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

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.

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

2017 ◽  
Vol 41 (S1) ◽  
pp. s771-s771
Author(s):  
A. Zdanowicz ◽  
P. Wierzbinski
Keyword(s):  
Electroconvulsive Therapy ◽  
Mental State ◽  
Kidney Diseases ◽  
Paranoid Schizophrenia ◽  
Deceased Donor ◽  
Mental Condition ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis ◽  
First Case ◽  
Competing Interest

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.

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

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.

Uncommon effects of clozapine

2016 ◽  
Vol 33 (S1) ◽  
pp. S614-S614 ◽  
Author(s):  
J. Jerónimo ◽  
J. Santos ◽  
L. Bastos
Keyword(s):  
Adverse Effect ◽  
Adverse Effects ◽  
Early Recognition ◽  
Paranoid Schizophrenia ◽  
Psychotic Symptoms ◽  
Treatment Resistant ◽  
Search Terms ◽  
Symptomatic Medication ◽  
Competing Interest ◽  
Left Parotid Gland

IntroductionClozapine is the first option for treatment-resistant schizophrenia, affecting about 20–30% of all patients. Weight gain, sedation, hypotension and hypersalivation are common and well-known adverse effects associated with clozapine. However, it is also important to be aware of uncommon adverse effects, like parotitis.ObjectiveWe report a case of clozapine-induced parotitis.MethodsLiterature was accessed through Pudmed, using the search terms parotitis and clozapine.ResultsA 36-year-old male with paranoid schizophrenia, whose psychotic symptoms have responded only slightly to two antipsychotic trial, with both haloperidol and olanzapine. Therefore, he began treatment with clozapine with the dose titrated to 400 mg/day. At first, the only registered adverse effect was hypersalivation. Eventually, after 3 months of treatment, he developed a unilateral swelling of the left parotid gland. Bacterial and viral parotitis were ruled out and the diagnosis of clozapine-induced parotitis was evoked. Patient scored 5 in the Parotitis-Specific Criteria Modified Naranjo Probability Scale. Symptomatic medication was initiated with paracetamol and a non-steroidal anti-inflammatory with a favorable outcome.ConclusionThere are few reports of clozapine-induced parotitis, a very rare and poorly known adverse effect with an unknown pathophysiology. Early recognition and proper management are essential to reduce morbidity associated with the treatment. There is no consensus how to manage these adverse effect, however, generally it is not necessary to discontinue the treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Maintenance Electroconvulsive Therapy in a Patient with Treatment-Resistant Paranoid Schizophrenia and Comorbid Epilepsy

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Beppe Micallef-Trigona ◽  
Joseph Spiteri
Keyword(s):  
Drug Treatment ◽  
Electroconvulsive Therapy ◽  
Antipsychotic Medication ◽  
Maintenance Treatment ◽  
Therapeutic Response ◽  
Paranoid Schizophrenia ◽  
Treatment Resistant ◽  
Maintenance Ect ◽  
Antipsychotic Drug Treatment ◽  
Atypical Antipsychotic Medication

The treatment of choice for acute schizophrenia is antipsychotic drug treatment and electroconvulsive therapy (ECT) and should only be considered as an option for treatment-resistant schizophrenia, where treatment with clozapine has already proven ineffective or intolerable. The use of ECT as a maintenance treatment for patients with schizophrenia and comorbid epilepsy is uncommon as scant evidence exists to support this. We describe a patient with a serious case of paranoid schizophrenia and comorbid epilepsy who had not responded to typical and atypical antipsychotic medication, but responded remarkably to acute ECT and required maintenance ECT to sustain a positive therapeutic response.

Influence of clozapine to modified electroconvulsive therapy in the treatment resistant schizophrenia

2017 ◽  
Vol 41 (S1) ◽  
pp. s817-s817
Author(s):  
Y. Kikuchi ◽  
T. Kanbayashi ◽  
T. Shimizu
Keyword(s):  
Electroconvulsive Therapy ◽  
Treatment Resistant ◽  
First Line ◽  
Clozapine Therapy ◽  
Significant Difference ◽  
Augmentation Strategy ◽  
Competing Interest ◽  
Modified Electroconvulsive Therapy ◽  
Monitoring Service ◽  
Effective Drugs

IntroductionClozapine is one of the most effective drugs for the treatment resistant schizophrenia (TRS). It was reported that modified electroconvulsive therapy (mECT) may be an effective clozapine augmentation strategy in TRS.ObjectiveThe objective of this study was to investigate the influence of clozapine to mECT in the TRS.MethodsForty-seven patients were recruited in this study, but eight patients were excluded because clozapine was discontinued by reason of side effects. Ultimately, 39 patients were enrolled.ResultsSeventeen patients received mECT before clozapine therapy. Two patients continued mECT after starting clozapine therapy. There was a significant difference between before–after clozapine therapy (χ2 test, P< 0.01). Intermittent mECT was performed for 3 patients before clozapine and for one patient after starting clozapine.DiscussionThis result suggests that clozapine therapy reduces mECT. In Japan, the first-line treatment for TRS is CLO. mECT is recommended for clozapine resistant schizophrenia patients. Prescription of CLO is limited in the part of medical facility because all physicians who prescribe clozapine must be registered with the clozaril patient monitoring service in Japan. It is considered that mECT is more readily selected than clozapine therapy. Therefore, the number of mECT is not reduced generally.ConclusionClozapine therapy reduces the necessity of mECT.Disclosure of interestThe authors have not supplied their declaration of competing interest.

An evaluation of the use of electroconvulsive therapy in a United Kingdom high secure psychiatric hospital

2017 ◽  
Vol 41 (S1) ◽  
pp. S373-S373
Author(s):  
H. Blott ◽  
S. Bhattacherjee ◽  
E. Harris
Keyword(s):  
Psychiatric Hospital ◽  
Electroconvulsive Therapy ◽  
Severe Depression ◽  
Depression Treatment ◽  
Treatment Resistant ◽  
Capacity To Consent ◽  
Consent To Treatment ◽  
Competing Interest ◽  
Analyse Case ◽  
Do So

IntroductionElectroconvulsive therapy (ECT) is an effective NICE-approved treatment for severe depression, treatment-resistant mania and catatonia; the Royal College of Psychiatrists’ (RCPsych) guidelines also support its use fourth line for treatment-resistant schizophrenia.ObjectivesEvaluate the use of ECT at Broadmoor High Secure psychiatric hospital, focusing on the indications for its prescription and patients’ capacity to consent.MethodAnalyse case records of all patients who received ECT, and of all patients referred for Second Opinion Appointed Doctor (SOAD) certified ECT treatment under Section 58 of the Mental Health Act 1983 (MHA) due to incapacity, between 01.09.11 and 30.07.15.ResultsAll patients lacked capacity to consent to treatment during this time. Thirty-three referrals were made to the SOAD service for 15 patients, and of these 30 resulted in certification (T6) of which 10 were not subsequently used. Improvements in mental state and agreement to take clozapine were common reasons for T6s either not being certified or used. Urgent treatment under Section 62 of the MHA was employed 7 times for 4 patients during this period. Of the referrals to the SOAD service, 25 were for treatment-resistant schizophrenia, 5 for mania, 3 for catatonia and none for depression.ConclusionsThose patients requiring ECT within this population tended to be the most unwell and all lacked the capacity to consent to it. The majority (76%) of patients receiving ECT at Broadmoor do so outside of NICE (but within RCPsych) guidelines. ECT may be an effective strategy for promoting compliance with clozapine.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Cannabinoids is a “No-Go” While a Cancer Patient is on Immunotherapy; but is It Safe to Use Psychedelics During Cancer Immunotherapy?

2021 ◽  
Author(s):  
E. Amit Romach ◽  
M. Nachliely ◽  
O. Moran ◽  
M. Brami ◽  
I. Lamensdorf
Keyword(s):  
Cancer Patients ◽  
Negative Impact ◽  
Checkpoint Inhibitors ◽  
Anxiety And Depression ◽  
Therapeutic Approaches ◽  
Immunomodulatory Effects ◽  
Negative Effects ◽  
Patients With Cancer ◽  
The Past ◽  
Therapeutic Benefits

AbstractThe use of Psychedelics by patients with cancer to relieve anxiety and depression has increased in the past few years. Since Psychedelics have immunomodulatory effects, their consumption among cancer patients should be carefully considered due to their potential negative effects on the tumor immune stroma, especially in view of the increase in the utilization of therapeutic approaches that are based on immune activation such as treatment with immune checkpoint inhibitors (ICIs). Preclinical data provided in this report indicate a potentially negative impact on tumor growth as a result of Psychedelics consumption during treatment with ICIs. Furthermore, our research suggests that the use of psychedelic agents (Lysergic acid diethylamide [LSD] or Psylocibin) might diminish the beneficial therapeutic benefits of ICIs.It might be necessary to expend this line of research in order to validate these findings, in view of the increase use of cannabinoids and psychedelics among cancer patients, some of them being treated with immune-based modalities.

scholarly journals THE RELATIONSHIP OF QUALITY OF LIFE INDICATORS AND PSYCHOLOGICAL STATUS FEATURES IN CADETS OF THE UFA LAW INSTITUTE OF THE MINISTRY OF INTERNAL AFFAIRS OF THE RUSSIAN FEDERATION WITH CHRONIC GENERALIZED CATARRHAL GINGIVITIS

2020 ◽  
Vol 16 (3) ◽  
pp. 66-73
Author(s):  
Olesya Sitdikova ◽  
Milyausha Kabirova ◽  
Oksana Gubina
Keyword(s):  
Quality Of Life ◽  
Physical Health ◽  
Social Life ◽  
Depressive Disorders ◽  
Negative Impact ◽  
Clinical Manifestations ◽  
Well Being ◽  
Psychological Status ◽  
Anxiety And Depression

Subject. Chronic generalized catarrhal gingivitis affects the physical condition of a person, as well as the psychology of their behavior, emotional reactions, as well as their role in social life. Doctors are not always set up to assess the quality of life and patient satisfaction with the therapy. The peculiarity of this disease is the vastness of its clinical manifestations, and the need to start treatment in a timely manner, and patients taking medications themselves, affects poor adherence to treatment. These characteristics have an impact on the quality of life, and if the quality of life improves as a result of therapy, this motivates patients to effectively control their condition. Goal ― to assess the quality of life, frequency and severity of anxiety and depressive disorders in cadets with chronic generalized catarrhal gingivitis. Methodology. We conducted a survey of 140 cadets aged 18 to 25 years. Results.The revealed patterns suggest that bleeding, gum pain,and halitosis often contribute to the clinical manifestation of anxiety and depressive disorders in cadets with chronic generalized catarrhal gingivitis, thereby impairing the quality of life. The combination of various metabolic factors in a closed circle mutually increases the severity of not only clinical manifestations of chronic generalized catarrhal gingivitis, but also affects the mental status of the patient, increasing the degree of neurosis-like manifestations Conclusion. Chronic generalized catarrhal gingivitis significantly affects the decline in indicators of not only physical health, but also mental well-being. High levels of anxiety and depression are most significantly correlated with indicators of mental and physical health of cadets . Thus, anxiety and depression of a somatogenic nature has a negative impact on the quality of life, aggravates the course of the underlying disease, significantly affecting the General well-being of the patient.

Toxic role in schizophrenia: A review by a clinical case

2016 ◽  
Vol 33 (S1) ◽  
pp. S292-S292
Author(s):  
M. Canseco Navarro ◽  
A. Peña Serrano ◽  
J.M. Hernández Sánchez ◽  
M. Canccino Botello ◽  
F. Molina López ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Negative Symptoms ◽  
Clinical Case ◽  
Paranoid Schizophrenia ◽  
Clinical History ◽  
Positive Symptoms ◽  
History Of ◽  
Competing Interest ◽  
Hospital General

IntroductionOften find it difficult diagnostic approach to patients with symptoms that could correspond to several clinical entities. This requires making a correct differential diagnosis to enable a better understanding and addressing the disease in an individualized way.ObjectiveDescribe pathogenetic factors of paranoid schizophrenia highlighting their relationship with drug consumption.MethodsReview of the clinical history of a patient admitted to acute ward of the Hospital General Universitario of Valencia.ResultsA case of a 30-year-old man, whose income is motivated by persistent and structured autolytic ideation occurs. It presents positive symptoms for several years and amotivational syndrome ago. It has a history of cannabis, cocaine and alcohol since he was thirteen and remains abstinent for more than six months ago. Differential diagnosis arises between amotivational toxic syndrome, reactive depressive symptoms to the disease and negative symptoms for chronic psychotic process. Finally diagnosed with paranoid schizophrenia and is included in the program of first psychotic episodes.Today the productive symptoms disappeared and remain negative though with less intensity achieving an improvement in overall activity.ConclusionsConsumption of toxic influences the development of a chronic psychotic process that may appear years later, becoming a etiological and maintainer factor, not only if its consumption continue, but other effects that occur long term amotivational syndrome and worsening prognosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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