European Psychiatry - Volume 33 - March 2016

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24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805 S591
2 Centro Hospitalar Trás-os-Montes e Alto Douro, Servic¸ o de
Psiquiatria, Vila Real, Portugal
3 Centro Hospitalar Trás-os-Montes e Alto Douro, Servic¸ o de
Neurologia, Neuropsicologia„ Vila Real, Portugal
∗ Corresponding author.
Introduction Rapidly progressive dementias (RPD) are conditions
that develop over days, weeks or months, which could be treatable
if diagnosed in the acute phase.
Clinical case A 62-year-old man with personal history of type 2
diabetes, started complaining of fronto-temporal headache, nausea
and sub-febrile temperature. He went to his family doctor who pre-
scribed ciprofloxacin 500mg bid. Later on, he had difficulty to sleep
and referred complex visual hallucinations. His family noted invol-
untary movements of the left upper limb and that he became more
clumsy needing help for daily life activities. He went to our hospi-
tal one week later. He was apyretic and hemodynamically stable.
On neurological examination, he had executive and visuospecial
dysfunction, left limbs bradykinesia and ipsilateral limb ataxia.
Involuntary movements of his left upper limb resembled alien limb
phenomena. Complete blood count, complete metabolic panel,
iron, folic acid, vitamin B12, anti-neuronal antibodies were nor-
mal. HIV, hepatitis B and C serologies were negative. Cerebrospinal
fluid study showed 4 cells (100% mononuclear), normal glucose
and protein levels, negative bacteriological exam but positive Her-
pes Simplex-1 Virus (HSV) DNA. Brain CT and MRI showed signs of
ischemic microangiopathic leukoencephalopathy. He started treat-
ment with acyclovir 30mg/kg/d IV and quetiapine 100mg id. His
symptoms improved but he remained with a mildmnesic cognitive
deficit and bradykinesia that stayed stable 3 years later.
Conclusion This case exemplifies atypical HSV-1 encephalitis,
one cause of RPD, that an early recognition is essential to reduce
its associated morbidity.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV754
Effectiveness of cognitive behavioral
therapy in the treatment of a phobic
disorder in a patient with Down
syndrome and early Alzheimer’s
disease
J. Mallet ∗, V. Guillard , O. Huillard , C. Dubertret , F. Limosin
1 AP–HP, Louis-Mourier Hospital, Psychiatry, Colombes, France
2 Groupe ERIC, Psychiatry, Plaisir, France
3 AP–HP, Cochin Hospital, Medical oncology and ethics, Paris, France
4 AP–HP, Corentin-Celton Hospital, Psychiatry, Issy-les-Moulineaux,
France
∗ Corresponding author.
Introduction Down syndrome was clinically described the first
time in France by Esquirol (1838) followed by Down (England,
1866), to the identification of a chromosomal abnormality in 1959
(trisomy 21), which is the most common abnormality in neurode-
velopmental disorders. Life expectancy increased from 9 years in
1929 to 55 currently. This is a common cause of mental retardation,
and few tools are suitable for the care of these patients, including
patients with Alzheimer’s disease (prevalence of 55% between 50
and 59) or depression (prevalence 30%). No study evaluates the
effectiveness of cognitive and behavioral therapy (CBT) in patients
with Down syndrome but it is known to be effective in Alzheimer’s
patients. Some cases have been reported on the efficacy of CBT on
phobias in patients with intellectual disability.
Objectives and aims To evaluate the efficacy of CBT in the treat-
ment of a specific phobia in a patient with Down syndrome and
early Alzheimer’s disease.
Method Literature review and clinical case of a 51-year-old
patient, hospitalized under constraints for behavioral disorders
(agitation, body treatments refusals).
Results By adapting CBT techniques to the problemof intellectual
disability, treatment against the phobia was effective with clinical
improvement, which allowed a return home.
Conclusion The tools provided by CBT are suitable for the treat-
ment of anxiety disorders in patients with intellectual disability,
especially in patients with Down syndrome. Psychiatric disorders
are under-diagnosed in these patients and under-treated. CBT is an
aid to the treatment. It may allow the dismantling of symptoms and
reduce behavioral problems.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV755
Cretinism muscular hypertrophy: An
unorthodox reflection
H. Mohsin ∗, A. Channa
Liaquat National Hospital, Psychiatry, Karachi, Pakistan
∗ Corresponding author.
The Kocher Debre Semelaigne Syndrome (KDSS) is also known as
cretinism muscular hypertrophy. It is an unusual presentation in
intellectually deficit children, commonly associated with congeni-
tal or iatrogenic hypothyroidism. The incidence of KDSS is less than
10%. It is more common in males, consanguineous marriage and
age range from 18 months to 10 years [4]. The creatinine phos-
phokinase (CPK) is usually elevated [5]. It might be misdiagnosed
particularly when other classical features of hypothyroidism are
not dominant at first presentation. We present a case of 15-year-
old intellectually deficit female. Her epilepsy had been managed
on phenytoin for a decade. She had rigidity, leg cramps, malaise,
oliguria, fever, myxedema, delayed deep tendon reflexes, calf mus-
cle hypertrophy and agitation. Her agitation was controlled by
haloperidol, which worsened the condition by altering her men-
tal status. The patient was initially managed on line of Neuroleptic
Malignant Syndrome due to raised CPK of 40,680 IU/L and mixed
presentation. Nevertheless, no significant change was noticed until
thyroid profile was done to exclude alternative resources. Thyroid
stimulating hormone (TSH) was 74.5 IU, free T3 1.22 ng/dL, and free
T4 0.43 ng/dL. Thyroxine was started along with change in anti-
epileptic and recovery was observed within five days. This case
report highlights the inconsistent finding from previously reported
cases of KDSS. The female gender, non-consanguineous marriage,
slightly delayed onset with primarily neuromuscular symptoms,
and raised CPK is not the frequent demonstration in KDSS. On par-
allel, thyroid work-up is not routinely done, which can lead to
misdiagnosis and mismanagement.
References not available.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV756
Pathologic aerophagia in patients
with intellectual disability: A review
of its pathophysiology, clinical
features and management
S. Sajith∗, W. Wong
Institute of Mental Health, General Psychiatry, Singapore, Singapore
∗ Corresponding author.
Background Pathologic aerophagia is characterised by excessive
swallowing of air resulting in significant abdominal distension or
belching. This is a relatively rare condition in general population but