European Psychiatry - Volume 33

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

S801

Introduction

Catatonia is a neuropsychiatric syndrome that

appears in medical, neurological or psychiatric conditions. There

are presentation variants: “malignant catatonia” (MC) subtype

shares many characteristics with the neuroleptic malignant syn-

drome (NMS), possibly reflecting common pathophysiology.

Objectives/methods

We present a clinical vignette and review the

literature available on online databases about MC/NMS.

Results

We present a man, 41-years-old, black ethnicity, with no

relevant medical history. He had two previous episodes compatible

with brief psychosis, the last one in 2013, and a history of adverse

reactions to low doses of antipsychotics. Since the last episode he

was asymptomatic on olanzapine 2.5mg id. He acutely presented

to the Emergency Room with mutism, negativism, immobility and

delusional speech, similar to the previous episodes mentioned and

was admitted to a psychiatric infirmary, where his clinical condi-

tion worsened, showing muscle rigidity, hemodynamic instability,

leukocytosis, rhabdomyolysis and fever. Supportive care was pro-

vided, olanzapine was suspended and electroconvulsive therapy

(ECT) was initiated. After two months, he was discharged with no

psychotic symptoms. He is still under ECT and no antipsychotic

medication was reintroduced.

Discussion/conclusion

Many studies suggest that clinical or labo-

ratory tests do not distinguish MC from NMS and that they are the

same entity. These two conditions are life-threatening and key to

treatment is a high suspicion level. There is no specific treatment;

supportive care and stopping involved medications are the most

widely used measures. ECT is a useful alternative to medication.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.2407

EV1423

Gynecomastia induced by trazodone:

A case report

M.D. Sánchez García

∗

, A. G

ómez Peinado , P. Cano Ruiz ,

S. Ca˜nas Fraile

HNSPS, Psychiatry, Albacete, Spain

∗

Corresponding author.

Introduction

Trazodone is a heterocyclic antidepressant that

exerts its effect via the inhibition of selective serotonin

reuptake and the antagonism of 5-HT2A and 5-HT2 C recep-

tors. Antidepressant-induced gynecomastia and galactorrhea and

increases in prolactin levels have rarely been reported.

Case report

A 73-year-old man presented to the psychiatric

clinic with depressive symptoms and insomnia that was the rea-

son that his GP introduced paroxetine 20mg/day three months

before. One month later because the insomnia persisted, trazodone

(100mg/day) was added to the treatment. At a 2-month follow-

up, the patient reported improvement in depressive symptoms but

also presented gynecomastia on the left side that is non-tender

on palpation. No other medications were noted. Laboratory testing

was within normal limits, with the exception of on elevated pro-

lactin level (38.2 ng/mL). Ultrasonography indicatednormal results.

Treatment included the tapering and discontinuation of trazodone

with continued paroxetine therapy. Lorazepam was initiated for

the treatment of insomnia. Two weeks later, the prolactin level was

13.1 ng/mL and gynecomastia was practically resolved. Lorazepam

was initiated for the treatment of insomnia.

Conclusions

Effects of trazodone on PRL are unclear, there is

one study reported that trazodone increases the PRL level, and

another one reported that trazodone reduces them, in our case, the

trazodone use led to hyperprolactinemia via hypothalamic post-

synaptic receptor stimulation and it should be remembered that

gynecomastia and galactorrhea may appear as a rare side effect of

trazodone.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.