GnRh agonists as precipitating components of psychiatric pathology. A case report.
Case report
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This case report describes a 45-year-old patient with endometriosis who developed a brief psychotic disorder following the initiation of GnRH agonist therapy. The authors analyze the potential mechanism linking these drugs to psychiatric pathology, citing evidence that hormonal suppression and subsequent estrogen loss may disrupt dopaminergic regulation and remove neuroprotective effects in sensitive individuals. The study highlights an association between the introduction of GnRH agonists and the onset of psychosis, emphasizing the need for clinicians to monitor for such adverse effects during treatment. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.
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Abstract
Introduction GnRh agonists are drugs used in various gynecological pathologies, among which is endometriosis. They act by stimulating GnRh receptors in the pituitary gland. This sustained and continuous stimulation of GnRh, will initially generate an increase in the release of luteinizing hormones and follicle-stimulating hormones, subsequently losing sensitivity to the receptors, internalizing them, and thus suppressing the release of these hormones, which would entail an ovarian suppression, thereby inhibiting the release of estrogens and progesterone. Psychiatric adverse effects have been described. Gonzalez-Rodriguez et al (Front Psychiatry 2020; 11:479), described this association with changes in mood, and the presence of a series of cases where the link between GnRh agonist and the possibility of presenting psychotic symptoms is observed. Wieck (Curr Top Behav Neurosci 2011;8:173-87), Frokjaer (J Neurosci Res 2020;98(7):1283-1292), Brzezinski-Sinai et al (Front Psychiatry 2020;11:693) reported that this association could be related with the relationship of the hypothalamic-pituitary-gonadal axis, hormonal fluctuation and its relationship with the dopaminergic regulation, a genetic component that would increase the predisposition to trigger psychiatric pathology in patients with greater sensitivity to hormonal fluctuations, and the loss of neuroprotection generated by the decrease of estrogens in the central nervous system. All of this in the context of multiple environmental and genetic factors that participate together in the appearance of the disease. Objectives To describe the importance of detecting the risk factors that can precipitate a psychotic episode, including the use of certain drugs, such as GnRh agonists. Methods We describe a case of a 45 year old patient with endometriosis with multiple organ involvement who went to the emergency room due to behavioral changes in the context of a brief psychotic disorder with “ad-integrum” recovery. Results A retrospective analysis of the case is conducted, observing an association between the introduction of GnRh agonists and the presentation of a first psychotic episode. Conclusions The importance of this case lies in the limited evidence of this association in the literature, and the implication of these drugs in the triggering of psychiatric pathology, being an aspect to be considered by psychiatrists in their patient’s follow-up. Disclosure of Interest None Declared
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Conclusions
Treatment with LAIs – Xeplion and Trevicta has an
unquestionable positive and lasting effect in the treatment of
schizophrenia. Proof of that is the definite improvement of the
symptoms, the increased social engagement and interpersonal
communication. Everything mentioned is a valid reason to direct
the treatment of schizophrenia in the direction of preservation of
the personality of the patients.
Disclosure of Interest: None Declared
EPV0911
CT OF THE ENDOCRANIUM IN THE FIRST
EPISODES OF PSYCHOTIC DISORDERS
A. Tomcuk*, J. Dedovic and A. Macic
Special Psychiatric Hospital Kotor, Kotor, Montenegro
*Corresponding author.
doi: 10.1192/j.eurpsy.2023.2210
Introduction
CT of the endocranium is an indispensable step in
the differential-diagnostic evaluation of a patient with the first
episode of psychotic disorder. In this context, the main goal of this
diagnostic procedure is to “exclude” the so-called organic disorders
of the brain tissue, which could be manifested by psychotic phe-
nomenology. However, during the past decades, pathological
changes in the brain parenchyma have been found during neuroi-
maging studies of psychiatric patients.
With the group of schizophrenic psychoses, the following are most
often associated: Expansion of the ventricular system, cortical
reductive changes, agenesis of the corpus callosum, a higher fre-
quency of some congenital anomalies of the brain, such as cavum
septum pellucidum and cavum verga.
Objectives
Consequently, the main goal of our study is to dem-
onstrate the possibility of diagnosing these changes and examine
the frequency of cases of so-called secondary psychotic syndromes,
where psychotic phenomenology arose on the basis of some other
illness.
Methods
Data were collected for 145 patients from the Acute Male
Department, who were treated in the period 2011-2019. CT scan of
the endocranium was performed as part of the diagnostic evalu-
ation during the first psychiatric hospitalization.
Results
Out of the total number of examinations (145), 20.7% of
patients had a pathological finding, with the following structure: In
6.9% of the age group up to 45 years, moderately expressed (dis-
proportionate for the age) cortical reductive changes were found.
Concomitant occurrence of cavum septi pellucid et cavum vergae
was observed in 3.4% and isolated septum pellucidum cyst in 1.3%
of patients. Post-stroke changes, post-contusion foci, and benign
congenital brain tumors were found with a frequency of 1.3%,
pronounced cortical reductive changes and pathological
calcifications with a frequency of 3%, while in individual cases
(0.68%) the presence of a subarachnoid cyst and atrophy of the
cerebellar cortex was recorded
Conclusions
CT of the endocranium represents a significant aid in
the evaluation of a patient with the first episode of psychotic
disorder. However, its use in order to analyze more complex
changes in psychiatric patients is significantly limited compared
to more modern neuroimaging modalities.
Disclosure of Interest: None Declared
EPV0912
GnRh agonists as precipitating components of
psychiatric pathology. A case report.
A. Guerrero Medina *, J. S. García Eslava, A. C. Martín Rodriguez,
L. Martinez Salvador, M. J. Alvarez Alonso and M. Aubareda
Magriña
Psychiatry, Consorci Hospitalari de Vic, Vic, Spain
*Corresponding author.
doi: 10.1192/j.eurpsy.2023.2211
Introduction
GnRh agonists are drugs used in various
gynecological pathologies, among which is endometriosis. They
act by stimulating GnRh receptors in the pituitary gland. This
sustained and continuous stimulation of GnRh, will initially gen-
erate an increase in the release of luteinizing hormones and follicle-
stimulating hormones, subsequently losing sensitivity to the recep-
tors, internalizing them, and thus suppressing the release of these
hormones, which would entail an ovarian suppression, thereby
inhibiting the release of estrogens and progesterone. Psychiatric
adverse effects have been described. Gonzalez-Rodriguez et al
(Front Psychiatry 2020; 11:479), described this association with
changes in mood, and the presence of a series of cases where the
link between GnRh agonist and the possibility of presenting psych-
otic symptoms is observed. Wieck (Curr Top Behav Neurosci
2011;8:173-87), Frokjaer (J Neurosci Res 2020;98(7):1283-1292),
Brzezinski-Sinai et al (Front Psychiatry 2020;11:693) reported that
this association could be related with the relationship of the
hypothalamic-pituitary-gonadal axis, hormonal fluctuation and
its relationship with the dopaminergic regulation, a genetic com-
ponent that would increase the predisposition to trigger psychiatric
pathology in patients with greater sensitivity to hormonal fluctu-
ations, and the loss of neuroprotection generated by the decrease of
estrogens in the central nervous system. All of this in the context of
multiple environmental and genetic factors that participate
together in the appearance of the disease.
Objectives
To describe the importance of detecting the risk factors
that can precipitate a psychotic episode, including the use of certain
drugs, such as GnRh agonists.
Methods
We describe a case of a 45 year old patient with endo-
metriosis with multiple organ involvement who went to the emer-
gency room due to behavioral changes in the context of a brief
psychotic disorder with “ad-integrum” recovery.
Results
A retrospective analysis of the case is conducted, observing
an association between the introduction of GnRh agonists and the
presentation of a first psychotic episode.
Conclusions
The importance of this case lies in the limited evi-
dence of this association in the literature, and the implication of
S1042 E-Poster Viewing
these drugs in the triggering of psychiatric pathology, being an
aspect to be considered by psychiatrists in their patient’s follow-up.
Disclosure of Interest: None Declared
EPV0913
Relation between stressful life events and psychosis
A. Osca Oliver 1*, R. Pérez Iglesias 2, M. V. López Rodrigo 1, V. Ros
Fons1, Y. D´Hiver 1, G. Sánchez 1 and M. Pérez Fominaya 1
1Hospital Nuestra Señora del Prado, Talavera de la Reina and2Hospital
Universitario Valdecillas, Santander, Spain
*Corresponding author.
doi: 10.1192/j.eurpsy.2023.2212
Introduction
Numerous studies establish clear connections
between traumatic childhood experiences and the risk of develop-
ing psychosis. According to the study carried out by Filippo Varese,
childhood traumas, understanding by; physical, psychological or
sexual abuse, abandonment, death of the parent and “bullying”,
increase up to three times the risk of suffering from psychosis.
Objectives
- Determine the prevalence of traumatic events in the sample
studied.
- Determine which traumatic event has a greater relationship
with the risk of presenting a psychotic episode.
- To determine whether traumatic events may be more strongly
associated or not with gender differences, age at onset and
family story.
Methods
A descriptive study is carried out in which the traumatic
events are evaluated (through the CAVE questionnaire) of
98 patients who have been treated for a psychotic episode in the
last two years in the Early Intervention Unit for Psychosis
(ITPCan).
The stressful life history questionnaire (CAVE) consists of 52 ques-
tions divided into blocks: school stage, work, partner, family, health
and other stressful events. All of them focused on those stressful
events prior to the onset of psychotic symptoms. Stressful events
have been considered to be those events in which the patients
studied have scored 10 (maximum score) on the anxiety scale.
Inclusion criteria:
- Older than 18 years-old
- Having presented a first psychotic episode.
Exclusion criteria:
- Intellectual disabilities
Results
For now, the data studied in this sample are similar to those
described in most of the studies reviewed: more than half of the
patients present at least one traumatic event before the onset of
psychotic symptoms and a third of these have had any traumatic
experience before the age of 18.
The percentage of the presence of at least one traumatic event
within the categories of the CAVE questionnaire would be:
14.2% in the school stage
26.7% in the workplace
26% in relationships
24.3% in family relationships
12.1% in events related to the patient ’s own health problems
Conclusions
We continue to increase the sample to have a more
significant result.
Disclosure of Interest: None Declared
EPV0914
Electroconvulsive Therapy for Neuroleptic Malignant
Syndrome: A case report
A. Osca Oliver1*, M. V. López Rodrigo 2, V. Ros Fons 2, M. Palomo
Monge2, A. Osca Oliver 1 and M. F. Tascón 2
1Unidad de Psiquiatría and 2Hospital Nuestra Señora del Prado,
Talavera de la Reina, Spain
*Corresponding author.
doi: 10.1192/j.eurpsy.2023.2213
Introduction
Neuroleptic malignant syndrome (NMS) is a rare
syndrome observed in around 0.2% of psychiatric patients. This
syndrome consists of the presentation of muscular rigidity, tachy-
cardia, hyperpyrexia, leukocytosis and elevated levels of CPK. Any
antipsychotic drug, including atypical ones, can cause this syn-
drome. This being an idiosyncratic response to dopamine receptor
antagonist medications.
The use of ECT in patients suffering from NMS is very effective,
seeing the progressive resolution of the picture in the first sessions.
Objectives
The patient was a 43-year-old man, whose somatic
history only highlights hypothyroidism, and according to his psy-
chiatric history, he was diagnosed of mental retardation and para-
noid schizophrenia. He was a resident of a group home. And he was
recently admitted to a mid-stay psychiatric unit. During this admis-
sion, the responsible doctor added haloperidol to his medication
regimen. His other medications at the time were; valproic acid,
risperidone and trazodone. A few days later, the patient began to
present a dysthermic sensation (presenting a temperature of 39ºC)
and drowsiness. A laboratory tests and a chest X-ray was per-
formed, highlighting: leukocytosis and an increase in elevated
creatine phosphokinase (CPK).
Due to his recent exposure to 2 different antipsychotics, with fever,
rigidity, and elevated CPK, we considered NMS. Antipsychotics
were withdrawn and supportive measures were started. Within the
next 2 days, his CPK level began to decline and the fever and
leukocytosis resolved. But without resolving muscle rigidity. At
the same time, he began to exhibit staring, negativism and prejudice
delusions. Therefore, electroconvulsive therapy sessions were
started.
Methods
.
Results
After the third session, his catatonic symptoms increased
to better; he became more verbal, with less negativism and the
psychotic symptomatology ceased. After the fifth session of ECT, he
returned to his initial level and was able to walk to the bathroom
without assistance and perform other activities of daily living.
Conclusions
It is extremely important that professionals special-
ized in psychiatry become familiar with ECT and consider this
technique as treatment in cases of neuroleptic malignant syndrome.
Disclosure of Interest: None Declared
European Psychiatry S1043
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