European Psychiatry - Volume 33 - March 2016

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24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805 S655
has been recently described the development of psychotic symp-
toms. Anti-NMDAR encephalitis is an autoimmune disorder that
involves IgG autoantibodies against the NMDA receptor subunit
GluN1. This last fact could support the relationship with the gluta-
matergic model of schizophrenia.
Objective To conduct a current review to deepen the detection
and management of anti-NMDAR encephalitis, due to the fre-
quent existence of psychiatric symptoms at onset, which have
contributed to the difficulty of diagnose.
Method Systematic review of the literature in English (PubMed),
with the following keywords: “Autoimmune encephalitis”, “psy-
chosis”, and “NMDA receptor”.
Results Autoimmune encephalitis appears more frequently in
children and young adults and it is characterized by a prodro-
mal period, in which there usually are non-specific symptoms of
headaches or fever. Next, it could progress to cognitive deficits,
seizures, catatonic symptoms and psychosis. However, sometimes
in the rarest clinical presentations, there is nothing but psychiatric
symptoms at the onset of encephalitis, which leads to misdiagnose
and lack of proper treatment. This fact has stimulated the curios-
ity of the psychiatry scientific community, since the anti-NMDAR
encephalitis may mimic the glutamatergic model of schizophrenia.
Conclusions To make an accurate and detailed diagnostic formu-
lation in people with psychiatric symptoms as onset of any disorder
is essential to determine whether it is a primary psychiatric disor-
der or symptoms associated to another disease.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV957
New-onset psychosis in patient with
untreated HIV
A.T. Carter (MD) ∗, A. Bulbena (MD) , N. Dunn (MD) ,
R. Gersh (MD) , R.G. Swift (MD)
Metropolitan hospital center, psychiatry, New York City, USA
∗ Corresponding author.
Introduction An infection by the human immunodeficiency virus
(HIV) causes damage to the central nervous system directly and
indirectlywhich can result in different psychiatric syndromes asso-
ciated with the onset and progression of the infection including
cognitive impairment, dementia, depression, mania, obsessive-
compulsive disorder, and psychosis. We present the case of a
patient that came to the outpatient psychiatric clinic with acute
psychotic symptoms in the context of HIV infection and antiretrovi-
ral treatment non-adherence. She reported new onset of disruptive
auditory hallucinations and paranoid delusions; at that time, all her
laboratories (including for infectious disease) were within normal
limits except for decreased level of CD4+ T cells and high viral load.
She denied any illicit substance use and her head CT was negative
for any acute disease. Patient required a brief psychiatric hospital-
ization where she was started on low doses of risperidone and her
symptoms resolved after her CD4+ T cells and the viral load val-
ues improved secondary to the antiretroviral treatment. A review
of the literature shows that psychiatric symptoms are common in
patients infected with HIV. Whether these complications are due to
the direct or indirect effects of HIV careful diagnosis and treatment
are necessary.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV958
Limbic encephalitis – notes for
psychiatric clinical practice
F. Couto Gomes
Centro hospitalar psiquiátrico de Lisboa, psychiatry, Lisboa, Portugal
Introduction Limbic encephalitis is a neuropsychiatric syndrome
with an autoimmune basis, treatedwith. Differential diagnosiswith
psychotic and mood disorders is thus essential for effective treat-
ment and the best outcome possible.
Objectives To systematize up-to-date clinical procedures to
identify possible limbic encephalitis cases and conduct proper eval-
uation and treatment of those cases.
Aims To improve differential diagnosis between limbic
encephalitis and psychotic and mood disorders, in psychiatric
clinical practice.
Methods Systematic review.
Results Limbic encephalitis presents sub-acutely with con-
vulsions and mood, cognitive and perceptive alterations. EEG,
neuroimaging, antibody testing and liquor analysis can be use-
ful in diagnosis, and the later also in treatment response
prediction. TPO, NMDA receptor, AMPA receptor, GABA-B recep-
tor and K+ channel antibodies are etiological factors for this
neuropsychiatric syndrome. Treatment consists of corticoids,
immunoglobulin, plasmapheresis, rituximab, cyclophosphamide,
azathioprine, mycophenolate, or the treatment of an underlying
tumor.
Conclusion Proper diagnosis of limbic encephalitis may prevent
disease progression and may improve outcome, according to its
etiology.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV959
Psychoneuroimmunology
alternations as a comorbidity of
post-traumatic stress disorder in
veterans – case report
F. Ðerke ∗, L. Filipovic-Grcic , M. Braˇs , V. Djordjevic
1 University of Zagreb school of medicine, student society for
neuroscience, Zagreb, Croatia
2 University of Zagreb school of medicine, centre for paliative
medicine, medical ethics and communication skills, Zagreb, Croatia
∗ Corresponding author.
Post Traumatic Stress Disorder (PTSD) is defined as an extensive
response to a major traumatic event. Psychoneuroimmunology
represents an integrative approach in tackling and understand-
ing various human diseases and disorders such as cardiovascular,
autoimmune and physical complaints/chronic pain. Psychosocial
context influences brain stress response pathways and modifies
stress-related behavior. In this case report, we observed 5 patients,
veterans from Croatian War of Independence (1990-1995), who
suffer from PTSD. They have altered stress reactivity, as well as
distinct expression for genes involved in immune activation. Those
patients have been found to exhibit a number of immune changes
including increased circulating inflammatory markers, increased
reactivity to antigen skin tests, lower natural killer cell activity,
and lower total T lymphocyte counts. The traumatic event (Croa-
tian War of Independence) generates downstream alterations in
immune function. This case report imply that immune dysfunction
caused by PTSD may mediate or facilitate somatic conditions.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.