

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.2016.01.2407EV1423
Gynecomastia induced by trazodone:
A case report
M.D. Sánchez García
∗
, A. Gómez 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.
Further readings
Arslan, Filiz Civil et al. Trazodone induced galactorrhea: a case
report. General Hospital Psychiatry 2015;37(4):373.e1–373.e2.
Madhusoodanan S., Parida S., Jimenez C. Hyperprolactinemia asso-
ciated with psychotropics – a review. Hum Psychopharmacol
2010;25:281–297.
http://dx.doi.org/10.1016/j.eurpsy.2016.01.2408EV1424
Why Portugal is pushing towards
migration?
S. Saraiva
1 ,∗
, C. Moreira
1, M. Andrade
2, S. Carneiro
3,
M. Pinto da Costa
41
Centro Hospitalar Psiquiátrico de Lisboa, CHPL, Lisbon, Portugal
2
ULS Nordeste, ULSN, Braganc¸ a, Portugal
3
Hospital Distrital de Santarém, HDS, Santarém, Portugal
4
Hospital Magalhães Lemos, HML, Porto, Portugal
∗
Corresponding author.
Background
International professional mobility is a reality, peo-
ple have skills they can put in the global marketplace. The
increasing migration of health professionals to wealthy countries
is a phenomenon known as “brain drain”.
Objectives/Aims
This work aims to present the push factors that
pressure people to migrate from Portugal.
Methods
A cross-sectional survey was carried out with the
psychiatric trainees in Portugal. A self-administered structured
questionnaire was distributed to collect psychiatry trainees’ demo-
graphic and educational characteristics.
Results
In Portugal, the majority of trainees have a Portuguese
citizenship. Almost 2/3 did not have a short-mobility experience,
and the majority never migrated to another country. Less than half
consider staying in Portugal in the next years, and nearly 4/5 have
considered leaving the country. Working conditions ranked first
as the priority condition to be improved in psychiatry in Portugal,
followed by financial conditions. In fact, an attractive job for psychi-
atry trainees in Portugal must have as the most important feature
a pleasant work environment.
Conclusions
An alarming percentage of psychiatry trainees from
Portugal intend to migrate. Impact on future career, financial con-
ditions of doctors, job opportunities and better working conditions
were some of the motivating factors behind the migration.
Disclosure of interest
The authors have not supplied their decla-
ration of competing interest.
http://dx.doi.org/10.1016/j.eurpsy.2016.01.2409EV1425
Internalization of stigma and
self-esteem as it affects the capacity
for intimacy among patients with
schizophrenia, comparison between
Jews and Arabs
J. Segalovich
1 ,∗
, T . Stolovi
2 , P. Behrbalk
1 , P. Romem
31
Lev Hasharon, Mental Health Center, Netanya, Israel
2
Lev-Hasharon, mental health center, Netanya, Israel
3
Ben Gurion University of the Negev, Nursing Department–Recanati
School for Health Professions, Beer Sheva, Israel
∗
Corresponding author.
In addition to the physical and psychological signs and symptoms
of their disorder, people who have schizophrenia also experience
severe repercussions associated with social isolation [1]. Internal-
ization of social stigma was found to be a statistically significant
core factor that affects self-esteemand the ability to create intimacy
among Jewish patients with schizophrenia. Significantly more
Muslim patients were married in comparison to Jewish patients.
There was statistically significantly less internalization of stigma of