Case Report: Three Years of Refractory Atypical Depression Successfully Treated With“Old School” Moclobemide (maoi-r)

2017 ◽  
Vol 41 (S1) ◽  
pp. s239-s239
Author(s):  
S. Latorre ◽  
I. Moreno ◽  
M.J. Gordillo
Keyword(s):  
Rating Scale ◽  
Manic Episode ◽  
Psychotic Symptoms ◽  
Specific Response ◽  
Good Tolerability ◽  
Atypical Depression ◽  
Competing Interest ◽  
Clinical Description ◽  
One Year ◽  
Amino Oxidase

BackgroundAtypical depression is linked to bipolarity and specific response to mono amino oxidase inhibitors (MAOI), treatments not commonly used due to their complex handling. We describe a successfully treated case.MethodologyClinical description. Depression severity is assessed with Montgomery Asberg depression rating scale (MADRS).Clinical caseFemale, 54-year-old. Major depression, since 2011, refractory to venlafaxine/aripiprazol and escitalopram 20 mg/day. Manic episode with psychotic symptoms after potentiation with duloxetine. Diagnose of schizoaffective disorder was made, treated with aripiprazol 10 mg/day, with established chronical depressive symptoms, despite addition of valproate and venlafaxine, and partial response to pramipexole up to 1 mg/day.– Decision of cleaning up aripiprazol during 8 days and switch to moclobemide monotherapy was made due to atypical features. Baseline MADRS: 31. At week 2, there is change in mood, expression, psychomotor features and speech formal and content alterations. At week 4, activity increases, and biorythms normalize. At week 8 (with 600 mg/day increased dose), full response is obtained, including drive, and anxiety, with MADRS 12.– After one year of treatment, she has kept stability with no manic or psychotic symptoms emergence. Reduction in dose are linked to depression relapses. She still struggles with psychosocial recovery.– Tolerance has been good in all moment, except for headache crisis, not linked to high blood pressure or diet.ConclusionsMAOI still has a role in affective disorders treatment, given its effectiveness, unique mechanism of action and good tolerability. Targeted psychopharmacological and phenomenology knowledge can be the key to a recovery.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Treatment of drug-resistant schizoaffective disorder with aripiprazol depot off-label: A case report

2017 ◽  
Vol 41 (S1) ◽  
pp. s820-s820
Author(s):  
L. Niell Galmés ◽  
R.A. Baena Mures ◽  
Í. Alberdi Páramo ◽  
M.M. Tenorio Guadalupe ◽  
G. Montero Hernández ◽  
...  
Keyword(s):  
Schizoaffective Disorder ◽  
Rating Scale ◽  
Treatment Guidelines ◽  
Safety Data ◽  
Psychotic Symptoms ◽  
Good Tolerability ◽  
Off Label ◽  
Competing Interest ◽  
New Treatment ◽  
Higher Doses

IntroductionWe expose a woman diagnosed with schizoaffective disorder 2 years ago, before she received several diagnostics. She was admitted to the psychiatry unit with hyperactivity, pressured speech without taking an appropriate turn, flight-of-ideas, irritability, expansiveness, emotional liability, ideas of reference and insomnia without diurnal tiredness. In addition, she admitted having abandoned the medication one month ago. She was diagnosed with maniac episode with psychotic symptoms and the medication was reintroduced. After two weeks, no response was observed so we decided to introduce ability depot 600 mg/3 weeks.ObjectivesWe want to show that is possible the use of ability depot off-label in patients with a special difficulty in handling. Also, we want to show that higher doses are not dangerous and it's possible to study new treatment guidelines for ability depot.MethodsWe use the Positive and Negative Syndrome Scale (PANSS) pre (the day of the introduction) and post (at two weeks) treatment with aripiprazol depot; the Clinical Global Impression rating scale (CGI), also pre and post.ResultsWe have obtained a punctuation of 180 in PANSS the day of the introduction of the aripiprazol depot and 45 at two weeks. In addition, we obtained 6 in CGI the day of the introduction and 3 at two weeks.ConclusionsIn this case, aripiprazol depot has shown good tolerability and efficacy for the acute phase of schizoaffective disorder at higher doses than recommended in clinical guidelines. The efficacy and safety data are consistent with short-term, placebo-controlled studies of aripiprazol depot conducted in similar populations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychosis in adolescence: A prognosis or a diagnosis? Integrated treatment with psychodynamic peer support

2017 ◽  
Vol 41 (S1) ◽  
pp. S126-S127
Author(s):  
L. Ciampa ◽  
F. Gucci
Keyword(s):  
Peer Support ◽  
Social Relations ◽  
Intervention Strategy ◽  
Real Life ◽  
Integrated Treatment ◽  
Psychotic Symptoms ◽  
Psychodynamically Oriented ◽  
Rehabilitative Intervention ◽  
Competing Interest ◽  
One Year

IntroductionOur work comprises an integrated intervention strategy for the treatment of psychotic manifestations and functioning in adolescents which, following the theories of Laufer and Chan, questions the usefulness of the diagnosis ‘psychotic’ during adolescence. We apply an “open light treatment” (IPOLT), which includes psychodynamically oriented peer-support.ObjectivesTo build a new form of therapeutic alliance with peer-support based on shared real life experiences enabling adolescents to reintegrate within their environment and re-establish cognitive functioning which has become disorganised, aiding a gradual return of the cohesion of ego and self and in some cases, cessation of psychotic symptoms.MethodologyAn observational study of one year on a group of ten adolescents aged 17 to 20 in institutional and private settings with psychotic manifestations and functioning. The group were tested at the start and end of the study using WAIS-IV and MMPI-A.ResultsThe adolescents recruited showed a faster recovery of the cohesive processes of their fragmented ego as well as a quicker resumption of social relations. Our model provided an organising function and a flexible yet secure ‘container’ (Bion, 1988) for the young people's psychic structure. The tests showed a demonstrable improvement in their verbal comprehension, visual-spazial reasoning, fluid reasoning, working memory and processing speed.ConclusionsPsychotic manifestations occurring in adolescence may decrease with an immediate integrated and rehabilitative intervention, without need of an institutional psychiatric setting. In conclusion, we find that “psychosis” in adolescence is a prognosis and not a diagnosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Treatment Complexities of a Young Woman Suffering Psychosis and Pituitary Adenoma

2011 ◽  
Vol 2011 ◽  
pp. 1-4
Author(s):  
Maxine Sigman ◽  
Kate Drury
Keyword(s):  
Pituitary Adenoma ◽  
Young Woman ◽  
Interdisciplinary Team ◽  
Psychotic Symptoms ◽  
Team Approach ◽  
Pharmacological Management ◽  
Clinical Description ◽  
One Year

This paper is a clinical description of the presentation, therapy, and pharmacological management of a 28-year-old woman who had nine admissions to a psychiatry ward, the last four within one year. It became clear that the treatments, which the patient had received concurrently for ten years for a pituitary adenoma and for psychotic symptoms, were counteractive. The case highlights the importance of the role of prolactin in psychosis and of an interdisciplinary team approach when patients present with complex symptoms.

Manic episode associated with interferon alpha therapy: A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S332-S332 ◽  
Author(s):  
L. González ◽  
C. Gomis ◽  
V. Rodriguez ◽  
C. Gomez ◽  
E. tercelan ◽  
...  
Keyword(s):  
Malignant Melanoma ◽  
Interferon Alpha ◽  
Neuropsychiatric Symptoms ◽  
Manic Episode ◽  
Chronic Fatigue ◽  
Psychotic Symptoms ◽  
Entire Family ◽  
Urine Drug ◽  
Competing Interest ◽  
Urine Drug Test

Interferon alpha is a cytokine with antiviral and antineoplastic action, which is commonly used for treatment of Hepatitis C and B, malignant melanoma, Kaposi's sarcoma, kidney cancer and certain hematologic diseases. It is well-known some of its neuropsychiatric symptoms such as depressive symptoms, cognitive impairment, chronic fatigue, dysphoria and anxiety, but there are also other less common like mania, psychotic symptoms and suicide risk that have been reported. These symptoms interfere in the quality of life very significantly, which at the end can affect treatment adherence.We report a case of a 33-year-old man who was taken to the emergency department by his family referring nervousness, irritability, verbose, and insomnia during the last 5 days. The patient had not psychiatric history. He was diagnosed with a malignant melanoma stage III A a year ago which required to start interferon alpha treatment.Patient and family tell that symptoms began after forgetting last interferon dose. In the psychopathology exploration, we could observe mood lability, delusion ideas of prosecution, which includes his entire family and autorreferentiality. In the emergency room the blood test, urine drug test and CT were normal.During the admission, and in collaboration with the Oncology service, it was agreed the reintroduction and maintenance of interferon combined with olanzapine up to 30 mg/day and clonazepam up to 6 mg/day, which resulted in the resolution of symptoms in two weeks.Disclosure of interestThe authors have not supplied their declaration of competing interest.

“…I Just Wanted to Report Me, I Went Into the Subway Without Paying 9 Times…”

2016 ◽  
Vol 33 (S1) ◽  
pp. S528-S528
Author(s):  
M. Canseco Navarro ◽  
M.M. Machado Vera ◽  
A. Peña Serrano ◽  
S. Alonso Guitiérrez ◽  
F. Molina López ◽  
...  
Keyword(s):  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Tolerability Profile ◽  
Behavioral Disturbances ◽  
Good Tolerability ◽  
Grammatical Errors ◽  
Competing Interest ◽  
Progressive Scan ◽  
Reason For Admission ◽  
Objective Improvement

A clinical case is presented. The reason for admission was for behavioral disturbances and agitation piscomotriz episode in the street: she had gone to a library to “denounce” the police for entering the subway without paying several times. The patient was very distraught because she was heavily guarded (someone had tapped her phone, entered her house, changed objects place, she was chased down the street…). In the psychopathological examination revealed the sphere of language, her speech was fluid, with pressured speech, full of details, with loss of thread and highlighted the presence of neologisms and grammatical errors (changes of subject and predicate…) and changes some letters by others in the same word. She often used sayings incorrectly and, when you are exploring about this fact, objectively presenting alteration in abstract thinking. In addition, it presents self-references on television. The diagnostic impression was chronic psychotic process of years of evolution. In this case, it was decided to administer intramuscular antipsychotic treatment because she was not aware of the disease but presenting good tolerability profile because, otherwise, leave the track and also a good social functioning was sought. Currently, she continues in mental health, she has not reported new crisis and a progressive scan objective improvement in the organization of thought and speech, leaving the psychotic symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Depot aripiprazole as maintenance treatment in bipolar disorder: Report of a case

2016 ◽  
Vol 33 (S1) ◽  
pp. S332-S332
Author(s):  
C. Gómez Sánchez-Lafuente ◽  
R. Reina Gonzalez ◽  
A. De Severac Cano ◽  
I. Tilves Santiago ◽  
F. Moreno De Lara ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Maintenance Treatment ◽  
Oral Treatment ◽  
Manic Episode ◽  
Mood Stabilizers ◽  
Community Center ◽  
Psychotic Symptoms ◽  
Competing Interest ◽  
Long Acting

IntroductionRecently, depot aripiprazole was approved as a maintenance treatment for schizophrenia. However, long-acting antipsychotics has not been established efficacy in manic episode or maintenance treatment of bipolar disorder.AimsDescribe a clinical case of multiresistant bipolar disorder.MethodsThirty-nine years old male, diagnosed since 8 years ago with bipolar disorder, current episode manic with psychotic symptoms, admitted to Acute Psychiatrist Unit. It was his seventh internment. He was dysphoric, had insomnia, and showed many psychotic symptoms like grandiose delusions and delusions of reference. He thought he was a famous painter from nineteenth century.His disorder was refractory to mood stabilizers monotherapy and to many neuroleptic and, like olanzapine 30 mg/day, depot risperidone, zuclopenthixol, haloperidol, palmitate paliperidone, He was on treatment with lithium 1200 mg/day (lithemia 0.62 prior to admission) and oral aripiprazole 15 mg/day that he was not taking regularly. Poor compliance to oral treatment. No awareness of illness.Resultsduring the patient admission, we started long-acting aripiprazole 400 mg per 28–30 days. First 3 days he persisted dysphoric, hostile, and showing delusions of mind being read. From the fourth day, delusions disappeared and later he was calmer and more friendly, He was discharged 9 days later fully euthymic.For 6 months follow-up, the patient came once a month to community center for aripiprazole injection and he was taking lithium regularly. Last lithemia 0.65 mEQ/L.ConclusionLong-acting antipsychotics, like depot aripiprazole could be a useful alternative to oral medication, specially when there is no awareness of illness and there is low adherence to oral treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Study of the Sensitivity of the Organic Psychosyndrome After One Year of the Disease

2017 ◽  
Vol 41 (S1) ◽  
pp. S661-S661
Author(s):  
K. Paschalidis ◽  
P. Argitis ◽  
K. Gatsiou ◽  
C. Chatzidai ◽  
P.P. Dalli ◽  
...  
Keyword(s):  
Rating Scale ◽  
The Elderly ◽  
Psychiatric Clinic ◽  
Acute Confusional State ◽  
Long Run ◽  
Hospitalised Patients ◽  
Organic Psychosyndrome ◽  
Icd 10 ◽  
Competing Interest ◽  
One Year

IntroductionThe delirium of the elderly is defined as an acute confusional state, with variation during the day, characterized by impaired consciousness, orientation, memory, thinking, attention and behavior.PurposeThe purpose of this research is to investigate whether the organic psychosyndrome of the elderly is a valid indicator of mortality after one year.MaterialIt was used material from patients with organic psychosyndrome older than 60 years, who were hospitalized in pathological clinics of the Hospital of Corfu and was diagnosed by the linker portion of the psychiatric clinic.MethodologyThe patients diagnosed with organic psychosyndrome neither suffered from a psychiatric disorder psychotic type in the past, nor previously preceded anaesthesia in the context of physical disease. For the recognition and the criteria of ICD-10 to the exclusion of another psychiatric condition, it was used the delirium rating scale method.ResultsAccording to the analysis of the data, 8% of patients died during hospitalisation, in the first 3 months after diagnosis, the 28% of the initially hospitalised patients, in 6 months the 42%, while during the year the 48% of the initial total patients died and in the next 12 months only one death was reported.ConclusionsThe analysis of the survey results shows that while the instrument psychosyndrome could be considered as a poor diagnostic marker for the first 12 months, 48% mortality, in the long run it seems to lose its prognostic value with the mortality approaching the mortality index of the hellenic statistical authority for 2015 at ages 60+ (1.2%).Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychological Effect of Semi-permanent Tattooing Rehabilitation in Patients with Mastectomy in 12 Months Period

2017 ◽  
Vol 41 (S1) ◽  
pp. S669-S669
Author(s):  
P. Argitis ◽  
P. Platari ◽  
K. Gatsiou ◽  
C. Chatzidai ◽  
K. Paschalidis
Keyword(s):  
Quality Of Life ◽  
Body Image ◽  
Sexual Activity ◽  
Rating Scale ◽  
Cancer Type ◽  
Body Image Scale ◽  
Scale Scores ◽  
Competing Interest ◽  
One Year

IntroductionBreast cancer is the most common cancer type in Greek women as more than 4000 new cases are diagnosed every year. Seventy percent of those patents performs a type mastectomy. The breast has a societal and social connotation of femininity, motherhood, and sexuality.BackgroundSeveral studies support the existence of the relationship between psychological problems and mastectomy surgery. Body image and feminine self-concept also seems to influence quality of life of those women, considering the breast association of femininity, motherhood, and sexuality. During this study, we try to investigate how a non-psychiatric intervention might influence the mental state and the quality of life of those women.MaterialA clinical interview was performed in 53 women with partial or total mastectomy before 3 and 52 weeks after the rehabilitation with the method of semi-permanent tattooing.MethodsData were collected during the personal interviews, using Hamilton anxiety rating scale (Ham-A), body image scale and sexual activity questionnaire.ResultsModerate levels of anxiety were identified before the rehabilitation, associated with poor body image scale scores and sexual difficulties. Both Ham-A and body image score ameliorated after 3 weeks with unchanged sexual behaviour. One year after rehabilitation, anxiety scale score raises close to initial values, body image remains unchanged, comparing with the 3rd week interview and significant improvement noticed in sexual activity.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Evaluation of the factors interfering with drug treatment compliance among Brazilian patients with schizophrenia

2005 ◽  
Vol 27 (3) ◽  
pp. 178-184 ◽  
Author(s):  
Moacyr Alexandro Rosa ◽  
Marco Antônio Marcolin ◽  
Hélio Elkis
Keyword(s):  
Rating Scale ◽  
Treatment Compliance ◽  
Psychotic Symptoms ◽  
Strongly Correlated ◽  
Duration Of Treatment ◽  
Schizophrenic Patients ◽  
Treatment Noncompliance ◽  
Psychiatric Rating Scale ◽  
One Year ◽  
Schizophrenic Outpatients

BACKGROUND: Treatment noncompliance among schizophrenic patients is as high as 50%. In order to rate compliance and assess the most significant differences between compliant and noncompliant patients, a Brazilian population of schizophrenic outpatients was followed for one year. METHODS: Fifty outpatients were selected. Clinical interview, the Brief Psychiatric Rating Scale - Anchored version (BPRS-A) and an expanded version of the Rating of Medical Influences (ROMI) scale (used to rate patient attitudes toward compliance) were applied at baseline. The BPRS-A was used in the follow-up visits (approximately once a month). Missing two consecutive appointments without explanation or taking less than 75% of the medication (by written family report) was considered noncompliance. RESULTS: Noncompliance was 48% over one year. Patients in the noncompliant group presented initial worsening of psychotic symptoms (p< 0.05) and had been treated for a shorter length of time (p = 0.007). The ROMI scale showed that "perceived day-to-day benefit" was most strongly correlated with compliance, and feeling "distressed by side effects" was most strongly correlated with noncompliance. DISCUSSON: This study evaluates the frequency of noncompliance and the main reasons for complying in a population of schizophrenic outpatients. CONCLUSIONS: Severity of psychopathology was found to correlate with noncompliance (although not necessarily as its cause), as well as with duration of treatment. Noncompliance rates are high and must be taken into account in any treatment program.

Long acting antipsychotics treatment of schizophrenia: A 24-month prospective study on patient's attitude towards treatment

2017 ◽  
Vol 41 (S1) ◽  
pp. S188-S188
Author(s):  
E. Calderani ◽  
F. Pietrini ◽  
I. Burian ◽  
F. Chiarello ◽  
D. Dahlke ◽  
...  
Keyword(s):  
Rating Scale ◽  
Short Form ◽  
Concomitant Treatment ◽  
Young Mania ◽  
Attitude Inventory ◽  
Schizophrenic Patients ◽  
Competing Interest ◽  
One Year ◽  
Long Acting ◽  
The Impact

IntroductionLong-acting injectable (LAI) second-generation antipsychotics (SGAs) are considered an alternative to oral antipsychotics for schizophrenic patients with low adherence to therapy. However, it is still a matter of debate whether LAI-SGAs are able to significantly improve patient's attitudes towards treatment (ATT) [1].ObjectiveTo investigate the impact of LAI on ATT over 24 months.MethodsNineteen schizophrenic patients were switched from either oral olanzapine (11) or paliperidone (8) to the corresponding LAI. Patients were assessed at baseline (T0), after 6 (T1), 12 (T2) and 24 months (T3). Drug Attitude Inventory-10 (DAI-10) [2] was used to assess ATT. Young Mania Rating Scale (YMRS), Montgomery-Asberg Depression Rating Scale (MADRS), Positive and Negative Syndrome Scale (PANSS), and Short Form Health Survey (SF-36) were used for psychopathology evaluations.ResultsEleven patients reached T3. Eight patients were excluded (4 olanzapine, 4 paliperidone): 4 required a significant change in concomitant treatment, 4 a change of antipsychotic (metabolic comorbidity). No changes in psychopathology occurred between T2 and T3, some scales improved from baseline to T2. DAI-10 mean scores were improved after 12 months, thus not significantly, and were further improved at 24 months (P = .008 vs baseline).ConclusionsATT keeps improving after one year of LAI treatment, unrelated to clinical response.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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