European Psychiatry - Volume 33 - March 2016

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S656 24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805
EV960
Possible anti-inflammatory role of
perivascular macrophages in a model
of depression induced by chronic mild
stress in rats
A. Sayd ∗, K. MacDowell , L. Monteagudo , D. Martin ,
J.L. Madrigal , J.C. Leza , J.R. Caso , L. Orio , B. Garcia-Bueno
1 Complutense university, pharmacology, Madrid, Spain
2 Complutense university, psychobiology, Madrid, Spain
∗ Corresponding author.
Perivascular macrophages (PVM) are hematopoyetic cells that
migrate to the brain perivascular space modulating the interac-
tions between the immune and central nervous systems (CNS).
Previously, their depletion with the icv administration of the pro-
apoptotic drug clodronate encapsulated in liposomes increased
the vascular production of the proinflammatory prostaglandin E2
(PGE2), the release of ACTH, corticosterone and fever, induced by
the intravenous administration of Lipopolysaccharide (LPS). Fur-
ther studies also demonstrated a decrease in the synthesis of the
anti-inflammatory prostaglandin 15d-PGJ 2.
With this background, we decide to deeper explore themechanisms
involved in the anti-inflammatory profile of PVMby depleting them
in a model of depression induced by chronic mild stress (CMS)
exposure in rats.
Our results showed an increase of the proinflammatory cytokines
TNF , IL-1 and IL-6 at mRNA levels in the prefrontal cortex of the
groups of animals where the PVM were depleted, as well as in the
protein levels of the pro-inflammatory nuclear factor NF- B, the
enzymatic pro-inflammatory enzymatic sources iNOS, COX-2 and
m-PGES-1 and their product PGE2. A concomitant decrease of the
15d-PGJ2 mediator was also observed. In addition, we also checked
whether the depletion of PVMs could regulate the expression of
molecules implicated in the leukocyte traffic and infiltration in the
CNS in our CMS model. Thus, the mRNA levels of the chemokines
MCP-1, fractalkine and the adhesion molecule VCAM appeared
increased in the animals without PVMs.
In summary, our results could suggest a potential anti-
inflammatory role for PVMs in a depression model chronic
stress-induced as CMS.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV961
Management and psychiatric
manifestations of anti-NMDA receptor
encephalitis, a case report
R. Gallego ∗, A. Flores
La Paz hospital, psychiatry, Madrid, Spain
∗ Corresponding author.
Introduction Anti-NMDA receptor (NMDAR) encephalitis, for-
mally recognized in 2007 by Dalmau et al, is an autoimmune
disorder with a complex presentation that includes psychiatric
symptoms, memory deficits, and autonomic instability. The exact
incidence is unknown but age, gender, and ethnicity may all play
a role. Presence of antibodies against the GluN1 subunit of the
NMDAR in the CSF and serum confirm the diagnosis of NMDAR
encephalitis.
Case report We report the case of a previously healthy, 19-year-
old woman, 6 weeks pregnant. She had a generalized tonic-clonic
seizure followed by psychiatric symptoms, including insomnia,
emotional lability, delusions, and disorganized behavior. During
the course of the disease, she demonstrated speech impairments
and catatonic features associated with abnormal movements.
She was provided lorazepam1mg twice a day to treat her catatonic
symptoms, her insomnia and her speech improved. Olanzapinewas
introduced, reaching a dose of 20mg/day for managing psychosis
and agitation.
Discussion NMDA-R encephalitis is a novel disorder with promi-
nent psychiatric manifestations that is widely underdiagnosed.
Neuroleptics may be helpful for managing psychosis and agitation,
but may exacerbatemovement abnormalities. Benzodiazepines are
helpful for agitation, insomnia and catatonia associated with this
condition.
Conclusion Earlier recognition of this illness is crucial as prompt
diagnosis andmultidisciplinary treatment, can potentially improve
prognosis. There is an increasing need for psychiatrists to become
aware of the disorder and consider it in their differential diag-
nosis, specially in patients with new onset psychosis, history of
encephalitis or subtle neurological symptoms. Careful selection of
psychopharmacological interventions may reduce suffering.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV962
Psychiatric correlates in deficit of
immunoglobulins
R. Hernandez Anton ∗, S. Gomez Sanchez , G. Isidro Garcia ,
E. Rybak Koite , A. San Roman Uria , T. Ballesta Casanova ,
J.A. Blanco Garrote , C. Noval Canga , M. Hernandez Garcia ,
L. Rodriguez Andres , P. Gutierrez Garcia , A. Alonso Sanchez
1 HCUV, PSQ, Valladolid, Spain
2 Complejo asistencial de Zamora, PSQ, Zamora, Spain
3 Hurh, MFYC, Valladolid, Spain
∗ Corresponding author.
Introduction Many neurological, oncological and autoimmune
diseases may have psychiatric symptoms; these diseases some-
times start with these symptoms, so the diagnosis may be confused
and the treatment is delayed.
Objective Review the relationship between the secondary
immune deficiency and increased predisposition to infectious
processes and the psychopathological conditions which manifest
themselves in some cases in these situations.
Methods A 17-year-old male patient, who began psychiatry con-
sultations when he was 3 years old due to psychomotor delay and
behavior disorders. He was diagnosed with ADHD and mild men-
tal retardation. Medical history: Viral encephalitis; Perthes disease;
recurrent urinary tract infections; intestinal giardiasis; Alport syn-
drome. He’s being treated with aripiprazole 5mg (1/2-0-0).
The patient presents an episode of perplexity, psychotic anguish,
auditory hallucinations and paranoid delusion. The patient pre-
sented an infectious process with general malaise, diarrhea and
vomiting during previous days.
Results The patient was assessed by the Departments of inter-
nal medicine, neurology and psychiatry. A cerebral TAC, lumbar
puncture, EEG and urine porphyrins were requested. The secondary
immune deficiency makes the patient more vulnerable in an infec-
tious process.
Discussion The diagnosis of psychotic disorder due to medical
condition may be transient or recurrent. Treating of the medical
condition often gets resolution of psychosis, although the symp-
toms can persist in some cases. There is often a prodomo of viral
syndrome weeks before the rest of symptoms appear. The differ-
ential diagnosis should be made with primary psychotic disorders,
affective disorders, confusional syndromes, impulse control disor-
der or sleep disorders, neuroleptic malignant syndrome, serotonin
syndrome and substance-induced psychotic disorders.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.