European Psychiatry - Volume 33 - March 2016

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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.
EV1364
Acute psychosis induced by
short-term treatment with
methylprednisolone – a case report
I.A. Andrei ∗, A.M. Cristache , M.E. Parfene-Banu , A.A. Frunz˘a ,
M.C. Boer , M.G. Puiu , B.E. Patrichi , M. Manea
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.
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.