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IntroductionInvestigation of resilience mechanisms in patients with clinical high risk for psychosis (CHR) may inform clinical practice for the development of early intervention programs. Resilience mechanisms in CHR who did not transit to psychosis for a long period of observation may be more pronounced than in CHR converters.ObjectivesWe aimed to compare CHR who did not convert to psychosis for 7.3 ± 1.7 years, patients with first-episode psychosis (FEP), and healthy controls (HC) in terms of brain functional connectivity and local coherence.MethodsTwenty-seven CHR (mean age 27.5 ± 3.1), 24 FEP (mean age 20.6 ± 3.6), and 27 HC (mean age 27.3 ± 4) underwent resting-state fMRI (3T). All participants were males. Functional connectivity between 32 regions of interest (components of default mode, sensorimotor, visual, salience, dorsal attention, frontoparietal, language, and cerebellar networks; CONN functional network atlas www.nitrc.org/projects/conn) and whole-brain local coherence (LCOR; Deshpande et al. HBM 2009; 30(1) 13-23) were compared between 3 groups of participants (one-way ANCOVA) with post hoc analyses.ResultsCHR and HC demonstrated higher functional connectivity between the occipital cortex (visual network) and right rostral prefrontal cortex (salience network) compared to FEP. CHR also showed higher local coherence in the right calcarine and cuneal cortex than FEP (the following differences did not survive the correction for multiple comparisons: CHR>HC and HC>FEP).ConclusionsOur findings on brain functional connectivity and local coherence may be considered as the markers of resilience mechanisms in patients with CHR as these parameters were different between CHR and FEP and were similar in CHR and HC.The research was supported by RFBR grant project 20-013-00748.Disclosure of InterestNone Declared

IntroductionInhalants are volatile psychoactive compounds whose effect varies from disorientation, excitement, euphoria to hallucinations. Different opinions have been raised concerning the relationship between inhalant use and psychosis and several publications have studied the incidence of psychotic disorders in the context of inhalant use. These studies concluded that using inhalants was independently associated with the development of psychosisObjectivesour aim is to determine the demographic and psychiatric profile of inhalant users previously hospitalized in our departmentMethodsThis is a retrospective descriptive study carried out by analyzing hospitalization records in the addictology department of the psychiatric university hospital Ar-Razi in Salé over a period of one year (from August 2020 to August 2021). The diagnoses are established according to the DSM 5 diagnostic criteria.ResultsSeventeen patients, inhalant users, were recruited after chart review, including 5 women and 11 men (68.7 %). The average age was 24.7 years (16; 41). The majority of the patients were single (81.2%), 62.5 % had a secondary education and 62.5 % were unemployed.The psychiatric evaluation showed that 87% of these patients had a history of incarceration, 50% had a diagnosis of schizophrenia, 12.5% had bipolar disorder and 14.2% had a cluster B personality disorder (DSM 5).The average age of onset of the addictive disorder in this population was 14.4 years and the entire sample was polyaddictive.ConclusionsMore than half of our sample had psychosis associated with their inhalant use disorder. these results are consistent with literature data.Disclosure of InterestNone Declared

IntroductionMoyamoya disease is a chronic progressive cerebrovascular occlusive disease with prominent basal collateral vessels which appear hazy like a puff of smoke on angiography. Neuropsychiatric disorders have been reported in 20–60% cases and the most common manifestations include depression, anxiety and other cognitive disorders. However, only a few case reports of onset of a psychotic disorder following a cerebrovascular accident. We present a rare presentation of Moyamoya disease in adulthood.CaseA 44-year-old man from Bangladesh presented with acute psychotic episodes of visual, auditory and tactile hallucinations, paranoia, somatoform disorders and non-epileptic attacks. He had a 3-year history of mental health disorders and was later admitted to the hospital with a headache and hemiparesis secondary to an intraventricular haemorrhage. The neuroimaging showed characteristic appearances of Moyamoya disease. Neurosurgical multidisciplinary meeting discussion opted for conservative management and stroke rehabilitation. Despite the improvement of his neurological deficits, he continued to show apathy, depression, psychogenic attacks with features of executive dysfunction. Due to family history of juvenile death in the family, the patient had genetic testing and was found to have the mutation in the gene Ring finger protein 213 (RNF213).ConclusionThis case highlights the awareness of neuropsychiatric manifestation of Moyamoya disease that could be related to the interruption of the striato-thalamo-cortical circuits. The susceptibility to Moyamoya disease-2 (MYMY2) may be conferred by variation in the RNF213 gene on chromosome 17q25.

A 24 year old woman was referred with a 3/52 history of headaches, memory problems, paranoia and confabulation.Examination was normal. AMT was 8/10. CT head and CSF were unremarkable. She self-discharged before an MRI. She was felt to have capacity.Four weeks later the psychiatry team sought advice reporting worsening symptoms. This patient was held under section. She reported significant headache, an unusual feature of a primary mental health problem.Anti NMDA of the serum and CSF were arranged (negative) an EEG did not show any concerning findings. During the hospital stay she managed to sneak off twice and was bought back by the police as it was felt that she lacked capacity.MRI revealed a pituitary microadenoma. She was assessed by Endocrinology. Extensive investigations concluded a diagnosis of ‘Cushing disease’. Metyrpaone was administered for Cortisol suppression. Tansphenoidal surgery took place after.On subsequent clinic visits, gradual improvement in the symptoms was reported until ultimately she was completely back to her normal self (around 2/12 post-surgery).DiscussionPsychosis is a rare feature of Cushing disease.1 This case demonstrates the diagnostic difficulties in these cases and the need of involvement and collaboration of different specialties for diagnosis and management.ReferencesMcCallum RW, Parameswaran V, Duffield A, Hoffman L, Burgess JR, Greenaway T. Cushing’s disease presenting as a Schizophreniform psychosis. Endocrine Abstracts (2006):11;P117.

The aim of this study is to describe the care pathways for patients with a recent onset of psychosis and to determine whether these routes are significantly affected by ethnicity and causal beliefs about this disorder. A total of 252 patients with schizophrenia in outpatient treatment (116 Aymara and 136 Non-Aymara) with a mean age of 35.6 years (SD = 12.5) from public mental health centers in Arica, Chile (33.6 %), Tacna, Peru (33.6 %) and La Paz, Bolivia (32.8 %) and their primary caregivers participated. They were interviewed regarding their help-seeking contacts using a semi-structured questionnaire. Out of the total patients, 64.7 % initially contacted a general practitioner for help, while only 14 % went to see a psychologist and 12 % sought a Yatiri (healers). The main factors associated with avoidance of a different route were the presence of a supportive family member or friend and the presence of a general practitioner. It is concluded that the main route of access to psychiatric services for patients with a recent onset of psychosis among Andean ethnic minorities is through a general practitioner, while a small portion of this population relies on community healers.

ObjectivesTo review a case of reversible cerebral vasoconstriction syndrome (RCVS) seen at a tertiary neurology centre with atypical features and rapid response to treatment.CaseA 47 year old female initially presented to the emergency department with severe sudden onset headache. Initial investigations did not reveal a cause for her presentation. Five days later she represented with a recurrence of severe headache. This was accompanied by left sided paraplegia and paraesthesia. CT revealed a large intracerebral haemorrhage with intraventricular and subarachnoid extension. Over subsequent days she worsened in her mental state, displaying features of psychosis. Further investigation did not clearly establish the underlying aetiology. Treatment was commenced with both high dose steroids and calcium channel blockade with significant, rapid improvement in the patient’s mental status.ConclusionsRCVS is an increasingly well recognised condition that has the potential for significant morbidity and mortality. This case presents a unique variation in presenting features, as psychosis associated with RCVS has not been well reported in the literature. While cerebral vasculitis was a consideration for her presentation, the rapidity with which she responded to treatment does not correlate with the expected course for this diagnosis. Thus the conclusion was drawn that this patient had an atypical presentation of RCVS with associated features of psychosis.

A young female patient, who was otherwise well, presented with acute hemiparesis, dysphasia and confusion after a night out in town. She was febrile and developed focal motor seizures that were difficult to control, culminating in secondary generalisation and status epilepticus. She required intubation and ventilation on ITU. Blood and CSF testing revealed no evidence of infection, drugs, or toxins. MRI brain scans and angiography showed subtle left hemisphere swelling associated with cerebral vasoconstriction, and a degree of cerebellar atrophy. EEG found delta waves over the left hemisphere. After extubation the patient developed delusional and paranoid thoughts about the medical team. All symptoms resolved rapidly after treatment with steroids and three anticonvulsants, and the patient recovered to baseline. The underlying diagnosis proved to be a rare variant of Familial Hemiplegic Migraine type I (CACNA1A I1709T) of which there are two previous reports in the literature, and which seems to have a characteristically severe phenotype.