Modified Electroconvulsive Therapy in Pseudocholinesterase Deficiency: A Case Report

2017 ◽  
Vol 41 (S1) ◽  
pp. s770-s771
Author(s):  
E. Yildizhan ◽  
N.B. Tomruk ◽  
M. Dereli ◽  
A. Özdemir ◽  
H. Yıldırım ◽  
...  
Keyword(s):  
Electroconvulsive Therapy ◽  
Neurological Diseases ◽  
Respiratory Muscles ◽  
Response To Treatment ◽  
Anesthetic Agents ◽  
Syndrome Scale ◽  
History Of ◽  
Competing Interest ◽  
Modified Electroconvulsive Therapy ◽  
Negative Syndrome

Introduction.Pseudocholinesterase (PCHE) deficiency is an inherited condition, in which recovery from anesthetic agents like succinylcholine and mivacurium is slow and complicated with prolonged paralysis of respiratory muscles in susceptible patients. Succinylcholine is used very frequently as a muscle relaxant during the procedure.Objectives.In Bakirkoy research and training hospital for psychiatric and neurological diseases, 24.310 patients were hospitalized for acute conditions and 3490 of these patients were treated with electroconvulsive therapy (ECT) in 3 years. We present a very rare case that we encountered in our practice; a severe PCHE deficiency case that could have complicated the modified ECT procedure unless necessary precautions were taken.Aims.Detection of PCHE levels of all patients eligible for ECT is part of our pre-ECT assessments procedure, and the case presented here shows the benefits of this method.Methods.The patient is a 29-year-old woman, with a 15 year history of schizophrenia. She was hospitalized for homicidal risk and refusal of treatment. Inadequate clinical response with pharmacological interventions and continuous aggressive excitations directed us to consider ECT.Results.After the detection of PCHE deficiency (PCHE level: 126 U/L), we performed the modified ECT with propophol and rocuronium instead of succinylcholine as usual. Sugammadex 100 mg was used for fastening the recovery. Response to treatment, which is recorded with positive and negative syndrome scale, was good and we completed 9 ECT sessions without complication.Conclusions.Screening for PCHE levels in the pre-ECT assessments is efficacious in order to decrease the complications of the ECT procedure.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Blonanserin augmentation in patients with schizophrenia – who is benefited from blonanserin augmentation?: An open-label, prospective, multicenter study

2016 ◽  
Vol 33 (S1) ◽  
pp. s226-s226
Author(s):  
Y.S. Woo ◽  
J.E. Park ◽  
D.H. Kim ◽  
I.K. Sohn ◽  
T.Y. Hwang ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Atypical Antipsychotics ◽  
Therapeutic Strategy ◽  
Psychiatric Symptoms ◽  
Open Label ◽  
Prospective Multicenter Study ◽  
Syndrome Scale ◽  
Schizophrenic Patients ◽  
Competing Interest ◽  
Negative Syndrome

IntroductionEvidences for antipsychotics augmentation for schizophrenic patients with suboptimal efficacy have been lacking although it has been widespread therapeutic strategy in clinical practice.ObjectivesThe purpose of this study was to investigate the efficacy and tolerability of blonanserin augmentation with an atypical antipsychotics (AAPs) in schizophrenic patients.MethodsA total of 100 patients with schizophrenia partially or completely unresponsive to treatment with an AAP recruited in this 12-week, open-label, non-comparative, multicenter study. Blonanserin was added to existing AAPs which were maintained during the study period. Efficacy was primarily evaluated using Positive and Negative Syndrome Scale (PANSS) at baseline, week 2, 4, 8, and 12. Predictors for PANSS response (≥ 20% reduction) was investigated.ResultsThe PANSS total score was significantly decreased at 12 weeks after blonanserin augmentation (–21.0 ± 18.1, F = 105.849, P < 0.001). Response rate on PANSS at week 12 was 51.0%. Premature discontinuation was occurred in 17 patients (17.0%) and 4 patients among them discontinued the study due to adverse events. Nine patients experienced significant weight gain during the study. Response to blonanserin augmentation was associated with severe (PANSS > 85) baseline symptom (OR = 10.298, P = 0.007) and higher dose (> 600 mg/day of chlorpromazine equivalent dose) of existing AAPs (OR = 4.594, P = 0.014).ConclusionsBlonanserin augmentation improved psychiatric symptoms of schizophrenic patients in cases of partial or non-responsive to an AAP treatment with favorable tolerability. Patients with severe symptom despite treatment with higher dose of AAP were benefited from this augmentation. These results suggested that blonanserin augmentation could be an effective strategy for specific patients with schizophrenia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Spontaneous dyskinesia and parkinsonism in never-medicated, chronically ill patients with schizophrenia: 18-month follow-up

2002 ◽  
Vol 181 (2) ◽  
pp. 135-137 ◽  
Author(s):  
R. G. McCreadie ◽  
R. Padmavati ◽  
R. Thara ◽  
T. N. Srinivasan
Keyword(s):  
Natural History ◽  
Disease Process ◽  
Chronically Ill ◽  
Abnormal Involuntary Movements ◽  
Syndrome Scale ◽  
History Of ◽  
Chronically Ill Patients ◽  
Negative Syndrome ◽  
Over Time

BackgroundSpontaneous dyskinesia and parkinsonism have been reported in never-medicated patients with schizophrenia but there has been no previous study of the natural history of these conditions.AimsTo determine the prevalence of spontaneous dyskinesia and parkinsonism in a group of never-medicated, chronically ill patients with schizophrenia on two occasions separated by an 18-month interval.MethodDyskinesia was assessed by the Abnormal Involuntary Movements Scale using Schooler and Kane criteria for its presence; parkinsonism by the Simpson and Angus scale; and mental state by the Positive and Negative Syndrome Scale for schizophrenia.ResultsThirty-seven patients were examined on two occasions. Nine (24%) had dyskinesia on both occasions, 12 (33%) on one occasion and 16 (43%) on neither occasion. Twenty-one (57%) had dyskinesia on at least one occasion. Thirteen patients (35%) had parkinsonism on at least one occasion.ConclusionsSpontaneous dyskinesia and parkinsonism fluctuate over time. The former was found on at least one occasion in the majority of patients. It is an integral part ofthe schizophrenic disease process.

Electroconvulsive therapy (ECT) treatments in late-onset schizophrenia: Report of a case

2016 ◽  
Vol 33 (S1) ◽  
pp. S556-S556
Author(s):  
M. Valverde Barea ◽  
F. Cartas Moreno ◽  
M.E. Ortigosa Luque
Keyword(s):  
Behavioral Disorders ◽  
Electroconvulsive Therapy ◽  
Psychotic Disorders ◽  
Late Onset ◽  
Personal History ◽  
Psychotic Symptoms ◽  
Sexual Content ◽  
History Of ◽  
Competing Interest ◽  
Effective Result

Female patient, 66 years old, who goes to the doctor because of behavioral disorders and delusional injury 8 months of evolution. She showed no personal history of psychiatric disorders. In the psychopathological examination some relevant symptoms are seen delusions of prejudice with their immediate surroundings, self-referential regarding neighbors and walls. Delusional interpretations of sexual content. Punitive pseudo hallucinations hearing which are identifies with her daughters and sex with her son-in-law. Behavioral disorders consisting of going out naked into the street overnight and rebuking pedestrians; furthermore, she showed heteroaggressivity towards objects. Logical psychotropic treatment is initiated as indicated by the guidelines having no effect. Electroconvulsive therapy being tested an effective result. The late-onset schizophrenia symptoms should be taken into account in people with psychotic symptoms start at an advanced age, but is most prevalent at younger ages. Electroconvulsive therapy (ECT) may be used as an adjunct to drug therapy or as second-line treatment in patients with affective or psychotic disorders resistant to treatment with psychotropic drugs. It is essential a differential diagnosis with dementia symptoms previously established, given that part of the late-onset schizophrenia evolves to dementia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The practitioner cope with adverse events on atypical antipsychotics: About 63 patients with schizophrenia

2016 ◽  
Vol 33 (S1) ◽  
pp. S537-S537
Author(s):  
I. Berrahal ◽  
R. Triki ◽  
R. Chebbi ◽  
B. Ghanjati ◽  
R. Ghachem
Keyword(s):  
Atypical Antipsychotics ◽  
Adverse Drug Events ◽  
Psychotic Symptoms ◽  
Appropriate Treatment ◽  
Syndrome Scale ◽  
Tunisian Patients ◽  
Insulin Dependent ◽  
Adult Outpatient ◽  
Competing Interest ◽  
Negative Syndrome

IntroductionThe propensity of atypical antipsychotics (AAP) for having a therapeutic effect with fewer side effects and the balancing of these supposed benefits with tolerance are the subject of many studies.Aims and objectivesWe focused on adverse drug events (ADEs), occurred under AAP, in a population of patients with schizophrenia to assess the prevalences and describe how the practitioner deal with these ADEs.MethodsWe have used a retrospective and descriptive study of 63 Tunisian patients with schizophrenia, consulting in the adult outpatient of Razi hospital and treated by one type of AAP. The study period was 6 months from the 1st January 2015. We used the Birchwood Insight Scale (BIS), Positive and Negative Syndrome Scale (PANSS) and Udvalg for Kliniske Undersogelser (UKU) to assess the insight, psychotic symptoms and ADEs.ResultsTwenty-four patients were on risperidone, 22 on olanzapine, 8 on amisulpride and 9 on clozapine. Antiparkinsonism drug (15.9%) was associated because of neurological ADEs mainly Parkinsonism. Asthenia had a prevalence of 20.6%. Hypersalivation and palpitation were estimated at 7.9% both. Weight gain's prevalence was 25.4%, including 1 case associated with hypercholesterolemia and 1 case of unbalanced non-insulin-dependent diabetes. The erectile dysfunction's prevalence was 36.3% and decreased libido 27%. There were 2 cases of neutropenia and thrombocytopenia. The management of these ADEs was observed when they moderately began to influence the patient's daily activity.ConclusionADEs must be subject to an appropriate treatment and if necessary resort to a specialist consultation to confirm or deny imputability to AAP.Disclosure of interestThe authors have not supplied their declaration of competing interest.

An Observational Retrospective Study Investigating Changes in Seizure Adequacy Parameters of Electroconvulsive Therapy and Their Relationships to Clinical Outcome in Schizophrenia and Schizoaffective Disorder

2020 ◽  
pp. 155005942093207
Author(s):  
Onur Durmaz ◽  
Tuba Öcek Baş
Keyword(s):  
Heart Rate ◽  
Retrospective Study ◽  
Clinical Outcome ◽  
Electroconvulsive Therapy ◽  
Schizoaffective Disorder ◽  
Predictor Variable ◽  
Peak Heart Rate ◽  
Syndrome Scale ◽  
Scale Scores ◽  
Negative Syndrome

The aim of the current study was to investigate a possible relationship between electroconvulsive therapy (ECT) seizure adequacy parameters and clinical outcome as well as differences between ECT responders and nonresponders in terms of ECT seizure parameters in patients diagnosed with schizophrenia and schizoaffective disorder. First and last ECT records data, sociodemographic variables, and baseline and post ECT Positive and Negative Syndrome Scale scores were obtained. Maximum sustained power was higher in last ECT in favor of responders while peak heart rate was higher in ECT nonresponders than responders in first ECT. Stimulus doses were higher in last ECT than in the first ECT in both groups. No predictor variable was observed among baseline ECT seizure parameters for clinical improvement. Study was insufficient to yield a precise finding pointing a relationship between electrophysiological seizure parameters and clinical outcome in schizophrenia and schizoaffective disorder.

Psychiatric Symptomatology as the Initial Presentation of Brain Cancer

2017 ◽  
Vol 41 (S1) ◽  
pp. S165-S165
Author(s):  
A. Fornelos ◽  
P. Macedo ◽  
A. Figueiredo ◽  
M. Roque
Keyword(s):  
Psychiatric Symptoms ◽  
Neurological Diseases ◽  
Mass Effect ◽  
Adult Brain ◽  
Neurological Deficits ◽  
Psychotic Symptoms ◽  
Social Maladjustment ◽  
Organic Brain Disease ◽  
History Of ◽  
Competing Interest

Glioblastoma multiforme is the most common primary adult brain tumor. Clinically, non-specific psychiatric symptoms may arise as their first and only manifestation, prior to any neurological deficits. The most form of psychiatric presentation of neurological diseases are depressive complaints, although these may also be accompanied by behavioral and/or cognitive, anxious and psychotic symptoms. By explaining this case report we aim to emphasize the importance of considering the diagnosis of an organic brain disease, even when only primary psychiatric symptoms are evident. The bibliographic research was made using PubMed and Scielo, and analysis of the electronic patient process. Man of 68 years with a history of hypertension, nephrectomy, splenectomy and left brachial plegia after a car accident. He had been previously seen by a psychiatrist for a 6-month history of depressive symptoms, which had been successfully treated. He later developed new behavioral changes such as heteroaggressiveness, social maladjustment and disfasia, for which he was sent to the emergency room. Brain-CT scan displayed a left front temporal expansive injury. Admitted to the Neurology Department for further diagnostic investigation. Subsequent MRI, detected massive infiltrative lesion with significant mass effect and cystic/necrotic area. The anatomopathology disclosed a glioblastoma grade IV. This case reinforces the importance of carrying a imagiologic workup in cases like this, especially on patients with atypical presentation of psychiatric symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Use of inhaled loxapine in acute psychiatric agitation

2016 ◽  
Vol 33 (S1) ◽  
pp. s228-s228
Author(s):  
S. Ovejero ◽  
M. Iza ◽  
S. Vallejo ◽  
C. Vera ◽  
A. Sedano ◽  
...  
Keyword(s):  
Rating Scale ◽  
Psychiatric Inpatient ◽  
Physical Restraint ◽  
Inpatient Unit ◽  
Young Mania ◽  
Non Invasive ◽  
Psychiatric Inpatient Unit ◽  
Syndrome Scale ◽  
Competing Interest ◽  
Negative Syndrome

ObjectivesThe aim of this work is to study the efficacy of loxapine inhalation powder on agitated patients in a psychiatric inpatient unit.MethodsNineteen patients sample, with an average age of 39.4 years old, diagnosed with schizophrenia, bipolar disorder or schizoaffective disorder. Patients inhaled loxapine 10 mg, using the staccato system, when they suffered a psychomotor agitation. The clinical efficacy was measured as a change from baseline in the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) and in the Young Mania Rating Scale (YMRS) one hour after the administration of loxapine.ResultsA mean of 9.8 points reduction (22.6 at baseline and 12.7 one hour after the administration) was found on the PANSS-EC (t-test, P < .001) and 68.4% of the patients were considered responders as they obtained a reduction of at least 40% of the basal score. On 10 of the total of the agitated patients showed an improvement of the psychomotor excitement, and this allowed the clinicians to remove the physical restraint; on 6 of the agitated patients the physical restraint could be avoided during the whole treatment; and 3 of the patients experienced a reduction of the excitement. The reduction on PANNS-EC on the latest group was not statistically significant (t-test, P = .121).ConclusionsInhaled loxapine was a non-invasive, rapid and effective alternative treatment for acute agitation in a psychiatric inpatient unit. It resulted more effective on mild and moderate cases; not been significantly effective on the severe cases of agitation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Elevated sera levels of galectin-3 in stable schizophrenia

2017 ◽  
Vol 41 (S1) ◽  
pp. S187-S187
Author(s):  
M. Borovcanin ◽  
I. Jovanovic ◽  
S. Minic Janicijevic ◽  
N. Gajovic ◽  
N. Arsenijevic ◽  
...  
Keyword(s):  
Serum Levels ◽  
Enzyme Linked Immunosorbent Assay ◽  
Autoimmune Encephalomyelitis ◽  
Gene Encoding ◽  
Mean Values ◽  
Syndrome Scale ◽  
Galectin 3 ◽  
Cytokine Milieu ◽  
Competing Interest ◽  
Negative Syndrome

IntroductionGalectin-3 (Gal-3) is a unique member of the lectin family involved in cell proliferation, adhesion, apoptosis and immune responses. Deletion of the Gal-3 gene reduces experimental autoimmune encephalomyelitis and variation of gene encoding for Gal-3 already showed to be related with cognitive function. Also, elevated Gal-3 sera levels were measured in patients with Alzheimer's disease.Aims and objectives We measured the serum concentrations of Gal-3 in patients with schizophrenia in remission and try to determine possible correlation of Gal-3 sera levels with clinical parameters, especially cognitive aspects.MethodsIn this pilot study were included patients with schizophrenia in remission on three months stable depot antipsychotic medication (risperidone and paliperidone) (n = 27) and healthy controls (n = 18). Serum levels of Gal-3 were measured using sensitive enzyme-linked immunosorbent assay (ELISA) kits, specific for humans (R&D Systems, Minneapolis). Cognition was evaluated using the Positive and Negative Syndrome Scale (PANSS) cognitive factors.ResultsHigher mean values of Gal-3 were measured in patients with schizophrenia in remission compared with healthy volunteers (1389.69 vs. 994.23 pg/mL; P = 0.011), but correlation with PANSS cognitive factor was not established (P = 0.748).ConclusionsThese findings suggest that the role of Gal-3 should be explored further, in different stages of disorder and depending on applied therapy, but also considering specific cytokine milieu.Disclosure of interestThe authors have not supplied their declaration of competing interest.

CHANGES IN SERUM LEVELS OF BRAIN-DERIVED NEUROTROPHIC FACTOR WITH ELECTROCONVULSIVE THERAPY AND PHARMACOTHERAPY AND ITS CLINICAL CORRELATES IN MALE SCHIZOPHRENIA PATIENTS

2021 ◽  
pp. 1-21
Author(s):  
Ibrahim Akbas ◽  
Ozlem Devrim Balaban
Keyword(s):  
Blood Sample ◽  
Electroconvulsive Therapy ◽  
Serum Levels ◽  
Treatment Modalities ◽  
Healthy Population ◽  
Sample Collection ◽  
Level Increase ◽  
Syndrome Scale ◽  
Negative Syndrome ◽  
Serum Bdnf

Abstract Objectives: It has been postulated that neurotrophin dysregulation leads to disorganization in neuronal networks, which results in schizophrenia. The current study sets out to evaluate if the finding of lower BDNF levels in schizophrenia patients could be confirmed in an independent cohort, and to investigate if the BDNF levels can be altered with different treatment modalities such as electroconvulsive therapy (ECT) and/or antipsychotic pharmacotherapy (PT). Methods: A total of 54 male patients with schizophrenia and 35 healthy controls were included in the study. Schizophrenia patients were subdivided into two groups as the ones who underwent ECT+PT and only PT. Clinical and sociodemographic data questionnaire, Positive and Negative Syndrome Scale (PANSS) and blood sample collection for BDNF assessment were applied to all patients (on first and last days of admissions) and healthy participants (on the day of the interview). Then, clinical parameters and blood sample outcomes were statistically analyzed. Results: Mean BDNF levels of healthy individuals was significantly higher than mean pre and post-treatment BDNF levels in both PT only and ECT+PT groups. While serum BDNF levels did not increase after ECT+PT, there was a trend level increase in the PT only group. There was no significant correlation between the change in serum BDNF levels with total PANSS scores in either group after treatment. Conclusions: We could confirm previously suggested data of lower serum BDNF levels in schizophrenia patients compared to healthy population but we couldn’t find significant increase in serum BDNF levels with ECT+PT or only PT as some previous studies suggested.

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