Options for the recovery of mental activity in children after acute brain damage

Introduction Children with acute brain damage make up a large group of patients who require multi-stage rehabilitation. Rehabilitation requires the creation of special conditions for psychiatric care and psychological and pedagogical correction of the consequences of severe damage to the nervous system. Objectives To identify the options for mental activity during the restoration of the level of consciousness in children after acute severe brain damage. Methods 210 children under the age of 18 with severe brain damage (traumatic brain injury, hypoxia, hydrocephalus). Clinical-psychopathological, pedagogical methods were used; additionally diagnostic scales, questionnaires. Results 4 groups were formed: 1st 37 (18%) patients had manifestations of mental activity with physical, cognitive and social capabilities in the minimal consciousness “+” (a- / hyperkinetic mutism with emotional reactions, understanding of addressed speech); 2nd 67 (32%) - manifestations of physical and cognitive abilities with minimal consciousness “-” (a- / hyperkinetic mutism without reactions); 3rd 95 (40%) - only the manifestation of physical capabilities at the exit from the vegetative status. 4th 11 (10%) - a low manifestation of mental activity in the form of physical capabilities with a vegetative status. Conclusions 4 variants of mental activity in children after acute severe brain damage have been identified: from minimal involuntary reactions or their absence in vegetative status to voluntary actions according to the instructions of an adult in minimal consciousness “+”. Taking into account the variability of mental activity helps to differentiate the methods of psychiatric and psychological-pedagogical assistance in the recovery of children already in the early stages of rehabilitation.

Introduction: Rarely, thyroid cancer can lead to hyperthyroidism. The link between dysthyroidism and psychiatric symptoms is well established, but cases of psychosis associated with hyperthyroidism are rarely reported in the literature. Objectives: Identifying psychosis secondary to hyperthyroidism caused by a secreting tumor through a case and literature review. Methods: We report the case of a patient with thyroid suspect tumor and chronic psychosis. We performed a literature review based on a PubMed search with the following keywords: "dysthyroidism psychosis". Results: Mr. S,32, with a personal psychiatric history of chronic psychosis evolving since 4 years, without notable pathological history, was hospitalized in psychiatry for psychomotor instability, verbal hetero-aggressiveness, subtotal insomnia and refusal of treatment. The psychiatric examination revealed the presence of a chronic delusional syndrome with a theme of persecution, mysticism,and an interpretive, intuitive and hallucinatory mechanism, without dissociative syndrome. The somatic examination objectified a cachectic patient with a bilateral symmetrical non-impulsive exophthalmos, a goiter with a thrill on palpation, dysphonia and sinus tachycardia.A laboratory workup revealed inflammatory syndrome, collapsed TSH (<0.05 mU / L) and an increased T4 to 37 pmol / L. Cervical ultrasound showed a strongly suspect left lobar heteronodular goiter and poorly structured peripheral lymphadenopathy (TI-RADS 4-B). Sedative diazepam therapy was started with antithyroid therapy and a beta blocker. The evolution was quickly favorable. The patient is referred for surgical treatement. Conclusions: The severity of the hyperthyroidism,neoplastic origin, the improvement in psychotic signs with antithyroid treatment are arguments in favor of the thyroid origin by thyroid neoplasia.

EPP0241
Options for the recovery of mental activity in children after acute brain damage. Introduction: Children with acute brain damage make up a large group of patients who require multi-stage rehabilitation. Rehabilitation requires the creation of special conditions for psychiatric care and psychological and pedagogical correction of the consequences of severe damage to the nervous system. Objectives: To identify the options for mental activity during the restoration of the level of consciousness in children after acute severe brain damage. Methods: 210 children under the age of 18 with severe brain damage (traumatic brain injury, hypoxia, hydrocephalus). Clinical-psychopathological, pedagogical methods were used; additionally diagnostic scales, questionnaires. Results: 4 groups were formed: 1st 37 (18%) patients had manifestations of mental activity with physical, cognitive and social capabilities in the minimal consciousness "+" (a-/ hyperkinetic mutism with emotional reactions, understanding of addressed speech); 2nd 67 (32%) -manifestations of physical and cognitive abilities with minimal consciousness "-" (a-/ hyperkinetic mutism without reactions); 3rd 95 (40%) -only the manifestation of physical capabilities at the exit from the vegetative status. 4th 11 (10%) -a low manifestation of mental activity in the form of physical capabilities with a vegetative status. Conclusions: 4 variants of mental activity in children after acute severe brain damage have been identified: from minimal involuntary reactions or their absence in vegetative status to voluntary actions according to the instructions of an adult in minimal consciousness "+". Taking into account the variability of mental activity helps to differentiate the methods of psychiatric and psychological-pedagogical assistance in the recovery of children already in the early stages of rehabilitation. Introduction: Dermatitis artefacta (DA) is a condition whereby self-induced skin damage is the means used to satisfy a desire to assume the sick role. Objectives: To describe clinical evaluation, diagnosis, treatment and evolution of an 15 years-old woman with DA. Methods: Retrospective review of clinical records, including dermatology, psychiatry and Pathology. Results: A 15-year-old woman, who come to the Child Psychiatry consultations derived by the Dermatology Service, which is attended by the appearance of multiple bullous lesions throughout the body. Since August, the patient has reported a worsening of her mood, with feelings of loneliness and vital emptiness, with somatic and psychic anxiety referred. In the Dermatology office, she does not recognize self-infliction and the patient is derived to psychiatry consultation and solicited a skin biopsia. In the psychiatric interview, she recognizes that burns occur with a deodorant spray. She admitted doubts about her sexuality for months, claiming to be homosexual for the first time. When she burns, feels pleasure and relief. At the exploration: She wears a gay pride flag bracelet. Expressionless attitude. Cold contact. Approachable. Slightly collaborative. Without major affective disorders. No somatic anxiety, nor psychic. Short speech, impoverished language. Personality traits Cluster B and C. •Salamanca Questionnaire: Dependent personality, and in the background anxiety and histrionic. •Plutchik Impulsivity Scale: 14. •Toronto Alexithymia Scale: 64 Conclusions: The prognosis of the condition is variable, but it has been shown that resolution of the underlying psychosocial stressor leads to improvement. Multinucleated keratinocytes, a pathognomonic lesion of cryodermatitis artefacta, are discovered in the Pathology.

EPP0244
This girl is on fire. Introduction: Burning mouth syndrome (BMS) is a chronic condition characterized by a burning sensation of the oral cavity and is often associated with taste disturbances and xerostomia. Objectives: To study the psychotropics as part of the possible etiologies of this síndrome.
Methods: A 67-year-old woman complained of burning pain in the tongue and oral mucosa, taste disorder, and sensory impairment. Slight improvement after treatment with Gabapentine 300mg (1-0-0). The pain is constant, with sharp characteristics. Improves when eating, the ability to taste is preserved. Subsequently, treatment with 2% lidocaine rinse (3-4 times / day) is tested, with temporary pain relief. Lorazepam 1mg (1-0-0), without improvement. Patient in follow-up by the Neuropsychiatry consultation for 3 years, due to major depressive disorder in treatment with Quetiapine 100mg (0-0-1). Results: In the first consultation the treatment is modified, adding Duloxetine 60 mg (1-0-0) and Alprazolam 0.5mg (1 / 2-1 / 2.0), and reducing the dose of Quetiapine to 75 mg and then 50mg. In the subsequent consultation, one month later, she only manages to reduce the neuroleptic dose by half, without noticing clinical improvement. After two months, she has completely removed the quetiapine, and completely disappearing the burning mouth sensation, improving his affective clinic in the same way.
Conclusions: There are a large number of drugs that produce xerostomia, in intimate relationship with the burning mouth. Among those we can find antihistamines, neuroleptics, antihypertensives, and benzodiazepines. In many cases, correcting or eliminating these etiologic agents does not improve or stop the initial symptoms, but sometimes, it does.

EPP0245
The particularities of microangiopathic and macroangiopathic complications in type 2 diabetes mellitus patients correlated with the presence or absence of type D personality. Introduction: According to our national data based on PREDA-TORR study, the point prevalence of diabetes mellitus in Romania was 11.6 % in adults between 20 and 79 years old. Unequivocally, type 2 diabetes mellitus is highly correlated with psychological and personality factors. Objectives: The objective of our research was to evaluate the frequency of type D personality in patients suffering from type 2 diabetes and its influence on angiopathic complications. Methods: A cross-sectional study was conducted in 173 patients with type 2 diabetes who were self-assessed by using Beck Depression Inventory I, STAI-Y scale and DS 14 scale for detection of type D personality. Results: Both depression (p = 0.012) and state and trait anxiety (p = 0.019 and 0.023 respectively) scores were significantly higher in diabetic patients with type D personality compared with non-type D diabetic patients. Lower limb complications were more frequent in non-type D personality diabetics (p = 0.018) while diabetic retinopathy and diabetic polyneuropathy (p = 0.004 and p = 0.010 respectively).