European Psychiatry - Volume 33 - March 2016

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S410 24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805
EV189
Significant response to amantadine in
a patient with malignant catatonia: A
case report
M. Maki ∗, O. Kato , J. Kunimatsu , T. Sato , S. Fujie
1 National center for global health and medicine hospital, general
internal medicine, Tokyo, Japan
2 National center for global health and medicine hospital, psychiatry,
Tokyo, Japan
∗ Corresponding author.
Purpose Catatonia is a complication of bipolar disorder, which is
a constellation of symptoms such as catalepsy, mutism, and stu-
por. Standard therapy for catatonia contains benzodiazepines and
electroconvulsive therapy. An uncomplicated catatonia is usually
a benign condition. On the other hand, malignant catatonia is a
life-threatening condition that is complicated with fever, auto-
nomic instability, delirium, and rigidity. The syndrome is typically
fulminant and progresses rapidly within a few days without appro-
priate intervention. Several previous reports suggested that some
catatonia are associated with the overstimulation of N-methyl-
D-aspartate (NMDA) receptor, and that amantadine may have an
effectiveness for catatonia, as a NMDA receptor antagonist. We
report a case of successful treatment formalignant catatonia refrac-
tory to benzodiazepines, by using amantadine.
Materials and methods/case A 64-year-old Japanese woman with
bipolar disorder was referred to our hospital because of 8-week
prolonged fever. On admission, she was in febrile and stuporous
states. Severe rigidity was observed in her extremities. Blood tests,
lumbar puncture, and blood cultures were all negative. Brain MRI
was normal. Consequently, we reached a diagnosis of malignant
catatonia, and thus we gave additional benzodiazepines for her
catatonic symptoms. However, there was no improvement, and we
finally add a 50mg/day amantadine for her malignant catatonic
state.
Result Her fever resolved in a few days. Gradual dose-titration
of amantadine led her clinical manifestation to completely disap-
peared.
Conclusion Amantadine can be a potential option as one of the
pharmacological therapies for refractory malignant catatonia.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV190
Social functioning and social
cognition in bipolar disorder: Is there
a connection?
V. Maria Iulia ∗, R.C. Delphine , H. Audrey , K. Arthur
1 Department of Psychiatry, University Hospital of Reims, Reims,
France
2 University Hospital of Reims, Reims, France
3 Cognition, Health, Socialisation Laboratory, EA 6291, Reims
Champagne-Ardenne University, Reims, France
4 Faculty of Medicine, Reims Champagne-Ardenne University, Reims,
France
∗ Corresponding author.
Introduction The research interest in social cognition in bipolar
disorder has increased in a significant way in the last decade show-
ing major impairments, especially in mental state reasoning, even
during euthymia (Samamé et al., 2012; Samamé et al., 2015). Social
cognitive processes in humans describe the ways individuals draw
inferences about other people’s beliefs and the ways they weigh
social situational factors in making these inferences (Green et al.,
2008). A causal relationship between social cognition deficits and
global functioning has been already established in schizophrenic
populations (Green et al., 2015). But there is still little information
regarding the relation between social cognition and social func-
tioning in bipolar disorder.
Aims To review the relationship between general/social func-
tioning and social cognitive impairments in bipolar patients.
Methods A systematic review of literature was conducted. Rel-
evant articles were identified through literature searches in
PubMed/Medline, EBSCOHost and Google Scholar databases dating
from2000 to 2015 using the keywords “bipolar”, “social cognition”,
“theory of mind”, “mentalizing”, “emotion recognition”, “emotion
processing”, “functioning” and “quality of life”.
Results The findings of the review will be discussed, regarding
the specificity of the thymic state of the patients and the social
cognition instruments used.
Conclusions To the best of our knowledge, the present review is
the first to explore specifically the relation between the social cog-
nitiondeficits and the general/social functioning of bipolar patients.
This exploration is of interest for a better comprehension of this
disorder to improve the outcome of the patients.
Keywords Bipolar disorder; Social cognition; Functioning
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV191
First episode of bipolar depression
and suicide attempt after bariatric
surgery in a 45-year-old woman
E. Muniz Magalhaes ∗, R. Gois Campos , L.M. Sarin , J.A. Del Porto
Universidade Federal de São Paulo, Psychiatry, São Paulo, Brazil
∗ Corresponding author.
Introduction Weight loss positively influences mental health
but findings are mixed in patients undergoing bariatric surgery.
The permanent changes in body image, diet-related stress, and
unmet expectations could increase mental health problems such as
major depression and self-harm behaviors. Mixed symptoms dur-
ing major depressive episode were often misdiagnosed as agitated
depression, and should be regarded as a risk factor for suicide and
rapid cycling course of illness.
Method Single case report.
Results A 45-year-old woman, initially diagnosed as a unipolar
depressive episode after bariatric surgery, did not show improve-
ment after SSRI treatment. She had no history of previous episode
but her temperament was described as hyperthymic. Antidepres-
sant worsened irritability, racing/crowded thoughts, heightened
anxiety and aggressive impulses, mood instability, impaired con-
centration, insomnia and she had a suicide attempt (antidepressant
overdose). After mood stabilizer and atypical antipsychotic, symp-
toms fully remitted and she is stable in the last year.
Conclusion Self-harm emergencies after bariatric surgery are
higher than before surgery. Intentional overdose is considered the
most common self-harm mechanism. Psychiatric follow-up after
bariatric surgery and early recognition of bipolar depression with
mixed features as a distinct condition among the variety of depres-
sive syndromes is essential to reduce the risk of self-harmbehaviors
and improve treatment outcomes. Premorbid temperamental fea-
tures, especially hyperthymic and cyclothymic temperaments, are
often responsible for such mixed depressive presentations.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV192
Mood disorder in epilepsy: A case
report
R.A. Baena ∗, I. Mesián , L. Mendoza , Y. Lázaro
1 Hospital Clinico San Carlos, Psychiatry, Madrid, Spain