European Psychiatry - Volume 33 - March 2016

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S546 24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805
EV614
Preventing self-harm and reducing
suicidal ideation through an
expedited regular supportive
psychotherapy and assertive case
management – protocol for a
three-arm partial randomised
controlled trial
V. Agyapong ∗, T. Behre , M. Juhas , A. Greenshaw
1 University of Alberta, Department of Psychiatry, Edmonton, Canada
2 QE II Hospital, Department of Psychiatry, Grande Prairie, Canada
∗ Corresponding author.
Aim To conduct a three-arm partial randomised controlled trail
to evaluate the effectiveness of expedited regular supportive psy-
chotherapy and assertive case management for patients presenting
with suicidal ideation or self-harm to the emergency department
(ED).
Hypothesis We expect expedited regular supportive psychother-
apy plus assertive case management will reduce the suicidality
and/or suicidal behaviour in patients by at least 20% at 4 weeks
compared to patients receiving only assertive case management or
routine care and these differences will be sustained at 6 months.
Methods This will be a longitudinal, prospective, three-arm con-
trolled single-rater-blinded partial randomized clinical trial with
a recruitment period of 12 months and an observation period of
6 months for each participant. Patients in the intervention group
will receive regular face-to-face or over the phone brief support-
ive psychotherapy during weekdays following presentation to the
ED with suicidal ideation or self-harm until patients are actively
enrolled in regular community mental health services with active
case management by the therapist. Patients in the control and the
assertive outreach arms will each receive the usual follow-up ser-
vices offered routinely to regular patients and assertive outreach
patients respectively who present to the ED with suicidal ideation
or self-harm.
Results Recruitment will commence in February 2016 and we
expect the results of the study to be available by September 2017.
Conclusion If our hypothesis is proved correct, our intervention
will be a new model for caring for patients with self-harm and
suicidal ideation and is expected to reduce suicide rates.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV615
Parasomnias and panic attacks: A case
report
S. Benavente López ∗, N. Salgado Borrego ,
C. Hernández Durán , E. Muro Fernández de Pinedo ,
A.P. García Marín , L. Pérez Ordo˜no , A. Sainz Herrero ,
A.M. Sanz Paloma , R. Barbosa Requena ,
L.T. Vázquez Rodríguez , G. Rodrigo Borja , J. Vila Santos ,
F. Jiménez Morillas , S. Bermejo Lorero , M.L. Castro Arias
1 Hospital Universitario 12 de Octubre, Psychiatry, Madrid, Spain
2 Hospital Dr. Rodríguez Lafora, Psychiatry, Madrid, Spain
3 Hospital Universitario 12 de Octubre, Emergency department,
Madrid, Spain
∗ Corresponding author.
Introduction Parasomnias are a category of sleep disorders in
which abnormal events occur during sleep, due to inappropriately
timed activation of physiological systems.
Case report We report the case of a 41-year-old female who has
no psychiatric history. The patient went to emergency department
because when she was starting to sleep, in the first state of sleep,
she felts a sensation of paralysis in all her body, with incapacity for
breathing, chest oppression and tactile hallucinations like some-
thing or someone was touching her entire body. Due to that, the
patient awoke frightened, with high levels of anxiety, with heart
palpitations, shortness of breath, trembling, choking feeling, sweat-
ing, nausea and fear of dying. When the patient arrived to the
emergency department, she was suffering a panic attack, thinking
that she could have some kind of neurological disease or she was
suffering a heart attack. After treating the panic attack with 1mg
of lorazepam, all the symptoms subsided gradually.
Discussion In this case report, we present a patient with a new-
onset parasomnia, with hypnagogic hallucinations and a panic
attack at the awakening. It is known that stress factors are closely
associated with parasomnias, as we can see in this case because the
patient was moving and she was sleeping in a new place.
Conclusions Parasomnias are very frequently present in general
population and they can trigger intense anxiety status that can lead
to panic attacks.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV616
Hyperthyroidism and psychotic
symptoms: A case report
S. Benavente López ∗, N. Salgado Borrego , L. Arroyave Villa ,
C. Hernández Durán , E. Muro Fernández de Pinedo ,
A.P. García Marín , L. Pérez Ordo˜no , A.M. Sanz Paloma ,
R. Barbosa Requena , M. Gil Mosquera , N. Bermejo Cabanas ,
R. Franco Sánchez-Horneros , I. Fernández Marín ,
A. Rodríguez Miravalles , M.L. Castro Arias
1 Hospital Universitario 12 de Octubre, Psychiatry, Madrid, Spain
2 Hospital Dr. Rodríguez Lafora, Psychiatry, Madrid, Spain
3 Hospital Universitario 12 de Octubre, Emergency department,
Madrid, Spain
∗ Corresponding author.
Introduction Hyperthyroidism may lead to high anxiety status,
emotional lability, irritability, overactivity, exaggerated sensitivity
to noise, and fluctuatingmood, insomnia and hyporexia. In extreme
cases, they may appear delusions and hallucinations as psychiatric
symptoms.
Case report We report the case of a 53-year-old female who was
diagnosed of hyperthyroidism and generalized anxiety disorder.
The patient went to emergency department because of high levels
of anxiety, with heart palpitations, trembling, shortness of breath
and nausea. She was presenting auditory hallucinations and delu-
sions as psychiatric symptoms. An urgent thyroid profile was made
and it was observed the next results: TSH< 0.005; T4:4; T3:21.
Due to a severe thyroid malfunction, the patient was admitted
and treated with antithyroid agent, improving the psychiatric and
somatic symptoms.
Discussion In this case, a patient diagnosed of hyperthyroidism
and generalized anxiety disorder presented very severe psychiatric
symptoms, with hallucinations and delusions. These symptoms
may be produced by primary psychiatric disorders, but is very
important to look for thyroid alterations, because if they are the
cause, the acute treatment of thyroid malfunction is the correct
management of the patient.
Conclusions Hyperthyroidism is very common in general popu-
lation, being infradiagnosed most of times. In patient with anxiety
or other psychiatric symptoms, it is very important to make a thy-
roid function tests before the diagnosis of a psychiatric disorder. In
extreme cases, hyperthyroidism status may lead to severe psychi-
atric and somatic complications.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.