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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.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.1738

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

1 ,

, V. Guillard

2

, O. Huillard

3

, C. Dubertret

1

, F. Limosin

4

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.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.1739

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.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.1740

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