Clinical case: Gynecological side effects caused by methylphenidate

2017 ◽  
Vol 41 (S1) ◽  
pp. S430-S430
Author(s):  
A. Ballesteros ◽  
Á.S. Rosero ◽  
F. Inchausti ◽  
E. Manrique ◽  
H. Sáiz ◽  
...  
Keyword(s):  
Side Effects ◽  
Attention Deficit Disorder ◽  
Clinical Case ◽  
Case Reports ◽  
Treatment Plan ◽  
Complete Recovery ◽  
Current Evidence ◽  
Drug Discontinuation ◽  
Pubmed Search ◽  
Competing Interest

IntroductionMethylphenidate drugs is prescribed in attention deficit disorder and hyperactivity. Among its rare side effects, include alterations in the gynecological. We report a clinical case and review current evidence regarding the tolerability this drug in this area.MethodsWe performed a PubMed search of articles published in English of different types (case reports or case/controls studies). We collected the clinical practice guidelines conclusions regarding adverse drug reactions.Case presentationOur patient is a 14-year-old male diagnosed of ADHD treated with methylphenidate (0.8–1 mg\kg). He developed bilateral and asymmetric gynecomastia under this treatment plan so a referral was made to rule out other causes of this event. After performing several work up tests, it was concluded that this clinical presentation was caused by methylphenidate. Hence, we initiated crossed titration swapping this drug to atomoxetine. Four months later, he was mentally stable and he experimented a volumetric decrease as concerns his gynecomastia.As regards methylphenidate, in 2009 a couple of cases in which alterations in the sexual sphere presented with the oros presentation were reported. There are series of reported pharmacological side effects (gynecomastia) and also denoted an improvement of the same months after drug discontinuation.ConclusionsGynecological clinic secondary to the use of psychotropic drugs in ADHD is uncommon. In line with our case, the current evidence suggests a drug suspension as adverse effects are usually reversible (although it may take several months to complete recovery). Further studies are needed to understand the mechanisms underlying these tolerability issues.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Antimicrobial-induced cognitive side effects

2016 ◽  
Vol 6 (4) ◽  
pp. 207-214 ◽  
Author(s):  
Amanda Warstler ◽  
Jennifer Bean
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Side Effects ◽  
Clinical Symptoms ◽  
Case Reports ◽  
Time Frame ◽  
Drug Induced ◽  
Pubmed Search ◽  
Neuropsychiatric Side Effects ◽  
Cognitive Side Effects

Abstract Introduction: Antimicrobial-induced cognitive side effects are often overlooked or underreported. Literature often reports symptoms of antimicrobial-induced cognitive impairment under more general blanket terms, such as neuropsychiatric side effects, neurotoxicity, or drug-induced delirium or encephalopathy. Methods: A PubMed search using terms including antibiotics, antifungals, antivirals, antimalarials, side effects, cognitive, neurotoxicity, encephalopathy, and delirium was conducted. Respectively, symptoms of cognitive impairment were teased out of the multiple neurologic complications presented for each case and reported based on antimicrobial class. Articles were excluded if they focused solely on neuropsychiatric side effects such as seizures, psychosis, hallucinations, or mood disturbances, were conducted in animals, or involved antiretroviral medication therapies. Results: Of over 50 case reviews, case reports, retrospective chart reviews, and prospective cohort studies analyzed, 25 were deemed appropriate for purposes of this review. Common antimicrobial-induced cognitive side effects for all antimicrobial classes included confusion, delirium, encephalopathy, and impaired concentration or attention. Recurring risk factors included, but were not limited to, older age and renal impairment. Mechanisms of cognitive impairment were relatively specific to each antimicrobial class. Discussion: Awareness of the potential for antimicrobial-induced cognitive side effects, including the general time frame of symptom onset and symptom presentation, is critical in challenging patient cases. This review article aims to summarize the risk factors, clinical symptoms, mechanisms, and management of antimicrobial-induced cognitive side effects. Pharmacists can play a key role in prevention through adjustment of medications for renal or hepatic dysfunction, avoidance of polypharmacy, and knowledge of critical drug interactions that may precipitate cognitive decline.

Antidepressant withdrawal mania: Two case reports

2017 ◽  
Vol 41 (S1) ◽  
pp. S540-S540
Author(s):  
D. Pereira ◽  
I. Carreira Figueiredo ◽  
M. Marinho ◽  
R. Fernandes ◽  
V. Viveiros
Keyword(s):  
Case Report ◽  
Emergency Service ◽  
Case Reports ◽  
Unipolar Depression ◽  
Clinical State ◽  
Gradual Improvement ◽  
Clinical Criteria ◽  
The Past ◽  
Pubmed Search ◽  
Competing Interest

IntroductionAlthough rarely reported, antidepressant discontinuation may induce hypomania or mania even in the absence of bipolar disorder [1,2].ObjectivesWe report two cases of antidepressant withdrawal induced mania.MethodsClinical process consultation and PubMed search were performed in November 2016 using the search keywords antidepressant, mania and discontinuation.ResultsCase report 1: a dysthymic 60 years old woman with 20 years of psychiatric following had been treated with venlafaxine 150 mg/daily the past year. She abruptly stopped taking this drug, developing heightened mood, irritability and racing thoughts five days later. She was admitted at our hospital, initiating then valproate and antipsychotics. Two weeks later, the hypomania clinical state remitted completely.Case report 2: a 64 years old woman, with a 12-year-old diagnosis of unipolar depression was brought to our emergency service with complaints of disorganized behavior, paranoid delusional ideas, excessive speech, irritable mood and reduced need for sleep, 1 week after abrupt trazodone 150 mg/daily discontinuation. Valproic acid 1000 mg/daily and olanzapine 20 mg/daily were introduced, with gradual improvement of symptoms. Two weeks later she was completely asymptomatic.ConclusionPsychiatrists should be aware of the risk of antidepressant withdrawal induced mania. More studies should be conducted about this subject, aiming for the clarification of risk factors and the establishment of clinical criteria for this phenomenon.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Sexual Side-Effects of Psychiatric Drugs

1989 ◽  
Vol 18 (3) ◽  
pp. 243-252 ◽  
Author(s):  
R. T. Segraves
Keyword(s):  
Erectile Dysfunction ◽  
Side Effects ◽  
Monoamine Oxidase ◽  
Sexual Function ◽  
Clinical Case ◽  
Case Reports ◽  
Psychiatric Drugs ◽  
Sexual Side Effects ◽  
Clinical Series ◽  
Retarded Ejaculation

Clinical case reports, clinical series, and a small number of controlled studies provide evidence that many commonly prescribed psychiatric drugs may have untoward effects on sexual function. Both heterocyclic antidepressants and monoamine oxidase inhibitors appear to be associated with ejaculatory impairment. Erectile dysfunction and retarded ejaculation have been associated with neuroleptics. Several benzodiazepines have been reported to interfere with ejaculation. This information has clear significance for the prescribing physician.

Electroconvulsive therapy: Brief versus ultrabrief pulse right unilateral electroconvulsive therapy

2016 ◽  
Vol 33 (S1) ◽  
pp. S618-S618
Author(s):  
M.R. Raposo ◽  
M.L. Medina ◽  
A.L. González ◽  
I. Martínez ◽  
A. Gil ◽  
...  
Keyword(s):  
Side Effects ◽  
Electroconvulsive Therapy ◽  
Meta Analysis ◽  
Electrode Placement ◽  
Current Evidence ◽  
List Type ◽  
Treatment Of Depression ◽  
The Subject ◽  
Competing Interest ◽  
Cognitive Side Effects

IntroductionElectroconvulsive therapy (ECT) is an effective depression treatment, but it has potential cognitive side effects. Bitemporal ECT has been traditionally used, but in recent decades, right unilateral (RUL) electrode placement has been proposed to decrease the cognitive side effects of ECT. Ultrabrief pulse (UBP) right unilateral (RUL) ECT is an increasingly used treatment option that can potentially combine efficacy with lesser cognitive side effects.ObjectivesTo evaluate whether ultrabrief pulse (UBP) right unilateral (RUL) electroconvulsive therapy (ECT) is as effective as brief pulse (BP) RUL ECT in addition to cause lesser cognitive side effects.Material and methodsA search is performed in the available scientific literature on systematic review and meta-analysis of the subject under study, through the database PubMed.Results– Current evidence supports the efficacy of right unilateral (RUL) electroconvulsive therapy (ECT) given with an ultrabrief pulse width in the treatment of depression;– ultrabrief pulse RUL ECT leads to lesser cognitive side effects than traditional forms of ECT;– ultrabrief pulse RUL ECT may be slightly less effective than traditional forms of ECT.ConclusionsBP compared with UBP RUL ECT was slightly more efficacious in treating depression and required fewer treatment sessions, but led to greater cognitive side effects. The decision of whether to use BP or UBP RUL ECT should be made on an individual patient basis and should be based on a careful weighing of the relative priorities of efficacy versus minimization of cognitive impairment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Hematological safety of olanzapine

2016 ◽  
Vol 33 (S1) ◽  
pp. s225-s225 ◽  
Author(s):  
A. Alageel ◽  
E. Gaffas
Keyword(s):  
Side Effects ◽  
Atypical Antipsychotic ◽  
Antipsychotic Medication ◽  
Case Reports ◽  
Small Body ◽  
Systemic Review ◽  
Competing Interest ◽  
Treatment Onset ◽  
Alternative Choice ◽  
Atypical Antipsychotic Medication

IntroductionOlanzapine is an atypical antipsychotic medication, previously expected to be safe in terms of hematological side effects and an alternative choice to clozapine in patients who develop hematotoxicities. However, since olanzapine was introduced to the market, a lot of cases reports have been published revealing it could cause hematoxicity. Some of them indicate that olanzapine induces agranulocytosis. Because of that, it raises the concerns about hematological safety of olanzapine.ObjectiveTo date, no review discusses this topic specifically, so we conducted a systemic review to explore and address this issue.MethodsWe searched Pubmed, Google Scholar, Ovid and Medline databases for articles between 1998 and 2015 that include keywords olanzapine, leukopenia, neutropenia, and agranulocytosis.ResultsA total of 38 publications were identified. The case reports included patients aged 16 to 83 years. Doses ranged from 2.5 to 30 mg. After starting treatment, onset of hematotoxicity varied from the first day to 2–3 years, but most commonly within the first month. Also, olanzapine could induce leukopenia in patients who have never developed drug-related leukopenia.ConclusionAmong antipsychotic medications, olanzapine is the third leading cause of neutropenia and the second leading cause of atypical antipsychotic medication. Because of the small body of literature regarding the hematotoxic side effects of olanzapine, we encourage further research to understand the mechanism by which olanzapine causes granulocytopenia. The identification of risk factors could facilitate the development of new surveillance guidelines in patients taking olanzapine. We recommend that the guidelines of using and monitoring olanzapine need to be reconsidered.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Efficacy of Cerebrospinal Fluid Beta-D-Glucan Diagnostic Testing for Fungal Meningitis: a Systematic Review

2020 ◽  
Vol 58 (4) ◽  
Author(s):  
Christian Davis ◽  
L. Joseph Wheat ◽  
Thein Myint ◽  
David R. Boulware ◽  
Nathan C. Bahr
Keyword(s):  
Systematic Review ◽  
Cerebrospinal Fluid ◽  
Case Reports ◽  
Corticosteroid Injection ◽  
Diagnostic Testing ◽  
Current Evidence ◽  
Content Type ◽  
Fungal Meningitis ◽  
Exserohilum Rostratum ◽  
Pubmed Search

ABSTRACT Several case reports and cohort studies have examined the use of (1,3)-beta-d-glucan measurement with cerebrospinal fluid to diagnose fungal meningitis. This systematic review aims to characterize the evidence regarding cerebrospinal fluid (1,3)-beta-d-glucan measurement to detect fungal meningitis. We searched PubMed for (1,3)-beta-d-glucan and each of several distinct fungi, cerebrospinal fluid, and meningitis. Summary data including diagnostic performance (where applicable) were recorded. A total of 939 records were examined via a PubMed search. One hundred eighteen records remained after duplicates were removed, and 104 records were excluded, as they did not examine cerebrospinal fluid, included animals, or focused on nonfungal infections. Fourteen studies were included in this systematic review. A variety of fungi, including species of Candida, Aspergillus, Exserohilum, Cryptococcus, Histoplasma, and Coccidioides, were studied, although most were case reports. Diagnostic accuracy was examined in 5 studies. Cerebrospinal fluid (CSF) (1,3)-beta-d-glucan measurement showed >95% sensitivity in the corticosteroid injection-related outbreak of Exserohilum rostratum. One study in Histoplasma meningitis found 53% (53/87) sensitivity and 87% (133/153) specificity, while another study of Cryptococcus meningitis found 89% (69/78) sensitivity and 85% (33/39) specificity. CSF (1,3)-beta-d-glucan testing may be useful, primarily as a nonspecific marker of fungal meningitis. Although the FDA black box warning states that Cryptococcus spp. do not make (1,3)-beta-d-glucan, the current evidence shows that (1,3)-beta-d-glucan is detectable in cryptococcal meningitis. Organism-specific testing should be used in conjunction with (1,3)-beta-d-glucan measurement.

Substance use disorders: Baclofen as a promising drug

2016 ◽  
Vol 33 (S1) ◽  
pp. S299-S299
Author(s):  
S. Gomes da Costa ◽  
O. Yanina Pasini ◽  
B. Maside Oliete ◽  
M.M. Balcells Olivero
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Clinical Case ◽  
Case Reports ◽  
Withdrawal Symptoms ◽  
Severe Withdrawal ◽  
Competing Interest ◽  
High Doses ◽  
Interesting Alternative

IntroductionBaclofen, a drug currently used in the treatment of spasticity, has been reported to be useful in reducing the intensity of withdrawal symptoms of substance use disorders of alcohol or other psychotropic drugs.ObjectivesWith our clinical case we aim to demonstrate that baclofen reduces severe withdrawal symptoms and also helps to achieve and maintain abstinence in severe cases, in agreement with the current literature.Aims/methodsWe present a clinical case of a 68 year-old patient with alcohol use disorder since his childhood, with familiar antecedents, multiples relapses and associated organic pathology such as alcoholic polyneuropathy and Wernicke syndrome. We used to high doses of baclofen to reduce the craving and withdrawal symptoms. Additionally, we searched in PubMed for more case reports and for a systematic review of the efficacy and tolerability of baclofen.ResultsWe were able to demonstrate that high doses of baclofen can be useful in resistant cases of substance use disorders like alcoholism. For our case study, we obtained positive results with a large remission, in comparison with the previous detoxications, with doses up to 150 mg/day.ConclusionsWe conclude that baclofen is an interesting alternative for resistant cases, with a good outcome and tolerability, in complicated patients, with important organic repercussions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Current Evidence on the Socket-Shield Technique: A Systematic Review

2017 ◽  
Vol 43 (5) ◽  
pp. 395-403 ◽  
Author(s):  
Amit S. Gharpure ◽  
Neel B. Bhatavadekar
Keyword(s):  
Systematic Review ◽  
Bone Loss ◽  
Clinical Case ◽  
Case Reports ◽  
Case Control ◽  
Current Evidence ◽  
Clinical Prognosis ◽  
Crestal Bone Loss

The recently popularized socket-shield technique involves intentional retention of a section of the remnant root at the time of immediate implant placement, thereby preserving the buccal/proximal bone from resorption. The objective of this systematic review was to assess the literature available on the socket-shield technique and weigh its biological plausibility and long-term clinical prognosis. A systematic search was performed on PubMed-Medline, Embase, Web of Knowledge, Google Scholar, and Cochrane Central for clinical/animal studies from January 1970 to April 2017. Twenty-three studies were assessed: 1 clinical case-control study, 4 animal histological reports, 1 clinical abstract, and 17+2* case reports. Eighteen out of the 23 studies had a duration of ≤12 months. A quality assessment of 5 studies (4 animal histologic and 1 clinical case-control) performed using the modified Animal Research: Reporting of In Vivo Experiments guidelines revealed that 4/5 studies had low scores. Fifty-eight out of 70 (82.86%) implants from 4 animal histological studies had complications; buccal/crestal bone loss (54.55%) and failure of osseointegration (27.27%) were the most common. Thirty-three out of 136 (24.26%) implants from 19+2 (2 studies had both histologic and clinical components, which are assessed separately) clinical studies had complications; buccal/crestal bone loss (78.78%) and shield exposure/failure (12.12%) were the most common. Other complications recorded were periodontal ligament and cementum formation on implant surfaces, pocket formation, inflammation, mucositis, and peri-implantitis. However, some clinical reports indicated stable results at 12 months. It would be difficult to predict the long-term success of this technique until high-quality evidence becomes available. A video abstract is available for viewing at https://youtu.be/lNMeUxj2XPA?list=PLvRxNhB9EJqbqjcYMbwKbwi8Xpbb0YuHI.

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