Eosinophilia associated with clozapine – A case report

2017 ◽  
Vol 41 (S1) ◽  
pp. S750-S751 ◽  
Author(s):  
T. Abreu ◽  
A. Carvalho ◽  
O. Von Doellinger
Keyword(s):  
Skin Rash ◽  
Clinical Case ◽  
Psychotic Disorders ◽  
Spontaneous Resolution ◽  
Close Monitoring ◽  
Anti Psychotic ◽  
Treatment Resistant ◽  
Hematologic Disorders ◽  
Medicine Service ◽  
Competing Interest

ObjectivesClozapine is an atypical anti-psychotic used in the treatment of schizophrenia and other psychotic disorders. It is associated with several side effects, namely, hematologic disorders, the more common being agranulocytosis. Some cases of eosinophilia have been described. This work describes a case of transient eosinophilia caused by clozapine.MethodsDescription of a clinical case.ResultsA 22-year-old female patient, with a treatment resistant psychotic disorder initiated clozapine in a slow titration to 300 mg. Ten days after initiating clozapine, the patient presented with eosinophilia (started with 6.6 × 108/L and peaked at 10.0 × 108/L). Two weeks later, the patient presented with a skin rash in the arms and legs. The case was discussed with internal medicine service and other causes of eosinophilia were excluded. Since the eosinophilia was mild, the rash was not severe and the patient did not present any other symptoms or signs, it was not considered necessary to stop clozapine. During the next three months, with close monitoring, the eosinophilia and the skin rash slowly resolved.ConclusionsThis is a case of a patient who presented mild eosinophilia and skin rash, associated to clozapine, with spontaneous resolution. We draw attention to the need of close monitorization and exclusion of other causes of eosiniphilia and rash. Furthermore, other hematologic disorders should be considered besides agranulocytosis, namely eosinophilia, when prescribing clozapine.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Autism-plus spectrum disorders: Interfaces with psychosis

2016 ◽  
Vol 33 (S1) ◽  
pp. S356-S356
Author(s):  
I. Peixoto ◽  
R. Velasco Rodrigues ◽  
C. Marques
Keyword(s):  
Autism Spectrum Disorder ◽  
Differential Diagnosis ◽  
Clinical Case ◽  
Psychotic Disorders ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Case Vignette ◽  
The Face ◽  
Competing Interest ◽  
Definition Of

IntroductionDespite categorical differentiation, autistic and psychotic disorders are historically related diagnostic entities and there is still much controversy regarding their limits and developmental course. Particularly in children, the presence of idiosyncratic fears, difficulties in the social sphere and thought disorder are important factors in the differential diagnosis. There are some research-derived clinical constructs that operationalize symptomatology aiming to highlight the interfaces and the overlap between such disorders. Their clinical implications can be extremely relevant in the face of the limits of current nosology.ObjetivesTo phenomenologically describe differentiating parameters and high-risk clinical profiles for the development of psychosis in children with autism spectrum disorder.MethodsSelective review of the literature in PubMed (MEDLINE). Illustration with a clinical case vignette.ResultsThe clinical case reflects well the difficulties posed in the differential diagnosis due to the multiple interfaces between autism and psychosis. Constructs such as “multiple complex developmental disorder” or “multidimensionally impaired syndrome” allow a clearer and more practice-friendly characterization of such individuals.ConclusionThe constelation of symptoms identified in these criteria may become useful through the definition of subgroups of autism spectrum disorder individuals with complex psychopathology. Studies in this regard are still scarce, but the validation and reproduction of the positive results observed in the near future can help optimize the clinical approaches in these children.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Schizophrenia and Pregnancy: The Tactics of Management

2017 ◽  
Vol 41 (S1) ◽  
pp. S271-S271
Author(s):  
S. Lukmonov ◽  
G. Ruzieva ◽  
I. Nazarova
Keyword(s):  
Pregnant Women ◽  
Mentally Ill ◽  
Deleterious Effect ◽  
Psychotic Disorders ◽  
Low Doses ◽  
Anti Psychotic ◽  
Number Of Children ◽  
Hereditary Factors ◽  
Competing Interest ◽  
Duration Of Pregnancy

PurposeThe study of literature data of the treatment of pregnant women with schizophrenia and making recommendations on the management of this category of patients.MethodsTheoretical analysis of a number of scientific works of foreign researchers, which studied questions of application of psychotropic drugs in patients with schizophrenia during pregnancy.DiscussionThe important source of problems for patients with schizophrenia is a protection against pregnancy. The number of children born in mentally ill mothers has increased at least three times. Hereditary factors in children born from two parents with schizophrenia plays, an important role: approximately 46–68% of these children may develop schizophrenia. In studies on psychotic means, there were no increase in number of anatomical anomalies or deviations in the development associated with this treatment. Low doses do not have a deleterious effect on fetal body weight, duration of pregnancy, fetal or neonatal mortality, as well as the frequency of malformations and deformities. Neither oral nor deposited anti-psychotic drugs are not associated with malformations and malformations of the fetus.Conclusion(1) The drugs should be administered at the lowest effective dose for the shortest possible time and decrease in the dose during the last days before the birth. (2) Pregnant women with acute psychotic disorders are dangerous, both for herself and for the child. (3) After the birth due to high risk of recurrence or exacerbation of schizophrenia taking anti-psychotic drugs should be in full dose.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Treatment-resistant schizophrenia during life span : Epidemiology, outcomes and innovative M-Health treatments within M-RESIST Project

2016 ◽  
Vol 33 (S1) ◽  
pp. S35-S35
Author(s):  
K. Rubinstein
Keyword(s):  
Psychotic Disorders ◽  
Clinical Importance ◽  
Treatment Resistance ◽  
The European Union ◽  
Treatment Resistant ◽  
Time Data ◽  
Information And Communication ◽  
Competing Interest ◽  
Definition Of ◽  
Psychosocial Approaches

Treatment-resistant symptoms of schizophrenia (TRS) complicate the clinical course of the illness, and a large proportion of patients do not reach functional recovery (Englisch and Zink, 2012). Out of the estimated 5 million people (0.2–2.6 %) suffering from psychotic disorders in the European Union, 30-50 % can be considered resistant to treatment, and 10–20 % ultra-resistant (Essock et al., 1996 ; Juarez-Reyes et al., 1995). The complexity of standard intervention within this population, along with the presence of persistent positive symptomatology, extensive periods of hospital care and greater risk of multi-morbidity, lead to a high degrees of suffering for the patients, family and social environment, and a high proportion of costs to the healthcare system (Kennedy et al., 2014).At present, a uniform definition of treatment resistance in the pharmacotherapy of schizophrenia is not available (Suzuki et al., 2011), as well as generally recommendable evidence-based treatment methods (Dold and Leucht, 2014).A recent systematic review on the topic showed that TRS is poorly a studied and understood condition, contrasted to its high prevalence, clinical importance and poor prognosis. There is lack of studies on epidemiology and risk factors of this disorder, as well as on outcomes and longitudinal course. Most of the available literature focuses on medication treatments, while very few examine efficacy of adjunctive therapeutic options (Seppala et al., in preparation).Treatments based on information and communication technology (ICT) present novel possibilities to improve the outcomes of schizophrenia. Previous studies have indicated suitability and promising results of such intervention techniques (Granholm et al., 2012 ; Ben-Zeev et al., 2013). m-RESIST is an innovative project aimed to empower patients with resistant schizophrenia, to personalize treatment by integrating pharmacological and psychosocial approaches, and to further develop knowledge related to the illness using predictive models designed to exploit historical and real-time data based on environmental factors and treatment outcomes.Disclosure of interestThe author has not supplied his declaration of competing interest.

The Novel Antipsychotic Drug Cariprazine and Cognition Enhancing Drugs: Indications for Their Use as an Add-on Therapy in Schizophrenia

2020 ◽  
Vol 26 ◽  
Author(s):  
Felix-Martin Werner ◽  
Rafael Coveñas
Keyword(s):  
Clinical Trials ◽  
Maintenance Therapy ◽  
Antipsychotic Drug ◽  
Cognitive Functions ◽  
Antipsychotic Drugs ◽  
Psychotic Disorders ◽  
Therapeutic Effects ◽  
Treatment Resistant ◽  
Long Acting ◽  
Novel Antipsychotic

Background: Schizophrenia and schizoaffective disorder are treated with antipsychotic drugs. Some patients show treatment-resistant forms of psychotic disorders and, in this case, they can be treated with clozapine. In these patients and based on previous reviews on novel antipsychotic drugs, it is important to know whether an add-on therapy with new drugs can ameliorate the positive and negative schizophrenic scale (PANSS) total score. Objective: The aim of this review is to suggest an appropriate treatment for patients with treatment-resistant forms of psychotic disorders. A combination of current available antipsychotic drugs with novel antipsychotic or modulating drugs might improve negative schizophrenic symptoms and cognitive function and thereby social functioning and quality of life. Results: The mechanisms of action, the therapeutic effects and the pharmacokinetic profiles of novel antipsychotic drugs such as cariprazine, brexipiprazole and lumateperone are up-dated. Published case reports of patients with treatmentresistant psychoses are also discussed. These patients were treated with clozapine but a high PANSS total score was observed. Only an add-on therapy with cariprazine improved the score and, above all, negative schizophrenic symptoms and cognitive functions. To ensure a constant antipsychotic drug concentration, long-acting injectable antipsychotic drugs may be a choice for a maintenance therapy in schizophrenia. New modulating drugs, such as receptor positive allosteric modulators (N-methyl-D-aspartate receptor; subtype 5 of the metabotropic glutamatergic receptor) and encenicline, an alpha7 nicotinic cholinergic receptor agonist, are being investigated in preclinical and clinical trials. Conclusion: In clinical trials, patients with treatment-resistant forms of psychosis should be examined to know whether a combination therapy with clozapine and a novel antipsychotic drug can ameliorate the PANSS total score. In schizophrenia, long-acting injectable antipsychotic drugs are a safe and tolerable maintenance therapy. In further clinical studies, it should be investigated whether patients with treatment-resistant forms of psychoses can improve negative schizophrenic symptoms and cognitive functions by an add-on therapy with cognition enhancing drugs.

Psychological treatment of trihotillomania: A case study

2017 ◽  
Vol 41 (S1) ◽  
pp. S417-S417
Author(s):  
T. Sarmiento Luque ◽  
J.M. Sanchez
Keyword(s):  
Public Health ◽  
Clinical Case ◽  
Psychological Treatment ◽  
Cognitive Behavioral ◽  
Clinical Aspects ◽  
Hair Pulling ◽  
Behavioral Techniques ◽  
Competing Interest ◽  
Treatment Procedures

This paper presents a clinical case of trichotillomania. Therefore, the aim of this study is to present in detail the procedure followed in a case of trichotillomania in a public health context, using cognitive-behavioral techniques, in order to deepen the knowledge of the efficacy of these treatment procedures and demonstrate the feasibility of implementation.The results obtained show significant improvements in different clinical aspects: first, the hair pulling behavior disappeared completely; moreover, anxiety diminished significantly and mood normalized. All these results allow us to conclude that the intervention was successful.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychiatric comorbidities in temporal lobe epilepsy: A case study

2017 ◽  
Vol 41 (S1) ◽  
pp. S474-S474
Author(s):  
L. Jouini ◽  
U. Ouali ◽  
R. Zaouche ◽  
R. Jomli ◽  
Y. Zgueb ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Psychotic Disorders ◽  
Psychiatric Symptoms ◽  
Complete Disappearance ◽  
Therapeutic Implications ◽  
Self Harm ◽  
Competing Interest

IntroductionPsychiatric disorders frequently occur in patients with temporal lobe epilepsy (TLE) (70%). This combination further reduces the quality of life of patients as diagnosis is difficult and therapeutic opportunities are often missed.ObjectivesThe aim of this case study is to show the possible association between TLE and psychiatric semiology and its therapeutic implications.MethodsPresentation of the clinical case of Mr BH who experienced psychosis like symptoms, was finally diagnosed with TLE and put under anti-epileptic drugs.ResultsMr BH, aged 22, with no family or personal history, was admitted for aggressive behavior, self-harm, pyromania, and depression. Three years prior to onset of psychiatric symptoms, he reports episodes of pulsatile- left-temporal headache followed by hypertonic movements of the neck. Symptoms were intermittently followed by total amnesia or impaired consciousness. The patient explained symptoms by an inner presence that he called “his twin” and to whom he attributed those behaviors contrary to his will. The discovery of bilateral hippocampal atrophy in magnetic resonance imaging with a normal electroencephalography suggested the diagnosis of TLE with post-ictal psychotic disorders. Patient was put initially on diazepam and olanzapine with partial improvement. Association of valproate led to progressive but then complete disappearance of symptoms and so confirmed our diagnosis.ConclusionsIt is often difficult to attach psychiatric symptoms to epilepsy. The diagnosis should be done on a set of clinical, radiological and electrical arguments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Clinical manifestations in patients with acute and transient psychosis

2016 ◽  
Vol 33 (S1) ◽  
pp. S363-S364
Author(s):  
Á. López Díaz ◽  
A. Soler Iborte ◽  
S. Galiano Rus ◽  
J.L. Fernández González ◽  
J.I. Aznarte López
Keyword(s):  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Clinical Manifestations ◽  
Retrospective Chart Review ◽  
International Classification Of Diseases ◽  
Exact Test ◽  
Chi Squared ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Competing Interest

IntroductionThe term, acute and transient psychosis, is comprehended as a heterogeneous group of disorders, which share, as a common feature, the abrupt and brief deployment of typical psychotic behaviour, either polymorph, delusional, or schizophreniform. This diversity of symptoms may also be present in other psychotic disorders, for which, some authors question its reliability.ObjetiveTo analyse the clinical manifestations present in acute and transient psychotic disorders (ATPD), and determine the differences between its different subcategories.MethodRetrospective chart review study of adult patients admitted in our psychiatric unit between 2011 and 2015, with a mean diagnosis of ATPD at hospital discharge. Diagnostic criteria was according to the International Classification of Diseases (ICD-10). Symptoms were divided under operative procedures, as set out in psychopatologic descriptions. For methodological reasons, statistical analysis was conducted between polymorphic features group (PM) and nonpolymorphic group (NPM). Chi-squared test and Fisher's exact test (as appropriate) were performed, using MedCalc software.ResultsThirty-nine patients met the inclusion criteria. Acute polymorphic psychotic disorder with and without symptoms of schizophrenia (39%), acute schizophrenia-like psychotic disorder (20%), acute predominantly delusional psychotic disorder (23%), other and NOS (18%). There were statistically significant differences between PM and NPM groups in emotional turmoil (>PM, P = 0.0006), grossly disorganized or abnormal motor behaviour (>PM, P = 0.0038), and type of onset (sudden >PM, P = 0.0145).ConclusionCurrently, the same concept encompasses two categories (PM and NPM) to be differentiated. The ATPD construct is under review, due its long-term instability.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A case of acute and transient psychosis–What to expect?

2016 ◽  
Vol 33 (S1) ◽  
pp. S364-S365
Author(s):  
M. Oliveira ◽  
J. Rebelo ◽  
A.S. Costa ◽  
C. Santos
Keyword(s):  
Psychotic Disorders ◽  
Fast Response ◽  
International Classification Of Diseases ◽  
Acute Onset ◽  
Antipsychotic Treatment ◽  
Duration Of Treatment ◽  
Diagnostic Stability ◽  
Affective Symptoms ◽  
Classification Of Diseases ◽  
Competing Interest

IntroductionThe Tenth Revision of the International Classification of Diseases (ICD-10) introduced the category of Acute and transient psychotic disorders (ATPD), that assimilate clinical concepts such as the French Bouffée Délirante, Kleist and Leonhard's cycloid psychosis, and the scandinavian reactive psychosis.Methods and aimsThe authors present a clinical case of ATPD and a literature review based on PubMed/MEDLINE, using the keywords: “acute and transient psychotic disorder”, “prognosis” and “diagnostic stability”, aiming to discuss the main challenges regarding the diagnosis, treatment and prognosis.ResultsThe patient is a male with 37 years old with two previous psychotic episodes (with 2.5 years of interval), both with an acute onset (of 7 and 3 days respectively), and a fast response to antipsychotic treatment, with periods of complete symptom's remission. He maintains treatment with 6 mg of paliperidone. In the literature, we found scarce information on ATPD. Though several variables have been described as having influence on the prognosis (gender, pre-morbid functioning, acute onset and presence of affective symptoms), this topic remains controversial. Another difficult aspect about ATPD seems to be its low diagnostic stability, with diagnosis changing mostly to Schizophrenia, Schizoaffective disorder and Bipolar disorder. Duration of treatment after complete remission of symptoms is another controversial aspect of this disease.ConclusionsATPD seems to have low diagnostic stability and poor research investment, and so it represents a challenge for psychiatrists on managing these patients in terms of treatment and follow-up plan. Further studies should be held regarding prognosis and treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Effectiveness of long-acting injectables and clozapine in a real-world setting during the early-stages of psychotic illness

2016 ◽  
Vol 33 (S1) ◽  
pp. S105-S105
Author(s):  
E.G. Ostinelli ◽  
E. Guanella ◽  
S. Cavallotti ◽  
C. Casetta ◽  
A. D’Agostino
Keyword(s):  
Psychotic Disorders ◽  
Pharmacological Intervention ◽  
Psychotic Illness ◽  
Treatment As Usual ◽  
Early Stages ◽  
Hospitalization Rates ◽  
Real World Setting ◽  
The Difference ◽  
Competing Interest ◽  
Long Acting

IntroductionIntervention in the early-stages of psychosis may be able to shape the clinical course; critical period (CP) is best represented by the first 5 years from first admission (FA).ObjectivesTo investigate the effectiveness of pharmacological intervention within and beyond the CP.Aims(1) To compare hospitalization rates of patients stabilized on treatment with LAIs and CLZ. (2) To determine whether treatment with LAIs and CLZ within CP can influence hospitalization rates.MethodsData were retrospectively collected from patients diagnosed with non-affective psychoses with FA between 2000 and 2014; 200 patients were then divided into three groups, according to stabilized treatment regimen during the final year of observation: treatment as usual (TAU), CLZ, LAIs. hospitalization duration (HSPD) and frequency (HSP) were calculated for each group.ResultsDespite a major severity before assignment to either CLZ or LAIs treatment, HSPD and HSP in both groups shifted below those observed for the TAU arm. Patients who began treatment with LAIs within the CP showed a highly significant decrease of both HSPD and HSP (respectively 17.4 ± 18 vs. 2.6 ± 8.2; Z = −2.856; P < 0.005 and 1.1 ± 0.8 vs. 0.2 ± 0.5; Z = −3.115; P < 0.005). No significant changes in hospitalization rates were observed for subjects who began treatment with LAIs after the CP.ConclusionsOur study confirms that treatment with either CLZ or LAIs significantly impacts the course of psychotic disorders. The data seem to suggest that LAIs and CLZ should be considered more effective than conventional oral antipsychotics in the early-stages of psychotic illness. The difference among treatments tends to wane beyond the CP, especially for LAIs.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Sign in / Sign up

Export Citation Format

Share Document