European Psychiatry - Volume 41 - April 2017

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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S465–S520 S493
EV0273
Neuropsychiatric manifestations in
patients with HIV treated with
antiretroviral drugs versus untreated
V. Gonc¸ alves ∗, A. Ribeirinho , L. Ferreira , P. Cintra
1 Santarem hospital, department of psychiatry and mental health
Santarém hospital, Santarém, Portugal
2 Cascais hospital, department of psychiatry and mental health of
Cascais hospital, Cascais, Portugal
∗ Corresponding author.
Introduction Untreated patients for H.I.V can present various
types of neuropsychiatric syndromes (NPS): subclinical cogni-
tive symptoms, behavioral changes, agitation, personality changes,
dementia complex associated with H.I.V and delirium, depressive
disorder, bipolar affective disorder or manic episode. However, it
is controversial whether antiretroviral induce NPS, or on the con-
trary, when there are patients will evolve into an AIDS stage for
therapeutic resistance or noncompliance.
Aims Describe qualitatively and quantify the epidemiological
point of the main subclinical and NPS symptoms in patients
untreated and treated with antiretroviral drugs and their frequen-
cies. Propose pharmacological treatments for each of the specified
conditions.
Methods Search in PubMed with the words “Neuropsychiatric
and antiretroviral therapy” by applying the limits: full and free
texts, past 10 years, Human, English language and adults; research
liaison psychiatry textbooks.
Results Results yielded 381 articles with the criteria selecting
102, the most relevant for the purposes of work. They chose four
most relevant chapters in the literature.
Conclusions The most effective treatment of NPS in unmedicated
patients is to start antiretroviral therapy; only if it does not improve
them should be introduced psychiatric drugs as if they were func-
tional. 50% of treated with efavirenz patients will develop NPS in
the early days with gradual decrease. The dropout rate associated
with these adverse events varies from 2.6–16%. Treatment of these
NPS a challenge by the existence of numerous drug interactions,
it is essential to know to deal with these entities to improve the
quality of life of people with this chronic disease.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0274
Sun lupus and energy. Systemic lupus
erythematosus presenting as mania
M.J. Gordillo Monta˜no ∗, S. Ramos Perdigues ,
M.A. Artacho Rodriguez , S. Latorre , C. Merino del Villar ,
C. Caballero Roy , S.V. Boned Torres , M. de Amuedo Rincon ,
P. Torres Llorens , M. Segura Valencia
1 Hospital Can Misses, psychiatry, Eivissa, Spain
2 Hospital Can Misses, medicine, Eivissa, Spain
∗ Corresponding author.
Introduction Systemic lupus erythematosus is a chronic disease
that can give neuropsychiatric episodes and systemic manifes-
tations. About 57% of patients with SLE have neuropsychiatric
manifestations in the course of their illness, however an initial
presentation with neuropsychiatric clinic is rare.
Objective Describe how patients receiving corticosteroids as part
of their treatment can develop mental disorders but not only them.
Method It will raise grounds with a case: 20-year-old woman
recently diagnosed with SLE because of arthritis in his ankle.
Treatment was initiated with prednisone 10mg and chloroquine
200 MG. After 20 days the patient comes to the emergency after
episode of turmoil at home with major affective clinical maniform.
Presenting fever. The presence of fever downloads the possibil-
ity of a psychosis chloroquine or corticosteroids to be a small
dose. Treatment was initiated with high doses of prednisone and
immunosuppressants. In addition to associating specific anticon-
vulsant and antipsychotic drugs at usual doses for a manic episode.
Results Treatment of psychosis in SLE is essentially empirical, and
depends on the etiology. It usually responds to the use of high doses
of corticosteroids combined with immunosuppressive drugs. Psy-
chosis induced by corticosteroids requires lowering them. It is valid
concomitant use of antipsychotics.
Conclusions The presence of psychotic symptoms in a patient
with systemic lupus erythematosus forces to distinguish between
various etiological possibilities.
Corticosteroids may cause a variety of psychiatric symptoms.
And yet, in patients with SLE these syndromes are not always
attributable to the use of corticosteroids.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0275
Confusion between symptom and
disease. Parkinson vs meningioma
M.J. Gordillo Montaño â'^, S. Ramos Perdigues ,
C. Merino del Villar , C. Caballero Roy , S. Latorre ,
M. Guisado Rico , A. Bravo Romero , S.V. Boned Torres ,
M. de Amuedo Rincon
Hospital Can Misses, psychiatry, Eivissa, Spain
∗ Corresponding author.
Introduction Parkinson’s disease is caused by decreased
dopaminergic neurons of the substantia nigra. Psychosis occurs
between 20 and 40% of patients with Parkinson’s disease.
Dopaminergic drugs act as aggravating or precipitating factor.
Before the introduction of levodopa patients had described visual
hallucinations but the frequency was below 5%.
Objective Illustrated importance of treatment, reassessment
after its introduction and refractoriness to answer; as well as the
importance of a differential diagnosis at the onset of psychotic
symptoms later in life.
Method Clinical case: female patient 75 years tracking Neurol-
ogy by parkinsonism in relation to possible early Parkinson disease.
She was prescribed rasagiline treatment. Begins to present visual
and auditory hallucinations, delusional self-referential and injury.
She had no previous psychiatric history. She went on several occa-
sions to the emergency room, where the anti-Parkinson treatment
is decreased to the withdrawal point and scheduled antipsychotics
did not answer. Doses of antipsychotics are increased despitewhich
symptoms persist and even increase psychotic symptoms. In this
situation it is agreed to extend the study. Subsequently an NMR of
the skull where the image is suggestive of a right occipital menin-
gioma appears.
Results/conclusions With the emergence of psychotic symptoms
later in life it will be important to ask a broad differential diagnosis,
since in a large number of cases will be secondary to somatic or to
drug therapies.
Parkinsonism can be a symptom of occipital meningioma, pre-
senting in the psychotic clinic. Refractoriness, on one hand to
the suspension of treatment for Parkinson’s disease, such as poor
response to antipsychotics, did extend the study, which ultimately
gave us the diagnosis.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.