General Hospital Psychiatry

Adequacy of depression treatment among college students in the United States

Daniel Eisenberg, Henry Chung — 2012-02-10

Abstract: Objective: There is no published evidence on the adequacy of depression care among college students and how this varies by subpopulations and provider types. We estimated the prevalence of minimally adequate treatment among students with significant past-year depressive symptoms.Method: Data were collected via a confidential online survey of a random sample of 8488 students from 15 colleges and universities in the 2009 Healthy Minds Study. Depressive symptoms were assessed by the Patient Health Questionnaire-2, adapted to a past-year time frame. Students with probable depression were coded as having received minimally adequate depression care based on the criteria from Wang and colleagues (2005).Results: Minimally adequate treatment was received by only 22% of depressed students. The likelihood of minimally adequate treatment was similarly low for both psychiatric medication and psychotherapy. Minimally adequate care was lower for students prescribed medication by a primary care provider as compared to a psychiatrist (P<.01). Racial/ethnic minority students were less likely to receive depression care (P<.01).Conclusions: Adequacy of depression care is a significant problem in the college population. Solutions will likely require greater availability of psychiatry care, better coordination between specialty and primary care using collaborative care models, and increased efforts to retain students in psychotherapy.

Changes in patients' beliefs about their antidepressant during the acute phase of depression treatment

James E. Aikens, Michael S. Klinkman — 2012-02-13

Abstract: Purpose: To test hypotheses regarding medication beliefs in relation to adherence, side effects, and response during the acute phase of an antidepressant treatment episode.Methods: Participants were 163 patients with unipolar major depression participating in the acute phase of a multi-stage trial of medication and psychotherapy. Before starting citalopram, patients underwent measures of treatment beliefs and depression. They continued taking citalopram until either responding, discontinuing due to side effects, or failing to respond within 14 weeks. Assessments of adherence, side effects and depression were made at weeks 2, 4, 6, 9, 12 and 14 (as applicable) and at trial exit. Beliefs were reevaluated at exit.Results: Perceived need for medication increased between baseline and exit (P=.01) while perceived medication harmfulness dropped between baseline and exit (P<.0001). Adherence was related to baseline perceived need (P=.022), and side effects were related to baseline perceived harmfulness (P=.002). Change in depressive symptoms was significantly related to both baseline perceived need (P=.039) and mean adherence (P=.036) but not baseline perceived harmfulness (P=.184) or side effects (P=.102). At exit, perceived need was unrelated to change in depression severity (P=.565), while perceived harmfulness was related to prior side effects (P<.0001).Conclusion: Patients’ medication perceptions become more pro-adherence as treatment proceeds. Their perceptions of antidepressant necessity predict their subsequent medication adherence and response, while their perceptions about medication harmfulness show strong prospective associations with actual side effects. Clinicians ought to adjust their prescribing decisions accordingly. Interventions that target beliefs ought to capitalize upon the apparently bidirectional association between harm perceptions and actual side effects.

Recognition of anxiety disorders by the general practitioner: results from the DASMAP Study

2012-02-20

Abstract: Objectives: The objectives were to determine the levels of general practitioner (GP) recognition of anxiety disorders and examine associated factors.Methods: An epidemiological survey was carried out in 77 primary care centers representative of Catalonia. A total of 3815 patients were assessed.Results: GPs identified 185 of the 666 individuals diagnosed as meeting the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) criteria for any anxiety disorder (sensitivity 0.28). Regarding specific anxiety disorders, panic disorder was registered in just three of the patients who, according to the SCID-I, did not meet the criteria for this condition .Generalized anxiety disorder was recorded by the GP in 46 cases, 4 of them being concordant with the SCID-I (sensitivity 0.03). The presence of comorbid hypertension was associated with an increased probability of recognition. Emotional problems as the patients' main complaint and additional appointments with a mental health specialist were associated with both adequate and erroneous recognition. Being female, having more frequent appointments with the GP and having higher levels of self-perceived stress were related to false positives. As disability increased, the probability of being erroneously detected decreased.Conclusion: GPs recognized anxiety disorders in some sufferers but still failed with respect to differentiating between anxiety disorder subtypes and disability assessment.

Depression in pediatric care: is the WHO-Five Well-Being Index a valid screening instrument for children and adolescents?

2012-02-13

Abstract: Objective: This study investigated the criterion validity of the WHO-Five Well-Being Index (WHO-5) in screening for depression in pediatric care.Method: A total of 446 children aged 9 to 12 and 324 adolescents aged 13 to 16, recruited from pediatric hospitals, completed the WHO-5 and a structured diagnostic interview serving as the gold standard. Diagnoses of depressive disorder included major depression and minor depression. Criterion validity was analyzed using the area under the receiver operating curve (AUC). Sensitivity and specificity were computed for optimal cutoffs. Additionally, unaided clinical diagnoses of depression made by the attending pediatricians were assessed.Results: Diagnoses of depressive disorder were established for 3.6% of children and 11.7% of adolescents. AUCs were .88 for the child and .87 for the adolescent sample. A cutoff score of 10 for children maximized sensitivity (.75) and specificity (.92). For the adolescent sample, decreasing the cutoff score to 9 yielded optimal sensitivity (.74) and specificity (.89). Sensitivity of the unaided clinical diagnosis of depression was .09, while specificity was .96.Conclusions: The WHO-5 demonstrated good diagnostic accuracy for both age groups. Further evidence is needed to support the feasibility of the WHO-5 as a depression screening instrument used in pediatric care.

Prevalence and incidence of diagnosed depression disorders in patients with diabetes: a national population-based cohort study

Chun-Jen Huang, Ching-Hua Lin, Mei-Hsuan Lee, Kao-Ping Chang, Herng-Chia Chiu — 2012-02-13

Abstract: Objective: This study aimed to investigate the prevalence and incidence of diagnosed depression disorders among patients with diabetes in Taiwan.Methods: Study subjects were identified by at least one service claim for ambulatory or inpatient care with a principal diagnosis of depression disorder, and at least two service claims for ambulatory care or one service claim for inpatient care with a principal diagnosis of diabetes from 2000 to 2004, as found in the National Health Insurance database.Results: The 1-year prevalence of diagnosed depression disorders in the general population was 11.22 per 1000 in 2000, while the 5-year cumulative diagnosed prevalence increased to 40.76 per 1000 in 2004. The 1-year prevalence rate of diagnosed depression disorders among patients with diabetes was 33.95 per 1000 in 2000, and the 5-year cumulative prevalence increased to 92.17 per 1000 in 2004. Patients with diabetes had a higher 5-year cumulative prevalence and annual incidence than the general population throughout the observation period. A higher diagnosed prevalence was associated with a monthly income

The relationship between depressive symptoms and medication nonadherence in type 2 diabetes: the role of social support

Chandra Y. Osborn, Leonard E. Egede — 2012-03-09

Abstract: Objective: Medication adherence promotion interventions are needed that target modifiable behavioral factors contributing to the link between depressive symptoms and poor adherence to diabetes self-care behaviors. In an effort to identify what factors contribute to this link, we examined the role of social support as a mediator of the relationship between depressive symptoms and medication nonadherence.Method: We recruited 139 subjects with type 2 diabetes. Using an indirect effect test with bias-corrected (BC) bootstrapping, we tested whether depressive symptoms had an indirect effect on medication nonadherence through a lack of social support.Results: More depressive symptoms were associated with medication nonadherence (total effect=.06, P<.001), more depressive symptoms were associated with less social support (direct effect of the predictor on the mediator=−.96, P=.02), and less social support was associated with medication nonadherence (direct effect of the mediator on the outcome=−.01, P<.01). While the relationship between more depressive symptoms and medication nonadherence persisted with social support in the predicted pathway, the degree of this relationship was partially explained by a relationship between more depressive symptoms and less social support (indirect effect=.01, 95% BC bootstrapped confidence interval of .0005 to .0325).Conclusion: Providing social support to patients with diabetes who have symptoms of depression may ameliorate some of the deleterious effects of depressive symptoms on medication nonadherence, but social support alone is not enough.

Depression and heart disease in US adults

Ashwini Niranjan, Andrea Corujo, Roy C. Ziegelstein, Evaristus Nwulia — 2012-03-09

Abstract: Objective: Major depressive disorder (MDD) with atypical features is characterized by mood reactivity, increased appetite/weight gain and hypersomnia. Since these characteristics may be associated with obesity and diabetes, we examined whether individuals with MDD with atypical features (MDD-AD) are more likely to exhibit cardiovascular disease than those with MDD without atypical features (MDD-NAD).Methods: Participants in the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of noninstitutionalized US adults, were categorized as having no lifetime depression diagnosis (n=34,979), MDD-NAD (n=4632) and MDD-AD (n=1063) and reported physician-confirmed specific cardiovascular diagnoses in the previous year.Results: Compared to individuals without depression, those with MDD had a 50% increased odds of any cardiovascular diagnosis (P<.0001) independent of sociodemographic factors. Adjusting for sociodemographic differences in MDD subgroups, MDD-AD (compared to MDD-NAD) was associated with 60% (P<.0001) and 43% (P<.005) increases in the odds of hypertension and any cardiovascular diagnosis, respectively. These latter associations were no longer significant after adjusting for body mass index and substance use.Conclusion: Individuals with major depression are at increased risk of heart disease. Whereas major depression with atypical features is associated with certain cardiovascular risk factors, there is no greater risk of cardiovascular diagnoses.

Circulating cytokine concentrations are not associated with major depressive disorder in a community-based cohort

2012-03-09

Abstract: Objective: The objective was to test the hypotheses that cytokine levels are elevated in community-residing persons at high risk for obstructive sleep apnea with major depressive disorder (MDD) compared to nondepressive persons and that cytokine levels show stronger correlations with somatic than psychological symptoms of depression.Method: A case–control study within the cross-sectional Akershus Sleep Apnea Project was performed. Two controls matched for age, gender, metabolic syndrome and obstructive sleep apnea were drawn for each case of MDD.Results: Group comparisons revealed no significant difference in the levels of 17 cytokines [interleukin-1β, -2,-4, -5, -6, -7, -8, -10, -12(p70), -13 and -17; tumor necrosis factor-α; interferon-γ; granulocyte colony-stimulating factor; granulocyte–monocyte colony-stimulating factor; macrophage chemoattractant protein-1 and monocyte inhibitory protein-1β] between persons with (n=34) and without MDD (n=68). There was no association between cytokines levels and MDD in multivariate regression analyses. The concentration of interleukin-4 was significantly more positively correlated with psychological than somatic symptoms (r=0.046 vs. −0.143, respectively, P=0.024), while no different correlations were observed for other cytokines.Conclusion: The cytokine levels were not elevated in MDD, and cytokine levels were not more strongly associated with somatic than psychological symptoms of depression. The depression-specific effect on inflammation may be weak in community-based samples with prevalent somatic comorbidity.

Cardiovascular risk factors in patients with first-episode psychosis in São Paulo, Brazil

2012-02-03

Abstract: Objective: The objective was to evaluate the cardiovascular profile of first-episode psychosis patients in São Paulo, Brazil, an issue that has not been sufficiently explored in low-/middle-income countries.Method: A cross-sectional study was performed 1 to 3 years after an initial, larger survey that assessed first-episode psychosis in São Paulo. We evaluated cardiovascular risk factors and lifestyle habits using standard clinical examination and laboratory evaluation.Results: Of 151 contacted patients, 82 agreed to participate (mean age=35 years; 54% female). The following diagnoses were found: 20.7% were obese, 29.3% had hypertension, 39.0% had dyslipidemia, 19.5% had metabolic syndrome, and 1.2% had a >20% 10-year risk of coronary heart disease based on Framingham score. Also, 72% were sedentary, 25.6% were current smokers, and 7.3% reported a heavy alcohol intake.Conclusion: Compared to other samples, ours presented a distinct profile of higher rates of hypertension and diabetes (possibly due to dietary habits) and lower rates of smoking and alcohol intake (possibly due to higher dependence on social support). Indirect comparison vs. healthy, age-matched Brazilians revealed that our sample had higher frequencies of hypertension, diabetes and metabolic syndrome. Therefore, we confirmed a high cardiovascular risk in first-episode psychosis in Brazil. Transcultural studies are needed to investigate to which extent lifestyle contributes to such increased risk.

Psychological comorbidities in Chinese patients with acute-on-chronic liver failure

Zhongping Duan, Yuanyuan Kong, Jie Zhang, Huimin Guo — 2012-02-03

Abstract: Objectives: Patients with acute-on-chronic liver failure (ACLF) experience long-term chronic liver diseases plus an acute liver function decompensation. This study aimed to determine whether psychological symptoms in patients with hepatitis B virus (HBV)-related ACLF differ from those with other chronic liver diseases and to identify which factors could predict psychological impairment in liver patients.Methods: This was a paired case–control study. A total of 120 inpatients, including 40 cases for HBV-related ACLF, 40 paired controls for HBV-related cirrhosis and 40 paired controls for chronic hepatitis B (CHB), as well as 40 paired healthy controls were studied.Results: A high proportion of patients with HBV-related ACLF were classified as Child's stage C. The prevalence of depression in patients with HBV-related ACLF was significantly higher than in CHB patients and healthy controls, but was equivalent to patients with HBV-related cirrhosis. Patients with HBV-related ACLF had significantly higher level of self-esteem than those with HBV-related cirrhosis. However, there was no significant difference among the three liver patient groups and healthy controls in anxiety and suicide intent. Lower education level, anxiety, poor sleep quality and greater severity of disease were associated with elevated depression.Conclusions: Patients with HBV-related ACLF and cirrhosis are at higher risk of depression. It appears that severity of liver disease measured by Child–Pugh class, rather than additional acute liver function decompensation, significantly predicted depression among liver patients.

Psychopathological dimensions of tinnitus and psychopharmacologic approaches in its treatment

Hasan Belli, Seyda Belli, Mehmet Faruk Oktay, Cenk Ural — 2012-01-30

Abstract: Background: The aim of this review to investigate presence of psychopathological states and efficacy of psychopharmacological drugs in the treatment of tinnitus.Materials and Methods: An extensive Internet search has been performed for this aim through PubMed by using related key words in English.Results: Higher anxiety and depression levels and somatoform disorder clusters are defined in patients with tinnitus. Additionally, impulsivity, hostility, demanding, physical discomfort, anxiety for health, emotionality and suicidal tendency are also defined in these people. Personality characteristics in these patients are depression, hysteria and hypochondriac features. Besides these symptom clusters, more severe psychopathologies like personality disorders may be encountered in these patients. Sertraline, paroxetine and nortriptyline can be considered as the first-line antidepressants in the psychopharmacological treatment of tinnitus. There are studies which have reported the efficacy of sulpiride. Carbamazepine, valproate and gabapentin can be effective as mood stabilizers. Short-acting benzodiazepines like alprazolam and midazolam are effective in signs of anxiety. Clonazepam and diazepam can be evaluated as other options. However, some glutamate receptor antagonists also can be used in the treatment of tinnitus.Disturbed sleep is frequently associated with tinnitus. Sleep disturbance can disrupt the quality of life in the patients with tinnitus. These patients might benefit from cognitive–behavioral therapy, which offers the promise of relief from tinnitus-related distress and insomnia.Conclusion: When pathophysiologic reasons are excluded, it should be at least considered that tinnitus is exaggerated by psychopathological symptoms. Life quality of patients can be increased by treating these symptoms.

Valproate-induced hyperammonemic encephalopathy: an update on risk factors, clinical correlates and management

2012-02-03

Abstract: Introduction: Valproate (VPA)-induced hyperammonemic encephalopathy (VHE) is a serious drug-related adverse effect characterized by lethargy, vomiting, cognitive slowing, focal neurological deficits and decreased levels of consciousness ranging from drowsiness to coma.Methods: We present a case series (n=5) and also review previous cases of VHE (n=30) in psychiatric patients to provide an update on risk factors, clinical correlates and management of VHE.Results: To our knowledge, there are 30 (16 female, 14 male) previously reported VHE cases in psychiatric patients. Risk factors for VHE include VPA–drug interactions, mental retardation, carnitine deficiency and presence of urea cycle disorders. Length of VPA treatment, VPA dosage, serum VPA levels and serum ammonia levels do not appear to correlate with onset or severity of VHE.VPA discontinuation is the primary treatment of VHE, although, l-carnitine, lactulose and neomycin have been used adjunctively in some patients.Conclusion: Clinicians should consider VHE in patients taking VPA who present with lethargy, gastrointestinal symptoms, confusion and decreased levels of drowsiness. VPA discontinuation is currently the mainstay of treatment for VHE, although more research is warranted to delineate the underlying risk factors for VHE and consolidate treatment modalities for this potentially life-threatening drug adverse effect.

School refusal by patients with gender identity disorder

2012-01-09

Abstract: Objective: The accumulating evidence suggests that school refusal behavior is associated with severe negative outcomes. However, previous research has not addressed school refusal by patients with gender identity disorder (GID). In this study, we tried to clarify the prevalence of school refusal among GID patients and the relationship of school refusal to demographic characteristics.Methods: A total of 579 consecutive Japanese GID patients at the outpatient GID Clinic of Okayama University Hospital between April 1997 and October 2005 were evaluated.Results: The prevalence of school refusal was 29.2% of the total sample. School refusal was more frequent among GID patients with divorced parents than those with intact families. Multiple logistic regression analysis showed that younger age at consultation and divorce of parents were significantly associated with school refusal among the male-to-female GID patients.Conclusion: The rate of school refusal among GID patients is high, and school refusal is closely related with a low level of education and current unemployment. We should pay more attention to GID patients of school age to prevent their school refusal, which results in low educational achievement.

Using root cause analysis to reduce falls with injury in the psychiatric unit

Alexandra Lee, Peter D. Mills, Bradley V. Watts — 2012-01-30

Abstract: Objective: The objective was to identify how falls on psychiatric units occur, the underlying root causes and effective action plans to reduce falls and injuries.Methods: A search of the Veterans Health Administration National Center for Patient Safety database was conducted to identify root cause analysis (RCA) reviews where a fall was sustained by a patient on a psychiatric unit. Seventy-five RCAs from January 2000 to March 2010 were included.Results: One hundred and thirty-eight actions were identified from the RCA reports. The most common activities the individual was engaged in during a fall included getting up from a bed, chair or wheelchair (21.3%); walking/running (10.7%); bathroom related (9.9%) or behavior related (9.9%). The most common root causes were environmental hazards (11.2%), poor communication of fall risk (8.9%), lack of suitable equipment (8.9%) and need for improvement of the current system for falls assessment (8.9%). Staff education (19.9%), development of tools to improve falls documentation (17.0%) and providing falls prevention equipment (14.2%) were the most frequent actions taken.Conclusions: The results describe the location, activity and root causes surrounding falls that occur in psychiatric units resulting in injury, and provide some suggestions on how to implement a successful action plan.

Clinical predictors of response to treatment in catatonia

2012-03-05

Abstract: Objective: This study aims at identifying predictors of treatment response to lorazepam in catatonia.Methods: The clinical charts of 107 inpatients, admitted over duration of 2 years, with a primary diagnosis of catatonia were examined for response to lorazepam trial. Trial was considered as having received 3–6 mg per day of lorazepam for at least 3 days.Results: Out of these 107 patients, 99 received lorazepam and 8 received electroconvulsive therapy as the first line of management. There were 32 responders and 67 nonresponders to lorazepam. The nonresponders were characterized by rural background (85.1% vs. 62.5%, P=.01), longer duration of catatonic symptoms (108.88 vs. 25.12 days, P=.018), mutism (63.6% vs. 31.3%, P=.02) and presence of first-rank symptoms like third-person auditory discussing-type hallucinations (16.4% vs. 12.0%, P=.03) and made phenomena (7.5% vs. 0%, P=.04). The presence of waxy flexibility (12.5% vs. 4.5%, P=.03) predicted good response.Conclusions: This study identifies that longer duration of illness, presence of catatonic sign of mutism and certain specific phenomena like third-person auditory hallucinations and made phenomena predicted poor response to lorazepam in catatonia. This could provide insight into the prediction and planning of the appropriate treatment strategies in this psychiatric emergency.

The New York PTSD risk score predicts having, not developing, PTSD

Jeffrey Sonis — 2012-02-03

Boscarino and colleagues describe the development and validation of a clinical prediction rule, the New York PTSD risk score. The results show that the Primary Care PTSD screening test was, by far, the strongest predictor of having (i.e., prevalent not incident) PTSD. Although the increase in discrimination of the model by adding psychosocial risk factors to the results of the PTSD screening was statistically significant, the size of the increase was small. For example, in the development sample, the positive predictive value increased from 29.3%, using only the Primary Care PTSD Screen, to 33.9% after adding the psychosocial risk factor variables. The negative predictive value was unchanged. In the trauma validation sample, the positive predictive value increased (from 40.3% to 48.6%) after adding the psychosocial variables to the model, while in the pain study validation sample, the positive predictive value actually decreased after adding psychosocial variables to the model (from 70.1% to 69.8%). These findings suggest that, for simplicity, a clinician who wants to screen for current PTSD would do just about as well by simply using the Primary Care PTSD screen without spending the additional time required to ask the psychosocial questions or use the nomogram developed by Boscarino and colleagues to estimate the probability that someone has PTSD.

Use of the New York PTSD risk score to predict PTSD: current and future research efforts

Joseph A. Boscarino, H. Lester Kirchner, Stuart N. Hoffman, Jennifer Sartorius — 2012-02-13

We appreciate Dr. Sonis' comments related to our paper recently published in General Hospital Psychiatry . As he suggests, the New York PTSD Risk Score we developed in that paper predicts current (i.e., incident and prevalent) PTSD status, and the Primary Care PTSD Screener (PCPS) is the strongest predictor of this status. He noted that although the increase in discrimination by adding psychosocial risk factors to the prediction results that included PCPS was statistically significant, the size of this increase was small. Dr. Sonis also pointed out that these findings suggest that a clinician who wants to screen for current PTSD would do well by simply using the PCPS, without the additional psychosocial variables we suggested. He further noted, correctly, that a clinical prediction model based on factors measured shortly after traumatic event exposure (but prior to the development of PTSD) that was capable of predicting PTSD at 12 months after exposure would be of more clinical utility since interventions designed to prevent PTSD could then be targeted among those at highest risk. Additionally, Dr. Sonis indicated that since peritraumatic factors that have been shown to predict PTSD development were not measured in our study, the NY PTSD Risk Score will not be useful to determine who is at higher risk of developing PTSD in the aftermath of trauma.

Life-threatening thrombocytosis following GCSF treatment in a case of clozapine-induced agranulocytosis

Sabita Dihingia, Kamala Deka, Dhrubajyoti Bhuyan, Supriya Kumar Mondal — 2011-10-24

Abstract: Clozapine was introduced in European market in 1972 as an effective treatment for schizophrenia without extrapyramidal side effects. Within a short while, the clozapine story virtually came to a halt following detection of life-threatening neutropenia and agranulocytosis. Judicial use of granulocyte colony stimulating factor (GCSF) can be life saving with infrequent side effects in these cases. Here we are presenting a case of clozapine induced agranulocytosis managed with GCSF but had transient but life-threatening thrombocytosis, a very uncommon complication of GCSF therapy. Expression of GCSF receptors on the surface of megakaryocytic lineage is thought to be the cause of this unusual phenomenon.

The diagnostic challenge of frontotemporal dementia in psychiatric patients: a case report

Lucio Ghio, Alice Cervetti, Francesca Pannocchia, Werner Natta — 2011-11-07

Abstract: Frontotemporal dementia (FTD) is often misdiagnosed early in the clinical course and may be confused with primary psychiatric disorders. This is especially true when patients have a psychiatric history. In this report, we describe a case that illustrates the diagnostic challenge of FTD in a patient with a history of obsessive–compulsive disorder.

Propranolol in yawning prophylaxis: a case report

Ahmad Ghanizadeh — 2011-11-07

Abstract: Objective: Yawning is a frequent behavior with circadian effects. Sometimes, its frequency is very high and it is disturbing. However, there is no evidence-based treatment for yawning.Method: This is a case report of a man with severe yawning from about 2 years ago.Results: Yawning reduced after taking propranolol.Conclusion: Current evidence suggests that propranolol may decrease yawning through its thermoregulation effect. It is worthwhile conducting controlled clinical trials to study whether propranolol is an effective treatment for yawning.

Cingulate cortex aplasia and callosal dysgenesia combined with schizencephaly in a patient with chronic lying

2011-11-14

Abstract: We report on a 19-year-old patient with a 4-year history of lying and cheating who presented neuropsychological abnormalities regarding attention deficits, hyperactivity and impulsivity. Cerebral magnetic resonance imaging scans revealed schizencephaly of the right central region, dysgenesia of the corpus callosum, a noneverted gyrus cinguli and hypoplasia of the left cerebellar hemisphere. Although the patient did not fulfill the diagnostic criteria for attention-deficit/hyperactivity disorder, we suggest that the patient's behavioral alteration could be related to the neuroanatomical alterations, especially the aplasia of the gyrus cinguli.

A case of severe oral self-injurious Tourette's syndrome alleviated by pregabalin

2011-12-02

Abstract: Self-injurious behavior (SIB) associated with Tourette's syndrome (TS) is a severe neuropsychiatric condition that causes significant distress and can impair social functioning. The current treatment options for the condition include pharmacological, physical and psychosocial interventions. However, given the need for more effective interventions, especially for those patients who are unresponsive and/or intolerant to standard medications, further exploration of novel treatments is imperative. In this report, we present a case of SIB-TS that was successfully treated with pregabalin. The patient received 1-year of follow-up and was noted to have considerable improvement in symptoms. Although rigorous controlled studies are required, based on our case study, pregabalin may be a potential treatment option in some cases of SIB with TS.

Catatonia and mania in patient with AIDS: treatment with lorazepam and risperidone

Om Prakash, Bhavani Shankara Bagepally — 2012-02-23

Abstract: A 30-year-old woman presented with psychiatric symptoms and was found to be HIV positive prior to admission to the hospital. We present the first case report of catatonia and mania in an HIV-positive subject unrelated to infectious processes. The catatonic symptoms were alleviated by intravenous lorazepam, and manic symptoms were adequately treated with risperidone. Clinicians need to be aware that HIV infection should be considered in all patients with new-onset mania alternating with catatonia or in those with HIV risk factors.

Announcements

2012-05-01

Psychosis associated with bromvalerylurea abuse in a patient with traumatic brain injury

Chun-Ya Kuo, Chih-Min Liu, Li-Ren Chang — 2011-12-12

Bromvalerylurea is a common ingredient of over-the-counter analgetic syrup in Asian countries. It has been widely used as analgesics, sedatives or hypnotics . The abuse of analgetic syrup may cause chronic bromvalerylurea intoxication . Neuropsychiatric manifestations of bromvalerylurea intoxication include psychosis, delirium, reversible dementia, ataxia, dysphagia, dysarthria and dystonia . Here we report a patient with traumatic brain injury (TBI) showing psychosis which warned us of the possible risk of analgetic syrup abuse in vulnerable patients.