of aggression against a relative threatening him with a kitchen knife. The family reports that since the change in antiepilepticus 1 month ago, the patient has presented strange behaviors. Te Patient is conscious, uncooperative. Barely Approachable. Suspicious of her surroundings, with psychomotor restlessness, self-reference ideas and sparse speech. Auditory hallucinations seem to be present, as well as depressed and irritable mood. Psychic and somatic anxiety is found. Levetirazetam is discontinued, being replaced by valproic acid. Risperidone is started at a 3 mg dose. Treatment is well tolerated, and clinical stability is achived. Cluster A personality traits are found. Complementary test Blood and Urine simples, Imaging tests (CT and MRI), electroencephalogram and Electrocardiogram show no alterations

Levetirazetam can cause psychiatric adverse effects. it is important to make a proper diagnosis before a first psychotic outbreak in later life. Drugs that can produce psychiatric side effects should be identified and patients should be inform.

No significant relationships.

Galactorrhea wiht antidepressants SSRIs or SNRI is a rarely adverse effect. Some authors believe that the risk of galactorrhea in women who use SSRIs is 8 times higher than in patients treated with other types of drugs. Serotonin is believed to be a potent physiological stimulator of prolactin release.Prolactin stimulates the growth of the mammary glands and the galactorrhea. The SSRIs would activate the serotonergic pathways, these in turn would stimulate the release of prolactin directly in the pituitary and in the hypothalamus, inhibiting the release of dopamine and increasing the release of stimulating factors. The main inhibitor of prolactin secretion is dopamine.

The objective is to reveal this rare complication through the report of a clinical case

A 45-year-old woman with a diagnosis of mixed anxiety-depressive disorder. Treatment with 20 mg of escitalopram was started, with a good therapeutic response, but with breast pain and swelling. She was switched to duloxetine 60 mg, with a good response and adequate tolerance. At 6 months of treatment, she begins to present breast pain and yellow-green breast discharge, with elevated prolactin levels and normal cranial MRI.

She was diagnosed with functional hyperprolactinemia, and treatment with vortioxetine was started. Finally, the Prolactin levels normalize.

Galactorrhea is a very rare and annoying side effect that can lead to discontinuation of treatment and requires a change in the therapeutic strategy.

No significant relationships.

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.