Recurrent hypersomnia: Kleine-Levin syndrome Rodríguez Andrés, L; Rodríguez Campos, A; Gallardo Borge, L ...
European psychiatry,
March 2016, Letnik:
33, Številka:
S1
Journal Article
Recenzirano
Introduction Kleine-Levin syndrome was first described by Kleine in 1925 and elaborated on by Levi in 1936. It is an infrequent syndrome that predominantly affects to teenagers, and boys are four ...times more likely to be affected than girls. It is rare for patients over 30 years although some cases have been reported. Kleine-Levin syndrome is a recurrent hypersomnia characterized by episodes of hypersomnia lasting for 2 days to 4 weeks associated with symptoms of hyperphagia, hypersexuality and cognitive impairment. It can be accompanied by other abnormal behavior such as aggression, personality changes and irritability. Deficits are resolved between episodes. Case report It is presented the case report of a patient that suffers from recurrent episodes of hypersomnia associated with hyperphagia and abnormal behavior. Electroencephalography EEG demonstrates slowing of drowsiness and a decrease in REM sleep. The test of multiple sleep latency is abnormal and the rest of complementary test are normal. Diagnosis F51.1 Recurrent hypersomnia (Kleine-Levin syndrome) 307.44. Discussion Kleine-Levin syndrome is an intriguing, severe and homogenous disease with no obvious cause or treatment. Treatment is generally supportive. It should be considered in any teenager presenting with recurrent episodes of hypersomnia concurrent with cognitive changes or disinhibition.
Without awareness of what I am Casanova, T; Blanco Garrote, J.A; Isidro García, G ...
European psychiatry,
March 2016, Letnik:
33
Journal Article
Recenzirano
Introduction Fifty-year-old male. As a summary note that has a history of psychotic disorder from 25 years to coincide with the theological studies and your income as a priest. It has continued since ...then reviews and consultations in psychiatry, with two previous hospitalizations in private hospitals. It was stable with low doses of risperidone. Apparently, it makes a routine life linked to the activities of the church. Two months ago, he began to be irritable, suspicious, with discussions and problems at work, coinciding with the abandonment of treatment. Since the death of her mother a year ago has presented worsening. Objectives It presents the case of a patient who has no awareness of illness. Methods Psychopathological examination: conscious, oriented, scarcely manageable. Psychomotor restlessness. Expansive while maintaining distances, dysphoric and irritable. Verbiage. Ideas prejudice family-centered. There appears to be perceptual disturbances. Sleep-wake rhythms preserved. Results Treatment was initiated with injectable paliperidone administered dose of 150 mg and 100 mg, with 12 mg of oral paliperidone with good response progressively. At high partial remission of symptoms, it is factual. Conclusions The lack of awareness of the disease is non-pharmacological factors that can make it difficult to comply with neuroleptic treatment. These patients do not calibrate well how important that medication has on the evolution of his illness. Therefore, the therapeutic substance of such failure worsens the quality of life of patients and their families, as well as the prognosis of their disease presenting increasingly severe relapses.
Introduction Bupropion is a dual antidepressant, a norepinephrine and dopamine reuptake inhibitor. Its main use is in affective disorders as major depression. Antidepressants have been commonly ...associated with sexual side effects in the libido, sexual arousal, orgasm and erectile function. Bupropion has negative influence in sexual function, even it could increase the libido. Due to this, it could be a good option in patients with active sexual life and affective disorder. Clinical report A 58-year-old female with a long history of depression disorder for 5 years. History of lots of side effects with different treatments, sexual dysfunction with serotonin-antidepressants. Treated with bupropion SR 150 mg/day and alprazolam, she suffered a relapse. The bupropion was increased to 300 mg/day. Three days later she appeared in the consultation room, presented a sense of pre-orgasmic of 72 hours of evolution, high increased libido, tiredness, muscle tension and insomnia. This sense did not improve after the sexual act. It had never happened previously. The side effect improved when the bupropion was reduced to 150 mg/day and disappeared with its withdrawal. Conclusions The case made a relationship between the increased of bupropion's dose and the appearance of unusual sexual side effects (increased of libido and pre-orgasmic sense). Not only bupropion is one of the antidepressants that do not cause sexual dysfunction, if not it was reported in some trials that could be a treatment against this dysfunction due to its prosexual effects. The mechanism is unknown but could be related with norepinephrine or dopamine transmission.
Antidepressants and thyroid hormones Gómez Sánchez, S; Rodríguez Andrés, L; Rodríguez Campos, A ...
European psychiatry,
March 2016, Letnik:
33
Journal Article
Recenzirano
Introduction Over the years, it has been shown that various psychopharmaceuticals cause alterations on thyroid function. The objective of this review is to summarize the most important thyroid side ...effects associated with them. Special attention is paid to antidepressants, which are widely used and whose side effects are not receiving the attention they deserve. Clinical cases This review presents three cases of patients who were undergoing treatment with venlafaxine. Before the start of treatment, we asked for an analytical with thyroid profile in which no change was observed. After establishing treatment, a decrease in total T4 and free T4 was observed, TSH remained unchanged. Discussion It is important to note the need for systematic evaluation of thyroid function at the beginning of an antidepressant treatment, and perform their monitoring controls. We cannot forget that the clinical of hypothyroidism sometimes presents with depressive symptoms, which could mask the effectiveness of treatment.
Background Medical students have higher levels of depressive symptoms than the general population. Additionally, depressed students are more likely to commit suicide. Recent studies find up to 10% of ...medical students experiment depression and suicidal ideation, which is meaningfully higher than general population of similar age (5–8%). However, little is known about depression and suicidal ideation in medical students in Spain. Objective This study aims to create a self-administered questionnaire to investigate the prevalence and factors involved in depression and suicidal behaviour in medical students from a Spanish University. Methods We evaluated the main risk factors leaning to suicide in students. In addition, we selected an appropriate scale to assess depression among the existing ones. The evaluated items included demographic reports, academic information (academic course, unfinished subjects and accomplishment) and sanitary data (psychiatric family history, psychiatric personal history, psychotropic drug consumption, distress emotional events in the last twelve months and drugs consumption). Furthermore, we selected the 9-item Patient Health Questionnaire (PHQ-9) because of its rapidly implementation and proven efficacy. Conclusions Rates of depression and suicidal ideation are high in medical students. Currently, there is no program to detect and prevent depression neither suicide in students. For that reason, we consider that creating a new instrument to evaluate mental health in student is useful in order to offer early detection and treatment at medical school.
How strange is everything Casanova, T; Blanco Garrote, J.A; Hernández Antón, R ...
European psychiatry,
March 2016, Letnik:
33
Journal Article
Recenzirano
Introduction Twenty-year-old woman. In summary, we noted that a year ago, she had an episode of psychotic features secondary to cannabis in London. She then presented a depressing picture. In the ...current episode, the patient is anxious to be in a kind of dream. She says it is able to communicate through thought, and says his mind thinks fast. Make interpretations, giving meaning to everything that is new. Refer to hear voices in his head of his children. It is told with great emotional impact. Absence of previous consumption. Objectives It presents the case of a patient with psychotic symptoms treated early. Methods Psychopathological examination: conscious, oriented, collaborative. Good looks and touch. Tachypsychia and tachylalia. Speech inconsistent with loose associations of ideas. Dysphoria with emotional lability and continuous crying, feelings of guilt. Great anxiety component. Phenomena of derealization and depersonalization. Delusional interpretations of objects. Alterations of the experience of self. Possible auditory hallucinations. Insomnia. Results During treatment with olanzapine, income starts to 20 mg and then proceeds to therapeutic change aripiprazole with good response, objectifying a partial remission of symptoms, quiet and adequate meeting, being aware of what happened. Conclusions Schizoaffective disorder describes a mental disorder characterized by recurrent episodes of mood changes underway in all cases with psychotic symptoms. People with schizoaffective disorder are more likely to return to their previous level of function than do people with other psychotic disorders.
Introduction Smoking is an addictive and chronic disease. Twenty-four percent of the Spanish population in 2012 smoked daily. Aims and objectives To evaluate a smoking cessation program in a Primary ...Care Center. Methods Observational, prospective study. We describe an individualized smoking cessation in Plaza del Ejército Health Center (Valladolid). Inclusion criteria: active smoker, ≥ 18 years old and belonging to the Health Center. Exclusion: severe mental illness. Included patients from November 2013 until January2014. Ended in July 2014. Four Medical residents participated, we present the results of one of them. During the first consultation motivational interviewing was conducted, physical examination and treatment was prescribed (cognitive behavioral therapy or drug treatment: varenicline). In subsequent consultations interview and follow-up. Variables: age, gender, pack-years, nicotine dependence (Fagerstrom) and Prochaska and DiClemente phase, weight, treatment used, dropout rate and final withdrawal of snuff. Results Eleven patients, mean age 48.18 (13.61), 7 (63.6) women. Comorbidity: 6 (54.5) anxious-depressive pathology, 1 (9.1) dysthymia, 2 (18.2) endocrine pathology and 1 (9.1) respiratory disease. Four (36.4) showed high dependency and 2 (18.2) extreme. Media packages 20.50/year (19,20). Seven (63.6) were in action phase of Prochaska and DiClemente and 2 (18.2) in preparation. Visits range: 1-11. The average was 4.55 (3.64). Three (27.27) patients attended only the first visit. Four (36.4) achieved complete abstinence, 3 (27.27) met maintenance phase. One (9.1) reduced consumption in half. Patients gained average 0.5 kg (2.47). Conclusions The results are similar to those reported in other series. Modest dropout rate. No pharmacological treatment was used due to high coexistence of comorbidities, the only patient who used varenicline suffered insomnia. Average age and media packages were superior to other series.
Introduction Many neurological, oncological and autoimmune diseases may have psychiatric symptoms; these diseases sometimes start with these symptoms, so the diagnosis may be confused and the ...treatment is delayed. Objective Review the relationship between the secondary immune deficiency and increased predisposition to infectious processes and the psychopathological conditions which manifest themselves in some cases in these situations. Methods A 17-year-old male patient, who began psychiatry consultations when he was 3 years old due to psychomotor delay and behavior disorders. He was diagnosed with ADHD and mild mental retardation. Medical history: Viral encephalitis; Perthes disease; recurrent urinary tract infections; intestinal giardiasis; Alport syndrome. He's being treated with aripiprazole 5 mg (1/2-0-0). The patient presents an episode of perplexity, psychotic anguish, auditory hallucinations and paranoid delusion. The patient presented an infectious process with general malaise, diarrhea and vomiting during previous days. Results The patient was assessed by the Departments of internal medicine, neurology and psychiatry. A cerebral TAC, lumbar puncture, EEG and urine porphyrins were requested. The secondary immune deficiency makes the patient more vulnerable in an infectious process. Discussion The diagnosis of psychotic disorder due to medical condition may be transient or recurrent. Treating of the medical condition often gets resolution of psychosis, although the symptoms can persist in some cases. There is often a prodomo of viral syndrome weeks before the rest of symptoms appear. The differential diagnosis should be made with primary psychotic disorders, affective disorders, confusional syndromes, impulse control disorder or sleep disorders, neuroleptic malignant syndrome, serotonin syndrome and substance-induced psychotic disorders.
I am trapped in a wrong body Hernandez Anton, R; Noval Canga, C; Rybak Koite, E ...
European psychiatry,
March 2016, Letnik:
33, Številka:
S1
Journal Article
Recenzirano
Introduction Gender dysphoria is incoherence between the sex a person feels or expresses and the biological. Objective Revise the inclusion criteria for hormone therapy and sex reassignment surgery ...in gender dysphoria. Expose the multidisciplinary approach. Make differential diagnosis with other psychological disorders. Methodology A 45 years old male patient (biological female), who was sent from Endocrinology Unit for a psychiatric evaluation before restart a hormonal treatment. Since his childhood, he has presented dissatisfaction with his sexual characteristics; he has had fantasies and dreams, in which he belonged to the other sex. He has always chosen male activities and male stereotypes companies. He has presented preference for cross-dressing from 9 years. Always felt the sexual attraction for women. He first consulted for this reason in 1995. Results It reported favorably to start hormone treatment after completing the eligibility criteria: > 18 years old; knowledge of the effects of hormones; and more 3 months documented real-life experience. The hormone therapy caused the growth of microprolactinoma, which was treated with dopamine agonists until it disappeared and the cessation of galactorrhea. Testosterone treatment is restarted. Laboratory tests are done every 3 months during the first year and then, every 6 months. Conclusions Is the gender disphoria a pathology? The EU recommends a reclassification as no pathological disorders in ICD-11. The treatment of gender dysphoria is necessary, and there is no reason to postpone it. The main difficulty is the differential diagnosis; there may be comorbidity with others mental disorders which are not exclusive (psychotic disorder, OCD, personality disorders and other disorders of gender identity).
