Anxiety and undiagnosed pheochromocitoma

2016 ◽  
Vol 33 (S1) ◽  
pp. S362-S362
Author(s):  
C. Cocho Santalla ◽  
C. Sanahuja
Keyword(s):  
Anxiety Disorders ◽  
Urinary Catecholamine ◽  
Potential Source ◽  
Clinical Presentations ◽  
Pubmed Search ◽  
History Of ◽  
Competing Interest ◽  
Manual Review ◽  
Previous Medical History ◽  
Acute Anxiety

IntroductionPheochromocytomas are rare catecholamine-secreting tumours from the adrenal medulla. The clinical presentations may mimic other disorders due to nonspecific symptoms produced by catecholamines in blood.ObjectivesWe report a case of undiagnosed pheochromocytoma in a 29-year-old woman with a two year history of anxiety. We undertook a literature review.MethodsPubMed search using “pheochromocytoma”, “anxiety” as key words. Follow by a manual review of identified publication. We report a case of a 29-year-old with a two-year history of anxiety pharmacologically treated without success. She presents episodes of acute anxiety accompanied, sometimes, by nausea or headache, without high blood pressure. She presented a previous medical history of thyroid carcinoma. The patient was referred to the endocrinology service for thyroid review, postulated as potential source for drug resistance. High catecholamine levels were found and pheochromocytoma diagnosis was confirmed histopathologically.ResultsThe releasing catecholamine in blood can lead to a number of symptoms that can include paroxysmal hypertension, headache, palpitations, anxiety, chest/abdominal pain, nausea. Hypertension may not be the main symptom. These symptoms can be misinterpreted as psychiatric disorders, in particularly anxiety disorders. Elevated urinary catecholamine suggested the diagnosis of pheochromocytoma.ConclusionsPheochromocytoma should be included in the differential diagnosis of anxiety disorders, especially if pharmacological treatment is not effective. The suspected cases should be investigated, even in the absence of hypertension, due to the potential morbidity of untreated pheochromocytoma.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Anxiety disorders and substance abuse

2016 ◽  
Vol 33 (S1) ◽  
pp. S384-S384
Author(s):  
I. Prieto Sánchez ◽  
M.D.L.C. Ramírez Domínguez ◽  
S. Fernández León ◽  
M. Reina Domínguez ◽  
N. Garrido Torres ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Dual Diagnosis ◽  
Behavioral Problems ◽  
Strong Association ◽  
Epidemiological Studies ◽  
Distinctive Features ◽  
Other Substances ◽  
History Of ◽  
Competing Interest ◽  
Substance Disorder

IntroductionPatients with anxiety disorders are more vulnerable to develop other comorbid conditions. In particular, large epidemiological studies show a strong association between different anxiety disorders and substance use disorders.ObjectivesTo show the prevalence of major anxiety disorders and the consumption of different substances. As well as the particular characteristics of this dual diagnosis and treatments that have proven more effective.MethodsExhaustive review of all the material published on this topic in the recent years.ConclusionsNearly 24% of patients with anxiety disorder suffer from a comorbid substance disorder use in their lifetime (17.9% diagnosis of alcohol abuse or dependence diagnosis and 11.9% of abuse or dependence on other drugs). Dual patients show a number of distinctive features, such as more frequency in males, family history of alcohol or other substances abuse and behavioral problems, early parental loss among others.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychoses of epilepsy – “Acute attacks of insanity”. What literature says and how we act

2016 ◽  
Vol 33 (S1) ◽  
pp. S630-S630
Author(s):  
N. Echeverría Hernández ◽  
M.D.M. Lázaro Redondo ◽  
F. de la Torre Brasas ◽  
A. Duque Domínguez ◽  
A. Mas Villaseñor ◽  
...  
Keyword(s):  
Seizure Activity ◽  
Published Data ◽  
Potential Association ◽  
End Of Treatment ◽  
Epileptic Patients ◽  
Pubmed Search ◽  
History Of ◽  
Acute Attacks ◽  
Competing Interest ◽  
Patients With Epilepsy

IntroductionPatients with epilepsy seem particularly liable to certain major psychiatric disorders. Prevalence of schizophrenia within an epileptic population varies between 3% and 7% (1% in general population). The aetiology is possibly multifactorial (drugs and neurosurgery).ObjectivesTo study comorbidity between psychoses and epilepsy and management in the literature and in our patients.AimsTo analyze factors that might influence the onset of psychoses within an epileptic population and how this potential association could influence our practice.MethodsPubMed search was conducted with interest in psychoses of epilepsy, pharmacology, and comorbidity. Up to 10 variables related with factors influencing psychotic episodes that required hospital admission in three patients with epilepsy were studied.ResultsUnlike published data, our patients did not have postictal psychoses. All cases had early onset temporal lobe epilepsy with no seizure activity since diagnosis (more than 20 years). No family history of either epilepsy or psychoses. Management included lamotrigine, oxcarbazepine, carbamazepine, zonisamide, and levetiracetam in conventional doses. The psychosis, which comprised affective, schizophrenic, and confusional elements, lasted longer and was more troublesome than psychosis in non-epileptic patients. Response to neuroleptics was poorer than in non-epileptic patients with psychoses. Consultation with Neurology Unit resulted in end of treatment with zonisamide and levetiracetam.ConclusionsLess than perfect evidence suggests the association between psychosis and epilepsy. In our patients, no postictal cases were recorded. Management showed poorer effect of neuroleptics when compared with non-epileptics, and zonisamide and levetiracetam were changed for other drugs with presumably lower association with psychoses.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Neuropsychiatric Properties of the ACE2/Ang-(1-7)/Mas Pathway: A Brief Review

2020 ◽  
Vol 27 (6) ◽  
pp. 476-483 ◽  
Author(s):  
Leonardo Augusto de Melo ◽  
Ana Flávia Almeida-Santos
Keyword(s):  
Anxiety Disorders ◽  
Therapeutic Target ◽  
Clinical Success ◽  
Renin Angiotensin System ◽  
Anxiety And Depression ◽  
Time Range ◽  
Proven Efficacy ◽  
Pubmed Search ◽  
Depression Disorders ◽  
New Research

The current pharmacological strategies for the management of anxiety disorders and depression, serious conditions which are gaining greater prevalence worldwide, depend on only two therapeutic classes of mood-stabilizing drugs: Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs). Although first line agents with proven efficacy, their clinical success in the management of anxiety disorders and depression is still considered highly complex due to the multifaceted nature of such conditions. Several studies have shown a possible therapeutic target could be found in the form of the Angiotensin-Converting Enzyme [ACE] type 2 (ACE2), Angiotensin [Ang]-(1-7) and Mas receptor pathway of the Renin- Angiotensin System (RAS), which as will be discussed, has been described to exhibit promising therapeutic properties for the management of anxiety disorders and depression. In this article, the literature to describe recent findings related to the role of the RAS in anxiety and depression disorders was briefly revised. The literature used covers a time range from 1988 to 2019 and were acquired from the National Center for Biotechnology Information’s (NCBI) PubMed search engine. The results demonstrated in this review are promising and encourage the development of new research for the treatment of anxiety and depression disorders focusing on the RAS. In conclusion, the ACE2/Ang-(1-7)/Mas pathway may exhibit anxiolytic and anti-depressive effects through many possible biochemical mechanisms both centrally and peripherally, and result in highly promising mental health benefits which justifies further investigation into this system as a possible new therapeutic target in the management of neuropsychiatric disorders, including any as of yet undescribed risk-benefit analysis compared to currently-implemented pharmacological strategies.

The role of personality traits in initiating and maintaining addictive behavior

2016 ◽  
Vol 33 (S1) ◽  
pp. S307-S307
Author(s):  
M. Manea ◽  
B. Savu
Keyword(s):  
Substance Abuse ◽  
Anxiety Disorders ◽  
Personality Traits ◽  
Trait Anxiety ◽  
Psychiatric Clinic ◽  
Strongly Correlated ◽  
Addictive Disorder ◽  
Substance Disorders ◽  
Competing Interest

IntroductionIt is well known that certain personality traits are more linked to drug abuse than others. Psychiatrists are more likely to emphasize the importance of impulsivity in the connection with substance disorders but in the following study we found an important percentage of patients that have a substance abuse were linked to anxiety through impulsiveness as a personality trait.ObjectivesMost youths admitted for a substance abuse are highly impulsive. Our quest was to differentiate what component of impulsivity was more frequently linked to a substance use disorder.MethodsIn the study were included 50 patients admitted in the 3rd Psychiatric Clinic, Substance Dependences Department, Cluj-Napoca. For the identification of the drug abused we used the multitest screening kit in correlation with the results from the Forensic Medicine Institute of Cluj-Napoca. Each patient completed the Barratt Impulsivity Scale and the Swedish Universities Scales of Personality.ResultsHigh scores on BIS-11 strongly correlated with attentional impulsiveness (Pearson's r correlation = .838) which means high inattention and cognitive instability this being linked with anxiety disorders. Cognitive Instability was correlated with Psychic Trait Anxiety (r = 0.29) and Motor Impulsiveness with Somatic Trait Anxiety (r = 0.3). Normal 0 false false false EN-US X-NONE X-NONE.ConclusionsThe underrecognized anxiety disorders in young adults whom are admitted for an addictive disorder prefrontal cortex is known to be the source of both impulsivity and could be linked to anxiety as well (valence asymmetry hypothesis). Normal 0 false false false EN-US X-NONE X-NONE.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A Brief History of Psoriasis Management in Canada

2020 ◽  
Vol 24 (3) ◽  
pp. 273-277
Author(s):  
Khalad Maliyar ◽  
Patrick Fleming ◽  
Boluwaji Ogunyemi ◽  
Charles Lynde
Keyword(s):  
20Th Century ◽  
Coal Tar ◽  
Historical Review ◽  
Chronic Inflammatory Disease ◽  
Biologic Therapies ◽  
First Line ◽  
Revolutionary Change ◽  
Clinical Presentations ◽  
History Of ◽  
The 19Th Century

Psoriasis is a chronic, inflammatory disease with a varying degree of clinical presentations. Managing psoriasis has always been arduous due to its chronicity and its propensity to relapse. Prior to the development of targeted biologic therapies, there were few effective treatments for psoriasis. Ancient psoriasis therapies included pinetar, plant extracts, psychotherapy, arsenic, and ammoniated mercury. In the 19th century, chrysarobin was developed. Then, in the early half of the 20th century, anthralin and coal tar were in widespread use. In the latter half of the 20th century, treatments were limited to topical first-line therapies, systemic drugs, and phototherapy. However, as the treatment of psoriasis has undergone a revolutionary change with the development of novel biologic therapies, patients with moderate to severe psoriasis have been able to avail therapies with high efficacy and durability along with an acceptable safety profile. This article is a brief historical review of the management of psoriasis prior to the inception of biologics and with the development of novel biologic therapies.

scholarly journals Strengths and Weaknesses of the Dutch Implementation of the Water Framework Directive

2017 ◽  
Vol 14 (3-4) ◽  
pp. 269-293 ◽  
Author(s):  
Lorenzo Squintani ◽  
Ernst Plambeck ◽  
Marleen van Rijswick
Keyword(s):  
Water Management ◽  
The Netherlands ◽  
Water Governance ◽  
Functional Approach ◽  
Governance System ◽  
Member States ◽  
Potential Source ◽  
History Of ◽  
Dutch Experience ◽  
Regional Water

The Netherlands has a long and fascinating history of water management. The main features of the Dutch water governance system for the implementation of the wfd are its regional water authorities based on hydrological scales and powers to regulate, decide and raise taxes for their water tasks. Their functional approach and the decentralised character make the regional water authorities very efficient and effective. It is therefore understandable that eu institutions and other Member States consider the Dutch system an interesting potential source of inspiration for other jurisdictions. Yet, it is not all gold what shines. This paper highlights the strength and weakness elements of the Dutch water governance system under the wfd. It exposes several points of concern. When considering using the Dutch experience as a source of inspiration in other Member States, these concerns should be taken in due account.

Attempted suicide attention at an emergency room: A hospital-based descriptive approach

2016 ◽  
Vol 33 (S1) ◽  
pp. S603-S603
Author(s):  
D. Torres ◽  
G. Martinez-Ales ◽  
M. Quintana ◽  
V. Pastor ◽  
M.F. Bravo
Keyword(s):  
Emergency Room ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Psychiatric Hospitalization ◽  
Study Results ◽  
History Of ◽  
Competing Interest ◽  
Reported Data ◽  
Medium Cost ◽  
Rule Out

IntroductionSuicide causes 1.4% of deaths worldwide. Twenty times more frequent, suicide attempts entail an important source of disability and of psychosocial and medical resources use.ObjectiveTo describe main socio-demographical and psychiatric risk factors of suicide attempters treated in a general hospital's emergency room basis.AimsTo identify individual features potentially useful to improve both emergency treatments and resource investment.MethodsA descriptive study including data from 2894 patients treated in a general hospital's emergency room after a suicidal attempt between years 2006 and 2014.ResultsSixty-nine percent of the population treated after an attempted suicide were women. Mean age was 38 years old. Sixty-six percent had familiar support; 48.5% had previously attempted a suicide (13% did not answer this point); 72.6% showed a personal history of psychiatric illness. Drug use was present in 38.3% of the patients (20.3% did not answer this question); 23.5% were admitted to an inpatient psychiatric unit. Medium cost of a psychiatric hospitalization was found to be 4900 euros.ConclusionThis study results agree with previously reported data. Further observational studies are needed in order to bear out these findings, rule out potential confounders and thus infer and quantify causality related to each risk factor.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Comorbid depression and ulcerative colitis – is there a connection?

2017 ◽  
Vol 41 (S1) ◽  
pp. S534-S534
Author(s):  
A. Melada ◽  
I. Krišto-Mađura ◽  
A. Vidović
Keyword(s):  
Ulcerative Colitis ◽  
Psychiatric Treatment ◽  
Psychiatric Symptoms ◽  
Specific Treatment ◽  
Unknown Etiology ◽  
Suicidal Thoughts ◽  
Symptoms Of Depression ◽  
Bidirectional Communication ◽  
History Of ◽  
Competing Interest

Ulcerative colitis (UC) is a subset disorder of inflammatory bowel disease (IBD) with chronic course and symptoms such as fatigue, gastrointestinal pain, fever, etc. IBD is associated with psychological manifestations including depression and anxiety. There is an increased number of studies trying to link these comorbidities. The gut-brain axis is regulated by intestinal microbiota and this bidirectional communication including immune, neural, endocrine and metabolic mechanisms may bring us closer to the answer. The following case concerns a 56-year-old patient with history of major depressive disorder who was in continuous psychiatric care and treated with antidepressants. Several years after the beginning of psychiatric treatment, he was hospitalized for diagnostic examination due to subfebrility of unknown etiology, but with no final somatic diagnosis. After two years he was referred to our department and at administration the patient showed symptoms of depression, anxiety, lack of motivation and suicidal thoughts and tendencies. Subfebrility was still present at that time. His psychopharmacotherapy was revised and there was a slight improvement in mood and behaviour. During outpatient follow-ups the symptoms of depression were still prominent and remission was not achieved even with modulation of antidepressant pharmacotherapy. The following year the patient was diagnosed with UC and started specific treatment after he presented with diarrhea in addition to subfebrility. Subsequently his mood improved, suicidal thoughts were diminished and ultimately remission was achieved. This case suggests that only after UC was being treated the psychiatric symptoms also withdrew which implicates that inflammatory mediators were involved in pathogenesis of depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Marriage, monogamy and HIV: a profile of HIV-infected women in south India

2000 ◽  
Vol 11 (4) ◽  
pp. 250-253 ◽  
Author(s):  
S Newmann ◽  
P Sarin ◽  
N Kumarasamy ◽  
E Amalraj ◽  
M Rogers ◽  
...  
Keyword(s):  
Risk Factor ◽  
Hiv Risk ◽  
South India ◽  
Reproductive Age ◽  
Indian Women ◽  
Clinical Presentations ◽  
Vertical Transmission Of Hiv ◽  
History Of ◽  
The Mean ◽  
Heterosexual Sex

A retrospective study was conducted on 134 HIV-infected females evaluated at an HIV/AIDS centre in south India to characterize their socio-demographics, HIV risk factors and initial clinical presentations. The mean age was 29 years; 81% were housewives; 95% were currently or previously married; 89% reported heterosexual sex as their only HIV risk factor; and 88% reported a history of monogamy. The majority were of reproductive age, thus the potential for vertical transmission of HIV and devastating impacts on families is alarming. Nearly half of these women initially presented asymptomatically implying that partner recruitment can enable early HIV detection. Single partner heterosexual sex with their husband was the only HIV risk factor for the majority of women. HIV prevention and intervention strategies need to focus on married, monogamous Indian women whose self-perception of HIV risk may be low, but whose risk is inextricably linked to the behaviour of their husbands.

Dissociative disorder – unraveling the mystery

2016 ◽  
Vol 33 (S1) ◽  
pp. S327-S327
Author(s):  
L. Sousa ◽  
A. Antunes ◽  
S. Oliveira
Keyword(s):  
Romantic Relationship ◽  
Clinical Information ◽  
Dissociative Disorders ◽  
Dissociative Disorder ◽  
Clinical Interviews ◽  
Medical Interventions ◽  
Brazilian Woman ◽  
History Of ◽  
Competing Interest ◽  
Car Accident

IntroductionDissociative disorders are among the most enigmatic and controversial psychiatric pathologies. In the last decades, great interest has emerged in understanding its pathophysiology, nonetheless, problems in recognition and management of these disorders are still challenging the psychiatric community.ObjectivesWe describe a paradigmatic case of a dissociative disorder illustrating the “choice” of dissociation as a strategy for coping with a traumatic reality.AimCall attention to problems that interfere with the recognition, diagnosis and management of dissociative disorders.MethodsBibliographic research was conducted through the PubMed in the Medline library and clinical information was obtained through medical records and clinical interviews with the patient.ResultsA 51-year-old Brazilian woman with no psychiatric history presented to the psychiatric outpatient care with apparent dissociative symptoms, these consisted of amnesia for episodes of agitation and aggressive behavior that occurred mainly at bed time. She had been previously on general practice and neurology consultations but none organic diagnose was made. Already in psychiatry, it was recognized that those symptoms developed together after a car accident and the beginning of a romantic relationship. It was also recognized that she has sexual dysfunction and a history of sexual abuse by a family member during her childhood, a known risk factor to dissociative disorders.ConclusionsSkepticism and lack of understanding might be the reason for late psychiatric referral after the realization of various expensive and time-consuming medical exams. Improving the recognition of dissociative disorders will conduce not only to better clinical outcomes but also improve cost effectivity of medical interventions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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