European Psychiatry - Volume 41 - April 2017

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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S645–S709 S683
EV0855
Protagonist-patient and
servant-doctor: A medicine for the
sick doctor-patient relationship
I. Ferraz ∗, A. Guedes
Clinica Veritas, Ambulatorio, Curitiba, Brazil
∗ Corresponding author.
The doctor-patient relationship (DPR) is very ill; it is in need of
emergency assistance. Although there have been change in this
relationship, no current model is satisfying. In 1972, Robert Veatch
defined some models of DPR. Likewise, Pierloot, in 1983, and Balint,
in 1975 and ultimately, Mead and Bower, 2000 with the model of
Person-center-care (PCC) medicine.
Objective Evaluate the different kinds of DPR described in the
literature and propose an abduction-based model of the Servant
DPR, in which patients are protagonists in their treatment.
Methods Pubmed literature review of the last forty years with
the keyword ‘physician-patient relations’.
Discussion While nursing care advanced in its professional effi-
cacy through Watson’s human care and through the leader servant
model, the DPR models demonstrated that the doctors are lost in
their posture, even feeling as abused heroes. Models that include
the patient in decision-making and that value the patient as a per-
son (PCC) promise a revolution in the medical realm. Nevertheless,
the PCC model is not enough to heal the DPR itself, because the role
of the doctor must be changed to adapt to the relationship, oth-
erwise, the PCC by itself can increase the burden upon the doctor.
Doctors with a role of remunerated servant (not slave), like any
other professional who delivers a service with excellence, focusing
in the main actor, the patient, can heal the DPR.
Conclusion The Servant DPR gives a positive counter transfer-
ence, increasing the doctor’s motivation and giving him back the
sense of purpose in medicine, increasing the health system’s effec-
tiveness.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0856
Asenapine in the treatment of
trichotillomania with comorbid
bipolar disorder: A case report
B. Francis∗, S.T. Jambunathan , J.S. Gill
University Malaya, Department of Psychological Medicine, Kuala
Lumpur, Malaysia
∗ Corresponding author.
Trichotillomania has been found to be associated with mood dis-
orders, particularly bipolar disorder. Trichotillomania has shared
similarities with bipolar disorder by virtue of phenomenology,
co-morbidity, and psychopharmacologic observations. In the past,
trichotillomania with comorbid bipolar disorder was treated with
lithiumand sodiumvalproate. There has been little, if any, literature
on using asenapine to augment treatment in patients with trichotil-
lomania with comorbid bipolar disorder. A patient presented with
hair-pulling episodes for a year, resulting in bald scalp patches. She
had no mood symptoms prior to this. She developed low mood,
anhedonia, poor sleep and poor appetite subsequently as she could
not stop pulling her hair. She was started on escitalopram 10mg
daily for he depressive symptoms. Three years later, she developed
hypomanic symptoms such as irritability and spending sprees. Her
hair pulling behaviourworsened at this time. At this point, a diagno-
sis of bipolar disorder type 2 was considered and she was started
on lithium 300mg daily. Her escitalopram was discontinued. As
her mood was still labile 10 months later, asenapine was added
to augment lithium in the treatment of the bipolar disorder. With
asenapine, her hair pulling frequency started to decrease rapidly.
Asenapinewas increased to 10mg daily and her hair pulling ceased.
Her mood also stabilized and she no longer had erratic periods of
mood lability. In conclusion, asenapine augmentation of lithium
has potential to be used in patients who have trichotillomania with
comorbid bipolar disorder due to its unique receptor profile.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0857
A case for considering differences
between organic and psychogenic
amnesia
R. García López ∗, J.M. Gota Garcés , J. García Jiménez ,
J.E. Mu˜noz Negro , L. Gutiérrez-Rojas
Complejo Hospitalario Universitario de Granada, Mental Health,
Granada, Spain
∗ Corresponding author.
Introduction Medical record, general examination, laboratory
findings, neuropsychological interview and multidisciplinary con-
sideration are essential to establish differencial diagnosis and
correct approach in amnesic episodes.
Aim To describe differences between organic and psychogenic
anterograde amnesia.
Methods Single case report and literature review.
Results A 51-year-old man with only diagnosis of DM I, sin-
gle, a good relationship with his family, without any personal or
familiar psychiatric or neurological history, came to the hospital
emergency department brought by his sisters referring disorienta-
tion, acute memory loss and mood changes, prevailing indifference
to the situation for the last three days. After general exploration,
including psychopatological examination and higher brain func-
tions study, we arrived to the conclusion that the patient suffered
from anterograde short-term severe amnesia as the only symp-
tom, with evident conservation of autobiographic memory. The
family referred as a possible stressor factor his mother’s recent
transfer to a different city, which had caused constant repeated
questions about her location. Given the questionable presenta-
tion and trigger we shared the case with the neurologist, who
ordered an array of tests to rule out any organic cause (LP, CT,
MRI. . . ), obtaining as a final result a diagnosis of limbic encephali-
tis, treated and effectively solved in two weeks with high-dose
glucocorticoids.
Conclusion Certain features of the symptoms exploration in
amnesic episodes such as reiterative questioning about a specific
topic, a non-modified autobiography or the absence of a clear trau-
matic precipitant factor, are essential for a correct approach and
may lead the clinic to an organic evaluation.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0858
Mental flexibility and problem solving
in adult patients who present
non-suicidal self-injury
A.K. Garreto ∗ iusti , M. Oliveira , H. Tavares , D. Rossini ,
S. Scivoletto
University of São Paulo School of Medicine, Department and Institute
of Psychiatry, São Paulo, Brazil
∗ Corresponding author.
Introduction Non-Suicidal Self-Injury (NSSI) is considered a dys-
functional way of dealing with problem situations.
Objective This study aimed to investigate the problem solving
capacity in adults with NSSI compared to controls.