Polydipsia and intermittent hyponatremia

2017 ◽  
Vol 41 (S1) ◽  
pp. s502-s502
Author(s):  
S. Ramos-Perdigues ◽  
M.J. Gordillo ◽  
C. Caballero ◽  
S. Latorre ◽  
S.V. Boned ◽  
...  
Keyword(s):  
Mentally Ill ◽  
Rare Condition ◽  
Psychotropic Medications ◽  
Auditory Hallucinations ◽  
Psychiatric Ward ◽  
Water Restriction ◽  
Hippocampal Dysfunction ◽  
Schizophrenic Patients ◽  
Competing Interest ◽  
Dilutional Hyponatraemia

IntroductionHyponatraemia occurs in 4% of schizophrenic patients. Dilutional hyponatraemia, due to inappropriate retention of water and excretion of sodium, occurs with different psychotropic medications and could lead to hippocampal dysfunction. This complication is usually asymptomatic but can cause severe problems, as lethargy and confusion, difficult to diagnose in mentally ill patients.ObjectivesTo describe a case of a patient with psychotropic poli-therapy, admitted three times due to hyponatremia and the pharmacological changes that improved his condition.AimsTo broadcast the intermittent hyponatraemia and polydipsia (PIP), a not rare condition, suffered by treated schizophrenic patients and discuss its physiopathology and treatment thorough a case report.MethodsA 56-year schizophrenic male was admitted for presenting disorganized behavior, agitation, auditory hallucinations, disorientation, ataxia, vomits and urinary retention. He was on clomipramine, haloperidol and clotiapine (recently added), quetiapine, fluphenazine and clonazepam. After water restriction his symptoms improved and he was discharged. Twenty-five days later, he was readmitted for presenting the same symptoms and after water restriction, he was discharged. Five days later, he was again admitted and transferred to the psychiatric ward.ResultsHaloperidol, fluphenazine and clomipramine were replaced by clozapine. These changes lead him to normalize the hypoosmolality and reduce his water-voracity. Endocrinology team did not label this episode of SIADH due to its borderline blood and urine parameters.ConclusionsHyponatremia is frequent in schizophrenic patients and may have severe consequences. Therefore, a prompt recognition and treatment is warranted.Disclosure of interestThe authors have not supplied their declaration of competing interest.

It is possible to change clozapine by another neuroleptic

2016 ◽  
Vol 33 (S1) ◽  
pp. S612-S612
Author(s):  
F.X. Fluvia ◽  
R. Pastor
Keyword(s):  
Schizophrenic Patient ◽  
Mentally Ill ◽  
Epileptic Seizures ◽  
Chronically Ill ◽  
Social Avoidance ◽  
Clozapine Treatment ◽  
Schizophrenic Patients ◽  
Resistant Patient ◽  
Competing Interest ◽  
Full Dosage

It is well known that when we have a schizophrenic patient who do not respond to two batches of neuroleptics at full dosage for more than six month, it may be wise to try with clozpine which is believed to be one of the best neuroleptics we have but with two main handicaps: it can produce leucopenia which can be fatal and epileptic seizures as well. We do think that in many cases, clozapine has been used too soon in the treatment of the schizophrenic patient, before we can really talk of a resistant patient. To prove that we have changed the clozapine treatment of four chronically ill schizophrenic patients admitted to a home for the chronically mentally ill. Two patients were changed from clozapine 400 mg/day to paliperidone 15 mg/day along two months time. They both improved in mental clarity and ability of thinking. Another patient were changed from 600 mg/day to 27 mg/day of paliperidone. That patient worsened a little bit mainly with hostility and social avoidance but it was mandatory to change neuroleptic because he had had two seizures and had low levels of platelets and therefore he was at risk of developing leukopenia. The fourth one was taking 300 mg of clozapine and was changed to 12 mg of paliperidone. We got no change in the clinical outcome.DiscussionWe discuss the different explanations for the results we got.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Outcomes of involuntary hospital admission. Satisfaction with treatment and the effect of involuntary admissions on patients

2017 ◽  
Vol 41 (S1) ◽  
pp. S328-S329 ◽  
Author(s):  
T. Reshetukha ◽  
N. Alavi ◽  
E. Prost ◽  
D. Groll ◽  
R. Cardy ◽  
...  
Keyword(s):  
Mentally Ill ◽  
Psychiatric Ward ◽  
Involuntary Admission ◽  
Involuntary Hospitalization ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Significant Difference ◽  
Satisfaction With Treatment ◽  
Competing Interest

IntroductionInvoluntary hospitalization in those presumed to be mentally ill has been a common practice. Although some patients are hospitalized for aggression, two-thirds of the patients are hospitalized because of the threat they pose to themselves. Although these patients require risk assessment and evaluation for possible presence of mental illness, the question is how much these patients will benefit from involuntary admission and what the long-term outcome would be.MethodAll patients admitted involuntary to the psychiatric ward in Kingston, Canada, and psychiatrists involved in their care were interviewed to see whether they think the involuntary admission was helpful. All patients were asked to fill-out MacArthur AES to assess their satisfaction with hospitalization.ResultsAlthough psychiatrists frequently reported that the admission was justified, only 29 out of 81 patients reported being explained to why they had been admitted involuntarily. Also, there was a significant difference in AES scores between those who were and were not given an explanation for admission. In addition, psychiatrists more often reported that the involuntary admission worsened the therapeutic relationship which was significantly associated with involuntary admission that was not explained to patients.DiscussionThe results of our study shows that patients admitted involuntarily often feel disappointed with staff and mental health system. It could lead to feeling of hopelessness, frustration and low self-esteem. If explained, some patients who present with risk to self might accept voluntary admissions, that will improve therapeutic alliance with psychiatrists and increase satisfaction from hospitalization. Result of this study could improve the decision making process for involuntary admissions.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.

scholarly journals COVID-19 Infection-Related Weight Loss Decreases Eating/Swallowing Function in Schizophrenic Patients

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1113
Author(s):  
Takeshi Kikutani ◽  
Yoko Ichikawa ◽  
Eri Kitazume ◽  
Arato Mizukoshi ◽  
Takashi Tohara ◽  
...  
Keyword(s):  
Weight Loss ◽  
Oral Feeding ◽  
Parenteral Feeding ◽  
Psychiatric Ward ◽  
Swallowing Function ◽  
Obesity Index ◽  
Life Prognosis ◽  
Before And After ◽  
Schizophrenic Patients ◽  
Level Scale

Background: In older people with psychoneurological diseases, COVID-19 infection may be associated with a risk of developing or exacerbating dysphagia. The aim of the present study was to examine the relationship between eating/swallowing function and COVID-19 infection. Methods: Subjects were 44 inpatients with confirmed COVID-19 infection being treated for schizophrenia in a psychiatric ward. Eating function was assessed using the Food Intake Level Scale (FILS) before and after infection. We also evaluated age, comorbidities, COVID-19 hospital stay, obesity index, weight loss rate, and chlorpromazine equivalent. Results: Subjects had a mean age of 68.86 years. Pre-infection, 20 subjects had a FILS score of 7–9 (presence of eating/swallowing disorder) and 24 subjects had a score of 10 (normal). Eating function after infection resolution showed decreasing FILS score compared to that before infection in 14 subjects (74.14 years). Six subjects (79.3 years) transitioned from oral feeding to parenteral feeding. A ≥ 10% weight loss during infection treatment was significantly associated with decreased eating function and a transition to parenteral feeding. Chlorpromazine equivalents, comorbidities, and number of days of hospitalization showed no associations with decreased eating function. Conclusions: Preventing malnutrition during treatment for COVID-19 infection is important for improving post-infection life prognosis and maintaining quality of life (QOL).

A case of rare allele T 126, 30,32 base pairs in a schizophrenic patient: A study case

2016 ◽  
Vol 33 (S1) ◽  
pp. S585-S586
Author(s):  
A.I. Sabau ◽  
P. Cristina ◽  
B. Valerica ◽  
P. Delia Marina
Keyword(s):  
Schizophrenic Patient ◽  
Complex Disease ◽  
Susceptibility Gene ◽  
Rflp Analysis ◽  
Rare Allele ◽  
Base Pairs ◽  
Gene Coding ◽  
Icd 10 ◽  
Schizophrenic Patients ◽  
Competing Interest

IntroductionSchizophrenia is a severe and complex disease clinically characterized by disturbed thought processes, delusions, hallucinations and reduced social skills. Gene coding for neregulin 1 (NRG 1) located in 8 p21chromosomeand single nucleotide polymorphism (SNPs) have been identified strongly supporting NRG1 gene as a susceptibility gene for schizophrenia.ObjectiveThe present preliminary study, determines the relationship between polymorphism nucleotide sites (SNPs2) of NRG1 gene and schizophrenia.AimsIdentifying rare allele T of neregulin 1 genein schizophrenic patients.MethodWe analyzed the polymorphism (SNPs2) of NRG1 gene in 20 patients recruited from Psychiatry Department of Emergency Clinical Hospital of Arad diagnosed with schizophrenia according to DSM-5-TM and ICD-10 criteria and 10 healthy controls. From all subjects, we obtained 2 mL of peripheral blood samples. Genomic DNA was extracted using the phenol-chloroform method. Genotyping was performed byPCR-based RFLP analysis for all subjects. The obtained PCR product mixture was completely digested with restriction enzyme, separated on SNP1 and SNP2 agarose gel. We present the case of a 31 years old, male, schizophrenic patient with the SNPs2 polymorphism and rare allele T 126.ResultsIn both groups, common allele G 127 and 60 base pairs was identified but only 2 schizophrenic patients presented rare allele T 126 and 30,32 base pairs.ConclusionsThe polymorphism SNPs2 of NRG1 gene with rare allele T 126 and 30,32 base pairs, may play a role in predisposing an individual to schizophrenia. Further and extended replicating studies with multiple sequencing of NRG1 gene are necessary.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Insight and aggressive Behavior in acute Schizophrenic Patients

2016 ◽  
Vol 33 (S1) ◽  
pp. S441-S441
Author(s):  
S. Campi ◽  
C. Esposito ◽  
P. andreassi ◽  
P. Bandinelli ◽  
P. Girardi ◽  
...  
Keyword(s):  
Aggressive Behavior ◽  
Treatment Compliance ◽  
Aggressive Behaviors ◽  
Self Monitoring ◽  
Poor Treatment ◽  
Schizophrenic Patients ◽  
Competing Interest ◽  
The Relationship ◽  
Acute Patients

Introductionaggressive behavior in wards is associated to poor treatment compliance and low clinical insight. Most studies focused on the clinical and cognitive dimensions of insight, while the relationship between metacognitive dimension and aggressive behaviors was not investigated. Our aim was to understand what relationship occurs between dimensions of insight (metacognitive, cognitive, clinical), and specific aggressive behaviors in acute patients.Methodswe recruited 75 acute schizophrenic patients using: aQ; MO aS; IS; P aNSS; BCIS.Resultsa positive correlation between the IS score and the hostility, angry and physical aggression sub-scores of the aQ was highlighted, while no correlation between the score of IS and MO aS total score was found. No correlation between the score of the P aNSS G12 item and the aQ scores and MO aS was found, and no correlation between BCIS scores, MO aS and aQ scores was found.Conclusionsin our patients, a higher level of metacognitive insight, but not clinical nor cognitive insight, was associated to higher levels of hostility. we suggest that a higher ability to monitor and appraise one's own altered processes of thought and related discomfort, feeling of destabilization and loss of control, could contribute to enhance resentment and suspiciousness. Findings help develop specific therapeutic strategies to enhance metacognitive and self-monitoring abilities, helping patient's understanding of the illness, improving compliance with treatment, and patient's quality of life. Our results support the multidimensional nature of insight in schizophrenia, confirming that clinical, cognitive and metacognitive dimensions are independent though related facets of the phenomenon of insight in schizophrenia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Koro Syndrome in an Obsessive-Compulsive Disorder Patient

2016 ◽  
Vol 33 (S1) ◽  
pp. S496-S496 ◽  
Author(s):  
L. Silva ◽  
C. Raposo-Lima ◽  
C. Soares ◽  
J.J. Cerqueira ◽  
P. Morgado
Keyword(s):  
Behavioral Therapy ◽  
Rare Condition ◽  
The Body ◽  
Obsessive Compulsive ◽  
Optimal Care ◽  
Related Disorder ◽  
Compulsive Disorder ◽  
Western Countries ◽  
Competing Interest ◽  
Psychiatric Department

IntroductionKoro syndrome is a culturally related disorder characterized by intense anxiety that the penis (vulva or nipples in females) is shrinking or retracting and will recede into the body. Usually it occurs in epidemics in Southeastern Asia, being extremely rare in western countries. The condition is more common in males and is classified within Obsessive Compulsive and Related Disorders.Case reportA 27-year-old single man was referred to the psychiatric department. By the age of 23, he began worrying that his penis was shrinking and retracting into the abdomen. He described these thoughts as intrusive, ridiculous and repetitive. During the first months the thoughts were not very disturbing but he progressively developed an urge to verify the length of his penis several times a day. To diminish the anxiety provoked by the obsessive doubts on penis length, he started to have repetitive thoughts and mental images about sexual acts, to consume pornography compulsively and to increase his masturbatory behaviors (from some times a week to several times a day). He described those thoughts and behaviors as unpleasant and uniquely driven to reduce anxiety provoked by obsessions.He was prescribed fluvoxamine 200 mg/day and initiated cognitive behavioral therapy with good response. Y-BOCS score decreased from 30 at initial evaluation to 18 after 3 months of treatment.ConclusionsKoro syndrome is a very rare condition in psychiatry in western countries, usually presenting secondarily to other psychiatric disorders. Awareness of this diagnosis and knowledge on its management are critical to provide optimal care to patients.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.

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