Electroconvulsive Therapy in Drug-Resistant Paranoid Schizophrenia on Patient with Transplanted Kidney – Case Study

The 22-year-old female patient had her first direct encounter with a psychiatrist in 2009 due to low mood, anxiety, anhedonia, lack of energy and olfactory hallucinations. Diagnosed with delusional depression syndrome, she was treated with SSRI group, and then combined with LLP group. In 2009, she was hospitalized in the Ward of kidney diseases and dialysis due to severe kidney failure, HA affecting the heart and the kidneys and facial nerve paralysis. In May 2012, she had a kidney transplanted from the deceased donor, which led to graft-versus-host disease. She received immunosuppressive therapy. In October 2012, she was diagnosed with paranoid syndrome. She was initially treated with levomepromazine 75 mg/d and amisulpride 800 mg/d (no results), then Olanzapine 20 mg/d and aripiprazole 15 mg/d (no results). After 10 week hospitalization she was discharged in a slightly improved mental state. Three weeks later, she was hospitalized again in a psychiatric institution where she received olanzapine 20 mg/d and haloperidol 6 mg/d (no results). Due to the severe mental condition, she was qualified for electroconvulsive therapy. In the end, the therapy met with the general positive reviews of consultants of different specialties. After 7 (of the 18) treatments the patient reached a significantly improved mental state with almost no sign of psychotic experiences and with a better day-to-day functioning. To the best of the authors’ knowledge, it is the first case of ECT on the patient who was the subject of a kidney transplant, and is one of the very few that have taken place in the entire world.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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When it's the Time to Switch the Therapeutic Approach on Electroconvulsive Therapy for Residual Positive Symptoms in Schizophrenia?

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.975 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S613-S613

Author(s):

I. Nechifor ◽

N. Nita ◽

M. Buzut

Keyword(s):

Electroconvulsive Therapy ◽

Social Life ◽

Negative Impact ◽

Paranoid Schizophrenia ◽

Anxiety And Depression ◽

Positive Symptoms ◽

Treatment Resistant ◽

The Past ◽

Competing Interest ◽

Depot Antipsychotics

IntroductionSchizophrenia is clearly one of the most debilitating diseases. Luckily, in the past 20 years, there has been a wide and good change in symptomatology due to the new atypical antipsychotics. Still, there are patients who are treatment resistant after different adjustments like switching or adding antipsychotics. Most of the clinicians consider Clozapine the “last resort”. But what if it doesn’t work so well on some patients?ObjectiveTo determine the point when it's time to try electroconvulsive therapy in schizophrenia treatment-resistant patients or remain on conventional approach.AimsThe aim of this work is to determine whether it's better for those patients who have residual positive symptoms to use oral/depot antipsychotics or to switch on electroconvulsive therapy.MethodsThis work presents the case of the patient C.D., 35 years, diagnosed with paranoid schizophrenia since 2008. Risperidone, Olanzapine, Aripiprazole were introduced during time, with some improvement on the positive symptomatology, but the patient developed several side-effects. At his last admission in our hospital, he came after a suicidal attempt caused by high anxiety and depression due to his false beliefs. Clozapine was introduced, but after one month of treatment, the patient still had the belief that his neighbours want to harm him somehow.ResultsThe patient and his mother definitively refused electroconvulsive therapy because of their personal beliefs. He affirmed that he can live with this “low-dose” of suspiciousness which, unfortunately, had a negative impact on his social life.ConclusionsWe still recommend electroconvulsive therapy in these situations, even though, there are many misconceptions regarding this approach.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Electroconvulsive Therapy Management in Benzodiazepine-Resistant Catatonic Syndrome: A Case Report

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1452 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S769-S770

Author(s):

I.I. Louzao Rojas ◽

Á. Orosa Duarte ◽

G. Martínez-Alés García ◽

I. Rubio Zavala ◽

A. Fraga Domingo ◽

...

Keyword(s):

Electroconvulsive Therapy ◽

Rating Scale ◽

Paranoid Schizophrenia ◽

Combined Treatment ◽

Case Series ◽

Hemodynamic Instability ◽

Blood Analysis ◽

Appropriate Treatment ◽

Competing Interest ◽

Catatonic Syndrome

Catatonia is a rare but potentially lethal neuropsychiatric syndrome. Despite its historical association with schizophrenic disorders, it is more frequent in affective ones, and is currently considered an independent pathological entity. The basis of the treatment, regardless of the cause, is the use of benzodiazepines and electroconvulsive therapy (ECT), without a clear consensus on the combined treatment. Regarding ECT, the frequency and number of effective sessions has not been clearly established. Therefore, clinical evolution is the main factor to be considered in order to determinate the appropriate treatment regimen, although the daily application of ECT is preferred, at least for the first week. We report the case of a 41-year-old patient with paranoid schizophrenia, who presented with a benzodiazepine resistant catatonic syndrome. The clinical picture included stupor, mutism, negativism, severe stiffness, catalepsy, waxy flexibility and diaphoresis, with slight CPK increase but with no other extrapyramidal symptoms, fever more than 39 and hemodynamic instability, which allowed to exclude a neuroleptic malignant syndrome. A blood analysis, lumbar puncture, CT, EEG and viral serologies were performed with inconclusive results. The patient required ICU admission and ECT treatment and we used the Bush-Francis Catatonia Rating Scale to evaluate the evolution of symptoms. Six daily treatments with ECT led to an almost full recovery of the patient. Further case series regarding the clinical management of this syndrome are needed, in order to reach consensus on an effective ECT regimen.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The Effective Treatment for Incomplete Recovery after Facial Nerve Paralysis

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2013.56.7.397 ◽

2013 ◽

Vol 56 (7) ◽

pp. 397

Author(s):

Jin Kim

Keyword(s):

Facial Nerve ◽

Effective Treatment ◽

Facial Nerve Paralysis ◽

Nerve Paralysis

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Evaluation and management of facial nerve paralysis in MGM medical college

MedPulse International Journal of ENT ◽

10.26611/10161335 ◽

2019 ◽

Vol 13 (3) ◽

pp. 44-48

Author(s):

B K Bhattacharya ◽

◽

Subhajit Sarkar ◽

Keyword(s):

Facial Nerve ◽

Facial Nerve Paralysis ◽

Nerve Paralysis ◽

Medical College

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OSTEOMYELITIS KRONIS MANDIBULA PASCA EKSTRAKSI GIGI DISERTAI BELL’S PALSY

ODONTO Dental Journal ◽

10.30659/odj.6.0.52-55 ◽

2019 ◽

Vol 6 ◽

pp. 52

Author(s):

Yayun Siti Rochmah

Keyword(s):

Facial Nerve ◽

Panoramic Radiograph ◽

Surrounding Tissue ◽

Facial Nerve Paralysis ◽

Muscle Paralysis ◽

Nerve Paralysis ◽

The Right ◽

Spread Of Infection ◽

Nerve System ◽

Intravenous Ketorolac

Background: Chronic osteomyelitis mandibula is one of the complications from dental extraction. Inadequate wound handling can have an impact on the spread of infection in the surrounding tissue like nerve which results in facial nerve paralysis. The purpose is to present a rare case that facilitative nerve paralysis as a result of the spread of osteomyelitis infectionCase Management: A 69 years old woman with chief complains numbness onher lips accompanied by pus out beside the lower teeth. No sistemic disease. Panoramic radiograph showed abnormal bone-like sequester. Extraoral examination appeared the bluish color on the right cheek and there was right facial muscle paralysis. Debridement, sequesterectomy by general anesthesia and medication using ceftriaxone intravenous, ketorolac injection, multivitamin, and corticosteroid, physiotherapy for facial nerve paralyze, also.Discussion: Pathogenesis mandibular osteomyelitis involves contiguous spreadfrom an odontogenic focus infection. The bacteria produce an exotoxin, which, while unable to cross the blood-brain barrier, can have deleterious effects on thePeripheral Nerve System (Fasialis Nerve) in up to 75% of cases, with the severity of presentation correlating with the severity of the infection.Conclusion: Chronic mandibular osteomyelitis can spread the infection to around another anatomy oral cavity like facials nerves.

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Eagle Syndrome Complicated by Posttraumatic Styloid Pseudoarthrosis and Facial Nerve Paralysis

Neurographics ◽

10.3174/ng.2170197 ◽

2017 ◽

Vol 7 (2) ◽

pp. 126-128

Author(s):

R.D. Beegle ◽

I.M. Schmalfuss

Keyword(s):

Facial Nerve ◽

Facial Nerve Paralysis ◽

Nerve Paralysis ◽

Eagle Syndrome

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Idiopathic Facial Nerve Paralysis

The Laryngoscope ◽

10.1288/00005537-199312000-00002 ◽

1993 ◽

Vol 103 (12) ◽

pp. 1326???1333 ◽

Cited By ~ 55

Author(s):

John R. Austin ◽

Steven P. Peskind ◽

Sara G. Austin ◽

Dale H. Rice

Keyword(s):

Facial Nerve ◽

Facial Nerve Paralysis ◽

Nerve Paralysis

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Facial Nerve Paralysis in Acute Suppurative Otitis Media-Management

Indian Journal of Otolaryngology and Head & Neck Surgery ◽

10.1007/s12070-017-1051-3 ◽

2017 ◽

Vol 69 (1) ◽

pp. 58-61 ◽

Cited By ~ 1

Author(s):

Sriranga Prasad ◽

K. V. Vishwas ◽

Swetha Pedaprolu ◽

R. Kavyashree

Keyword(s):

Facial Nerve ◽

Otitis Media ◽

Facial Nerve Paralysis ◽

Media Management ◽

Suppurative Otitis Media ◽

Nerve Paralysis

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Granulomatous interstitial nephritis in a patient with SARS-CoV-2 infection

BMC Nephrology ◽

10.1186/s12882-020-02213-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Katarzyna Szajek ◽

Marie-Elisabeth Kajdi ◽

Valerie A. Luyckx ◽

Thomas Hans Fehr ◽

Ariana Gaspert ◽

...

Keyword(s):

Acute Kidney Injury ◽

Interstitial Nephritis ◽

Kidney Biopsy ◽

Kidney Diseases ◽

Case Reports ◽

Kidney Injury ◽

Maculopapular Rash ◽

Tubular Injury ◽

Granulomatous Interstitial Nephritis ◽

First Case

Abstract Background Acute kidney injury (AKI) associated with severe coronavirus disease 19 (COVID-19) is common and is a significant predictor of morbidity and mortality, especially when dialysis is required. Case reports and autopsy series have revealed that most patients with COVID-19 – associated acute kidney injury have evidence of acute tubular injury and necrosis - not unexpected in critically ill patients. Others have been found to have collapsing glomerulopathy, thrombotic microangiopathy and diverse underlying kidney diseases. A primary kidney pathology related to COVID-19 has not yet emerged. Thus far direct infection of the kidney, or its impact on clinical disease remains controversial. The management of AKI is currently supportive. Case Presentation The patient presented here was positive for SARS-CoV-2, had severe acute respiratory distress syndrome and multi-organ failure. Within days of admission to the intensive care unit he developed oliguric acute kidney failure requiring dialysis. Acute kidney injury developed in the setting of hemodynamic instability, sepsis and a maculopapular rash. Over the ensuing days the patient also developed transfusion-requiring severe hemolysis which was Coombs negative. Schistocytes were present on the peripheral smear. Given the broad differential diagnoses for acute kidney injury, a kidney biopsy was performed and revealed granulomatous tubulo-interstitial nephritis with some acute tubular injury. Based on the biopsy findings, a decision was taken to adjust medications and initiate corticosteroids for presumed medication-induced interstitial nephritis, hemolysis and maculo-papular rash. The kidney function and hemolysis improved over the subsequent days and the patient was discharged to a rehabilitation facility, no-longer required dialysis. Conclusions Acute kidney injury in patients with severe COVID-19 may have multiple causes. We present the first case of granulomatous interstitial nephritis in a patient with COVID-19. Drug-reactions may be more frequent than currently recognized in COVID-19 and are potentially reversible. The kidney biopsy findings in this case led to a change in therapy, which was associated with subsequent patient improvement. Kidney biopsy may therefore have significant value in pulling together a clinical diagnosis, and may impact outcome if a treatable cause is identified.

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