General Hospital Psychiatry - Articles in Press

How does subjective experience of pain relate to psychopathology among psychiatric patients? - Corrected Proof

2012-05-17

Abstract: Objective: The study aimed to investigate to what extent general psychopathology is associated with subjective experience of pain in psychiatric outpatients without comorbidity with severe physical diagnosis and whether there are any differences in the experience of pain between genders or diagnoses.Method: Participants were 575 consecutive outpatients affected by mood disorder or anxiety disorder. Patients completed the West Haven-Yale Multidimensional Pain Inventory (WHYMPI) and the Symptom Checklist 90-Revised.Results: Women had higher mean scores on the Global Severity Index (1.52±0.76 vs. 1.33±0.79), higher perception of negative responses from others (1.84±1.59 vs. 1.46±1.35) and higher perception of pain severity (3.31±1.73 vs. 2.88±1.63) than men. They also reported higher mean scores on the WHYMPI's General Activity (2.14±0.98 vs. 1.93±0.95) and Household Chores (3.64±1.75 vs. 2.27±1.58) and lower mean scores on the Outdoor Work (1.24±1.26 vs. 1.87±1.51) dimension than men. Higher pain severity, more negative responses from others and higher household chores are predictors of higher psychopathology, while the general level of activity may be considered as a protective factor.Conclusions: Pain and its subjective experience play a central role in psychiatric disorders, and it is a great burden for patients and caregivers. Clinicians should pay more attention to recognize and adequately treat painful symptoms in patients with anxiety and depressive disorder.

Patients' perspectives on quality of mental health care for people with MS - Corrected Proof

D.J. Rintell, D. Frankel, S.L. Minden, B.I. Glanz — 2012-05-16

Abstract: Objective: The objective was to obtain multiple sclerosis (MS) patients' report on their experience receiving mental health care.Methods: We convened focus groups at four MS clinical care centers to identify the aspects of mental health care that were important to people with MS. All patients (n=54) had received mental health care in the past year. Data were analyzed by coding comments under specific themes.Results: Patients wanted prompt intervention after diagnosis and ongoing screening for mental health problems; they prefer providers with knowledge about MS and experience working with people with MS; they appreciated being able to access mental health services that were on-site at their MS center and noted the benefit of inclusion of family members in treatment.Conclusions: Mental health care should be provided promptly after diagnosis, with regular screening and interventions that include family members as indicated thereafter. Mental health providers should be familiar with MS, collaborate with neurologic care providers and provide services on-site at MS centers.

The lipid profiles in Japanese patients with schizophrenia treated with antipsychotic agents - Corrected Proof

2012-05-16

Abstract: Objective: Antipsychotic-treated schizophrenia patients are susceptible to dyslipidemia. However, the results of previous studies of North American and UK populations including various races have been contradictory with regard to which lipid measure was the most affected in patients with schizophrenia taking antipsychotic agents. The aim of this study was to investigate the effect of schizophrenia patients receiving antipsychotic agents on each lipid measure in a Japanese population.Methods: The samples included 136 control individuals and 157 patients with schizophrenia treated with antipsychotic agents. Age, gender distribution and body mass index (BMI) of the controls were matched with the patients.Results: The high-density lipoprotein cholesterol (HDL-cholesterol) levels were significantly lower in patients than in the control subjects (P<.001). However, there were no significant differences in either the low-density lipoprotein cholesterol (LDL-cholesterol) or triglyceride levels between the patient and control groups. We performed a multiple linear regression analysis, and schizophrenia receiving antipsychotics was an independent predictor of decreased HDL-cholesterol. An increased BMI, male gender and cigarette smoking were also major predictors of a decreased HDL-cholesterol level (r2=0.42, P<.001).Conclusion: At least in Japanese with schizophrenia receiving antipsychotic agents, the HDL-cholesterol levels should be closely monitored in all patients, even those who are not obese or do not smoke, to decrease their risk of cardiovascular disease.

Trends in US emergency department visits for attempted suicide and self-inflicted injury, 1993–2008 - Corrected Proof

2012-05-04

Abstract: Objective: The objective was to describe the epidemiology of emergency department (ED) visits for attempted suicide and self-inflicted injury over a 16-year period.Method: Data were obtained from the National Hospital Ambulatory Medical Care Survey including all visits for attempted suicide and self-inflicted injury (E950–E959) during 1993–2008.Results: Over the 16-year period, there was an average of 420,000 annual ED visits for attempted suicide and self-inflicted injury [1.50 (95% confidence interval, 1.33–1.67) visits per 1000 US population], and the average annual number for these ED visits more than doubled from 244,000 in 1993–1996 to 538,000 in 2005–2008. During the same time frame, ED visits for these injuries per 1000 US population almost doubled for males (0.84 to 1.62), females (1.04 to 1.96), whites (0.94 to 1.82) and blacks (1.14 to 2.10). Visits were most common among ages 15–19, and the number of visits coded as urgent/emergent decreased from 0.95 in 1993–1996 to 0.70 in 2005–2008.Conclusions: ED visit volume for attempted suicide and self-inflicted injury has increased over the past two decades in all major demographic groups. Awareness of these longitudinal trends may assist efforts to increase research on suicide prevention. In addition, this information may be used to inform current suicide and self-injury related ED interventions and treatment programs.

Is hyperemesis gravidarum associated with mood, anxiety and personality disorders: a case–control study - Corrected Proof

Faruk Uguz, Kazim Gezginc, Fatih Kayhan, Erdinc Cicek, Ali Haydar Kantarci — 2012-05-04

Abstract: Objective: Intractable nausea and vomiting, known as hyperemesis gravidarum (HG), are relatively common medical problems among pregnant women. Although there are some studies based on psychiatric symptom scales, the relationship between HG and psychiatric disorders, particularly anxiety and personality disorders, is unclear. In this study, we aimed to investigate whether there is a difference among women with and without HG with respect to frequency of mood, anxiety and personality disorders.Methods: The study sample was composed of 52 patients with HG and 90 control pregnant women. Mood and anxiety disorders were ascertained by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Personality disorders were assessed with the Structured Clinical Interview for DSM, Revised Third Edition, Personality Disorders (SCID-II).Results: The prevalence of any mood disorder and any anxiety disorder in women with HG was 15.4% and 36.5%, respectively. In addition, 19 (36.5%) of the patients with HG had at least one personality disorder. According to reports collected from the participants in the study, most of the mood or anxiety disorders occurred before the pregnancy in women with HG. The prevalence of major depression, generalized anxiety disorder, avoidant personality disorder and obsessive–compulsive personality disorder was significantly higher in women with HG compared to the control subjects.Conclusions: The results of the present study suggest that mood and anxiety disorders, and personality disturbances are frequently observed among women with HG and that there is a potential relationship between these psychiatric disorders and HG during pregnancy.

Comorbid psychiatric diagnoses in suicide attempt by charcoal burning: a 10-year study in a general hospital in Taiwan - Corrected Proof

2012-05-03

Abstract: Objective: Over the last decade, charcoal burning has become a common method of suicide in Taiwan; however, the underlying psychiatric diagnoses and gender differences have yet to be examined.Methods: We conducted a retrospective chart review on inpatients after suicide attempt by charcoal burning during 2000-2010. The patients were referred to the psychiatric consultation team and diagnoses were made according to DSM-IV. We chose those who were admitted to the nephrology ward in the same period due to accidental carbon monoxide intoxication as controls. Demographic and laboratory data, psychiatric diagnoses and reasons for suicide were obtained and analyzed.Results: Among seventy-three patients, major depressive disorder (49.3%) and adjustment disorder (41.1%) were most frequently diagnosed. Breaking-up, financial debt and physical/mental illnesses were the top three reasons for suicide (17.8% each). The male-to-female gender ratio was 1.5:1. Female patients had higher rates of major depressive disorders, while male patients presented more adjustment disorders comorbid with alcohol use disorders.Conclusion: There were gender differences in patients of suicide attempt by charcoal burning, in terms of demographic profiles and psychiatric diagnoses. Suicide risk assessment and prevention should be tailored by gender.

Prevalence of baseline lipid monitoring in patients prescribed second-generation antipsychotics during their index hospitalization: a retrospective cohort study - Corrected Proof

2012-05-03

Abstract: Background: Second-generation antipsychotics have been found to increase a patient's risk of dyslipidemia. Despite consensus statement recommendations for lipid monitoring, studies indicate that up to 90% of patients still do not have a baseline lipid panel prior to prescription of a second-generation antipsychotic.Methods: This study retrospectively examined the prevalence of baseline lipid monitoring in patients prescribed second-generation antipsychotics during their index psychiatric hospitalization at Duke University Hospital between July 1, 2005, and July 1, 2010.Results: Seventy patients were included in the study, with a mean age of 21.5±2.5 years. Of these patients, 22 (31.4%) had baseline lipid panels drawn during hospitalization. Lipid monitoring was statistically more frequent in males than in females (P=.01). Although not statistically significant, lipid monitoring was also more likely to occur among subjects who were African American (40%; P=.07) and with the prescription of olanzapine (50%; P=.07). About half of baseline lipid panels demonstrated either a low high-density lipoprotein or high triglycerides, indicating at least one risk factor for the metabolic syndrome.Conclusion: This study provides alarming evidence that, even in an academic setting with active discussions among psychiatrists regarding issues of metabolic risk and appropriate monitoring, adherence to American Psychiatric Association/American Diabetes Association consensus statement recommendations on rates of baseline lipid monitoring is disappointingly low in the absence of systems to encourage or automate best practice.

Associations between coping, diabetes knowledge, medication adherence and self-care behaviors in adults with type 2 diabetes - Corrected Proof

2012-05-03

Abstract: Background: Few studies have examined the emotional approach to coping on diabetes outcomes. This study examined the relationship between emotional coping and diabetes knowledge, medication adherence and self-care behaviors in adults with type 2 diabetes.Methods: Data on 378 subjects with type 2 diabetes recruited from two primary care clinics in the southeastern United States were examined. Previously validated scales were used to measure coping, medication adherence, diabetes knowledge and diabetes self-care behaviors (including diet, physical activity, blood sugar testing and foot care). Multiple linear regression was used to assess the independent effect of coping through emotional approach on medication adherence and self-care behaviors while controlling for relevant covariates.Results: Significant correlations were observed between emotional coping [as measured by emotional expression (EE) and emotional processing (EP)] and self-care behaviors. In the linear regression model, EP was significantly associated with medication adherence [β −0.17, 95% confidence interval (CI) −0.32 to −0.015], diabetes knowledge (β 0.76, 95% CI 0.29 to 1.24), diet (β 0.52, 95% CI 0.24 to 0.81), exercise (β 0.51, 95% CI 0.19 to 0.82), blood sugar testing (β 0.54, 95% CI 0.16 to 0.91) and foot care (β 0.32, 95% CI −0.02 to 0.67). On the other hand, EE was associated with diet (β 0.38, 95% CI 0.13 to 0.64), exercise (β 0.54, 95% CI 0.27 to 0.82), blood sugar testing (β 0.42, 95% CI 0.09 to 0.76) and foot care (β 0.36, 95% CI 0.06 to 0.66), but it was not associated with diabetes knowledge.Conclusion: These findings indicate that coping through an emotional approach is significantly associated with behaviors that lead to positive diabetes outcomes.

A patient with type II citrullinemia who developed refractory complex seizure - Corrected Proof

Shigeaki Sakamoto, Hideto Shinno, Misao Ikeda, Hisaaki Miyoshi, Yu Nakamura — 2012-05-03

Abstract: A 31-year-old Japanese male was admitted to our hospital for refractory complex seizures. He had no history on medical or psychiatric illness. He began to exhibit aberrant behavior accompanied by cloudiness of consciousness. Thereafter, he exhibited partial seizures followed by a twilight state or abnormal behavior. Previous treatment with valproate and carbamazepine failed to improve his seizures. Because an increase in plasma ammonia was noted, anticonvulsant was discontinued within a week. He was then transferred to our department. Blood examination revealed an increase in ammonia. Amino acid analysis demonstrated a marked increase in citrulline and decrease in arginine. He was diagnosed with type II citrullinemia. After being treated with arginine hydrochloride, the seizures and disturbed consciousness improved. He was then discharged, and remains in remission.Accumulations of citrulline and ammonia and a reduction of arginine are noted in argininosuccinate synthetase deficiency, which results in the sudden emergence of consciousness disturbance and abnormal behavior. It is essential to examine amino acid levels as well as ammonia levels in patients with unexplained neuropsychiatric symptoms, especially those with altered consciousness levels and seizures.

Peritraumatic distress predicts acute posttraumatic stress disorder symptoms after a first stroke - Corrected Proof

2012-04-30

Stroke is a life-threatening condition that affects an estimated 5 in 1000 people each year worldwide . Although exposure to a life-threatening event has long been a requirement for a diagnosis of posttraumatic stress disorder (PTSD), it was not until the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders that medical conditions were considered to qualify. Recent research suggests that 3% to 30% of stroke victims develop PTSD ; however, little data are available on the early risk factors for PTSD in this population. Peritraumatic distress, referring to fear, helplessness, horror and emotional reactions during or immediately following trauma, and peritraumatic dissociation, referring to alterations in the experience of time, place and persons during or immediately following trauma, have both been found to be robust prospective predictors of PTSD symptoms after a variety of traumas . Although retrospective studies suggest that distress and dissociation following a stroke might increase the risk for PTSD , prospective data are needed.

Lung transplantation in a Japanese patient with schizophrenia from brain-dead donor - Corrected Proof

2012-04-30

Abstract: We herein report a case of lung transplantation in a patient with schizophrenia. The findings show that patients with schizophrenia can be considered for lung transplant after careful evaluation of psychiatric status and indications.

Psychiatric comorbidity and gender differences among suicide attempters in Bangalore, India - Corrected Proof

Gopalkrishnan Vishnuvardhan, Sahoo Saddichha — 2012-04-30

Abstract: Background: Suicides are an entirely preventable cause of death, with current suicide rates being 11.4 per 100,000 population in India. The city of Bangalore in India is often called the suicide capital of India because of its high suicide and attempted suicide rate. This study attempted to evaluate the psychiatric comorbidity and gender differences among suicide attempters presenting to a general hospital in the city of Bangalore, India.Methods: Using a structured questionnaire [Structured Clinical Interview for DSM-IV (SCID)-I and SCID-II], the study gathered data on the psychiatric diagnoses as well as the reasons for and mode of attempted suicides on 100 suicide attempters after taking written informed consent. In addition, the Beck Depression Inventory was also used to evaluate the severity of depression, the most commonly detected psychiatric comorbidity.Results: Forty-two percent of the sample had a psychiatric comorbidity, with depression (14%) and dysthymia (12%) being the most common disorders. Among personality disorders (PDs), borderline PD (5%) and dependent PD (3%) were the most commonly detected. Severe depression was detected in 15% of those with a mood disorder. Gender differences were found in both mode and reasons for attempted suicide.Conclusion: The presence of any psychiatric comorbidity was observed to confer a high risk of suicide. All attempters should therefore be comprehensively evaluated by a qualified health care professional, and attempts should be made for continuous follow-up.

Citalopram-induced subacute cutaneous lupus erythematosus — first case and review concerning photosensitivity in selective serotonin reuptake inhibitors - Corrected Proof

Susanne Röhrs, Franziska Geiser, Rupert Conrad — 2012-04-25

Abstract: Objective: This report describes a case of subacute cutaneous lupus erythematosus (SCLE) in a patient treated with citalopram and discusses evidence linking selective serotonin reuptake inhibitors (SSRIs) to the induction of photosensitivity.Method: Case report and review of published literature.Results: A 71-year-old woman with major depression developed 2 days after intake of 20 mg citalopram a strongly itching and largely dimensioned confluencing erythema with infiltrations and blisters all over the trunk with fever and malaise. Histological and laboratory investigations were consistent with the diagnosis of SCLE. After stopping citalopram intake, dermatologic symptoms significantly improved within 2 weeks. SSRIs have been associated with 14 cases of adverse cutaneous events as a result of SSRI-induced photosensitivity. No case of SSRI-induced SCLE has been described.Conclusion: In clinical practice, indication and dosage of citalopram and other SSRIs should be carefully monitored. In the case of a SSRI-induced photosensitivity, medication can be switched to an antidepressant from another class.

Antidepressants and menstruation disorders in women: a cross-sectional study in three centers - Corrected Proof

2012-04-25

Abstract: Objective: The relationship between menstruation disorders and antidepressant drugs usage in women remains unclear. In this study, we aimed to investigate the incidence rate of antidepressant-related menstruation disorders and to examine whether or not antidepressant use is associated with menstrual disorders in women.Methods: The study sample was gathered from three centers and four hospitals. A total of 1432 women who met the criteria of inclusion were included in the study. The sample was divided into two groups: the antidepressant group (n=793) and the control group (n=639). The menstruation disorders were established with reports from the study participants on the basis of related gynecological descriptions.Results: The prevalence of menstrual disorders was significantly higher in the antidepressant group (24.6%) than the control group (12.2%). The incidence of antidepressant-induced menstruation disorder was 14.5%. The antidepressants most associated with menstrual disorders were paroxetine, venlafaxine, sertraline and their combination with mirtazapine. Overall, the incidence rate was similar in women receiving selective serotonin reuptake inhibitors and serotonin noradrenaline reuptake inhibitors.Conclusions: The results of the present study suggest that menstruation disorders are frequently observed in women taking antidepressants and that it appears to be associated with antidepressant use at least in some women.

Eight-year trends of cardiometabolic morbidity and mortality in patients with schizophrenia - Corrected Proof

2012-04-20

Abstract: Objective: We examined cardiometabolic disease and mortality over 8 years among individuals with and without schizophrenia.Method: We compared 65,362 patients in the Veteran Affairs (VA) health system with schizophrenia to 65,362 VA patients without serious mental illness (non-SMI) matched on age, service access year and location. The annual prevalence of diagnosed cardiovascular disease, diabetes, dyslipidemia, hypertension, obesity, and all-cause and cause-specific mortality was compared for fiscal years 2000–2007. Mean years of potential life lost (YPLLs) were calculated annually.Results: The cohort was mostly male (88%) with a mean age of 54 years. Cardiometabolic disease prevalence increased in both groups, with non-SMI patients having higher disease prevalence in most years. Annual between-group differences ranged from <1% to 6%. Annual mortality was stable over time for schizophrenia (3.1%) and non-SMI patients (2.6%). Annual mean YPLLs increased from 12.8 to 15.4 in schizophrenia and from 11.8 to 14.0 for non-SMI groups.Conclusions: VA patients with and without schizophrenia show increasing but similar prevalence rates of cardiometabolic diseases. YPLLs were high in both groups and only slightly higher among patients with schizophrenia. The findings highlight the complex population served by the VA while suggesting a smaller mortality impact from schizophrenia than previously reported.

Clozapine-induced stuttering: a case report and analysis of similar case reports in the literature - Corrected Proof

Sandeep Grover, Anant Kumar Verma, Naresh Nebhinani — 2012-04-20

Abstract: There is limited literature reporting clozapine-associated stuttering. In this case report, we present a case of a young male who developed stuttering with clozapine, which improved with dose reduction. Computer-assisted searches on clozapine-induced stuttering yielded 16 cases, and analysis of these case reports suggests that stuttering may be linked to seizures or movement disorders, but other putative mechanisms may be at work, which need further research.

Pityriasis Rosea-like eruption associated with Clozapine: a case report - Corrected Proof

Ya-Wen Lai, Che-Yi Chou, Winston W. Shen, Mong-Liang Lu — 2012-04-20

Abstract: Adverse cutaneous drug reactions (ACDRs) are common in clinical practice and occur in about 5% of antipsychotic-treated patients. Most ACDRs are benign, but a small percentage of them are serious and life threatening. Pityriasis rosea (PR)-like eruption is a common cutaneous adverse reaction related to many drugs. Clozapine, a complex neurotransmitter receptor-binding in antipsychotic agent, is usually used for treatment-resistant schizophrenia. Clozapine-related ACDRs have been reported frequently, but clozapine-induced PR-like eruption has been reported once in the literature. We report a 54-year-old male patient with chronic schizophrenia who had received clozapine for 28 days and developed generalized skin rashes, high fever, and elevated values in liver function tests. His clozapine was immediately discontinued. He received acute managements with steroid and antihistamine, and his symptoms were relieved after treatment. This case report can be used to remind clinicians of keeping in mind the potential of clozapine-associated ACDRs.

Symptom profile of delirium in children and adolescent—does it differ from adults and elderly? - Corrected Proof

2012-04-20

Abstract: Objective: The objective was to evaluate the phenomenology, etiology and outcome of delirium in children and adolescents (8–18 years of age) seen in a consultation–liaison psychiatric service in India. Additionally, an attempt was made to compare the phenomenology with adult and elderly patients with delirium.Method: Thirty children and adolescents (age 8–18 years) diagnosed with delirium by the consultation–liaison psychiatry team were rated on the Delirium Rating Scale-Revised-98 (DRS-R-98) and compared with DRS-R-98 data on 120 adults and 109 elderly patients.Results: The commonly observed symptoms in children and adolescents with delirium were disturbance in attention, orientation, sleep–wake cycle disturbances, fluctuation of symptoms, disturbance of short-term memory and motor agitation. The least commonly seen symptoms included delusions and motor retardation. Compared to adults, children and adolescents had lower frequency of long-term memory and visuospatial disturbances. Compared to the elderly, children and adolescents had higher frequency of lability of affect. For severity of symptoms, compared to adults, the children and adolescents had lower severity of sleep–wake disturbances, abnormality of thought, motor agitation, orientation, attention, short-term memory, long-term memory and visuospatial abilities. When compared to elderly patients, children and adolescents had higher severity of lability of affect and lower severity of language disturbances, short-term memory and visuospatial abilities.Conclusions: In general, phenomenology, of delirium in children and adolescents (age 8–18 years) is similar to that seen in adults and elderly patients.

Acute neurogenic pulmonary edema following electroconvulsive therapy: a case report - Corrected Proof

2012-04-20

Abstract: Objective: We report the case of a 47-year-old man with depression who developed acute dyspnea, hypoxemia, and mild hemoptysis after electroconvulsive therapy (ECT).Method: Intravenous carbazochrome sodium sulfate hydrate as a hemostatic drug (100 mg/day) was prescribed for 2 days. On the day of ECT, oxygen inhalation (4 L/min) was continued, and SpO2 was maintained at 94–96%.Results: Chest radiography showed improvement in alveolar infiltration. Chest CT 6 days after ECT also confirmed the disappearance of ground glass opacities in the lung fields.Conclusion(s): NPE is lifethreatening and should be recognized as an uncommon adverse event associated with ECT.

Bottlenecks in the Emergency Department: the psychiatric clinicians' perspective - Corrected Proof

2012-04-20

Abstract: Objective: To ask psychiatric clinicians for their perspectives on the rate-limiting steps (RLS) in patient care in the Emergency Department (ED) and to compare them to the patient's actual length of stay.Method: Prospective cohort study of clinicians' perspectives on the RLS among 1092 adult ED patients. Medical records were abstracted for ED time and other data.Results: Clinicians identified five RLS: limited availability of staff, limited availability of beds after discharge, need for clinical stability, need for additional history and patient's financial issues. The last RLS was the only one not associated with increased wait times in the ED. There were significant differences in the patterns of RLS by trainee status and hospital. For example, significantly higher proportions of trainees reported that RLS in patient care were due to the need for clinical stability and additional history and lack of bed availability. In contrast, non-trainee clinicians were more likely to cite problems with the availability of ED staff as an RLS.Conclusions: Most of the RLS in patient care identified by clinicians were associated with actual increases in ED wait time for their patients. Next steps include asking clinicians for possible solutions to the delays their patients experience.

The use of short message service (SMS) among hospitalized coronary patients - Corrected Proof

Svein Bergvik, Rolf Wynn — 2012-04-20

Abstract: Objective: The use of cell phones and short message service (SMS, also called “texting”) has become pervasive in Western society and increasingly throughout the world. Despite the importance of this technology in everyday life, little is known about how patients draw on SMS to keep in contact with family and friends during their hospitalization.Methods: A questionnaire was distributed to patients with coronary artery disease discharged from a Norwegian university hospital during the period from June 2005 to June 2006. In addition to questions pertaining to demographics, illness and treatment, mental distress, personality traits, perceived control, Internet usage and lifestyle, respondents were asked if they had contact with family and friends by SMS while in the hospital.Results: Four hundred twelve responded (59%), of which 216 had undergone surgery and 196 had undergone percutaneous coronary interventions. Sixty-three percent had used SMS to keep in touch with family and friends during their stay at the hospital. Use of SMS was positively predicted by Internet usage, gender and the personality trait of Openness, and was negatively predicted by the belief that illness and health were caused by luck or destiny.Conclusions: SMS is an important means of communication during hospitalization for a majority of coronary disease inpatients.

Metoprolol-induced psychosis in a young patient - Corrected Proof

Ying Zhao, Wuqiang Xu, Liping Qiu, Wenli Yang — 2012-04-20

Abstract: Metoprolol is widely used in cardiology for the treatment of hypertension and arrhythmia. The neuropsychiatric adverse reactions associated with the use of beta-blockers are relatively uncommon, but sometimes take place when poisoning or overdosing on elderly patients. We present a case of a young patient with low-dose metoprolol which induced acute delirium and in whom the symptoms disappeared within 3 days after metoprolol was ceased. The results illustrated that the neuropsychiatric adverse reactions of metoprolol could be developed not only in elderly patients but also in young patients, which has great significance to direct physicians in their clinical practice.

Hyperthyroidism presenting as mixed affective state: a case report - Corrected Proof

2012-04-20

Abstract: Thyroid disorders have long been associated with psychiatric illness, commonly mood disorders. In bipolar disorder, hypothyroidism is quite a common abnormality. Little is known about the association of thyroid disorders and mixed affective states. We present a case of hyperthyroidism presenting as a mixed affective state and the successful resolution of psychiatric symptoms with antithyroid medication along with a mood-stabilizing agent.

Risperidone-induced leukopenia: a case report and brief review of literature - Corrected Proof

2012-04-20

Abstract: A Caucasian, male, young adult with recurrent agitated depression and suicidal ideation received lithium and oral olanzapine. His white blood cell count was normal at that time. Due to unsatisfactory response, he received 4 mg/day risperidone. While symptoms improved, leukopenia emerged, specifically directed towards neutrophils. Upon risperidone discontinuation, white blood cell count returned to reference values within 1 week. As symptom control was satisfactory, we attempted no risperidone rechallenge. Accurate blood testing must accompany atypical antipsychotic drug administration since blood dyscrasias are always possible with these drugs.

Effects of various drug therapies on Kleine–Levin syndrome: a case report - Corrected Proof

Chi-Chun Yao, Ying Lin, Hui-Ching Liu, Chau-Shoun Lee — 2012-04-20

Abstract: Kleine–Levin syndrome (KLS) is a rare sleep disorder, predominantly affecting adolescent males, which presents as recurrent episodes of hypersomnia, behavioral and cognitive disturbances, hyperphagia and sometimes hypersexuality (Lisk, “Kleine–Levin syndrome.” Pract Neurol 2009;9:42–45). Modafinil has been reported to show an effect in shortening the duration of symptomatic periods, but does not affect the recurrence rate (Huang et al., “Kleine–Levin syndrome: current status.” Med Clin N Am 2010;94:557–562). However, no single drug therapy has been consistently successful, despite various psychotropic agents, including lithium, anticonvulsants and antidepressants, having been systematically tried (Arnulf et al., “Kleine–Levin syndrome: a systematic study of 108 patients.” Ann Neurol 2008;63:482–492). This study reports a male adolescent with KLS who received several courses of drug therapy, providing a chance to compare differential drug effects over time.

Type D personality is associated with increased comorbidity burden and health care utilization among 3080 cancer survivors - Corrected Proof

2012-03-29

Abstract: Objective: Cancer survivors often report comorbid diseases, but there are individual differences in risk. Type D personality is a general propensity to psychological distress that is related to poor cardiovascular outcomes. In this study, we examined whether type D was also related to comorbidity burden and health care utilization among cancer survivors.Methods: Individuals diagnosed with endometrial cancer or colorectal cancer between 1998 and 2007, or with lymphoma or multiple myeloma between 1999 and 2008 as registered in the Eindhoven Cancer Registry, received the Self-Administered Comorbidity Questionnaire, questions on health care utilization and the Type D personality scale; 69% (n=3080) responded.Results: Nineteen percent of survivors had a type D personality. Over a 12-month period, type D survivors significantly more often reported osteoarthritis, back pain, and depression than non–type D survivors. Also, type D survivors more often reported to feel bothered by high blood pressure, osteoarthritis, heart disease, depression, diabetes and lung disease during daily activities. Type D survivors more often visited their general practitioner than non–type D survivors (P 5: 9% vs. 5%; P 5 visits: 30% vs. 23%; P<.01).Conclusion: Type D personality is a vulnerability factor that may help to identify subgroups of cancer survivors who are at an increased risk for comorbidity burden and increased health care utilization.

Low-dose venlafaxine-induced severe rhabdomyolysis: a case report - Corrected Proof

Shiau-Shian Huang, Hsin-Yu Yang, Yu-Chen Lin, Chin-Hong Chan — 2012-03-29

Abstract: Venlafaxine is a relatively new antidepressant with selective effects. Compared with traditional antidepressants, this agent has fewer adverse side effects. However, venlafaxine overdose has been reported with severe complications such as seizure, ventricular tachycardia, serotonin syndrome, neuroleptic malignant syndrome and rhabdomyolysis. We present a 21-year-old female with bipolar depression who took a low dose of venlafaxine, but subsequently developed severe rhabdomyolysis. Her plasma level of creatine kinase increased up to 18 711 U/L in few days. These findings may serve as a reminder to physicians to be alert to the possibility of rhabdomyolysis in patients who have only taken a low dose of venlafaxine.

Antipsychotic polypharmacy: a needle in a haystack? - Corrected Proof

Amaia López de Torre, Unax Lertxundi, Rafael Hernández, Juan Medrano — 2012-03-29

Abstract: Objective: The aim of our study was to assess the antipsychotic polypharmacy (APP) prevalence in a psychiatric hospital and to find the supporting evidence for the 10 most prescribed two-drug combinations. Secondarily, how many included clozapine, prevalence in the elderly, high dosage and clinically relevant interactions were also assessed.Method: Clinicodemographic and computerized prescription data on 29th March 2011 were collected. High dosage was defined as more than 1000 mg of chlorpromazine equivalents (CPZeqs). A t test for unpaired measures was applied to compare means of dosage (CPZeq) and age among patients on APP vs. monotherapy. The χ2 test was applied to compare proportions of patients on a high dose on APP vs. monotherapy. GraphPad Prism 5 software was used to perform statistical analysis.Results: From 201 patients admitted on 29th March, 172 had any antipsychotic prescription. APP prevalence was 47.1%, corresponding almost to 24% of elderly patients. Quetiapine was the drug most prescribed in combination, achieving a prevalence rate of 56.8%. Clozapine was not included in 67% of all combinations. Supporting evidence for two-drug combinations was only found for 6 of the 10 most prescribed. Relevant interactions were found in 12 patients on APP. The mean CPZeq dose and percentage of patients on high dosage were significantly higher in the APP than in the monotherapy group (1162±776.1 mg vs. 455.4±369.3 mg; 54% vs. 9%, respectively; P<.0001).Conclusions: Our study shows that APP was being considered earlier in the management plan than what guidelines recommend. This practice was associated with higher total antipsychotic doses. Until further clinical trials are available, a wise APP practice will require a thoughtful choice of products guided by patient's prior history and interaction liability, a proper consent by the patients or their representatives and a careful monitoring of clinical outcomes and emerging side effects in order to avoid indefinite administration of ineffective and potentially harmful combinations.

Physical complications of severe, chronic obsessive-compulsive disorder: a comparison with general psychiatric inpatients - Corrected Proof

2012-03-29

Abstract: Background: This research examines the physical health of patients with severe, chronic obsessive–compulsive disorder (OCD) and compares the findings with patients admitted to an acute general psychiatric ward.Methods: Successive admissions to a specialist inpatient unit treating patients with OCD were included in the study. Information including gender, age, weight and height were recorded along with the results of blood tests for urea, liver function tests and blood lipids. In addition, type and dose of medication were also recorded. These data were compared with information obtained via the case records from successive admissions to a general psychiatric ward.Results: A total of 104 patients with OCD and 101 patients admitted to an acute psychiatric unit were studied. OCD patients were generally younger than the controls and were on a lower dose of antipsychotic medication. Despite this, the OCD patients were more likely than the general psychiatric patients to have raised blood lipids. Raised creatinine was also more common among OCD patients.Conclusion: The study demonstrates that patients with severe OCD have significant evidence of serious physical health problems.

The prevalence of somatoform disorders in internal medicine outpatient departments of 23 general hospitals in Shenyang, China - Corrected Proof

2012-03-29

Abstract: Objective: The objective was to assess the prevalence, demographics and risk factors of somatoform disorders (SDs) in departments of internal medicine at 23 randomly selected general hospitals in Shenyang, China.Method: A two-stage screening process was followed based on an expanded Chinese version of the 12-item General Health Questionnaire and the Structured Clinical Interview for DSM-IV-TR Axis I Disorders . A total of 5312 consecutive attendees of the outpatient at the departments of internal medicine were screened; 60 patients of 15 years or older were confirmed to have current SDs.Results: The 1-month prevalence of any type of SD was 1.56% [95% confidence interval (CI): 1.19%–2.02%], and those of undifferentiated SD, pain disorder, hypochondriasis and somatization disorder were 0.68% (0.47%–0.98%), 0.44% (0.15%–1.26%), 0.38% (0.22%–0.64%) and 0.06% (0.02%–0.20%), respectively. The prevalence of any SD and two types of SDs was higher in females than in males: relative risk (95% CI) for any SD=1.82 (1.11–2.97), for pain disorder=12.70 (1.63–99.19).Conclusion: The prevalence of SDs among outpatients at urban China's internal medicine departments is lower than that reported in most Western countries. SDs were more prevalent among female outpatients at general hospitals.

Abbreviated PTSD Checklist (PCL) as a guide to clinical response - Corrected Proof

2012-03-29

Abstract: Objective: The objective of this study was to evaluate two abbreviated versions of the PTSD Checklist (PCL), a self-report measure of posttraumatic stress disorder (PTSD) symptoms, as an index of change related to treatment.Method: Data for this study were from 181 primary care patients diagnosed with PTSD who enrolled in a large randomized trial. These individuals received a collaborative care intervention (cognitive behavioral therapy (CBT) and/or medication) or usual care and were followed 6 and 12 months later to assess their symptoms and functioning. The sensitivity of the PCL versions (i.e., full, two-item, six-item), correlations between the PCL versions and other measures, and use of each as indicators of reliable and clinically significant change were evaluated.Results: All versions had high sensitivity (.92–.99). Correlations among the three versions were high, but the six-item version corresponded more closely to the full version. Both shortened versions were adequate indicators of reliable and clinically significant change.Conclusion: Whereas prior research has shown the two-item or six-item versions of the PCL to be good PTSD screening instruments for primary care settings, the six-item version appears to be the better alternative for tracking treatment-related change.

Hyperlipidemia in patients with schizophrenia: a national population-based study - Corrected Proof

Jer-Hwa Hsu, I-Chia Chien, Ching-Heng Lin, Yiing-Jenq Chou, Pesus Chou — 2012-03-29

Abstract: Objective: The objective was to examine hyperlipidemia among Taiwanese patients with schizophrenia.Methods: We obtained a random sample of 766,427 subjects aged ≥18 years in 2005. Subjects with at least one primary diagnosis of schizophrenia and with a primary or secondary diagnosis of hyperlipidemia or medication for hyperlipidemia were identified. We compared the prevalence and incidence of hyperlipidemia in schizophrenic patients with the general population.Results: The prevalence of hyperlipidemia in patients with schizophrenia was higher than that in the general population (8.15% vs. 8.10%; odds ratio 1.17; 95% confidence interval, 1.04–1.31) in 2005. Compared with the general population, schizophrenic patients had a higher prevalence of hyperlipidemia in individuals aged <50 years, among those with higher insurance amount, and among persons living in northern and central regions and in urban areas. The average annual incidence of hyperlipidemia in schizophrenic patients with second-generation antipsychotic use from 2006 to 2008 was higher than that in the general population (1.57% vs. 1.29%; odds ratio 1.31; 95% confidence interval, 1.11–1.55).Conclusions: Patients with schizophrenia had a much higher prevalence of hyperlipidemia in young adulthood than that in the general population. Schizophrenic patients with second-generation antipsychotic exposure had a higher incidence of hyperlipidemia than individuals in the general population.

Early neuropsychiatric involvement in antiphospholipid syndrome - Corrected Proof

Jou-Yin Lai, Po-Chang Wu, Hsi-Chung Chen, Ming-Been Lee — 2012-03-29

Abstract: Objective: Neuropsychiatric symptoms may be the main manifestations and very early symptoms of developing autoimmune diseases. Early detection and treatment could reverse psychotic symptoms and restore cognitive function.Case Report: A 24-year-old woman presented with acute psychotic symptoms. Routine physical examinations revealed only mild fever. Due to positive antiphospholipid antibodies, low protein S with elevated d-dimer and brain hypoperfusion, early-phase antiphospholipid syndrome (APS) was suspected. Early immunomodulation treatment led to complete remission of the psychotic symptoms, preservation of cognitive function and prevention of APS progression.Conclusion: Since early detection and treatment can reverse the progression of autoimmune diseases with central nervous system involvement, these should be highlighted when managing high-risk patients.

Changes in cardiovascular disease burden associated with psychopathology in Australian adults 2004–2008 - Corrected Proof

Evan Atlantis, Thomas Sullivan — 2012-03-29

Abstract: Objective: The objective was to investigate changes in self-reported cardiovascular disease (CVD) burden associated with psychopathology for Australia from 2004 to 2008.Method: Data analyzed were from 32,073 participants aged ≥25 years from the 2004–2005 or 2007–2008 National Health Surveys. Lifetime diagnosis of CVD (heart attack or stroke) was by self-report. Psychopathology was determined by the 10-item Kessler Psychological Distress Scale (using scores ≥30) and use of antidepressants or antianxiety (AD/AA) medications.Results: The prevalence of CVD (4.1% to 4.5%, P=.045) had increased slightly from 2004 to 2008 for the general population, but not among those with psychopathology. On average, psychological distress only [odds ratio (OR) 2.00; 95% confidence interval, 1.52–2.62] and AD/AA medications with (OR 2.02; 1.41–2.88) and without psychological distress (OR 1.24; 1.00–1.55) were associated with increased odds of CVD over the 4-year period, independent of sociodemographic, lifestyle and chronic disease covariates. Both psychological distress only (OR 1.61; 1.15–2.25) and AD/AA medications with psychological distress (OR 1.62; 1.08–2.44) conferred higher odds of CVD than AD/AA medications without psychological distress.Conclusion: In comparison to those without psychopathology, the odds of self-reported CVD were persistently higher among people with psychopathology from 2004 to 2008, particularly for psychological distress.

Prevalence of physical symptoms and their association with race/ethnicity and acculturation in the United States - Corrected Proof

Amy M. Bauer, Chih-Nan Chen, Margarita Alegría — 2012-03-29

Abstract: Objective: Physical symptoms are common and a leading reason for primary care visits; however, data are lacking on their prevalence among racial/ethnic minorities in the United States. This study aimed to compare the prevalence of physical symptoms among White, Latino and Asian Americans, and examine the association of symptoms and acculturation.Methods: We analyzed data from the National Latino and Asian American Study, a nationally representative survey of 4864 White, Latino and Asian American adults. We compared the age- and gender-adjusted prevalence of 14 physical symptoms among the racial/ethnic groups and estimated the association between indicators of acculturation (English proficiency, nativity, generational status and proportion of lifetime in the United States) and symptoms among Latino and Asian Americans.Results: After adjusting for age and gender, the mean number of symptoms was similar for Whites (1.00) and Latinos (0.95) but significantly lower among Asian Americans (0.60, P<.01 versus Whites). Similar percentages of Whites (15.4%) and Latinos (13.0%) reported three or more symptoms, whereas significantly fewer Asian Americans (7.7%, P<.05 versus Whites) did. In models adjusted for sociodemographic variables and clinical status (psychological distress, medical conditions and disability), acculturation was significantly associated with physical symptoms among both Latino and Asian Americans, such that the most acculturated individuals had the most physical symptoms.Conclusions: The prevalence of physical symptoms differs across racial/ethnic groups, with Asian Americans reporting fewer symptoms than Whites. Consistent with a “healthy immigrant” effect, increased acculturation was strongly associated with greater symptom burden among both Latino and Asian Americans.

Juvenile Huntington's disease presenting as difficult-to-treat seizure and the first episode of psychosis - Corrected Proof

Yi-Ping Chuo, Po-Hsun Hou, Chin-Hong Chan, Chih-Chien Lin, Yi-Chu Liao — 2012-03-29

Abstract: Objective: The objective was to describe a case of juvenile Huntington's disease that first presented with seizures and psychosis.Methods: A male patient with no history of epilepsy and psychiatric disorder had his first seizure at the age of 20 years, which was followed by 3 years of psychotic disorder.Results: Laboratory investigations were normal, and mild diffuse cortical atrophy was detected using magnetic resonance imaging. Both the seizures and psychosis were difficult to treat. Three years later, chorea and personality changes appeared. Genetic tests revealed an expanded allele with 60 CAG repeats, confirming the typical Huntington's disease characteristic.Conclusion: Patients with difficult-to-treat seizures and the first episode of psychosis should be considered for the diagnosis of juvenile Huntington's disease.

Are sleep and life quality of family caregivers affected as much as those of hemodialysis patients? - Corrected Proof

Gülperi Çelik, Bilge Burcak Annagur, Mümtaz Yılmaz, Tarık Demir, Fatih Kara — 2012-03-09

Abstract: Objective: The purpose of this study was to determine and compare the quality of sleep, quality of life, and anxiety and depression symptoms reported by hemodialysis (HD) patients and family caregivers of HD patients.Methods: The study included 142 pairs of HD patients and their caregivers. To assess quality of sleep, quality of life, and anxiety and depressive symptoms, the 36-item Short Form, Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale, respectively, were used.Results: For the patients, 73.9% were poor sleepers. Low Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were found in 89.1% and 76.3% of HD patients, respectively. For the caregivers, 88% were poor sleepers. Low PCS and MCS scores were found in 62% and 70.4% of the caregivers, respectively. Mean PSQI scores, subjective sleep quality scores, sleep latency, sleep efficiency, sleep disturbance, use of sleep medications, and daytime dysfunction scores of the caregivers were significantly higher than the scores of the HD patients (P<.001).Conclusions: Caregivers of dialysis patients experience adverse effects on their quality of sleep and quality of life. Educational, social, and psychological support interventions should be considered to improve their ability to cope.

Acceptability of mental health screening in routine addictions treatment - Corrected Proof

2012-02-13

Abstract: Objective: The objective was to investigate patients' views on the application of case finding and screening methods for common mental disorders in an addiction treatment service.Method: Qualitative thematic analysis of semistructured interviews with a purposive sample of 19 participants. Participants took part in diagnostic assessments (Revised Clinical Interview Schedule, CIS-R) and completed brief screening questionnaires for depression (Patient Health Questionnaire, PHQ-9) and anxiety (Generalized Anxiety Disorder Scale, GAD-7).Results: Patients generally favored the use of screening questionnaires to detect psychological problems, to monitor changes in symptoms and to facilitate targeted and specialist treatment. On the whole, respondents seemed to find such methods familiar and easy to use. The need for staff support was strongly emphasized, both to deal with the emotional impact of screening and to overcome accessibility and literacy problems. Good therapeutic rapport with practitioners came across as an important factor that influences patients' willingness to discuss psychological problems. Patient readiness and the timeliness of assessments were additional factors influencing acceptability. Participants discussed how psychological problems and substance misuse are associated in complex ways, often resulting in discrimination, poor recognition of such problems and limited access to treatment.Conclusions: Mental health screening is generally acceptable to patients and can help to identify comorbid mental disorders in order to provide appropriate support and treatment.

Damage in the dorsal striatum alleviates addictive behavior - Corrected Proof

J.B. Muskens, A.F.A. Schellekens, F.E. de Leeuw, I. Tendolkar, S. Hepark — 2012-02-13

Abstract: The ventral striatum has been assigned a major role in addictive behavior. In addition, clinical lesion studies have described involvement of the insula and globus pallidus. To the best of our knowledge, this is the first report of alleviation of alcohol and nicotine addiction after a cerebrovascular incident in the dorsal striatum. The patient was still abstinent from alcohol and nicotine at follow-up. This observation suggests that the dorsal striatum may play a critical role in addiction to alcohol and nicotine.

Drug-induced psychosis associated with albendazole–ivermectin combination therapy - Corrected Proof

Pallavi Sinha, Amit Garg, Om Prakash, Nimesh G. Desai — 2012-02-13

Abstract: We report a case that experienced psychosis after combination therapy of albendazole and ivermectin. This case report represents the first report of psychosis caused by this combination therapy and its treatment with clonazepam.

A case of ‘cybersuicide’ attempt using chloroform - Corrected Proof

Manon J. Gosselink, Andrea M. Siegel, Eefje Suk, Erik J. Giltay — 2012-02-03

Abstract: Background: The effects of the internet on suicide attempts are not well known. On the internet, there is a wide spectrum of suicide prevention sites. However, prosuicide information can also be obtained via the internet.Objective: The objective was to obtain awareness to medical professionals of the observed growing influence of internet on suicidal patients.Method: We present a 20-year-old man who tried to attempt suicide by means of chloroform inhalation, after easily obtaining both option and the resources via the internet. When found, he had an oxygen saturation below 60%, dilated pupils, a Glasgow Coma Scale of 3 and supraventricular tachycardia. In our hospital, he developed severe rhabdomyolysis, toxic hepatitis and massive hemolysis caused by the delayed production of toxic metabolites of chloroform. Diuresis was forced by intravenous fluids. He fully recovered.Conclusion: The internet has to be considered as a double-edged tool, having both positive and negative effects on suicidal thoughts. Awareness of and effective preventive strategies against ‘cybersuicide’ are amended.

Comorbidity of attention-deficit/hyperactivity disorder, Tourette's syndrome and bipolar I disorder in an adolescent patient with schizencephaly - Corrected Proof

Chou-Yu Yeh, Liang-Jen Wang, Yu-Chieh Huang — 2012-01-30

Abstract: There is compelling evidence for an association between structural brain deformities and psychiatric disorders. We report the case of an adolescent boy who was diagnosed with both attention-deficit/hyperactivity disorder and Tourette's syndrome. A full-blown manic episode occurred when he was 13 years old. During his admission to a psychiatric ward, closed-lip schizencephaly in the left frontal lobe and the right parietal lobe was identified through brain imaging. Effective control of his manic symptoms was achieved with quetiapine monotherapy within 3 weeks. This case report implies that the pathophysiology of psychiatric disorders, especially in young patients with multiple comorbid conditions, may be associated with abnormalities in the anatomical and functional development of the brain.

Psychosis risk syndrome comorbid with panic attack disorder in a cannabis-abusing patient affected by Arnold–Chiari malformation type I - Corrected Proof

2012-01-30

Abstract: Objective: An 18-year-old man with Arnold–Chiari malformation (ACM) type I developed sudden panic attacks. He also manifested sleep disorder, cannabis abuse, and psychosis-risk syndrome (PRS). Although with average–superior intelligence, he had executive dysfunction. This prompted us to explore the relation between ACM, cannabis abuse, PRS and panic disorder.Method: We report the case and briefly review the literature focusing on ACM and psychiatric disorders.Results: Behavior therapy led to gradual abstinence from cannabis with disappearance of anxiety symptoms. The patient is currently well and maintained on omega-3 polyunsaturated fatty acids.Conclusions: Locus coeruleus compression and cannabis abuse may have triggered the symptoms, and the latter might also be PRS-related. PRS and anxiety symptoms should be explored in ACM patients to allow better prevention of psychosis and anxiety disorders.

Reversible ptosis probably related to duloxetine use - Corrected Proof

Mustafa Mehmet Ozkose, Sinan Guloksuz, Bahri Ince, Kursat Altinbas — 2012-01-24

Duloxetine (Cymbalta) is a dual serotonin–noradrenaline reuptake inhibitor and is used to treat depressive disorders, stress urinary incontinence and fibromyalgia . Here we report a case of reversible ptosis of eye lid that we judged to be related to duloxetine use.

WITHDRAWN: Auditory hallucination and agitation due to memantine in a patient with Alzheimer's disease: a case report - Corrected Proof

Seishi Terada, Yosuke Uchitomi — 2012-01-16

This article has been withdrawn at the request of the Author and Editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Cobalamin deficiency presenting as obsessive compulsive disorder: case report - Corrected Proof

Vivek Sharma, Devdutta Biswas — 2012-01-09

Abstract: Cobalamin deficiency commonly presents with a wide range of neuropsychiatric manifestations ranging from myelopathy, neuropathy, optic neuritis and dementia to mood disorders, chronic fatigue and psychosis even without classical hematological abnormalities like anemia and macrocytosis. However, obsessive compulsive disorder (OCD) in relation to vitamin B12 deficiency has not been described so far. We report a case of middle-aged man presenting with OCD, low serum cobalamin and a positive family history of vitamin B12 deficiency who responded well to methylcobalamin replacement.

Postpartum catatonia treated with electroconvulsive therapy: a case report - Corrected Proof

2012-01-09

Abstract: Catatonia is a rare syndrome that occurs in mood and psychotic disorders, and general medical conditions. Postpartum depression affects 10%–15% of women within 6 months after delivery. Postpartum psychosis affects 0.1%–0.5% of women within weeks after delivery, though it can occur within hours; it carries risk for suicide and infanticide. There is limited evidence available to guide treatment. We review a case of postpartum psychosis that presented with catatonia and was resistant to medications, but responded to electroconvulsive therapy.

Delirium secondary to pregabalin - Corrected Proof

Catherine Hickey, Barbara Thomas — 2011-12-16

Abstract: Fibromyalgia is a common and disabling disease, and treatment can be challenging. More recently, pregabalin has been approved to treat pain associated with fibromyalgia. However, it can have serious neuropsychiatric sequelae. Several case reports have documented delirium secondary to pregabalin, usually in older patients with multiple medical comorbidities and concurrent medications. We describe a case of delirium in a young patient without significant medical problems and in the absence of other potentially causal medications. In this case, pregabalin appears to be the single causal etiology for delirium. We recommend clinicians to consider the causal role it may play in any patient who presents with delirium.

Oral-paliperidone-induced tardive dyskinesia: a case report - Corrected Proof

Han-Ting Wei, Ya-Wen Lai, Mu-Hong Chen, Ying-Sheue Chen — 2011-12-12

Abstract: Objectives: Tardive dyskinesia (TD) is generally considered the most severe extrapyramidal sequelae of antipsychotic treatments.Method: Case report.Results: We present a 20-year-old woman with previous treatment of risperidone 6–7 mg daily for approximately 4 years. She developed TD 2 years later after switching to paliperidone 9 mg daily. To the best of our knowledge, she is the first case report of having direct paliperidone-induced TD. Immediate treatments including paliperidone dose reduction to 6 mg daily, clonazepam 1.5 mg daily and trihexyphenidyl 2 mg daily were performed for 1 month, and her symptoms were relieved eventually after switching to clozapine 75 mg daily.Conclusion: Although second-generation antipsychotics such as paliperidone are considered to have a lowered risk of developing TD, this case could bring awareness to clinicians of the possibility of TD with the use of any antipsychotics.

Factitious disorder in a psychogeriatric inpatient - Corrected Proof

Lori-Anne Williams, Ana Hategan, James A. Bourgeois — 2011-12-02

There is a dearth of literature on factitious disorder (FD) in the geriatric population. We highlight the challenges associated with diagnosing FD in the elderly and the importance of early diagnostic consideration in order to minimize iatrogenic harm. Moreover, we report that the use of validation therapy can be successful in the management of FD.