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

S783

EV1363

Psychosis due to traumatic brain

injury – controversies and diagnoses

difficulties

A. Amorim

São João da Madeira, Portugal

Introduction

A traumatic brain injury (TBI) can cause numerous

psychiatric complications. Humor and anxious disorders, person-

ality disorders and psychoses are some of those possible problems.

The diagnosis of psychosis due to traumatic brain injury (PDTBI),

although controversial, has been subject of crescent debate and the

idea that a TBI could cause a psychosis is gaining credibility. Diag-

nosing a PDTBI can be difficult. DSM-5 criteria are rather vague and

there are many potential confounding factors due to similarities

with other etiological psychosis.

Objectives and aims

Alert clinicians to the diagnosis of PDTBI,

clarify this clinical entity and define features that may allow them

to do the differential diagnosis with other etiologic psychotic dis-

orders.

Methods

The authors performed a research in PubMed using the

keywords psychosis and traumatic brain injury and selected the

adequate articles to meet the objectives proposed.

Results

Differential diagnosis of PDTBI should be done with

schizophrenia, schizoaffective psychosis, delusional disorder,

substance-induced psychosis, psychosis due to other medical con-

dition andwithposttraumatic stress disorder. Differentiating PDTBI

and schizophrenia can be particularly difficult. Some features

have been proposed in the literature as potentially differentiat-

ing, namely the presence of negative symptoms (more common

in schizophrenia), findings in MRI/CT and EEG.

Conclusions

Establishing PDTBI diagnosis can be difficult. While

awaiting new studies, clinicians should, in cases of TBI related psy-

chosis, achieve a meticulous clinical history and mental exam, in

order to ensure a correct diagnosis and, therefore, determine an

appropriate intervention.

Disclosure of interest

The author has not supplied his/her decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.2348

EV1364

Acute psychosis induced by

short-term treatment with

methylprednisolone – a case report

I.A. Andrei

1 ,

, A.M. Cristache

2

, M.E. Parfene-Banu

2

, A.A. Frunz˘a

1

,

M.C. Boer

3

, M.G. Puiu

4

, B.E. Patrichi

5

, M. Manea

4

1

“Carol Davila” University of Medicine and Pharmacy, Psychiatry

and Psychology, Bucharest, Romania

2

“Prof. Dr. Al. Obregia” Psychiatry Hospital, IVth Clinical Department

of Psychiatry, Bucharest, Romania

3

“Prof. Dr. Al. Obregia” Psychiatry Hospital, “Prof. Dr. Al. Obregia”

Psychiatry Hospital, Bucharest, Romania

4

“Carol Davila” University of Medicine and Pharmacy, Psychiatry

and Psychology Department, “Prof. Dr. Al. Obregia” Psychiatry

Hospital, IVth Clinical Department of Psychiatry, Bucharest, Romania

5

“Carol Davila” University of Medicine and Pharmacy, Psychiatry

and Psychology Department, “Prof. Dr. Al. Obregia” Psychiatry

Hospital, IXth Clinical Department of Psychiatry, Bucharest, Romania

Corresponding author.

Steroid treatment has been widely used for immunologic and

inflammatory disorders. Psychiatric symptoms are not uncom-

mon complications of the corticosteroid treatment. Correlations

between the hypothalamic-pituitary-adrenal (HPA) axis and var-

ious psychoses have been already established in the specialty

literature (modified HPA activity by drugs or not, glucocorti-

coid receptors downregulation, reduced hippocampal volume). The

prevalence of corticosteroid-induced psychotic disorders varies

around 5–6%. Most corticosteroid-induced symptoms start dur-

ing the first few weeks after treatment initiation, but their onset

can also be in the first 3–4 days. We would like to report the

case of a 30-year-old woman who was taken to the psychiatry

emergency room for psychomotor agitation, auditory and visual

hallucinations, and bizarre delusions, disorganized thinking and

modified behavior. The patient had no personal or family history

of psychiatric illness. One month earlier, she was admitted in a

neurosurgery ward and underwent lumbar surgery for L4–L5 disc

protrusion; at discharge, eight days later, she began treatment with

methylprednisolone 80mg/day for three days. One week later, psy-

chotic symptoms emerged that resulted in her hospitalization in

our ward for apparent steroid-induced psychosis. Treatment with

risperidone (up to 6mg/day) and diazepam (10mg/day, rapidly dis-

continued) was initiated. The endocrinology examination revealed

modified plasmatic cortisol. The psychosis resolved several weeks

later and the patient was discharged. Psychiatric complications

induced by steroids underline the role of physicians that have to

educate the patients and their families about these side effects and

their early recognition.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.2349

EV1365

Predictors of aggressive behavior

among acute psychiatric patients: 5

years clinical study

T. Aparicio Reinoso

, S. Gonzalez Parra

Hospiatl Dr. Rodriguez Lafora, Psychiatry, Madrid, Spain

Corresponding author.

Introduction

The problem of violence and aggressive behaviour

among patients with psychiatric disorders need careful assessment

to improve the quality of psychiatric care.

Objective

The aim of this paper is to describe the characteristics

of repeated episodes of violence among patients admitted to a Psy-

chiatricWard, which is a total of 66 beds at Doctor Rodriguez Lafora

Hospital from January 2009 to December 2014.

Methods

We designed a retrospective, longitudinal and observa-

tional study over a 5-year period in two brief hospitalization units

of Doctor Rodriguez Lafora Hospital in Madrid. The main variables

studied were: type of admission, diagnosis, age, trigger and shift.

Results

In our study, we analyzed the prototypical person who

carries out these episodes of aggression: a male between 31–40

years, diagnosed with psychotic disorder or personality disorder,

involuntary admitted. This episode is associated as amain trigger to

mood disturbances, lack of acceptance of standards and psychotic

symptoms. These episodes occur more frequently in the afternoon

shift one business day and often processed without injuries or

minor bruises to other patients and/or nursing assistants. In our

practice, we have observed that in most cases adequate verbal

restraint in the beginning is sufficient to prevent the episode of

aggression.

Conclusions

Understand the aggressive factors can influence the

production of violent behavior and the use of appropriate contain-

ment techniquesmay be considered a therapeutic option to prevent

and address violent behavior in psychiatric patients hospitalized in

brief hospitalization units.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.2350