European Psychiatry - Volume 41 - April 2017

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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S645–S709 S699
2 D.a Estefânia Hospital, Centro Hospitalar de Lisboa Central,
Portugal, Lisboa, Portugal
3 Magalhães Lemos’ Hospita, Porto, Portugal, Porto, Portugal
4 Infectious Diseases’ Department, Centro Hospitalar de São João,
Porto, Portugal, Porto, Portugal
5 Medical Imaging, Faculty of Medicine, University of Porto, Portugal,
Porto, Portugal
6 Clinic of Psychiatry and Mental Health, Centro Hospitalar de São
João, Clinical Neurosciences’ Department, Faculty of Medicine,
University of Porto, Portugal, Porto, Portugal
∗ Corresponding author.
Introduction Lyme disease (LD) caused by the spirochete Borrelia
burgdorferi (Bb) results from human contact with rural environ-
ments and is transmitted by infected ticks (Ixodes spp.)
Objectives/aims To report a case with LD and to highlight the
importance of differential diagnosis in a first psychotic episode.
Methods Case report and systematic review of the literature.
Results We report a case of a 19-year-old man that was admit-
ted because of strange behaviour with alienation, perplexity and
persecutory delusions. He had one previous admission to an inpa-
tient unit two years prior and was diagnosed with psychosis
not otherwise specified. After being admitted to the psychi-
atric ward a medical work up was completed. The patient had
had a long stay in a rural environment; so anti-body specific
to Bb was ordered and came positive. LD was diagnosed based
on cerebral magnetic resonance imaging (MRI) findings and the
presence of Bb in the cerebrospinal fluid. During treatment
with anti-psychotic and antibiotic there was a noticeable clini-
cal amelioration correlated with improvement of MRI’s perfusion
patterns.
Conclusions LD is relatively rare, but physicians need to be
aware of typical neuropsychiatric symptoms, given that they may
occur months to years after the initial infection. Prompt diag-
nosis and effective treatment are crucial to avoid the possibly
irreversible mental illness. In the evaluation of a first psychotic
episode LD should be considered and excluded, principally if there’s
an epidemiological context and no psychiatric family history. MRI
may be another useful asset in the diagnostic evaluation of this
condition.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0905
The relevance of Paraphrenia: Case
report
M. Peixoto ∗ . Oliveira Braganc¸ a
1 Psychiatry and Mental Health Clinic of Centro Hospitalar do Porto,
Coimbra, Portugal
2 Clinic of Psychiatry and Mental Health, Centro Hospitalar de São
João, Porto, Portugal
∗ Corresponding author.
Introduction Paraphrenia is a chronic psychotic disorder with a
better-preserved affect and minimal disturbances of emotion and
volition and a much less cognitive deterioration and personality
changes.
Objectives/aims To report a case with probable Paraphrenia and
to highlight the importance of the differential diagnosis in a first
psychotic episode.
Methods Case report and systematic review of the literature.
Results We report a case of a 41-year-old man without a past
psychiatry history that was led to the psychiatry emergency
department (PED), by officers, because of strange behaviour and
aggressiveness towards his family. In the PED the patient said
that his real father was his father-in-law and that his ex-wife
was his sister. His mental exam revealed disinhibition, disor-
ganized speech with slightly mood elation, persecutory, mystic
and influential delusions with various delusional interpretations.
After being admitted to the psychiatric ward, in compulsatory
care, he began treatment and a medical work up was com-
pleted. According to the family the patient had begun this
strange behaviour four years prior. During the hospitalization
it became clear that the patient was experiencing imaginative-
confabulatoric multi-thematic delusions, sometimes interviewer
guided, without showing cognitive deterioration and retaining his
personality.
Conclusions The diagnosis of atypical psychosis or psychosis
not otherwise specified is not satisfactory since it agglutinates
different conditions together. Paraphrenia is a well-established
concept and should be used in order to define a group of
psychotic patients who exhibited characteristic symptoms of
schizophrenia, minus personality impairment and slower cognitive
decline.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0906
A systematic report review of Ganser
syndrome: 118 years of case studies
S. Petrykiv ∗, L. De Jonge , W. Sibma , M. Arts
1 UMC Groningen, Department of clinical farmacy and farmacology,
Groningen, The Netherlands
2 Leonardo Scientific Research Institute, Department of Geriatric
Psychiatry, Groningen, The Netherlands
3 GGZ Friesland, Department of Clinical Psychiatry, Leeuwarden, The
Netherlands
4 UMC Groningen, Department of Old Age Psychiatry, Groningen, The
Netherlands
∗ Corresponding author.
Introduction Ganser syndrome was first described by a German
psychiatrist Ganser in 1898, in a patient who showed a pecu-
liar twilight state. Ganser syndrome is defined as the presence of
approximate answers, somatic conversion symptoms, clouding of
consciousness, and pseudo-hallucinations. The etiology of this dis-
ease remains a subject of debate. While the DSM-IV-TR classifies
Ganser syndrome under the heading of dissociative disorder, it is
not listed as a diagnosis in the DSM-V.
Objectives and aims The purpose of this paper is to review avail-
able literature on Ganser syndrome, published in Dutch, English,
German, and French for examining the etiological debate, in order
to gain insight into the etiology of this disorder.
Methods The study design was a retrospective case series of all
published cases since 1898. For this purpose we used the electronic
databases PubMed and Embase.
Results Over a period of 118 years, we found 79 papers, describ-
ing 117 case reports on Ganser syndrome. It generally occurs in
patients who are exposed to somatic disorders or to psychological
stress, however, often in absence of a psychiatric disorder.
Conclusions Ganser syndrome remains a controversial disorder
in terms of its etiology. Ganser syndrome has been associated with
organic disorders, as well as with stressful and intolerable life
events. Based on this report, it is noteworthy that this syndrome
predominantly occurs in the absence of co-morbid psychiatric dis-
orders and is often associated with stress factors and underlying
somatic diseases.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.