European Psychiatry - Volume 33 - March 2016

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S800 24th European Congress of Psychiatry / European Psychiatry 33S (2016) S349–S805
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1419
Autistic spectrum disorder masked by
mental retardation and impulse
control disorder
L. Rodríguez Andrés ∗ allesta Casanova ,
M.S. Hernández García , C. Noval Canga , L. Gallardo Borge ,
J.A. Espina Barrio
Hospital Clínico Universitario de Valladolid, Psychiatry, Valladolid,
Spain
∗ Corresponding author.
Clinical case report A48-year-oldmale, diagnosedwith impulsive
control disorder, sex addiction disorder andmental retardationwas
followed-up by different psychiatrists for the last 20 years. He con-
sults because of presenting depressive symptoms and behavioural
disturbances related to the death of his mother two years before.
The patient reports to experimenting depressed mood, irritability,
insomnia and trends to cry. He has lost motivation for his job and
hobbies (he used to show interest in topics such as physics, philos-
ophy, maths, and medicine). He has feelings of loneliness, which
make him look for social interaction and support through continu-
ous calls to telephone sex lines. This act has made him spend large
amounts of cash, thus, making him be in deep debts. He does not
feel integrate in society.
Mental status examination Introvert, limited social skills, coher-
ent language, echolalic, monotone, tangential speech, depressed
mood, feelings of guilt and futility, dysphoria, partial anhedonia,
ideas of hopelessness, structured death ideation, unconscious-
ness of his own acts, with trend to impulsiveness and compulsive
behaviour and insomnia.
Complementary test Wais test: no mental retardation found.
Diagnosis Autistic spectrum disorder (F84.0); major depressive
disorder (F32.1); bereavement (V62.82).
Discussion The patient showed classic diagnostic criteria DSM 5
associated with autistic spectrum disorder (Asperger’s disorder in
DSM-IV); the permanent inability for social interactions and repet-
itive, restricted and stereotypic behavioural patterns.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1420
Gestchwind syndrome and epileptic
psychosis, beyond the schizophrenia
frontier
V. Rodriguez ∗, C. Gómez , C. Gomis , L. González ,
E. Tercelán , J. Pérez , L. García , M. Ainbarro , C. Ortigosa
1 Aicante, Spain
2 Hospital de San Juan, Servicio de Psiquiatría, Alicante, Spain
3 Hospital de San Juan, Servicio de Psiquiatria, Alicante, Spain
∗ Corresponding author.
During late 19th and early 20th century neuropsychiatrists began to
identify commonbehavioral and cognitive disturbances in epilepsy,
but it is not until 1973 that Norman Gestchwind described the
basics of what we know as Gestchwind syndrome. This syn-
drome includes the triada of hyper-religiosity, hypergraphia and
hypo/hypersexuality and it was mainly associated with temporal
lobe epilepsy. Moreover, it is well known the association between
epilepsy and psychotic symptoms, the so-called schizophrenia-like
syndrome, which can lead us to a false diagnosis of schizophrenia.
We report a 44-year-old man who was brought to the hospi-
tal with delusional ideation of prosecution and reference in his
work environment with important behavioral disruption, as well
as delusional ideation of religious content. He had a diagnosis of
schizophrenia since he was 18-years-old and personal history of
generalized tonic-clonic convulsions in his twenties. During the
admission, he recovered ad integrum very rapidly with low doses
of risperidone, but referred recurrence of déjà vu episodes. After
reviewing his patobiography and past medical history, we identi-
fied the presence of hypergraphia, hypersexuality and a profound
religious feeling, fulfilling the criteria for Gestchwind syndrome, in
the context of which was later diagnosed as chronic epileptic psy-
chosis. It is very important a careful approach to the patobiography
and personal history. Also, we should include classic differential
diagnosis such as Gestchwind syndrome, as they can lead us finally
to the correct diagnosis, which in this case meant not only a differ-
ent treatment but also a better prognosis.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1421
Trichotillomania in delusional
infestation
P. Sales ∗, A. Lopes , S. Hanemann
1 Hospital Garcia de Orta, Psiquiatria, Almada, Portugal
2 Centro Hospitalar Psiquiátrico de Lisboa, Psiquiatria, Lisboa,
Portugal
∗ Corresponding author.
Introduction Trichotillomania is described as a recurrent failure
to resist impulses to pull out hairs. It is usually associated with
obsessive-compulsive disorder and body dismorphic disorder. It is
usually confined to one or two sites in the body.
Objective The aim of our work is to describe a case of delusional
infestation with secondary trichotillomania and briefly review the
theoretical aspects of this clinical presentation.
Methods We searched online databases and reviewed current
case reports published, using the keywords “delusional infesta-
tion”, “Ekbom syndrome” and “trichotillomania” and compared
similarities in the presentation, development and outcome. We
present a clinical vignette of a 38-year-old female, with no rele-
vant psychiatric history. The patient developed severe itching that
she believed was caused by bugs that lived inside her hair follicles,
so she pulled out completely all of her eyebrows, eyelashes, pubic
and underarms hairs. She maintained some hair on her head, that
she repeatedly pulled out and proceeded to break in order to kill
the bugs. She claimed to have absolutely no itchiness in the hairless
areas of her body.
Results The patient was referred to psychiatric consultation and
was started on oral antipsychotics but, as the review from literature
suggested, the clinical evolution only became satisfactory when an
antidepressant (SSRI) was added.
Conclusion Although, trichotillomania is more commonly seen in
clinical practice in association with other psychiatric disorders, it
may also present itself as a symptom of delusional activity.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1422
Malignant catatonia and neuroleptic
malignant syndrome: How
different/similar are they?
P. Sales ∗, M. Bernardo , A. Lopes , E. Trigo
Hospital Garcia de Orta, Psiquiatria, Almada, Portugal
∗ Corresponding author.