E. Diaz-Mesa

P03-317 - Agomelatine facilitates benzodiazepine discontinuation in schizophrenia with severe insomnia

We present the case of a schizophrenic patient with severe insomnia that had a partial response to high doses of benzodiazepines and sedating antipsychotics. Treatment with agomelatine allowed to suspend benzodiazepine treatment and restore quality of sleep. Case report Mr. Y is a 36 year old male patient diagnosed with simple schizophrenia that has complained of insomnia since the age of sixteen. During the last three years the treatment that the patient was following was stable and consisted of 100 mg of diazepam, 300 mg of levomepromazine and 120 mg of clotiapine every night. During the last year 60 mg of duloxetine were added to treat a moderate depression. His mood improved with the prescribed treatment, but eleven months later it worsened. In an attempt to simultaneously treat the mood and the sleep disorder, during a period of 4 days, a dosis of 12.5 mg of aglomelatin at dinner was introduced while the morning dose of duloxetine was reduced to 30mg. On the fifth day, agomelatine was increased to 25 mg at dinner while duloxetine was suspended. The antipsychotic treatment was kept stable while the patient was instructed to reduce 10 mg of diazepam every week until next appointment one month later. In the next appointment the patient had completely suspended diazepam one week before the appointment. The patient referred improved sleep quality and no rebound insomnia. Conclusion Agomelatine may be a valid treatment of insomnia in schizophrenia.

Secondary Mania and Tapentadol

Introduction Tapentadol is a centrally-acting synthetic analgesic which acts as a mu-opioid receptor agonist as well as a norepinephrine re-uptake inhibitor. It is use to treat cronic pain. Most prevalence adverse effects are gastrointestinal and nervous symptoms. Furthermore, it has objectified, with less frequency, psychiatric disturbances. Objetives To analyse the relationship between a maniac episode and tapentadol. Methods Forty-nine-year-old female, with personal history of dyslipidemia and lumbar herniated discs in L4-L5, L5-S1, in treatment with tapentadol 200 mg/day for 20 days and no past psychiatric history. She was admitted to the Psychiatry Department due to a maniac episode, with desinhibition, pressure and loud speech, euphoria, megalomaniac delusion and sleep disturbance for the last 10 days. Young Mania Rating Scale (YMRS) was 36 points. Olanzapina 15 mg/day was introduced and tapentadol was removed. Symptoms remitted quickly and 6 days later, at discharge, YMRS was 4 points. One year later, the patient continued to be asymptomatic. Results Opioids can produce psychiatric disorders like hallucination, sleep disorders, depressed mood, disorientation, agitation, nervousness, restlessness, euphoric mood. Secondary mania to tapentadol mechanism is unknown, but having opiate cases described, it is possible to attribute this episode to tapentadol. Conclusions – Secondary mania is associated with various medical conditions, including vitamin B12 deficiency, brain injury, HIV infection and drugs such as alcohol, caffeine, sympathomimetics, steroids, bupropion, isoniazid, clarithromycin and opioids. – Further research is required to determine if the maniac episode was only isolated by the tapentadol or it is the beginning of a bipolar disorder.

Introversion/extraversion Does Not Affect Serum Melatonin Levels

Introduction Few studies focus on peripheral biological markers of personality. Melatonin (MLT), the main hormonal product of the pineal gland, has been used both as a diagnostic and therapeutic element and has been related with chronotype, depression and schizophrenia, among other psychiatric conditions. However, there is a paucity of studies on its use as a personality marker. The present work aims to determine whether serum MLT levels are related with the Eysencks personality extraversion/introversion (E/I) dimension. Methods A sample of 100 healthy volunteers participated in the study. The E/I personality dimension was evaluated using the EPQ-BV (Eysenck Personality Questionnaire – Brief Version). Three blood samples were taken (at 09:00, 12:00 and 00:00 h) to measure MLT. MLT was analysed in serum by an ELISA. Serum MLT concentrations are expressed in pg/ml. Results MLT levels displayed a clearly circadian pattern, with night levels being significantly higher than day-time levels (00:00: 35.78 ± 23.53 vs. 09:00: 7.78 ± 5.56, 12.00: 3.35 ± 1.94, p Conclusions There is no relationship between MLT levels and the E/I personality dimension. Future studies should examine the neuroticism dimension of personality.

EPA-0294 – Can alpha 1 glycoproptein be considered as a marker of negative symptoms in schizophrenia patients?

Introduction Recently, a renaissance of interest in ‘negative symptoms’ as emotional withdrawal or blunted affect, has occurred. Some investigators believe that these symptoms are important indicators of outcome, of response to treatment and of a distinct underlying pathologic process. Research on the negative-symptom syndrome in schizophrenia has been handicapped until recently. Aims This research aims at studying whether acute phase proteins, precisely, Alpha1-glycoprotein, can be considered as a marker of negativesymptom in Schizophrenia. Methods 29 chronic schizophrenics were assessed by the Positive and Negative Syndrome Scale (PANSS). A routine blood test including Alpha1-glycoprotein levels was carried out. Results Alpha1-glycoprotein shows a positive correlation, according to Pearson correlation coefficient, with the Negative Scale at an almost significant level (p=.05), and at a significant level in the following items, Blunted affect (p=.03), Passive/apathetic Social Withdrawal (p=.01) of the Negative spectrum and Poor Attention (p=.02) of the General Psychopathology Scale. Conclusions There is a significant correlation with two Negative variables and an almost significant one, spite of the small sample, with the Negative Scale. Further studies with bigger samples are needed in order to consider alpha1-glycoprotein as a schizophrenia negative psychopathology marker.

EPA-0289 – Psychopathology sex differences in asthmatics

Introduction Although asthma has been one of the most investigated topics in psychosomatics, studies and papers on psychopathology in asthma are fairly scarce and of diverse meaning. Furthermore, psychopathology acoording to sex in asthma is not a common research topic. Aim This study aims at analyzing psychopathology sex differences in asthmatics. Methods The psychopathology profile in a sample of 84 adult asthmatics in a hospital outpatient facility, mean age 34.62 (s.d.12.78), 36 male / 48 female, is studied. The Symptom Checklist-90-R (SCL-90-R) Self-Report Questionnaire was administered. Results The symptomatic profile is characterized by higher scores in women, with a main elevation in the dimensions of Somatization (1.92), Depression (1.66), Obsession-Compulsion (1.62) and Anxiety (1.44) whereas lower scores are recorded in men, with a profile dominated by Hostility (1.70), Anxiety (1.68), Interpersonal Sensitivity (1.58) and Depression (1.44). These scores mainly contribute to the psychopathology pattern according to sex. Conclusions The possible clinical implications of the observed psychopathology sex differences should be taken into account in the management of these patients.

P03-133 - First episode psychosis and multiple sclerosis

Objectives There is a significant incidence of psychiatric symptoms in patients with multiple sclerosis, the most common after receiving the diagnosis. We describe a man who was admitted for a first episode psychosis and a diagnosis of multiple sclerosis was made moreover. Methods A 24-year-old man was admitted with a paranoid delusion, auditory hallucinations with emotional response and the believe that their thoughts were being interfered. Blood test and cranial CT were normal. Risperidone was started. He developed ataxia and sensitive disturbances on the right arm. A cranial and spinal cord MRI revealed multiple T2 and FLAIR hyperintense lesions located in supra and infratentorial white matter, lesions in C3, and one lesion in right basal ganglia that enhanced with gadolinium. CSF analysis showed oligoclonals bands. Three years ago the patient had had transient sensitive symtoms. A diagnosis of relapsing-remitting multiple sclerosis was made and was started methyl-prednisolone intravenously. Risperidone was changed for amisulpride 800 mg/day because lack of response. He was discharged after 25 days. Six months later he has attenuated psychotic symptoms without news lesions in MRI. Glatiramer acetate has been started. Results and conclusions The most frequent disorder associated to multiple sclerosis is depression (prevalence of 20%). Psychosis is unusual, transient, sometimes as the onset relapse followed by remission. Theres evidence of correlation between psychosis in multiple sclerosis and multiple lesions in temporal periventricular area. We suggest that in our case these two disorders are two separated entities since the enhanced lesion does not correpond with clinical findings.

P03-154 - Serum levels of S100B proteins as a marker of positive psychopathology in schizophrenic inpatients

Introduction Schizophrenia is a chronic disease. Several etiopathogenic aetiologies have been posed, among them the existence of cerebral inflammation. S100B is a calcium-binding protein, mainly produced and secreted by astrocytes, that mediates the interaction among glial cells and between glial cells and neurons. Serum S100B levels have been proposed as a peripheral marker of brain inflammation. Objectives The aim of this research is to study if the serum level of the protein S100B has relationship with positive psychopathology. Methods 31 paranoid schizophrenic inpatients (22 male and 9 female, 36.7±10.3 years) meeting DSM-IV criteria participated in the study. Blood was sampled by venipuncture at 12:00 and 24:00 hours. Blood extractions were carried out during the first 48 hours after hospital admission. Psychopathology was assessed by the Positive and Negative Syndrome Scale (PANSS). Serum S100B levels were measured by sandwich ELISA techniques. Results Correlations between serum levels of S100B protein and PANSS positive scores are shown in the following table. The first figure corresponds to the Pearsons correlation coefficient, while the figure in brackets corresponds to its statistical significance. S100B Total Positive Score Delusions Conceptual disorganization Hallucinations Hyperactivity Grandiosity Suspiciousness/ persecution Hostility 12:00 0.354 (0.051) 0.210 (0.249) 0.291 (0.106) 0.412 (0.019) -0.128 (0.486) 0.274 (0.135) 0.010 (0.957) 0.026 (0.887) 24:00 0.462 (0.009) 0.266 (0.141) 0.446 (0.011) 0.345 (0.053) -0.148 (0.419) 0.486 (0.006) 0.064 (0.728) 0.013 (0.942) [panss] Conclusions Serum levels of S100B protein may be used as a biological marker of positive psychopathology in paranoid schizophrenia.Acknowledgement

P03-60 - Infant trauma and psychopathology in paranoid schizophrenia

Background Stress and trauma have been reported as leading contributing factors in schizophrenia. And certainly child abuse (neglect, emotional, physical and sexual abuse among others) has a lasting negative impact, which is well established in literature. Objectives To consider the presence of infant trauma and its relationship with psychopathology in paranoid schizophrenics.Methods. 37 patients (mean age 29±6.3; years from onset 9.20±4.7), meeting DSM IV paranoid schizophrenia criteria, undergoing treatment in a university hospital are studied. The PANSS is administered in order to rate psychopathology. Results 27 patients had infant trauma (55.8%). Main traumas are: sexual abuse (12.8%), child abuse (7.7%), both sexual and child abuse (5.18%), parental separation (7.7%), extra-rigid parents (2.6%), alcoholic parents (18.2%), child abuse and mothers death in childhood (2.6%). Infant trauma and psychopathology showed a significant relationship concerning Hostility (No 1.75±1.209, Yes 2.26±1.759), Unnatural Movements and Posture (No 1.55±0.945, Yes 1.16±0.545), Depression (No 1.25±0.550, Yes 1.74±1.284) and Preoccupation (No 2.75±1.410, Yes 3.26±1.996). Conclusions Infant trauma is common in paranoid schizophrenia and our findings give some evidence to a relationship with psychopathology, especially with dimensions as Hostility, Unnatural Movements and Posture, Depression and Preoccupation. Despite sample size, a high proportion (55.8%) of the patients presented infant trauma and future research is needed in order to open new avenues in this field, particularly studies concerning infant trauma and symptomatology specificity will be greatly appreciated as well as the plausible link to personality traits and personality disorders.