IntroductionVitamin B12 deficiency may cause neurological and psychiatric symptoms, especially among elderly patients. Two clinical cases are presented of patients admitted to an Acute Inpatient Psychiatry Unit due to psychotic symptoms, being reported a B12 deficiency.ObjectivesReview clinical information about vitamin B12 deficiency as a factor involved in the development of psychiatric disorders, specifically psychotic symptoms, pointing out the peculiarities regarding clinical presentation, diagnosis, prognosis, and treatment management.MethodsSearch in the medical database PUBMED, MEDSCAPE and UPTODATE.ResultsVitamin B12 deficiency is associated with hematological, neuropsychiatric, and digestive disorders, is estimated that around 5-40% of the elderly population may present it. Neuropsychiatric syndromes may be the first, and sometimes sole, manifestation, related to a different etiological mechanism. Vitamine B12 deficiency implies enzymatic defects that cause an accumulation of methylmalonic acid and homocysteine, which is proportionally related to the severity of the neuropsychiatric symptoms. The range of clinical features includes psychotic and affective episodes, behavioral disorders, cognitive impairment, along with other neurological manifestations such as polyneuropathy and encephalopathy. The diagnosis delay is crucially important, as early detection could lead to reverse the neuropsychiatric symptoms and some of the neuroradiological alterations. Parenteral and oral vitamin B12 supplementation should be initiated, monitoring levels in plasma, together with psychiatric drugs until the symptoms are controlled.ConclusionsVitamin B12 deficiency is a factor that may be involved in the etiopathogenesis of psychiatric disorders. Thus, screening must be considered among the vulnerable population when presenting neuropsychiatric disorders as early diagnosis and treatment are key to clinical prognosis.

IntroductionParaphrenia is a classic diagnostic entity characterized by an insidious development of a vivid and exuberant delusional system, more or less systematized, hallucinations and confabulations.ObjectivesIncrease knowledge about paraphrenia, a classic diagnosis that no longer appears on international classifications.MethodsExtensive research on the historical path of the paraphrenia diagnostic entity was carried out. Patient’s data is obtained from medical history and psychiatric interviews done during her hospitalizations.Results68 year-old patient attended the hospital emergency service due to a demonic possession delusion that emerged when she was 44 year-old, when she first consulted a psychiatrist because she believed someone introduced the demon inside her body. She described kinesthetic hallucinations as “movements of her brain” and an intense headache, both originated by the demon; as well as other types of hallucinations and confabulations. However, there was no deterioration in her personaliy or her intellectual capacity, as it could have been seen in a case of schizophrenia. This clinical case is considered a paraphrenia phantastica as it presents the typical features raised by the classic authors (mainly Henry Ey): paralogical thought dominance, megalomania, confabulation and integrity of relation with reality.ConclusionsCurrent internacional classifications do not consider paraphrenia as a differentiated diagnostic entity, as it also occurs with other classical entities. This causes a loss of important tools that would achieve a better approach to the patient’s condition.DisclosureNo significant relationships.

IntroductionChemsex is the term used to describe the use of psichoactives drugs to practice sex, mostly among men who have sex with other men. When drugs are administered by intravenously it is know as slamming or slamsex. Mephedrone is drug more used to this practice, in combination with other as anfetamines. This practice has been associated with a lot of psychiatric and organic complications.ObjectivesDescribe a case about one of chemsex complications such as drug- induce psychosis. Moreover, show the multiple medical complications associated with this practice.MethodsPatient’s data is obtained from medical history, psychiatric interviews carried out during his hospitalizations and his psychological follow-up in CAID.Results45 year-old man patient was admitted into a psychiatric unit due to paranoid ideation, behavioral disturbances and heteroaggressive behavior after mephedrone, amphetamines and other drugs intoxication in the context of slamsex practice. He has a history of two previous autolytic attempts but no psychotic episodes. After one week of hospitalization and antipsychotic treatment psychotic symptons disappear. Concerning his medical history, he was infected for HIV, syphilis, hepatitis A, visceral Leishmania.ConclusionsIt is necessary to be aware of the increased in chemsex and slamsex rates and therefore of the comorbilities that have associated. Rapid detection is important in order to reduce and control the severe addiction they entail (especially intravenous consumption).DisclosureNo significant relationships.

IntroductionEarly grief is a concept about which there is little literature. This generates difficulties in order to perform a differential diagnosis, as it poses complications to determine if the symptoms that the patient suffers are relative to the mourning or if they appear as part of a comorbid disorder.ObjectivesTo assess the difficulty in discriminating when accompaniment is necessary and when the patient can benefit from pharmacological, psychotherapeutic or combined treatment.MethodsPatients’ data is obtained from their medical history as well as psychological interviews carried out during the process.Results 32-year-old woman, with a previous history of depression. The patient was living abroad when her father was diagnosed with a terminal illness, so she decided to return home, making a radical change in her life. She is currently facing the functional deterioration of her father, who is rapidly getting worse. The patient shows symptoms of anxiety, tendency to cry and apathy. 34-year-old woman, with no history in Mental Health. As a result of her father’s illness, the patient develops a clinical manifestation of anxiety and low spirits. After one year, the clinic is maintained according to the variations in the health of her father. She also reports problems concentrating, fatigue, ruminative thoughts and structured autolithic ideas. Finally, she is referred to begin a psychotherapeutic follow-up.ConclusionsBearing in mind that we are facing an increase in diagnoses of terminal illnesses, I consider it is necessary to reflect on this concept in order to provide a better response to patients.DisclosureNo significant relationships.

IntroductionParaphrenia is a psychotic disorder characterized by an insidious development of a vivid and exuberant delusional system, accompanied by hallucinations and confabulations, without a personality deterioration. It is considered to be an intermediate entity between the disorganization of schizophrenia and the systematization of a delusional disorder.ObjectivesDevelop knowledge about paraphrenia as an individualized diagnostic entity and its historical path through the classical authors’ texts.MethodsExtensive research on the historical path of the paraphrenia diagnostic entity was carried out, as well as the current situation of the term.ResultsIn the German psychiatry it was Karl Kahlbaum who first introduced the term of paraphrenia. Later many authors of the German psychiatry delved into this diagnostic entity. Emil Kraepelin described four different subtypes of paraphrenia: paraphrenia systematica, expansiva, confabulans and phantastica. However, other authors such as Kleist or Bleuler, considered paraphrenia should not be judge as an individualized diagnostic entity as it should be considered inside schizophrenia, so the term disappeared in the German psychiatry. In the French psychiatry, unlike the German, the independence of chronic psychosis from schizophrenias was recognized, so the term had a longer path. Henry Ey recognized four important clinical features in this disorder: paralogical thought dominance, megalomania, confabulation and integrity of relation with reality.ConclusionsCurrently the term paraphrenia is no longer considered an individualized diagnostic entity. In fact, in today’s textbooks of psychiatry paraphrenia is considered a psychotic disorder that has nothing in common with the one described by the classical authors, and it is part of the late-onset psychosis.DisclosureNo significant relationships.