General Hospital Psychiatry - Articles in Press

A case of schizophrenia with dysphagia successfully treated by a multidimensional approach - Corrected Proof

Kuo T. Tang, Ming H. Hsieh — 2010-03-17

Abstract: Dysphagia in patients with psychiatric illnesses contributes to morbidities and mortalities. It is, however, an overlooked problem in clinical practice. We report a patient of schizophrenia with dysphagia who was successfully treated using a multidimensional approach, which included medication adjustment, swallowing training and diet modification.

Quality of care for heart failure among disabled Medicaid recipients with and without severe mental illness - Corrected Proof

2010-03-17

Abstract: Objective: To examine the association between severe mental illness (SMI) and quality of care in heart failure.Methods: We conducted a cohort study between 2001 and 2004 of disabled Maryland Medicaid participants with heart failure. Quality measures and clinical outcomes were compared for individuals with and without SMI.Results: Of 1801 individuals identified with heart failure, 341 had comorbid SMI. SMI was not associated with differences in quality measures, including left ventricular assessment [adjusted relative risk (aRR) 0.99; 95% CI 0.91–1.07], utilization of angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) (aRR 1.04; 95% CI 0.92–1.17), or beta-blocker use (aRR 1.13; 95% CI 0.99–1.29). During the study period, 52.2% of individuals in the cohort filled a prescription for an ACE inhibitor or ARB and 45.5% filled a beta-blocker prescription. Individuals with and without SMI had similar rates of clinical outcomes, including hospitalizations, readmissions, and mortality. Both medication interventions were associated with improved mortality.Conclusions: In this sample of disabled Medicaid recipients with heart failure, persons with SMI received similar quality of care as those without SMI. Both groups had low rates of beneficial medical treatments. Quality improvement programs should consider how best to target these vulnerable populations.

What is the role of consultation–liaison psychiatry in the management of depression in primary care? A systematic review and meta-analysis - Corrected Proof

John Cape, Craig Whittington, Peter Bower — 2010-03-12

Abstract: Objective: To assess the effectiveness of consultation–liaison services, involving mental health professionals working to advise and support primary care professionals in the management of depression.Methods: Studies of consultation–liaison for depression in primary care were identified from a systematic search of electronic databases, augmented by identification of papers from reference lists, published reviews and from hand searching. Data on study quality, intervention characteristics and outcomes were extracted by two reviewers, and outcome data were meta-analyzed.Results: Five studies met the criteria. There was no significant effect of consultation–liaison on antidepressant use (risk ratio 1.23, 95% CI 0.91 to 1.66) or depression outcomes in the short- (standardized mean difference −0.04, 95% CI −0.21 to 0.14) or long-term (standardized mean difference 0.06, 95% CI −0.13 to 0.26).Conclusions: Evidence concerning consultation–liaison for depression in primary care remains limited, but the existing studies do not suggest it is more effective than usual care. Further research is required to explore the mechanisms by which consultation–liaison might be made more effective, including the potential role of consultation–liaison in combination with other models of care, and in other patient populations.

Prevalence, correlates and recognition of depression among inpatients of general hospitals in Wuhan, China - Corrected Proof

2010-03-11

Abstract: Objective: To determine the prevalence, correlates and recognition of depression among inpatients of general hospitals in Wuhan, China.Method: A total of 513 patients were randomly selected from 1923 inpatients from three general hospitals and evaluated with a Chinese version of the Structured Clinical Interview for Diagnostic and Statistical Manual-IV Axis I disorders by eight psychiatrists. Logistic regression was used to identify factors that were associated with depression.Results: The prevalence (95% confidence interval) of all current depressive disorders and major depressive disorder (MDD) was found to be 16.2% (13.0–19.4%) and 9.4% (6.8–11.9%), respectively. The correlates for depression include higher hospital class, divorce/being widowed/separation, low family income, chronic diseases, lack of medical insurance, dwelling in rural area, suffering from severe illness and multiple hospitalization history. None of the patients with current MDD were detected, treated or referred to psychiatric consultation.Conclusions: The prevalence of depression among inpatients of general hospitals in Wuhan, China, was high. None of the depressive patients were recognized or treated for depression, indicating a serious neglect of depression in general hospitals. Our studies suggest an urgent need to improve clinicians' ability to detect and treat depression.

Depressive symptoms in adolescence: the association with multiple health risk behaviors - Corrected Proof

2010-03-02

Abstract: Objective: Although multiple studies of adolescents have examined the association of depression with individual health risk behaviors such as obesity or smoking, this is one of the few studies that examined the association between depression and multiple risk behaviors.Methods: A brief mail questionnaire, which screened for age, gender, weight, height, sedentary behaviors, physical activity, perception of general health, functional impairment and depressive symptoms, was completed by a sample of 2291 youth (60.7% response rate) aged 13–17 enrolled in a health care plan. A subset of youth who screened positive on the two-item depression screen and a random sample of those screening negative were approached to participate in a telephone interview with more in-depth information obtained on smoking and at-risk behaviors associated with drug and alcohol use.Results: Youth screening positive for high levels of depressive symptoms compared to those with few or no depressive symptoms were significantly more likely to meet criteria for obesity, had a poorer perception of health, spent more time on the computer, got along less well with parents and friends, had more problems completing school work and were more likely to have experimented with smoking and a wide array of behaviors associated with drug and alcohol use.Conclusions: Because many adverse health behaviors that develop in adolescence continue into adulthood, the association of depressive symptoms with multiple risk behaviors and poor functioning suggest that early interventions are needed at an individual, school, community and primary care level.

Psychosis in a patient with Danon cardiomyopathy - Corrected Proof

2010-03-02

Danon disease is an X-linked cardioskeletal myopathy related to a primary deficiency in lysosome-associated membrane protein-2 (LAMP-2) . LAMP-2 is a glycosylated protein coating the inner side of the lysosomal membrane. It is suggested that LAMP-2 protects the membrane from the destructive enzymes contained within the lysosome . With a hemizygous mutation in this essential protein, lysosomes become autophagic and are deposited as vacuoles within various tissues, leading to systemic pathology .

Comorbidity between common mental disorders and chronic somatic diseases in primary care patients - Corrected Proof

2010-03-02

Abstract: Objective: To estimate the prevalence of the most common mental disorders in primary care patients with chronic somatic diseases based on physicians' diagnoses and compared with healthy probands.Method: A systematic sample of 7940 adult primary care patients was recruited by 1925 general practitioners (GPs) in a large cross-sectional national epidemiological study. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was used as standardized instrument for the assessment of mental disorders. Medical diagnoses were provided by patient's GP.Results: The prevalence rate of mental disorder was significantly higher in patients with chronic somatic diseases (56.8%) compared with physically healthy subjects (48.9%; OR: 1.37). Prevalence of depressive and anxiety disorders is higher among individuals with neurological, oncological or liver disease. The differences are significant in all comparisons, with the exception of anxiety disorders in patients with musculoskeletal disorders. There is an increase in prevalence rates of mental disorders according to the number of somatic diseases.Conclusions: The study provides evidence of the comorbidity of common mental disorders and somatic diseases. We need a predominant focus on affective and anxiety disorders in primary care patients with chronic somatic diseases. Symptoms overlap makes it necessary to discriminate these differences more in detail in future studies.

Peritraumatic reactions and posttraumatic stress symptoms in school-aged children victims of road traffic accident - Corrected Proof

2010-03-02

Abstract: Objective: The purpose of this study is to investigate the power of self-reported peritraumatic distress and dissociation to predict the development of posttraumatic stress disorder (PTSD) symptoms in school-aged children.Methods: School-aged children aged 8 to 15 years admitted to an emergency department after a road traffic accident were enrolled (n=103). Participants were assessed with the child versions of the Peritraumatic Distress Inventory and the Peritraumatic Dissociative Experiences Questionnaire within 1 week. Posttraumatic stress disorder symptoms were then assessed at 5 weeks.Results: A significant association between peritraumatic variables and two measures of PTSD symptoms was demonstrated. However, in a multivariate analysis, peritraumatic distress was the only significant predictor of acute PTSD symptoms (β=.33, p<.05).Conclusions: As has been found in adults, peritraumatic distress is a robust predictor of who will develop PTSD symptoms among school-aged children.

Measuring improvement in depression in cancer patients: a 50% drop on the self-rated SCL-20 compared with a diagnostic interview - Corrected Proof

2010-02-25

Abstract: Objective: To determine the validity of a 50% drop in the 20-item Symptom Checklist Depression Scale (SCL-20) score against the “gold standard” of no longer meeting criteria for major depression as assessed using a diagnostic interview in an outpatient cancer population and also to examine the validity of other potential cut-offs (i.e., percentage drops).Materials and Methods: Secondary analysis of data from a randomized trial which compared collaborative care with usual care for cancer patients with major depression. A total of 194 trial participants who had both SCL-20 scores and depression diagnoses on the Structured Clinical Interview for DSM-IV at both baseline and at 12-week outcome formed the analyzed sample.Results: A 50% reduction in the SCL-20 score from baseline to 12 weeks correctly identified the patients who no longer met criteria for major depression in 153 (78.9%) of 194 (95% CI 73.1% to 84.6%) cases. Most of those misclassified had not achieved a 50% reduction in SCL-20 score despite no longer meeting criteria for major depression. Examination of the performance of percentage drops other than 50% on the SCL-20 using a receiver operating characteristics (ROC) curve and histogram of misclassification suggested that the 50% drop was best if both a low overall misclassification rate and the minimizing of false positives of improvement were required.Conclusions: A 50% reduction in the SCL-20 score performs well as a conservative measure of change in depression status in cancer patients.

Psychiatric morbidity following miscarriage in Hong Kong - Corrected Proof

Adrian kwan-ho Sham, Michael gar-chung Yiu, Winsom yau-bong Ho — 2010-02-22

Abstract: Objective: The aim of this study is to examine the pattern of psychiatric morbidity up to 3 months following miscarriage and to identify the risk factors of post-miscarriage depressive disorder among Chinese women in Hong Kong.Method: This is a longitudinal cohort study. Women were interviewed immediately after miscarriage to collect psychiatric and sociodemographic data. Three months later, 161 subjects (89%) were assessed by a 12-item General Health Questionnaire (GHQ-12) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) as screening and diagnostic instruments, respectively.Results: Three months after miscarriage, 10% of subjects suffered depressive disorder, 1.2% were diagnosed with anxiety disorder not otherwise specified, and another two subjects each suffered obsessive compulsive disorder (0.6%) and posttraumatic stress disorder (0.6%), respectively. Risk factors of post-miscarriage depression included younger age, history of infertility and past history of depression.Conclusions: Given the local annual figure of more than 7000 first-trimester miscarriages, about 900 local women suffer post-miscarriage psychiatric disorder each year. This finding may prompt general hospitals in Hong Kong to screen for post-miscarriage psychiatric disorders, particularly depression.

Risperidone induced stuttering - Corrected Proof

Devender Singh Yadav — 2010-02-22

Abstract: Stuttering as a side effect of antipsychotics is rare.There are a few case reports of antipsychotic-induced stuttering, namely, chlorpromazine, levomepromazine, trifluoperazine, fluphenazine, olanzapine and clozapine.Risperidone is commonly used as an atypical antipsychotic. It is licensed for both acute and chronic psychosis and mania. There is only one documented case report mentioned on risperidone induced stuttering. One case report of risperidone-induced stuttering is now described. Stuttering is a rare side effect and requires a high index of suspicion for diagnosis.Further study and research to identify the neurophysiological and psychological processes behind adult onset stuttering and identification of the processes involved in risperidone induced stuttering would help our understanding further.

The Child Stress Disorders Checklist-Short Form: a four-item scale of traumatic stress symptoms in children - Corrected Proof

Michelle Bosquet Enlow, Nancy Kassam-Adams, Glenn Saxe — 2010-02-22

Abstract: Objective: To develop a user-friendly scale that measures traumatic stress responses in injured children. Though injured youth are at high risk for traumatic stress reactions and negative sequelae, there are limited options available for assessing risk, particularly in acute settings.Method: Participants were children and adolescents (ages 6–18) hospitalized with burns or acute injuries (N=147). During hospitalization, parents and nurses completed the Child Stress Disorders Checklist (CSDC), a 36-item observer-report measure of traumatic stress symptoms. Other established measures of child traumatic stress were completed by parents and children during hospitalization and 3 months postinjury. A brief version of the CSDC was created using standard psychometric scale development techniques. The psychometric properties of the resultant scale were compared to those of the original CSDC.Results: A four-item scale (CSDC-Short Form, CSDC-SF) emerged that demonstrated internal, interrater, and test–retest reliability and concurrent, discriminant, and predictive validity comparable to that of the full scale.Conclusions: The CSDC-SF assesses traumatic stress reactions in injured children. Because the measure is very short and does not require specialized training for administration or interpretation, it may be a useful tool for providers who treat injured youth to identify those at risk for traumatic stress reactions.

Psychological distress in twins with urological symptoms - Corrected Proof

2010-02-22

Abstract: Objective: Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic pain condition with unclear underlying etiology. Our objectives were to determine whether psychological distress was higher in twins with urological symptoms commonly found in IC/PBS than in twins without, and if so, did familial influences contribute to this association.Method: Data from 1165 female twins in a community-based sample were used. Urological symptoms, symptoms of posttraumatic stress disorder (PTSD), depression, anxiety and perceived stress were assessed with standardized questionnaires. Generalized estimating equation (GEE) regression models were used to examine the relationship between psychological distress and urological symptoms.Results: Compared to unaffected twins, twins with urological symptoms were more likely to report PTSD symptoms (OR=3.9; 95% CI=2.6–5.8), depression (OR=3.1; 95% CI=2.0–5.0), anxiety (OR=3.4; 95% CI=2.3–5.2) and perceived stress (OR=3.2; 95% CI=2.1–4.9). After adjusting for familial influences, the within-pair effects remained significant for PTSD symptoms (OR=2.2; 95% CI=1.2–3.8) and perceived stress (OR=2.2; 95% CI=1.2–3.8).Conclusion: Familial influences partially explained the relationship between indicators of psychological distress and urological symptoms. Future research should examine shared environmental and genetic mechanisms that may further explain this relationship and improve diagnosis and treatment of this unexplained clinical condition.

Social and clinical factors associated with psychiatric emergency service use and civil commitment among African-American youth - Corrected Proof

Michael A. Lindsey, Sean Joe, Jordana Muroff, Briggett E. Ford — 2010-02-05

Abstract: Purpose: We examined the social and clinical factors associated with arrival status (e.g., involuntary versus voluntary) and civil commitment decisions in psychiatric emergency services (PES) to assess African-American youths' help-seeking patterns and entrée into care.Methods: Patient records were reviewed for 1621 African-American youth from an inner-city PES between October 2001 and September 2002. Multivariate logistic regression was used to examine the social and clinical factors associated with arrival status (e.g., involuntary vs. voluntary admission) and case disposition among youth who were involuntarily and voluntarily admitted (e.g., disposition upheld vs. dismissed).Results: Low-income youth with behavior disorders were less likely to arrive voluntarily to PES. Medical insurance, suicidality, DSM diagnosis, substance involvement, Global Assessment of Function (GAF) scores and time of day the youth arrived to PES were predictors of voluntary arrival. Older age and GAF scores significantly predicted the decision to uphold an involuntary commitment. Age (younger age less likely), higher GAF scores, insurance status, substance abuse involvement and arrival time (evening shift) significantly predicted the decision to uphold a voluntary decision.Implications: Our findings suggest that psychiatric and nonpsychiatric factors influence both how African-American youth arrive to PES and the decisions made regarding their voluntary/involuntary commitment.

Pseudotumor cerebri in a patient being treated for bipolar disorder - Corrected Proof

Yeşim Yetimalar Beckmann, Yaprak Seçil, Buket Belkız Güngör — 2010-02-01

Pseudotumor cerebri (PTC), also termed idiopathic intracranial hypertension, is a well-recognized disorder of unknown etiology associated with elevated intracranial pressure, normal neuroimaging and normal cerebrospinal fluid composition, found mostly among obese females of childbearing age. Several medications have been associated with PTC. We report a case treated with valproic acid, olanzapine and paroxetine who developed PTC and emphasize the potential role of these drugs in developing PTC.

Association of nonsexual and sexual traumatizations with body image and psychosomatic symptoms in psychosomatic outpatients - Corrected Proof

Martin Sack, Katja Boroske-Leiner, Claas Lahmann — 2010-02-01

Abstract: Objective: A coherent body image is constituted in an interpersonal process during early development. Violations of body self-boundaries (e.g., sexual traumatizations during childhood) could alter the development of a coherent body image and promote symptoms of dissociation and somatization.Method: A total of 240 psychosomatic outpatients underwent a clinical diagnostic interview and a psychometric evaluation including the Posttraumatic Stress Scale (PDS), the Body Image Questionnaire (FKB-20), an inventory of somatoform symptoms (SOMS-7), the Brief Symptom Questionnaire (BSI) and the Dissociative Experiences Scale (DES). Subjects were assigned to one of the following subgroups according to their self-reported trauma status: “nontraumatized,” “nonsexually traumatized” and “sexually traumatized”.Results: Nonsexual traumatizations were more often reported by men (53.4% vs. 35.9%), whereas women more often reported sexual traumatization (9.6% vs. 33.5%). Women reporting sexual traumatizations showed a significantly higher negative validation of their own body and significantly more psychological symptoms (BSI-GSI), whereas both men and women with sexual traumatizations reported significantly more somatoform complaints and more dissociative symptoms when compared with nonsexual or nontraumatized patients.Conclusion: Victims of sexual trauma suffer from a more complex symptom pattern including a more negative perception of their own body compared with patients with nonsexual trauma or no trauma.

Ecchymoses as an adverse effect of fluvoxamine treatment in an adolescent girl - Corrected Proof

Boričević Maršanić Vlatka, Aukst-Margetić Branka, Margetić Branimir — 2010-02-01

Reports of bleeding in patients receiving selective serotonin inhibitors (SSRIs) appeared soon after their introduction. Case reports have described adult patients with various bleeding disorders (e.g., ecchymoses, purpura, epistaxis), while observational studies have focused on upper gastrointestinal bleeding, intracranial bleeding and bleeding during surgery . Bleeding complications of fluvoxamine treatment have been described in adults . However, reports of bleeding complications of SSRI treatment are not limited to the adult population. Several cases of abnormal bleeding under SSRI treatment have been described in children and adolescents with similar clinical manifestations . We report a case of an adolescent girl who manifested ecchymoses during fluvoxamine treatment.

Improving health and productivity of depressed workers: a pilot randomized controlled trial of telephone cognitive behavioral therapy delivery in workplace settings - Corrected Proof

Penny E. Bee, Peter Bower, Simon Gilbody, Karina Lovell — 2010-02-01

Abstract: Objective: To examine the feasibility of telephone-delivered cognitive behavioral therapy (T-CBT) in an occupational context, with reference to participant recruitment, treatment adherence, follow-up and effect.Method: Eligible participants comprised all employees of a large communications company with authorized work absence due to mild/moderate mental health difficulties over a 10-month period. Fifty-three consenting participants were centrally randomized to 12 weeks T-CBT or usual care, with minimization on age, gender and illness severity. Primary (symptom severity) and secondary outcomes (self-rated work performance and productivity) were measured at baseline and 3-months via postal questionnaires. Intention-to-treat analysis comprised multiple regression modeling with adjustment for missing response predictors, minimization variables and baseline values.Results: Twenty-three employees attended one or more T-CBT sessions. T-CBT was associated with medium–large effects sizes on clinical outcomes (0.63–0.77) and work productivity scores (0.75–0.88). Twenty-one patients failed to return 3-month primary outcome data. Non-respondents were more likely to be male and more severely ill.Conclusion: Delivery of T-CBT in an occupational context is feasible with evidence of potential effect. Larger-scale trials are warranted. These studies demand assertive outreach or telephone-based assessment strategies in order to maximize participant recruitment and follow-up.

A case of methamphetamine use disorder treated with the antibiotic drug minocycline - Corrected Proof

2010-01-22

Abstract: Methamphetamine (METH) use is one of the major public health concerns worldwide. Long-term use of METH induces not only dependence but also psychosis which is associated with METH-induced brain damage, including neuroinflammation produced by activated microglia. We report the case of a female patient whose psychotic symptoms in METH use disorder were successfully improved by anti-inflammatory drug minocycline therapy. Although the precise mechanism(s) underlying the efficacy of minocycline in METH use disorder are currently unclear, minocycline appears to be a good candidate for future investigation clinical trials for medication development in METH using populations.

Predictors of carbon monoxide poisoning-induced delayed neuropsychological sequelae - Corrected Proof

Hsiao-Lun Ku, Kai-Chun Yang, Ying-Chiao Lee, Ming-Been Lee, Yuan-Hwa Chou — 2010-01-11

Abstract: Objective: Carbon monoxide poisoning (COP) commonly results in delayed neuropsychological sequelae (DNS). The aim of the article is to demonstrate the clinical characteristics and potential predictors of COP-induced DNS later.Method: Retrospective medical record review was performed for patients who had COP in the past year at a National Medical Center in Taiwan. Sixty patients with COP were registered during a one-year period. Fifty-six of them (93.3%) were COP because of suicide attempt. Patients with COP who have a complete medical record of carboxyhemoglobin (COHb) and Glasgow Coma Scale (GCS) and Mini-Mental Status Examination (MMSE) scores were recruited. Multiple regression analysis was performed to search for the predictive factors of DNS.Results: Forty-three patients were recruited. Most had attempted suicide (93.0%) using CO, and thirteen developed DNS later. A longer duration of admission, more sessions of hyperbaric oxygen therapy, and positive findings in brain computed tomography (CT) scans were more often found in patients with DNS than those without DNS. The GCS and MMSE scores and positive findings in brain CT scans were associated with the development of DNS but COHb was not.Conclusions: Our results identified several potential predictors of DNS. This finding may help clinicians understand and treat COP patients efficiently.

Comments on “Aripiprazole in major depression and mania: meta-analyses of randomized placebo-controlled trials.” Authors' response - Corrected Proof

Beatriz Arbaizar, Trinidad Dierssen-Sotos, Inés Gómez-Acebo, Javier Llorca — 2010-01-11

Meta-analyses on clinical trials should be periodically updated, especially if they refer to a field in continuous development, as usage of aripiprazole is. The trial of Berman et al. was published in print the same month we performed our last search, so we are pleased to see our meta-analysis updated so soon. The letter by Chi-Un Pae (this issue) confirms what we suggested in our manuscript : augmentation with aripiprazole is effective in major depression when current antidepressive treatments have failed; this result is now based on three randomized clinical trials from the same research group.

TakoTsubo syndrome and emotional stress: a Heuristic approach - Corrected Proof

François Sirois — 2010-01-04

Abstract: While acute and reversible coronary syndrome without anatomical damage, called TakoTsubo syndrome, has been repeatedly associated with emotional stress, the specific categories of stressors have been ill-defined. Following a review of variously described emotional stressors associated with that specific cardiomyopathy, a clinical report is presented to raise two issues: the overlap of biological risk factors with emotional stress and the interplay of acute and subacute emotional stressors.

Catatonia induced by idiopathic hypertrophic pachymeningitis - Corrected Proof

2009-12-21

Abstract: We describe the case of a 63-year-old woman with catatonia induced by idiopathic hypertrophic pachymeningitis (IHP). The patient was treated for IHP with prednisolone for approximately 1 year. When she presented with catatonia, no significant changes could be detected by magnetic resonance imaging (MRI) compared with the previous imaging results; electroencephalography (EEG) revealed a delta-wave focus over the left frontotemporal region. High-dose steroid therapy was effective in resolving the catatonic symptomatology and EEG abnormality.

Posterior reversible encephalopathy syndrome in chronic alcoholism with acute psychiatric symptoms - Corrected Proof

Ryo Kimura, Makoto Yanagida, Aki Kugo, Satoki Taguchi, Hidenori Matsunaga — 2009-12-17

Abstract: Objective: To highlight the association between posterior reversible encephalopathy syndrome (PRES) and chronic alcoholism.Methods: We present a case report, a review of the literature and a discussion.Results: We report on the case of a 51-year-old man with chronic alcoholism, who suddenly developed visual disturbance and confusion. Magnetic resonance imaging (MRI) on admission demonstrated abnormal findings. However, clinical symptoms and imaging promptly improved, indicating the diagnosis of PRES.Conclusion: PRES should be considered when making a diagnosis for disturbed consciousness in alcoholic patients.

Suxamethonium induced prolonged apnea in a patient receiving electroconvulsive therapy - Corrected Proof

Avinash Waghmare, Channaveerachari Naveen Kumar, Jagadisha Thirthalli — 2009-12-03

Abstract: Suxamethonium causes prolonged apnea in patients in whom pseudocholinesterase enzyme gets deactivated by organophosphorus (OP) poisons. Here, we present a similar incident in a severely depressed patient who received electroconvulsive therapy (ECT). Prolonged apnea in our case ensued because the information about suicidal attempt by OP compound was concealed from the treating team.

Delusional parasitosis in neurological patients - Corrected Proof

Jesus Ramirez-Bermudez, Mariana Espinola-Nadurille, Narda Loza-Taylor — 2009-11-16

Abstract: Objective: Delusional parasitosis has been described in a wide range of patients with general medical conditions, but there are few reports about its frequency and possible pathogenic mechanisms in neurological patients. This paper describes this delusional syndrome in a sample of neurological patients.Methods: We reviewed all clinical charts of hospitalized patients at the neuropsychiatry ward of a neurological center, from January 2005 to June 2009. Cases with delusional parasitosis were described in terms of demographic, clinical and brain imaging features.Results: From a total sample of 1598 patients, we identified 636 patients with neurological disease (39.80%); of these, four patients showed delusional parasitosis (0.62% of the neurological sample). Their diagnoses were brain cysticercosis (n=1), cerebrovascular disease (n=2), and dementia due to vitamin B12 deficit (n=1). They were women in late life, with depressive features. Three of them had significant cognitive decline. Two of them had paraesthesia and pruritus related to peripheral neuropathy. One of them had pruritus of unknown origin (possibly hallucinatory).Conclusions: Delusional parasitosis was infrequent in this sample of hospitalized neurological patients. Female sex, advanced age, depressive features, cognitive decline, pruritus and paraesthesia of peripheral or central origin may contribute to delusional parasitosis in this population.

A case of oxybutynin dependency - Corrected Proof

Sinan Guloksuz, Kenan Eren, Defne Tamar Gurol — 2009-10-30

Anticholinergic abuse in the population with chronic mental illness using antipsychotics is a common problem . However, the abuse of anticholinergics in addicts who are not using antipsychotics is very low. In this case, we report a dependency of oxybutynin (Ditropan) which is an anticholinergic medication used to relieve urinary and bladder difficulties including frequent urination and urge incontinence by decreasing muscle spasms of the bladder . To our knowledge, this is the first case representing a dependency of oxybutynin which has relatively low anticholinergic effect.

Charles Bonnet syndrome and vitamin B12 deficiency: a case report - Corrected Proof

2009-09-25

Abstract: The Charles Bonnet syndrome (CBS) is a condition associated with complex visual hallucinations occurring in the elderly in patients with visual impairment and normal mental health. Here, we report the case of a 78-year-old woman who has a limited visual acuity with a CBS that we postulated to be in relationship to a vitamin B12 deficiency. This case is the first report of vitamin B12 deficiency-associated CBS.

Onset of psoriasis during therapy with fluoxetine - Corrected Proof

Lynnette Tan Pei Lin, Seow Khee Kwek — 2009-09-25

Abstract: Objective: Psoriasis is a commonly diagnosed skin disorder that requires a long-term management and can have a profound impact on the quality of life of patients. Drugs that have been associated with the precipitation or exacerbation of psoriasis include lithium, beta-adrenergic receptor blocking agents and antimalarials. Despite extensive use of selective serotonin reuptake inhibitors (SSRIs) in clinical practice, there have been very few reports of selective serotonin reuptake inhibitor-related psoriasis. The main purpose of this study was to report fluoxetine-induced psoriasis in two Chinese women.Results and Conclusion: Although both patients had been taking fluoxetine for an extended period of time, the time scale of these two case studies suggests that fluoxetine played a causative role in these patients' psoriasis.

A possible case of mixed mania due to neurosarcoidosis treated successfully with methylprednisolone and ziprasidone: another example of frontal–subcortical disinhibition? - Corrected Proof

David R. Spiegel, Christopher S. Thomas, Pallav Shah, Kristin D. Kent — 2009-09-14

Abstract: Sarcoidosis is an idiopathic systemic granulomatous disease recognized by clinical and radiographic findings, which ultimately require histopathologic confirmation of noncaseating granulomas for a definitive diagnosis. Psychiatric manifestations occur in 20% of patient with neurosarcoidosis [http://dynaweb.ebscohost.com.chekov.evms.edu/Detail.aspx?id=306337&sid=bdce39cc-d2bd-4977-9e4d-786f2e768d57@sessionmgr4]. We present a case of suspected mixed mania due to neurosarcoidosis, with the manic symptoms responding early and robustly to ziprasidone.

Major depressive episode secondary to condylomata acuminata - Corrected Proof

2009-08-28

Abstract: Psychiatric and psychological morbidity is often associated with skin diseases. Recent research has focused on the epidemiological and clinical aspects of human papillomavirus infection, whereas the psychosocial and emotional factors related to the disease have not been well established. We describe the experience of a 22-year-old male who, after being diagnosed of condyloma acuminata, developed a major depressive disorder.

Euprolactinemic galactorrhea associated with use of imipramine and escitalopram in a postmenopausal woman - Corrected Proof

Rajnarayan Mahasuar, Pratima Majhi, Jayprakash Rusell Ravan — 2009-08-28

Abstract: Hormonal side effects of antidepressants are infrequent, and galactorrhea is seldom mentioned among tricyclic antidepressant (TCA) and selective serotonin reuptake inhibitor (SSRI)-related side effects. Antidepressants can directly stimulate postsynaptic 5-HT receptors in the hypothalamus or indirectly inhibit the tuberoinfundibular dopaminergic neurons through 5-HT, which may increase prolactin levels and later cause galactorrhea. We describe a case of euprolactinemic galactorrhea in a postmenopausal woman, induced by imipramine and escitalopram. This report highlights the presence of unidentified novel mechanisms of antidepressant-induced galactorrhea and other possible contributors.

Unexpected interaction between quetiapine and valproate in patients with bipolar disorder - Corrected Proof

Chih-Chia Huang, I-Hua Wei — 2009-08-10

Abstract: Quetiapine, a second-generation antipsychotic originally used in the treatment of schizophrenia, was also found to be effective as monotherapy or as an adjunctive therapy for acute mania. Delirium in patients treated with quetiapine seems to be a rare phenomenon; however, we report two patients with bipolar disorder who developed delirium when prescribed quetiapine as an adjunct to valproate for acute mania. Both had previously developed mild renal insufficiency after an episode of lithium intoxication. The delirium resolved after quetiapine was discontinued. Unexpected interactions may occur when medications are combined without being subject to controlled clinical trials.

Mothball induced encephalopathy presenting as depression: it’s all in the history - Corrected Proof

Suzanne B. Murray, Megan Dwight-Johnson, Mitchell R. Levy — 2009-06-01

Abstract: Case reports of mothball ingestion have shown that paradichlorobenzene, the organic compound found in mothballs, can induce multiple organ effects, including encephalopathy. Psychiatrists are often involved in these cases due to presumed depression. Diagnosis is frequently delayed and/or inaccurate due to the inability to obtain a full history. A delay in diagnosis may result in an inappropriate treatment plan. We present a case involving a woman who ingested mothballs due to Pica emphasizing the importance and challenges of getting a thorough history. Barriers include cultural differences, shame and obtaining collateral information.

Lithium in chronic renal failure: a case report - Corrected Proof

Ravindra B. Belgamwar, Fami Ebrahim, Catherine Campbell — 2009-05-22

Abstract: A 73-year-old woman with bipolar disorder was stable on lithium. After long-term use of lithium, she developed chronic renal failure. We stopped her lithium and tried alternatives but this was not successful and resulted in poor quality of life for the patient including long hospital admissions. We respected patient’s wish and capacity to make decision and retried lithium. This case report gives key points in managing such cases.

Repeated angioedema following administration of venlafaxine and mirtazapine - Corrected Proof

Ching-En Lin, Chih-Lun Chen — 2009-04-16

Abstract: We report a rare case of a 48-year-old female who presented with bilateral lower-leg swelling due to a medication-induced angioedema resulting from the use of two common classes of antidepressants, venlafaxine and mirtazapine. Although the mechanisms by which the antidepressants achieve these effects are not understood, the recent recognition of a novel antidepressant-dependent form of angioedema may offer important insights into the mechanisms by which the antidepressants exert their effects.