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Introduction: Psychotic patients often require pharmacological treatment, which may prove ineffective, leading to treatment-resistant psychosis necessitating the use of clozapine. However, the emergence of side effects can result in discontinuation, potentially triggering a relapse of psychotic symptoms. One significant side effect is antipsychotic-induced weight gain which, over time, can lead to adverse metabolic events. Recent translational research is evaluating the impact of prenatal factors on the metabolic outcomes of psychotic patients, using a surrogate marker of the intrauterine milieu such as birth weight (BW). Objectives: We aim to evaluate the changes in leptin, adiponectin, and insulin levels in patients with treatment-resistant psychosis who initiate clozapine treatment due to persistent psychotic symptoms. Methods: Subjects older than 18 years with a diagnostic of a major mental disorder and initiating clozapine were enrolled in this 18-months longitudinal study. Neurohormones levels, including leptin, adiponeptin, and insulin were measured at baseline, 8 and 18 months during follow-up. Statistical analysis were conducted by using a fixed-effects model. Results: A total of 23 subjects initiating clozapine were evaluated during the initial mandatory 18-week period. Neurohormones, specifically leptin and adiponectin, were measured at three time points: baseline, 8 weeks, and 18 weeks. The changes in leptin levels were significantly associated with birth BW with sex differences, being inversely correlated only in females. Adiponectin was significantly associated with BW, being inversely correlated in males. Conversely, there was no observed association between insulin levels and BW. Conclusions: Our findings highlight the significance of prenatal factors in influencing the subsequent evolution of neurohormones in individuals initiating clozapine treatment. This suggests that subjects with lower BW tend to exhibit elevated neurohormone values, emphasizing the role of prenatal events in this context. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction: 25-year-old woman originary from China. Moved to Barcelona 2 years ago for her master studies. Not known personal or familiar psychiatric record. Admitted to the psychiatric ward due to a 3-month psychotic episode with delusional features including transportation delusions "people can travel into other dimensions"; megalomaniac delusions, "I communicate with a Buddhist divinity called Guan Yin", "I have the mission of rejuvenating the population"; nihilistic and Cotard-like delusions "people around is old and dead"; denial of lineage syndrome, intermetamorphosis syndrome and doppelgänger syndrome. Nohallucinatory featureswere present. Severe emotional and behavioural implications were associated. Objectives: To analyse the transcultural component of bizarre delusions in a Chinese patient. Methods: Somatic causes for psychosis were ruled out. Risperidone up to 6 mg was started and afterwards intramuscular paliperidone palmitate 150+100 mg was administered, suspending risperidone. Results: Psychotic symptoms remitted progressively during hospitalization, so that the patient was discharged after 1-month. Conclusions: 1. This patient presented polymorphous bizarre delusions, some of them related to the Chinese culture. 2. Psychotic contents are influenced by the cultural beliefs. In this case, Guan Yin divinity (from Chinese religion) acquires psychotic implications being part of the cultural background of the patient. 3. The denial of lineage syndrome, which can be misinterpreted as a Capgras syndrome, is one of the most common delusions in China. 4. Due to the one-child policy, Chinese population aging will be a forecasted problem. The patient expressed this concert in a megalomaniac delusional manner. [ABSTRACT FROM AUTHOR]

Introduction: Clinical lycanthropy is an uncommon delusion of turning into a wolf. A systematic review in 2016 found only 13 case descriptions, only one not secondary to a psychiatric disorder. Objectives: To identify and describe an unusual symptom based on a clinical case. Methods: The present study is a case report of a patient admitted for clinical lycanthropy to our hospital. Wealso searched previously case reports, series and systematic reviews of clinical lycanthropy using a pubmed query ("lycanthropy", "cerebellum", "hydrocephalus", "psychosis"). Results: Mr. CJ. is a 38-year-old Mexican male, with no prior psychiatric history or substance use. He was admitted for bizarre behaviors and delusions. He had been living in the forest for the last weeks with the belief that he was a werewolf, and on full moon he behaved like a wolf (naked and howling). He also presented multimodal hallucinations, headache, ataxia and visual blur. The mental evaluation did not suggest a delirium. A CT scan revealed a left cerebellar lesion and hydrocephalus (Image 1,2,3). He experienced full remission of psychotic symptoms after external ventricular drain and antipsychotic treatment (risperidone, olanzapine). After surgical r emoval the histology revealed a cerebellar hemangioblastoma. Conclusions: The clinical presentation suggested the diagnosis of a psychotic disorder due to cerebellar hemangioblastoma with consequent hydrocephalus. Cerebellum abnormalities and hydrocephalus have been associated to psychotic symptoms. Furthermore, other case reports showed rapid recovery of psychosis due to hydrocephalus after neurosurgical intervention. To our knowledge, this is the first report about clinical lycanthropy due to a tumor of the central nervous system. [ABSTRACT FROM AUTHOR]

Introduction: 50-years-old man, originary from Germany, living in Spain since he had 26 years old. Not known personal psychiatric record; first grade relative with alcohol use disorder. As somatic medical record he presented paroxysmal atrial fibrillation treated with bisoprolol and amiodarone. He is brought to the Emergency room with disorganized behaviour and delusional ideas of prejudice, surveillance and complot. He also presents organic symptoms: fluctuating disorientation, dysarthria, tremors, fever, heat intolerance, weight loss, swallowing pain, decreased need for sleep and an antecedent of a recent phototoxic reaction. Objectives: To report an exceptional case of organic psychosis and to remark the need to screen somatic ethiologies for psychoses. Methods: A lumbar puncture, EEG and brain MRI with normal results ruled out neurological causes. The blood test showed neutrophilic leucocytosis and elevated T3 with supressed TSH. Olanzapine 20 mg was started. The Endocrinology Service started treatment with prednisone 40 mg and Methimazole 25 mg was started. Bisoprolol was maintained and amiodarone was stopped. A thyroid ultrasound was performed and concluded type 2 thyroiditis diagnosis. Results: Psychotic symptoms remitted in 1 week. Neurological and infectious causes were ruled out. Psychosis was related to a hyperthyroidism state. Amiodarone was established as the trigger of thyroxicosis. Conclusions: 1. Thyroxicosis, though atypical, can present with psychiatric symptoms. 2. It is always required to screen somatic ethiologies for psychoses, especially when somatic features (as in the case) are present. 3. Amiodarone overuse can cause endocrine and dermatological symptoms, as well as secondary psychiatric symptoms. [ABSTRACT FROM AUTHOR]