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S668

24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805

Objectives

This study reports a case initially diagnosed as

psychotic depression that after a rigorous psychopathologic inves-

tigation revealed to be an unspecified dissociative disorder.

Case presentation

Twenty-four-year-old female, with a past of

psychiatric treatment since 18-years-old, reports brief dysphoric

episodes associated with visions of bleeding clowns and skulls that

were always connected to a psychosocial stressor. At the interview

she asserts that she understands those symptoms as pathological

and caused by her mind, and associate them with external stres-

sors. These episodes were brief and remitted spontaneously. The

mental state examination did not showany psychopathological dis-

turbance. The reduction and suspension of antipsychotics did not

result in worsening of these symptoms.

Results

The psychopathological disturbances reported by the

patient did not represent a true hallucination. The presence of

insight, the evolution and duration of the symptoms, and the asso-

ciation with psychosocial stressors has shown that the phenomena

and symptoms are associated to a dissociative disorder. Therefore,

the prescription of antipsychotics involves unnecessary pharmaco-

logical and clinical risks for this patient at the moment.

Conclusion

Despite the use of psychopathology is considered by

some as outdated, it is still an important semiological instrument

for an accurate diagnosis and planning therapeutic conduct.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.1983

EV999

Atypical cognitive dysfunction due to

brain damage: A case report

C.A. Welte-Santana

, A.F. Macedo de Queiroz ,

N. Merola Fontoura , C. Lima de Melo ,

M. Ribeiro Garcia de Rezende , P.C. Ferreira da Silva , L. Oliveira ,

L. Carvalho de Toledo

Hospital Municipal Jurandyr Manfredini, Ambulatório de Psiquiatria,

Rio de Janeiro, Brazil

Corresponding author.

Introduction

The diagnosis of a primary psychiatric disorder

requires the exclusion of an organic etiology. However, Brazilian

public hospitals commonly lack resources. Diagnostic precision

requires also the congruence of the clinical history and the natural

history of the investigated disorder.

Objectives

This study reports a rare case of hallucinations and

retrograde amnesia, due to organic brain lesion but without other

cognitive impairments.

Case presentation

Fifty-three-years-old male Brazilian, was eval-

uated after one year in Brazil after beingmissing for 25 years inUSA.

Encountering his family, he did not recognize his mother, did not

remember his life in Brazil, including his infancy, nationality and

mother language. He was found as a homeless in poor hygiene. In

the exam, he only presented retrograde amnesia, without any dis-

turbances of fixation memory, intelligence, formal thought, affect

or psychomotor function. Patient reported hallucinations. Blood

tests showed no abnormalities. EEG showed diffuse slow rhythms.

Brain MRI showed cortical and hippocampal atrophy. After weekly

evaluations for 5 months, he remained stable despite lack of pre-

scription. Some weeks after MRI, patient reported frequent alcohol

and inhalant use when missing. No hints of secondary gain were

found until present.

Discussion

Organic etiology was suspected due to atypical

presentation: hallucinations, evocative amnesia, with no fur-

ther cognitive and affect disturbances. This is not compatible

with schizophrenia, dementia or dissociative disorder. The brain

abnormalities and recent data highly suggest this etiological

hypothesis.

Conclusion

Since this clinical presentation does not fit into any

specific psychiatric category, the case will continue to be studied.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.1984

Psychopharmacology and pharmacoeconomics

EV1000

Atypical antipsychotic switching

versus atypical antipsychotic

combination in schizoaffective

disorder – A clinical case

A. Ballesteros

1 ,

, B. Cortés

2

, A. Petcu

3

, L. Montes

4

, W. Jaimes

5

,

F. Inchausti

6

1

Red de Salud Mental Gobierno de Navarra, CSM Estella, Estella,

Spain

2

Consulta Dr. B. Cortés, Psychiatry, Salamanca, Spain

3

Greater Manchester West Mental Health NHS Foundation Trust,

Psychiatry, Manchester, United Kingdom

4

Red de Salud Mental Gobierno de Navarra, Complejo Hospitalario

de Navarra, Pamplona, Spain

5

Hospital de Donostia Osakidetza, Psychiatry, Donostia, Spain

6

Proyecto Hombre de Navarra, Comunidad terapéutica Proyecto

Hombre de Estella, Estella, Spain

Corresponding author.

Introduction

Recent studies suggest that aripiprazole (ARP)

shows a better profile in terms of mental state and extrapyrami-

dal symptoms (EPS) in psychosis. However, other studies consider

that a combination of atypical antipsychotics (AAP) may also be

an option for some refractory patients. We present a case of a

schizoaffective disorder, manic type (SAFM) (F25.0, ICD-10 criteria)

that improved in terms of EPS adverse effects after switching from

long-termfluphenazine (LTF) to Long-acting injectable aripiprazole

(LAIA) but showed relapse symptoms.

Objective

We present a clinical case of SAFM that improved clin-

ically in our outpatient clinic after 1 month of bi-therapy with low

doses of oral risperidone and standard dose of LAIA. We study oral

AAP-LAIA drug combination utility in this clinical setting.

Aims

To study “oral AAP-LAIA combo” benefits in refractory

SAFM cases.

Methods

Our patient is a 68-year-old female diagnosed of SAFM

clinically stable with a combination of lithium and LTF. She pre-

sented severe cogwheel stiffness in the upper limbs and postural

tremor. We switched from long-term fluphenazine to LAIA and 4

weeks later, she showed discrete cogwheel stiffness but also per-

secutory delusions and dysphoria.

Results

We maintained LAIA (400mg/28 days) and lithium

(800mg/day) doses and added-on risperidone 1mg/day. She pre-

sented clinical relapse 1 month later. She kept her better EPS

tolerance as she only had discrete cogwheel in upper limbs only

by using attention distraction techniques.

Conclusions

Oral risperidone-LAIA drug combination appears as

an effective and well-tolerated treatment in refractory SAFM cases.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.1985