European Psychiatry - Volume 41 - April 2017

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S456 25th European Congress of Psychiatry / European Psychiatry 41S (2017) S405–S464
EV0163
Pediatric acute onset neuropsychiatric
syndrome associated with
Epstein–Barr infection in child with
Noonan syndrome
G.P. Tisi ∗, M. Marzolini , G. Biffi
Asst Santi Paolo e Carlo, San Carlo Hospital, Psychiatry, Milan, Italy
∗ Corresponding author.
Introduction Pediatric acute onset neuropsychiatric syndrome is
associated with various infections (i.e. Streptococcus , Mycoplasma
pneumoniae).
Objectives We describe a case of PANS associated with mononu-
cleosis, in a patient with Noonan syndrome.
Aims To report a case of EBV-related PANS.
Methods A 13-year-old patient, diagnosed with Noonan syn-
drome, was referred to the pediatric unit of our hospital in August
2016 because of aggressive behavior and suicidal ideation. He had
no personal or family history of psychiatric disorder. His parents
andhimdenied substance abuse. His symptoms had begun abruptly
onemonth prior to our evaluation, after watching an internet video,
and consisted in intrusive thoughts and images associated with
mental compulsions. Suicidal thoughts and verbal aggressiveness
emerged because he felt overwhelmed by these symptoms.
Results He was initially treated with sertraline 25mg, and sub-
sequently switched to aripiprazole because of increased anxiety.
Throat cultures and anti-streptolysin titer (ASO) were negative,
as well as Ig(M) and Ig(G) antibodies for M. pneumoniae. Erythro-
cyte sedimentation rate (ESR) and C-reactive protein (CRP) were
also negative. Epstein–Barr virus Ig(M) and Ig(G) were positive. He
continued therapy with aripiprazole 10mg after hospital discharge
with partial benefit.
Conclusions Epstein–Barr virus infection has been reported to
precede various neuropsychological disorders, but to the best of
our knowledge, rare cases of PANS following mononucleosis have
been described in literature. In our case, psychopharmacological
treatment for OCD symptoms was the only treatment performed
and led to a partial remission of symptoms.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0164
Behavioral disorder of adolescents
with Prader–Willi SY
M. Tripkovic ∗, S. Knez Kovaˇci´c , M. Bogadi , I. Bakija ,
S. Ropar
1 Psychiatric Hospital for Children and Youth, Psychiatric Hospital for
Children and Youth, Zagreb, Croatia
2 General Hospital Karlovac, General Hospital Karlovac, Karlovac,
Croatia
3 Psychiatric Hospital “Sv. Ivan”, Zagreb, Croatia
∗ Corresponding author.
Introduction The paper discusses the problem of psychiatric
treatment of rare diseases and “diagnostic screening” of certain
psychic symptoms that affect people with intellectual disabilities.
Prader–Willi (PWS) is a genetic syndrome that belongs to a group
of rare diseases and is caused by deficiency or loss of function of
genes on chromosome 15 inherited from the father. This disease
affects both sexes and its main characteristics are: obesity, hyper-
phagia, mental retardation and hypogonadism. Chronical feeling
of insatiable hunger and slow metabolism leads to excessive body
weight which is, according to existing date sources and monitor-
ing studies, the primary cause of premature death of patients with
PWS. Anxiety, psychomotor agitation, behavioral problems, diffi-
culties with short-term memory, frequent skin injury in the form
of wounds and bruises are the symptoms of this disease that hinder
diagnosis and treatment. Research suggests that patients with PWS
have unusual reactions to the standard drug dosages, specifically
anxiolytics.
Aim We shall present a multidisciplinary approach of pharma-
cological and psychotherapeutic treatment of a 16-year-old female
patient with PWS.
Result This patient responded well to a small dosage of que-
tiapine, at the same time monitoring other physical parametres.
Pharmacotherapy, combined with psychotherapy, along with pro-
viding counseling and support for parents resulted in decreased
psychomotor restlessness and, subsequently, better control of food
intake and prevention of weight gain.
Conclusion This paper has emphasis on the importance of a mul-
tidisciplinary approach, as well as experience from clinical practice
in the treatment of complex and rare syndrome diseases.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0165
Handwriting disorders in children
with developmental coordination
disorder (DCD): Exploratory study
C. Lopez , C. Hemimou , L. Vaivre-Douret ∗
1 Faculty of Medicine, University of Paris Descartes, Sorbonne Paris
City, Paris, France
2 CESP, Paris Sud University, UVSQ, Inserm 1018, Paris-Saclay
University, Villejuif, France
3 Department of Child Psychiatry, Necker–Enfants-Malades
University Hospital, AP–HP, Paris, France
4 Department of Pediatrics, Cochin-Port Royal, Paris Center
University Hospital, AP–HP, Paris, France
5 Laboratory of Endocrinology, Imagine Institut,
Necker–Enfants-Malades University Hospital, Paris, France
∗ Corresponding author.
Introduction Although more than 85% of children with DCD are
affected by handwriting disorders, their characteristics and under-
lying mechanisms remain poorly known.
Objectives We aim to better identify the nature of handwriting
disorders in subtyping DCD children.
Methods School children aged between 5 to 15 years and exhib-
ited a DCD (according to DSM-5) are eligible for inclusion. They
were classified in three subtypes of DCD: ideomotor (IM), visual-
spatial and/or constructional (VSC), and mixed (MX). They were
assessed with a standardized handwriting evaluation including
quality and speed and a clinical observation of motor gestual
developmental and temporal-spatial organization of handwriting
highlighting six qualitative criteria: irregular handwriting (crite-
rion 1), immaturity of handwriting gesture (criterion 2), excessive
pressure of the pen on the paper (criterion 3), neuro-vegetative
responses (criterion 4), trembling (criterion 5), slow handwriting
velocity (criterion 6). Two groups are established: children with
poor handwriting (PH) and children with dysgraphia (DysG).
Results While 89% of children have handwriting disorders, only
20% exhibit dysgraphia. IM DCD is characterized by an immatu-
rity of handwriting gesture and is associated with PH. Dysgraphia
appears only in VSC and MX DCD which are characterized by the
association of criteria 1, 2, 3, and 4. This association appears tomore
than 80% in DysG. Slow handwriting velocity is constant between
PH and DysG.
Conclusion Immaturity of handwriting gesture is a possible
underlying mechanism of poor handwriting. Dysgraphia is asso-
ciated with specific impairments in spatial organization of letters
and in motor control of handwriting gesture.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.