European Psychiatry - Volume 33 - March 2016

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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some as outdated, it is still an important semiological instrument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.
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.
Psychopharmacology and pharmacoeconomics
EV1000
Atypical antipsychotic switching
versus atypical antipsychotic
combination in schizoaffective
disorder – A clinical case
A. Ballesteros ∗, B. Cortés , A. Petcu , L. Montes , W. Jaimes ,
F. Inchausti
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.