Introduction
Aripiprazole is a third generation atypical antipsychotic and a dopamine serotonin system stabilizer, effective against positive and negative symptoms of schizophrenia. Within the group ...of atypical antipsychotics, aripiprazole shows a relatively benign safety profile (e.g. lower metabolic impact, mild effect on cardiovascular parameters), although the reported rate of extrapyramidal side effects is measurable.
Oculogyric crisis (OGC) is a rare movement disorder characterized by a prolongued involuntary upward deviation of the eyes, lasting minutes to hours. In most cases, OCG is a drug-induced adverse event with acute or tardive onset often attributable to a functional impairment of dopaminergic neurotransmission.
Objectives
OGC is seldom reported in children and young adults during treatment with aripiprazole, althouh it is commonly used in youths.
Methods
We report a case of an aripiprazole-induced oculogyric crisis in a 19 year old girl who diagnosed with schizophrenia (paranoid).
Results
There was a complete remission of the OGC’s following aripiprazole dose reduction, suggesting the clinical manifestation was a dose-dependent phenomenon.
Conclusions
The present report should raise awarness among clinicians for this relevant possible adverse event, that can happen also with the use of aripiprazol, not only with typical or more antidopaminergic antipsychotics. Future research in the field should emphasize neurobiological dysfunctions as the basis of EPS/OGC in patients.
Disclosure of Interest
None Declared
Clinical case report A 48-year-old male, diagnosed with impulsive control disorder, sex addiction disorder and mental retardation was followed-up by different psychiatrists for the last 20 years. He ...consults because of presenting depressive symptoms and behavioural disturbances related to the death of his mother two years before. The patient reports to experimenting depressed mood, irritability, insomnia and trends to cry. He has lost motivation for his job and hobbies (he used to show interest in topics such as physics, philosophy, maths, and medicine). He has feelings of loneliness, which make him look for social interaction and support through continuous calls to telephone sex lines. This act has made him spend large amounts of cash, thus, making him be in deep debts. He does not feel integrate in society. Mental status examination Introvert, limited social skills, coherent language, echolalic, monotone, tangential speech, depressed mood, feelings of guilt and futility, dysphoria, partial anhedonia, ideas of hopelessness, structured death ideation, unconsciousness of his own acts, with trend to impulsiveness and compulsive behaviour and insomnia. Complementary test Wais test: no mental retardation found. Diagnosis Autistic spectrum disorder (F84.0); major depressive disorder (F32.1); bereavement (V62.82). Discussion The patient showed classic diagnostic criteria DSM 5 associated with autistic spectrum disorder (Asperger's disorder in DSM-IV); the permanent inability for social interactions and repetitive, restricted and stereotypic behavioural patterns.
Introduction Drawing can be a tool to complete the psychodiagnose process, especially in children with expression and verbal problems. The Autistic Spectrum Disorder (ASD) children have problems to ...describe their feelings and emotions, they can provide us many information drawing their own world. Objective The purpose of this study was to discover the psychopathology of children with ASD through their drawings. Methods A4-sized booklets were given for ASD children from 6 to 16 years to draw an imaginary family (L. Corman), a human figure (Buck) or a free drawing. Results In most of the drawings of ASD children we could find at least one of the three criteria of ASD: social deficits, communication difficulties and restricted interests. Conclusions A projective technique as drawing could help us to discover additional information about our patients, specially children and mainly the ones who had problems with the expression of feelings like ASD children. The act of drawing can be used to understand children's struggles, their internal world. Moreover it could also help the children gain insight and review progress through drawing records.
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.
Belle de jour : A case of hysteria Noval Canga, C; Gómez Sánchez, S; Cepedello Pérez, S ...
European psychiatry,
March 2016, Letnik:
33, Številka:
S1
Journal Article
Recenzirano
Introduction Histrionic Personality Disorder is one of the most common personality disorders diagnosed in Psychiatry. This disorder has been known to be present in more than 40% of patients. There is ...also a high tendency for those diagnosed with this disorder to be female. Objectives The case is to show all the difficulties caused by this pathology, differencial diagnosis with other personality disorders, groups of characteristics from different clusters and also, complications produced in daily routine. Methods The purpose is to study a clinical case of a 27-year-old woman, with a degree in journalism, who began with a depressive episode after a failed relationship. After being diagnosed of infertility, she debuted with dissociative episodes and somatization symptoms. After that, she suffered several depressive episodes. At the moment, all the clinical symptoms support the diagnosis of histrionic personality disorder. Results Histrionic Personality Disorder can be found in the cluster B group of personality disorders. They often present in an overly dramatic, erratic or emotional manner. They may fulfil their need for attention through speech and behaviour that draws one's focus of attention toward themselves, and also demanding and manipulative in interpersonal relationships. There are high comorbidity rates in those who suffer from HPD with other diagnoses. Conclusions Histrionic Personality Disorder appears to be one of the least threatening diagnosis among personality disorders as those affected are high functioning and do not seek relief for the disorder itself. There is also very little research on HPD which makes treatment options limitless.
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 Narcolepsy is a neurological disorder characterized by disturbances in REM sleep. The symptoms that the patient could present are excessive daytime sleepiness, cataplexy, sleep paralysis, ...hypnagogic hallucinations and disrupted nocturnal sleep. Its etiology is unknown. Currently, there is established pharmacotherapy for symptomatic treatment, which are often unsatisfactory. Objective Review of new treatments for narcolepsy based on recent advances about its ethiopathogenesis. Method Seventy-five year-old female with a personal history of arterial hypertension and obstructive sleep apnea syndrome. The patient presented several episodes of abrupt muscular weakness, nightmares, sleep paralysis and excessive daytime sleepiness. Diagnosed of narcolepsy and treated with methylphenidate immediate-release (IR) 10 mg, alprazolam 1 mg, and trazodone 100 mg with good response. Results Due to persistent symptoms, treatment was modified to osmotic-release oral system (OROS) – methylphenidate resulting on a substantial weight loss (12 kg) and persistence of symptoms. Another methylphenidate preparations were unsuccessfully tested. Currently she continues treatment based on methylphenidate release-release and she improved significantly though she sometimes presented daytime sleepiness. Discussion Recent studies have shown that a loss of the hypothalamic neuropeptide hypocretin causes Narcolepsy with cataplexy and that an autoimmune mechanism may be responsible for this loss (related to HLA DQB*0602). Pathophysiology of narcolepsy without cataplexy is less understood. Although amphetamines and its derivatives are the mainstay of management, therapies that involve hypocretine seems to be hopeful (intranasal, peripherical or hipocretin cell transplantation). Monotherapy with GHB, H3 antagonist receptors, TRH analogs and immunotherapy are also being studied.
A bizarre love Noval Canga, C; Hernández Antón, R; Cepedello Pérez, S ...
European psychiatry,
March 2016, Letnik:
33, Številka:
S1
Journal Article
Recenzirano
Introduction Adoption constitutes a discontinuity in child care trajectory, that falls into a separation and a lost of reference figures, and therefore, the need to set up new attachment figures into ...a suitable familiar atmosphere. Objectives This case is a review of how a child adoption process, that can be something positive at first, can also produce many problems in the future, added to dificulties in order to regulate stressing situations and also solving problems. Methods The clinical case consists in a 25-year-old woman, who suffers from anxiety and self-injure behaviour. She has a diagnosis of non-specified personality disorder with limit characteristics. The patient was adopted a few months after her birth. At the moment she's living with her adoptive father, her adoptive mother passed away when she was 4. At the age of 21, the patient meets her biological mother and since that moment she spends most of the weekends with her. After a few medical appointments, she admits that she has allowed sexual relationships with her biological mother since six months ago. Results It's important to appreciate the value of familiar atmosphere, and in addition, the attachment between child and his parental figures. The quality of the attachment is going to have influence in emotional regulation. Conclusions Children who have suffered neglect from their biological parents and have been adopted develop attachment behaviours characterized by negative experiences. In spite of being in a good familiar environment, they feel vulnerable and insecure. Early and appropriate attachment experiences can improve relationships between children and their new family.
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.
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.
