Antipsychotic-induced hyperprolactinemia

2017 ◽  
Vol 41 (S1) ◽  
pp. S701-S701
Author(s):  
S. Khouadja ◽  
R. Ben Soussia ◽  
A. Bouallagui ◽  
I. Marrag ◽  
S. Younes ◽  
...  
Keyword(s):  
Prolactin Level ◽  
Atypical Antipsychotics ◽  
Antipsychotic Agents ◽  
University Hospital ◽  
Therapeutic Assessment ◽  
Assessment And Monitoring ◽  
Competing Interest ◽  
A Prospective Study ◽  
Psychiatric Department

IntroductionAs antipsychotic agents are increasingly used, many patients are at risk for antipsychotic-induced hyperprolactinemia.Aims of the studyEstimate the prevalence of hyperprolactinemia in patients treated by a single antipsychotic and identify the risk factors for its occurrence.MethodsThis is a prospective study carried out at the psychiatric department of psychiatry of university hospital of Mahdia during 24 months. We have included all patients with a follow up and treated by single antipsychotic for at least 12 weeks. A pituitary MRI has been requested for patients with a prolactin level higher than 100 ng/ml.ResultsWe have collected 92 patients. Hyperprolactinemia was found in 34.8% of patients among which 7.6% have had prolactin level greater than 150 ng/ml. Pituitary MRI have revealed 2 cases of macro-adenoma. The decrease of the antipsychotic doses has significantly improved prolactin levels. The switch of antipsychotic with another less inducing hyperprolactnimea has significantly decreased prolactin levels. 7 factors were correlated significantly to hyperprolactinemia: sex (female), substance use, presence of side effects, combination of psychotropic drugs, atypical antipsychotics, type of antipsychotic: Haloperidol and amisulpride, antipsychotic dose greater than 1000 mg Chlorpromazine equivalent.ConclusionHyperprolactinemia must be carefully identified, through a pre-therapeutic assessment and monitoring of patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Ultra-resistant schizophrenia and potentiation strategies

2017 ◽  
Vol 41 (S1) ◽  
pp. s834-s834 ◽  
Author(s):  
S. Khouadja ◽  
R. Ben Soussia ◽  
S. Younes ◽  
A. Bouallagui ◽  
I. Marrag ◽  
...  
Keyword(s):  
Treatment Resistance ◽  
Cost Benefit ◽  
Clinical Excellence ◽  
University Hospital ◽  
Dsm Iv ◽  
Competing Interest ◽  
A Prospective Study ◽  
Psychiatric Department ◽  
The Cost ◽  
The University

IntroductionTreatment resistance to clozapine is estimated at 40–70% of the treated population. Several clozapine potentiation strategies have come into clinical practice although often without evidence-based support.ObjectiveThe aim of our work was to identify the potentiation strategies in ultra-resistant schizophrenia depending on the subtype of schizophrenia.MethodologyThis is a prospective study conducted on patients with the diagnosis of schizophrenia, based on DSM-IV-TR criteria, and hospitalized in the psychiatric department of the university hospital in Mahdia, Tunisia. The study sample consisted of patients meeting the resistant schizophrenia criteria as defined by national institute for clinical excellence (NICE), and the prescription of clozapine for 6 to 8 weeks was shown without significant improvement.Resultswe have collected 10 patients. The mean serum level of clozapine was 462.25 mg/L. The potentiation strategies were different depending on the subtype of schizophrenia. For the undifferentiated schizophrenia, we have chosen ECT sessions. For the disorganized schizophrenia, we opted for amisulpiride and aripiprazole. For the paranoid forms, we have chosen the association of risperidone and ECT. A psychometric improvement was noted in BPRS ranging from 34 to 40%.ConclusionEvery potentiation strategy entails a cost, whether it is an additional monetary cost, adverse effects or greater stress to caregivers. The cost/benefit equation should be thoroughly evaluated and discussed before commencing a strategy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The acting out in patients with Schizophrenia examined in a forensic psychiatric assessment

2017 ◽  
Vol 41 (S1) ◽  
pp. S591-S591
Author(s):  
S. Khouadja ◽  
S. Younes ◽  
S. Chatti ◽  
R. Ben Soussia ◽  
L. Zarrouk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mentally Ill ◽  
University Hospital ◽  
Acting Out ◽  
Psychiatric Assessment ◽  
Schizophrenic Patients ◽  
Forensic Psychiatric ◽  
Competing Interest ◽  
Psychiatric Department ◽  
Forensic Psychiatric Assessment

IntroductionMany studies have shown that schizophrenic patients are responsible for the highest rates of violence among all the mentally ill patients.Aims of the studyDescribe the socio-demographic and clinical characteristics of patients with schizophrenia examined in a forensic psychiatric assessment and identify the risk factors of violence in these patients.MethodologyA retrospective study carried out in the psychiatric department of university hospital of Mahdia during fifteen years involving 40 patients with schizophrenia examined in a forensic psychiatric assessment following a forensic act. These patients were compared to a population of 40 patients followed in the same establishment for the same disease and without criminal record.ResultsAge average of 36.08 years, male (95%), rural origin (65%), primary level education (47.5%), single (65%), unemployed (65%) and average socio-economic level (65%). Personal psychiatric history (87.5%), personality disorder (12.5%), judiciary history (12.5%) and substance abuse (57.5%). Subtypes of schizophrenia: undifferentiated (52.5%) and paranoid (30%). They have committed serious physical assaults (55%) and aggression against property (27.5%). The victim was mostly a family member (40%), under the influence of toxic (22%), driven by delusions of persecution (61%), with hallucinatory mechanism (55%). The psychiatric expert has concluded an abolition of discernment in 77.5% of cases. Risk factors of acting out were: rural origin, alcohol and psychoactive substances use, productive forms of schizophrenia, poor adherence and irregular monitoring.ConclusionThe knowledge of risk factors improves the management and allows us better prevention of violence among our patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Pain following stroke: A prospective study

2012 ◽  
Vol 3 (3) ◽  
pp. 194-195 ◽  
Author(s):  
Anne P. Hansen ◽  
Ninna S. Marcussen ◽  
Henriette Klit ◽  
Helge Kasch ◽  
Troels S. Jensen ◽  
...  
Keyword(s):  
Shoulder Pain ◽  
Joint Pain ◽  
Considerable Effect ◽  
Stroke Onset ◽  
University Hospital ◽  
Prevalence Of Pain ◽  
A Prospective Study ◽  
The Impact

AbstractBackground/aimsPain following stroke is common and affects the quality of life in stroke survivors. The most common types of pain following stroke are headache, shoulder pain, other joint pain and central post-stroke pain (CPSP). The objectives of this study were to determine the prevalence of pain at stroke onset and 6 months after stroke and classify the different pain types.MethodsAll consecutively eligible patients admitted to the Stroke Unit at Aarhus University Hospital from February 1 to October 1, 2007 and from February 1 to August 1, 2008 were included. An interview on pain prior to and at stroke onset was conducted at admission followed by interviews on current pain by phone 3 and 6 months after the stroke.ResultsA total of 300 patients were included in the study, and 275 of them completed the 6-month follow-up. The mean age of the 275 patients was 65.9 years old and 55.2% was male. Pain prior to stroke was reported by 49.1% of patients at stroke onset and newly developed pain defined as pain not experienced prior to stroke was reported by 37.8% at stroke onset, 41.8% at the 3-month follow-up and 45.8% at the six month follow-up. The impact on daily life was moderate to severe in 36.4% and 33.6% of the patients with newly developed pain at the 3- and 6-month follow-up, respectively. More than one type of newly developed pain was experienced by 32.2% and 36.5% at the 3- and 6-month follow-up. Headache was reported by 33.5% at stroke onset and newly developed headache by 15.3% at 3-month follow-up and 13.1% at 6-month follow-up. Shoulder pain was reported by 1.5%, 13.1% and 16.4% at stroke onset, and the 3-and 6-month follow-up, respectively. Other joint pain was reported by 7.4% at 3-month and 11.7% at 6-month follow-up. Evoked pain was experienced by 3.6% at stroke onset and by 5.5% and 9.1% at the follow-up interviews.Other types of pain were also reported; 7.3% at stroke onset, 18.9% at 3-month follow-up and 20.0% at 6-month follow-up. Possible CPSP was identified in 10.5% of patients from the different pain groups.ConclusionPain following stroke is common and may have a considerable effect on the everyday life of the patient.

scholarly journals Variables Associated with Endometriosis-related Pain: A Pilot Study using a Visual Analogue Scale

2019 ◽  
Vol 41 (03) ◽  
pp. 170-175 ◽  
Author(s):  
Mauro Cozzolino ◽  
Maria Coccia ◽  
Giacomo Lazzeri ◽  
Francesca Basile ◽  
Gianmarco Troiano
Keyword(s):  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Complex Disease ◽  
Smoking Habit ◽  
Clinical Information ◽  
University Hospital ◽  
History Of ◽  
Vas Scores ◽  
A Prospective Study

Objective Endometriosis is a complex disease, and pain is an important component of the syndrome. One of the most used methods to assess pain is the visual analogue scale (VAS). The aim of the present research was to study the pain experienced by patients who referred to our unit for endometriosis, using the VAS to understand the variables that could influence it. Methods We have conducted a prospective study from February 2012 to December 2016, enrolling 388 patients who referred to a university hospital, in Florence, Italy. We have included in the present study patients during their follow-up for endometriosis; we have also included patients who underwent surgery with a histological diagnosis of endometriosis. We have collected sociodemographic and clinical information regarding age, body mass index (BMI), smoking habit, number of pregnancies, and endometriosis staging. Finally, we have administered the VAS for several symptoms. Results Dysmenorrhea was the symptom associated with the highest perception of pain (mean VAS score of 5.76). The logistic regression showed that the stage of endometriosis could influence the pain associated to constipation and to dysuria. The linear regression showed that age could influence the pain associated to constipation, to dyspareunia, and to dysmenorrhea. A positive correlation was found between dysmenorrhea and chronic pelvic pain (CPP), between dysmenorrhea and dyspareunia, and between constipation and dysuria. Conclusion Using a validated method, the VAS, we have studied the pain experienced by a group of patients with a history of endometriosis and observed that smoking habit and BMI did not influence the VAS scores, and that dysmenorrhea was associated with the highest perception of pain.

Metabolic and Endocrine Disturbances in Psychiatric Disorders: A Multidisciplinary Approach to Appropriate Atypical Antipsychotic Utilization

CNS Spectrums ◽  
2005 ◽  
Vol 10 (S14) ◽  
pp. 1-16 ◽  
Author(s):  
Prakash S. Masand ◽  
Larry Culpepper ◽  
David Henderson ◽  
Scott Lee ◽  
Kimberly Littrell ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Atypical Antipsychotics ◽  
Multidisciplinary Approach ◽  
Antipsychotic Agents ◽  
Endocrine Disturbances ◽  
Cardiovascular Morbidity And Mortality ◽  
Increase Risk ◽  
Consensus Report ◽  
Ongoing Monitoring

AbstractPatients with psychiatric disorders have an increased rate of cardiovascular morbidity and mortality compared with the general population. Metabolic issues such as weight gain, dyslipidemia, diabetes mellitus, diabetic ketoacidosis, and pancreatitis have been reported with the use of antipsychotic agents. Although atypical antipsychotics have not been linked directly to the development of metabolic syndrome, these medications have been shown to increase risk factors that can lead to metabolic and endocrine disturbances. Therefore, clinicians should provide ongoing monitoring for patients who are being treated for psychiatric disorders with these agents. According to the 2004 Consensus Report on Antipsychotics, screening measures should include baseline and follow-up monitoring of personal/family histories, weight (body mass index), waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile.

Evolutionary Aspects of Psychotic Disorders Induced by Cannabis

2017 ◽  
Vol 41 (S1) ◽  
pp. S203-S203
Author(s):  
F. Guermazi ◽  
R. Ennaoui ◽  
N. Halouani ◽  
S. Chouayakh ◽  
J. Aloulou ◽  
...  
Keyword(s):  
Psychotic Disorders ◽  
Cannabis Use ◽  
University Hospital ◽  
Early Screening ◽  
Effective Strategies ◽  
Competing Interest ◽  
Psychiatric Department ◽  
The University ◽  
Evolutionary Aspects ◽  
Chronic Psychosis

IntroductionCannabis is increasingly used by young people. Its several noxious effects on mental health have become a matter of preoccupation. Although cannabis use may be involved in the etiology of acute psychosis, there has been considerable debate about the association observed with chronic psychosis.Aims(1) To describe the profile of patients with cannabis use disorders (CUD); (2) to determine the evolutionary aspects.MethodsWe proceed with a retrospective and descriptive study conducted among 16 male patients with CUD and hospitalised for the first time in the psychiatric department at the University Hospital Hedi Chaker during the period from 1 January 2012 to 31 December 2014.ResultsAn overwhelming majority of the subjects were single and unemployed. One-third of the users had a stay abroad, the half was incarcerated at least once and one patient was implicated in illegal drugs trade. CUD were associated with specific personality disorders: borderline (18.8%) and antisocial (6.3%) personality. Into at least the 2 years of follow-up, different evolutionary aspects were distinguished. Many of the patients were lost to follow (18.8%). A total restitution of symptoms or a recurrence of the same disorders were observed in 25% of cases. About 56.3% of subjects had a change in diagnosis to either schizophrenia (43.3%) or affective disorder (12.5%).ConclusionThis study showed that cannabis use can be a cause of the emergence of chronic psychosis. This emphasizes the importance of early screening of the vulnerability to psychotic disorder and identify more effective strategies to improve intervention.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Metabolic and Endocrine Disturbances in Psychiatric Disorders: A Multidisciplinary Approach to Appropriate Atypical Antipsychotic Utilization

CNS Spectrums ◽  
2005 ◽  
Vol 10 (10) ◽  
pp. 819a-819l ◽  
Author(s):  
Prakash S. Masand ◽  
Larry Culpepper ◽  
David Henderson ◽  
Scott Lee ◽  
Kimberly Littrell ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Atypical Antipsychotics ◽  
Multidisciplinary Approach ◽  
Antipsychotic Agents ◽  
Endocrine Disturbances ◽  
Cardiovascular Morbidity And Mortality ◽  
Increase Risk ◽  
Consensus Report ◽  
Ongoing Monitoring

AbstractPatients with psychiatric disorders have an increased rate of cardiovascular morbidity and mortality compared with the general population. Metabolic issues such as weight gain, dyslipidemia, diabetes mellitus, diabetic ketoacidosis, and pancreatitis have been reported with the use of antipsychotic agents. Although atypical antipsychotics have not been linked directly to the development of metabolic syndrome, these medications have been shown to increase risk factors that can lead to metabolic and endocrine disturbances. Therefore, clinicians should provide ongoing monitoring for patients who are being treated for psychiatric disorders with these agents. According to the 2004 Consensus Report on Antipsychotics, screening measures should include baseline and follow-up monitoring of personal/family histories, weight (body mass index), waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile.

scholarly journals Vascular ultrasonography for follow-up of endovascular repair of abdominal aorta aneurysms

2014 ◽  
Vol 13 (3) ◽  
pp. 168-174 ◽  
Author(s):  
Domingos Moraes Filho ◽  
Fernando Barbosa Trevisan ◽  
José Manoel da Silva Silvestre ◽  
Wander Eduardo Sardinha ◽  
Eduardo Durante Ramires ◽  
...  
Keyword(s):  
Abdominal Aorta ◽  
Endovascular Repair ◽  
Aortic Aneurysms ◽  
University Hospital ◽  
X Rays ◽  
Abdominal Aortic ◽  
Vascular Ultrasonography ◽  
A Prospective Study ◽  
The University

BackgroundThere is little information available on follow-up of abdominal aortic aneurysm patients treated with endovascular repair using vascular ultrasonography in Brazil or on how it compares with the results of angiotomography. Since ultrasonography is an examination that is risk-free, inexpensive and widely available, it is a very attractive method. In this study we attempted to evaluate the sensitivity and specificity of vascular ultrasonography for follow-up of these patients by comparing the method with angiotomography.Materials and methodsWe conducted a prospective study from June 2012 to May 2013. We examined patients followed-up at the endovascular surgery clinic run by the University Hospital of Londrina after endovascular repair of abdominal aortic aneurysms. All patients underwent angiotomography for follow-up and were also examined using simple abdominal X-rays and vascular ultrasonography.ResultsA total of 30 patients were analyzed, with a mean age of 73 years and a mean aneurysm diameter of 6 cm. Four endoleaks were detected. Vascular ultrasonography achieved sensitivity of 75% and specificity of 96% for classification of these endoleaks, in comparison with angiotomography.ConclusionsVascular ultrasonography is an excellent primary method for evaluation and post-surgical follow-up of patients treated with endovascular repair of abdominal aorta aneurysms. However, when ultrasonography detects problems or is difficult to accomplish, it should be supplemented with a more specific investigation for diagnostic confirmation.

Low-FODMAP-diet in irritable bowel syndrome offers benefits not only in terms of gastrointestinal symptoms, but also in terms of psychopathology in the medium- and long-term

2016 ◽  
Vol 33 (S1) ◽  
pp. S395-S395 ◽  
Author(s):  
D. Piacentino ◽  
S. Rossi ◽  
L. Piretta ◽  
D. Badiali ◽  
N. Pallotta ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Control Diet ◽  
Gastrointestinal Symptoms ◽  
University Hospital ◽  
Psychiatric Disease ◽  
Diary Card ◽  
Competing Interest ◽  
Irritable Bowel ◽  
Fodmap Diet

IntroductionLow-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diets are strongly recommended to improve irritable bowel syndrome (IBS) symptoms. They are also hypothesized to improve the psychopathological status that often accompanies the syndrome. A study (Ledochowski et al., 2000) suggested that the ingestion of FODMAPs affected negatively the mood and that the elimination of dietary FODMAPs improved depressive symptoms.Objectives/aimsWe aimed to assess the levels of psychopathology pre- and post-diet in IBS patients free of any severe psychiatric disease (e.g., bipolar disorder, major depressive disorder, schizophrenia) or alcohol/substance abuse.MethodsWe consecutively recruited 75 IBS outpatients (68% females; age range = 21–68 years) at the Gastrointestinal Outpatient Center of our University Hospital. They filled out the Symptom Checklist-90-Revised (SCL-90-R), a visual analogue scale (VAS) to rate the intensity of abdominal bloating/pain, and a 2-week diary card registering the frequency of bloating/pain. Then, they were blindly assigned to a low-FODMAP diet, a low-FODMAP gluten-free diet and a control diet for 4 weeks. During the last 2 weeks they filled out a 2nd diary card and rerated the intensity of bloating/pain. Patients were reassessed after a 16-month follow-up. Independent t-test, χ2 test, and one-way ANOVA with Tukey post-hoc test were used.ResultsBaseline characteristics did not differ between the three groups. Post-diet and at follow-up, the two low-FODMAP diets, vs. the test diet, improved not only the intensity and frequency of bloating/pain, but also the SCL-90-R GSI, anxiety, and phobic anxiety scores (P-values < 0.05).ConclusionsThe low-FODMAP diet may improve psychopathology in IBS patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Gynecomastia induced by trazodone: A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S640-S640 ◽  
Author(s):  
M.D. Sánchez García ◽  
A. Gómez Peinado ◽  
P. Cano Ruiz ◽  
S. Cañas Fraile
Keyword(s):  
Case Report ◽  
Depressive Symptoms ◽  
Prolactin Level ◽  
Psychiatric Clinic ◽  
Receptor Stimulation ◽  
Normal Limits ◽  
Patient Reported ◽  
Rare Side Effect ◽  
Competing Interest

IntroductionTrazodone is a heterocyclic antidepressant that exerts its effect via the inhibition of selective serotonin reuptake and the antagonism of 5-HT2A and 5-HT2 C receptors. Antidepressant-induced gynecomastia and galactorrhea and increases in prolactin levels have rarely been reported.Case reportA 73-year-old man presented to the psychiatric clinic with depressive symptoms and insomnia that was the reason that his GP introduced paroxetine 20 mg/day three months before. One month later because the insomnia persisted, trazodone (100 mg/day) was added to the treatment. At a 2-month follow-up, the patient reported improvement in depressive symptoms but also presented gynecomastia on the left side that is non-tender on palpation. No other medications were noted. Laboratory testing was within normal limits, with the exception of on elevated prolactin level (38.2 ng/mL). Ultrasonography indicated normal results. Treatment included the tapering and discontinuation of trazodone with continued paroxetine therapy. Lorazepam was initiated for the treatment of insomnia. Two weeks later, the prolactin level was 13.1 ng/mL and gynecomastia was practically resolved. Lorazepam was initiated for the treatment of insomnia.ConclusionsEffects of trazodone on PRL are unclear, there is one study reported that trazodone increases the PRL level, and another one reported that trazodone reduces them, in our case, the trazodone use led to hyperprolactinemia via hypothalamic postsynaptic receptor stimulation and it should be remembered that gynecomastia and galactorrhea may appear as a rare side effect of trazodone.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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