DELUSIONAL PARASITOSIS TREATED BY ATYPICAL ANTIPSYCHOTIC AND SELECTIVE SEROTONIN REUPTAKE INHIBITOR: A CASE REPORT

Background: Delusional parasitosis (DP) is an uncommon psychiatric disorder. Patients suffering from this disorder have the fixed false belief of being infested by a parasite. Because of this condition, patients mainly consult with dermatologists or general practitioners. They are often reluctant to see a psychiatrist and to take treatment with antipsychotics because of their belief. The following describes the case of a woman who has the particularity that the DP started a few days after sertraline interruption. This situation raises the question of the impact of the sertraline interruption on pruritus and its role as a trigger of DP. Subjects and methods: Case report description and research on medline, pubmed with the keyword: delusional parasitosis, Ekbom syndrome, pruritus, SSRI. Results: Any other pathology that could explain the patient’s symptomatology was excluded which allows us to diagnose this patient with DP. The disappearance of the symptoms was obtained with 200 mg of sertraline and 2 mg of risperidone. It appears that pruritus can be favored by cutaneous dryness due to age and anxiety. Symptoms of discontinuation of SSRIs may include anxiety and paresthesia. Conclusions: The main hypothesis explaining the onset of DP would be the raise of paresthesia followed by the interruption of sertraline (discontinuation symptom) on a favorable field, which means an elderly woman of an anxious nature and having cutaneous dryness. It therefore seems necessary to discuss the discontinuation symptoms at the initiation of a treatment for this kind of patient to avoid false interpretations of skin symptoms such as paresthesia or itching

MANAGEMENT OF ADULT PATIENTS WITH ANOREXIA NERVOSA: A LITERATURE REVIEW

Background: Anorexia is a frequent pathology; not only does it cause major changes in patients’ quality of life, but also the mortality rate is high. This mortality mainly affects young people. However, care remains controversial. The aim of this literature review is, therefore, to review current guidelines. Subjects and methods: A review of the literature published between 2006 and 2017, from articles contained in the Cochrane, PubMed, Scopus and PsychINFO databases. Keywords were ‘anorexia nervosa’, ‘adults’ and ‘management’. Results: Patient management must be multidisciplinary and prioritise weight gain. For this to happen, outpatient monitoring must include a gradual normalisation of eating habits. This always involves psychotherapy and sometimes prescription medication. However, no specific therapy or psychotropic drug has demonstrated statistical superiority in the management of anorexic patients. Cognitive behavioural therapy remains the most effective therapy in preventing relapse, and family therapies for the treatment of young patients who are still living with their families of origin. Hospitalization is sometimes necessary and must then include gradual and closely monitored refeeding to avoid the potentially fatal refeeding syndrome. Conclusions: The management of anorexic patients is complex but always involves reaching a normal weight. The best prognosis is found in young patients with the least chronic disease

IMMUNITY, COPING AND DEPRESSION

Background: On the one hand, this psycho-immunological theory makes it possible to forge links between immunity and depression. On the other hand, we know that coping strategies are an important variable in the model of vulnerability to depression. Our study weighs the influence of cellular immunity and coping strategies on the severity of depression. Subjects and method: 498 inpatients with major depressive disorder were enrolled in an open-label trial. In addition to a sociodemographic questionnaire, they answered a Cousson’s coping test and the Beck Depression Inventory (BDI). Results: In terms of immunity, there are correlations between the BDI and percentages of CD8 (p=0.000; r=0.163), CD19 (p=0.046; r=0,090), CD16&56 (p=0.011; r=0.282), ratio CD4/CD8 (p=0.003; r=-0.135). A linear regression model for immune variables explained 25% of the BDI. In terms of coping, there is a correlation between severity of depression and ea (escape avoidance) (p=0.000; r=0.218), pr (positive reappraisal) (p=0.000; r=-0.265) and pps (planful problem solving) (p=0.000; r=-0.296). However, there is no correlation between the severity of depression and d (distancing). A linear model for coping strategies explained 12% of the BDI. Finally, there are correlations between distancing and CD8 (p=0.005; r=-0.119), CD19 (p=0.017; r=-0.102) and CD 16&56 (p=0.029; r=-0.227) but also CD3 (p=0.008; r=-0.114) and CD4 (p=0.027; r=-0.095) but not between those immune variables and the other coping strategies. In this case, a linear regression for distancing explained 10.3% of immune variables. Conclusion: Every coping strategy has an impact on depression. But not in the same way. Ea, pps and pr strategies influence directly the risk of depression while distancing influences the immune variables themselves. Knowing that those variables impact the risk of depression, distancing has then an indirect effect on depression

WHY DO CYBERBULLIED ADOLESCENTS STAY IN CONTACT WITH THEIR HARASSER? A Literature Review and Reflection on Cyberbullied Adolescents’ Coping Strategies

Background: Many young patients who are cyberbullied maintain communication with their harasser, despite the fact that this behaviour perpetuates the harassment. Numerous studies describe coping strategies adopted by cyberbullied adolescents. None describe what motivates adolescents to continue to communicate with their harassers. Methods: We conducted a literature review of cyberbullying, taking into account the challenges of adolescence. We used several search engines (Scopus, PsycINFO, Cairn and PubMed), using the following keywords: cyberbullying, teens, behaviour, coping strategies, social network, Facebook, counterpart. Our search returned 526 results, which were subsequently sorted as a function of their relevance. We also consulted reference books on adolescent psychology. Results: The adolescent, whose identity is being rebuilt, seeks a peer group, but also a relationship with a counterpart. This search is replayed on social networks and can lead adolescents to meet a counterpart harasser. Studies show that adolescents who suffer from cyberbullying are more likely than others to be in search of new friendships, and use social networks to make up for a lack or absence of fulfilling social relationships. They have fewer friends, have more difficulty maintaining social ties, and have fewer communication skills. In addition, cyberbullied adolescents have poorer relationships with their parents and teachers than their peers. Conclusions: Narcissistically fragile adolescents are at greater risk of being unable to stop communicating with their cyberbully. If the adolescent has no other relationships that enable him or her to develop their identity, they will be unable to put an end to this harmful counterpart relationship. It would be interesting to supplement this review with an experimental study, and to consider the development of new, secondary prevention strategies in the adolescent population

EFFECTS OF FINANCIAL PRECARIOUSNESS ON MENTAL HEALTH

Background: The physical and mental health of a population is based, in particular, on its quality of life and its access to health care. Given these determinants, Greece’s population has greatly suffered due to the sharp cuts in the budget for social benefits and health care (some measurable evidence is the recent increase in the suicide rate). Starting January, the 1st of 2015, unemployment benefits in Belgium have been eliminated for all recipients who do not have a full-time year of work over the last three years. Therefore, we must ask whether there will be similar psycho-medical consequences for Belgium’s population. Subjects and methods: Open study over a year (01/07/14 – 30/06/15) of emergencies admitted to the University Hospital Center of Mont-Godinne including a psychopathological motif. In addition to general socio-demographic data, psychic disorders are measured, as well as different types of crises (familial, professional or couple crisis), familial support and its dynamic (FACES III of Olson) and finally social integration (social isolation scale from the National Social Life, Health, and Aging Project (NSHAP)). These patients are compared with those admitted during the six months preceding the Act modifying the unemployment benefits. Results: Between July the 1st of 2014 and June the 30th of 2015, we saw an increase in the number of admissions to the psychiatric emergency department by 2.5% in six months, despite a decrease in the number of admissions to all-cause emergencies. Our study also shows a degradation of social network quality characterized by a more pronounced social isolation of our patients. At last, an alteration of cohesion in the patient’s origin family was highlighted. Conclusion: Although we cannot establish a direct causal link between this law and the results of this study, these may suggest a weakening of the population mental health due to difficult socio-economic context. As a result, we are faced not only with a public health problem but also with one concerning health care organization

ROLE OF GUT MICROBIOTA IN THE INTERACTION BETWEEN IMMUNITY AND PSYCHIATRY: A LITERATURE REVIEW

Background: Psychiatric disorders may be correlated with a low-grade systemic inflammation but the origin of this inflammatory response remains unclear and both genetics and environmental factors seems to be concerned. Recent researches observed that gut microbiota seems to have an impact on the brain and immune processes. Method: We review recent literature to a better understanding of how microbiota interacts with brain, immunity and psychiatric disorders. We search on Pubmed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords ”gastrointestinal microbiota” and “mental disorders” or “psychological stress”. Results: We showed links between gut microbiota and brain-gut axis regulation, immune and endocrine system activity, neurophysiological changes, behavior variations and neuropsychiatric disorders. Communications between brain and gut are bidirectional via neural, endocrine and immune pathway. Microbiota dysbiosis and increase gut permeability with subsequent immune challenges seems to be the source of the chronic mild inflammation associated with neuropsychiatric disorders. Repeated immune or stress events early in life may lead to neurodevelopmental disorders or sickness behavior later in life. Conclusions: psychological stress impact gut microbiota with subsequent immune activation leading to neurodevelopmental disorders or sickness behavior and altering neurophysiology and reactivity to stress or lifestyle