Methodological Issues in a Study of Long-Term Maintenance Therapy With Quetiapine Versus Haloperidol Decanoate (original) (raw)
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Use of electroconvulsive therapy in an adolescent patient with catatonia
Indian Journal of Psychological Medicine, 2014
INTRODUCTION Catatonia was first described by Kahlbaum [1] in 1874, as a brain disorder, which has cyclic, alternating and progressive course. Over the years, understanding about catatonia has increased and it is now well-known that besides the primar y psychiatric disorders, catatonia is associated with many neurological and medical disorders. [2] Catatonia in adolescents has been reported to be associated with affective, psychotic, autistic, developmental, drug induced and medical conditions. [3] Evidence suggests that the symptom profile of catatonia in adolescents is similar to adults. Further, as in adults, catatonia in children and adolescents also responds to benzodiazepines and electroconvulsive therapy (ECT). However, the literature on the use of ECT in adolescents with catatonia is limited. In this case report, we present a case of catatonic schizophrenia, treated with ECT and review the literature on the use of ECT in adolescent catatonia. CASE REPORT A 16-year-old single girl presented with an insidious onset illness of 3 year duration. For the initial 1 year, the symptoms were characterized by fearfulness, anxiety, derealization and poor academic performance. During the 2 nd and 3 rd years of symptomatic phase, she developed additional symptoms of social withdrawal, poor initiative, irritability, muttering and gesturing in air, suspiciousness, delusions of reference and persecution and delusion of misidentification, poor self-care and stopped studying. About a month prior to presentation to our center, her speech output started reducing, she had perseveration and later became mute, had marked psychomotor retardation, ambitendency, active and passive negativism, posturing and refusal to eat. She was taken to a psychiatrist for her symptoms and was given intravenous lorazepam up to 8 mg/day along with risperidone up to 4 mg/day, but did not show any improvement. Following this, consultation
Psychiatric Syndromes Related to Antiepileptic Drugs
Epilepsia, 1999
All antiepileptic drugs may provoke positive or negative psychiatric reactions in individual patients. These psychotropic effects are not simply idiosyncratic but depend on the drug's anticonvulsive strength and the person's genetic and biographic psychiatric predisposition. Mechanisms related to psychiatric adverse events are polytherapy and folate deficiency, forced normalization, drug toxicity, and withdrawal. Our knowledge on dose independent, idiosyncratic psychotropic side effects is still limited. With respect to the older antiepileptic drugs there are almost no systematic data, and knowledge is largely empirical and based on anecdotal reports. With respect to the new generation of anticonvulsants there are data on psychiatric side effects from drug trials. However, these data are not always entirely transparent to the interested epi-leptologist. Moreover, drug trials are designed to test anticonvulsive efficacy and psychiatric adverse events are not systematically reported, thus severity psychopathologic nature of behavioral problems remain obscure. Differences in patients included in trials do not allow comparisons of psychiatric risks of specific drugs, particularly since following the vigabatrin experience, patients with a psychiatric history were often excluded from trials. In this chapter, methodological issues related to data on psychiatric adverse events of AED are discussed followed by an overview on the current knowledge on psychiatric side effect profiles of old and new antiepileptic drugs.
Era's Journal of Medical Research
We report on a 24 year old woman presented with low mood, reduced appetite, disturbed sleep and anxiety for which she was prescribed oral medication from a local practitioner in form of antidepressant(SSRI), anxiolytic(BZD) and upon no improvement, she underwent 8 rounds of successful electroconvulsive therapy (ECT) on which she responded partially and was discharged on SSRI.A few days after visited the same doctor and reported of having low mood, crying spells, referential and paranoid ideas and an attempt of suicide for which 10 more sessions of ECT were given. She presented in psychiatry OPD with catatonia where she was advised admission and diagnosed as a case of recurrent depressive disorder with catatonia and was managed with suprathresholddoses of SSRI and responded well.
Catatonia Development in a Schizoaffective Patient following Electroconvulsive Therapy
Iranian journal of psychiatry and behavioral sciences, 2010
riteria of Diagnostic and Statistical Manual of Mental Disorders, published by the American Association (DSMIV), for Catatonia syndrome is as follows: Motor immobility which is evidenced by catalepsy (including waxy flexibility) or stupor, excessive motor activity (which is apparently purposeless and is not influenced by external stimuli), extreme negativism (which is an apparently motiveless resistance to all instructions or maintenance of a rigid posture against all attempts to be moved) or mutism, peculiarities of voluntary movements evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing and echolalia or echopraxia (1). Catatonia can be treated with electroconvulsive therapy (ECT), benzodiazepines or barbiturates (2). ECT can also be a treatment for lifethreatening depression or anti-depressant
Catatonia and Transcranial Magnetic Stimulation
American Journal of Psychiatry, 2014
The Food and Drug Administration approved oxcarbazepine on Jan. 14, 2000, for the treatment of epilepsy. It has been reported to be effective in the treatment of mood disorders (1, 2). This report is about four Caucasian patients with bipolar II disorder with comorbid substance abuse who experienced significant improvement with oxcarbazepine. Mr. A was a 52-year-old married man who was referred by a therapist in his employment assistance program for hostile behavior, which affected his relationships with family members and co-workers. He had been treated unsuccessfully with divalproate and psychotherapy. He began oxcarbazepine monotherapy, up to 1200 mg/day. He experienced better work productivity, an absence of physical violence toward his wife and co-workers, and fewer depressive days. He reported no side effects. Ms. B was a 27-year-old single woman who was in treatment for childhood sexual abuse, self-mutilation, several suicide attempts, and episodic violent behavior. Since her adolescence, she had been in numerous inpatient and outpatient treatments, which had not produced significant improvement in her symptoms or function. Oxcarbazepine was initially added to her regimen of lorazepam, buproprion, fluvoxamine, trazodone, quetiapine, levothyroxine, and modafinil. Over the next year, she reduced her medications to oxcarbazepine, 600 mg b.i.d., levothyroxine, and trazodone. She had no hospitalizations and no temper outbursts or depressive episodes, was working full-time, and was not receiving Medicaid. Mr. C was a 40-year-old married man who was referred to the clinic for treatment of agitation and conflict with his wife. He was taking buspirone, buproprion, and lithium. Oxcarbazepine, up to 1200 mg/day, was added to his dose of lithium, 900 mg/day. His irritability decreased, his depression lifted, his relationship with his wife improved, and he obtained full-time employment. In the past year, he has been well maintained with oxcarbazepine, 1200 mg b.i.d., and modafinil, 400 mg/day, before his shift work. Mr. D was a 33-year-old man who was referred for treatment of domestic violence. He began oxcarbazepine monotherapy, up to 1200 mg/day. Since then, he has controlled his angry outbursts, felt happier, improved his home life, reduced his alcohol and cannabis consumption to occasional use, and given up his part-time job as a bar bouncer. His friends have also noted the improvement. These patients were initially given 150 mg/day of oxcarbazepine; the dose was increased every 3-4 days by 150 mg until it reached 600 mg at bedtime. Morning dosing was then added, as needed, up to the maximum dose reported per patient. None of these patients had developed hyponatremia when tested within 1 month of initiation of treatment.
Life-saving electroconvulsive therapy in a patient with near-lethal catatonia
Rivista di psichiatria
A young woman with bipolar I disorder and comorbid catatonia on enteral nutrition from several months, developed a form of near-lethal catatonia with weight loss, pressure sores, muscle atrophy, electrolyte imbalance, and depression of vital signs. A compulsory treatment was necessary, and informed consent was obtained from her mother for electroconvulsive therapy (ECT). After 7 ECT sessions, the patient recovered and resumed feeding. ECT may save the life of a patient with catatonia provided that legal obstacles are overcome. Clinicians should carefully evaluate patients with near-lethal catatonia, taking into account the risk of pulmonary embolism and other fatal events. The medical-legal issues, which vary across state regulations, should be addressed in detail to avoid unnecessary and potentially harmful delay in intervention.