Electroconvulsive Therapy and Depression with Psychotic Symptoms: a Case Report

2011 ◽  
Vol 26 (S2) ◽  
pp. 1136-1136
Author(s):  
A. Castillo ◽  
M. Lloret ◽  
M. Harto ◽  
A. Tatay ◽  
C. Almonacid ◽  
...  
Keyword(s):  
Major Depression ◽  
Electroconvulsive Therapy ◽  
Bipolar Affective Disorder ◽  
Manic Episode ◽  
Antipsychotic Agents ◽  
Pharmacological Therapy ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Psychotic Features ◽  
Depressive Episodes

IntroductionPsychotic symptoms in depression are indicators of severity and poor prognosis. It usually requires psychopharmacotherapy with antidepressants and antipsychotic agents and it may even require electroconvulsive therapy (ECT).Aims, methodologyTo review the indications of ECT in major depression through the study of a clinical case of a patient admitted in an indoor psychiatric unit.ResultsA 64-year-old woman diagnosed as bipolar affective disorder 20 years ago. Her first manic episode required hospitalization. Afterwards, she remained clinically stable for 18 years with pharmacotherapy with lithium. Lately she was admitted due to a major depressive episode with psychotic features (injury delusions, ruin and catastrophe). Antidepressant and antipsychotic treatment was added, improving her symptoms. However, she had to be readmitted two months later with severe psychotic symptoms that did not improve with pharmacological treatment. ECT was added to her treatment. She improved after a few sessions. During the last years, she has presented depressive episodes with psychotic symptoms at least once a year, and all of them have required ECT.ConclusionsECT is an alternative to pharmacological therapy in depression with psychotic symptoms in patients with no response to drugs. According to studies and clinical practice, ETC has been effective as we see in this case. Therefore, ECT is a technique to consider in major depression, not only in patients who do not respond to drug therapy but also in those who do not tolerate psychopharmacological, who suffer from severe or psychotic symptoms, suicide thoughts or those, psychomotor agitation or stupor.

Neurodevelopmental antecedents of early-onset bipolar affective disorder

1999 ◽  
Vol 174 (2) ◽  
pp. 121-127 ◽  
Author(s):  
Engilbert Sigurdsson ◽  
Eric Fombonne ◽  
Kapil Sayal ◽  
Stuart Checkley
Keyword(s):  
Affective Disorder ◽  
Motor Development ◽  
Early Onset ◽  
Bipolar Affective Disorder ◽  
Manic Episode ◽  
Unipolar Depression ◽  
Psychotic Symptoms ◽  
Affective Symptoms ◽  
Icd 10 ◽  
Psychotic Features

BackgroundDevelopmental impairments have been identified as a risk factor for early-onset schizophrenia. Affective symptoms are more common in children and adolescents with disordered neurodevelopment than in healthy controls.AimsTo test the hypothesis that severe early-onset mood disorders are associated with developmental antecedents.MethodWe retrospectively identified 38 adolescent cases (15 female, 23 male; mean age 14.4 years, range 11–18) who met ICD–10 Research Diagnostic Criteria for a manic episode, bipolar affective disorder or psychotic depression, and 41 controls (25 female, 16 male, mean age 14.2 years, range 11–18) with depression but without psychotic features.ResultsCases were significantly more likely to have experienced delayed language, social or motor development (OR 5.5, 95% CI=1.4–21.6, P=0.01). in particular those who develop psychotic symptoms (OR 7.2, 95% CI=1.8–28.6, P=0.003).ConclusionsCompared to early-onset unipolar depression, neurodevelopmental antecedents are over-represented in early-onset bipolar disorder. The validity of this finding was supported by contemporaneous IQ scores that are not subject to the same potential biases as case-note ratings.

Fenetyline as possible treatment in non-responder depressive patients

1990 ◽  
Vol 5 (1) ◽  
pp. 29-30
Author(s):  
F Lang ◽  
J Pellet ◽  
B Estour
Keyword(s):  
Major Depression ◽  
Sleep Deprivation ◽  
Therapeutic Response ◽  
Manic Episode ◽  
Endogenous Depression ◽  
Recurrent Depression ◽  
Different Types ◽  
Depressive Episodes ◽  
Depressive Patients

SummaryThe authors report the case of a 45-yr-old male who presented from 1979 to 1986 with several severe depressive episodes. The patient fulfilled Feighner criteria for major depression, Newcastle criteria for endogenous depression: the depressive episodes were all classified as severe recurrent depression without melancholia according to DSM III. The patient was resistant to different types of treatment (ECT, tricyclic and MAOI drugs, lithium, sleep deprivation). With a treatment of 10 cg/day of fenetyline, reduced to 5 cg/day after 6 months, (atypical manic episode), the patient improved considerably for 20 rnonths. The therapeutic response decreased after this period but after a month of withdrawal, the patient again responded. The authors cannot explain the duration of this therapeutic response.

An Exploratory Retrospective Evaluation of Ropinirole-Associated Psychotic Symptoms in an Outpatient Population Treated for Restless Legs Syndrome or Parkinson's Disease

2009 ◽  
Vol 43 (9) ◽  
pp. 1426-1432 ◽  
Author(s):  
Steven C Stoner ◽  
Megan M Dahmen ◽  
Mignon Makos ◽  
Jessica W Lea ◽  
Lora J Carver ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dopamine Receptors ◽  
Restless Legs Syndrome ◽  
Dopamine Agonists ◽  
Dual Therapy ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Restless Legs ◽  
Psychotic Features

Background: Traditional treatment approaches for the management of restless legs syndrome (RLS) and Parkinson's disease (PD) include the use of medications that either directly or indirectly increase dopamine levels. In turn, a potential adverse event that could be expected is the development or exacerbation of psychiatric-related symptoms. Objective: To evaluate and describe the incidence of psychosis and associated behavioral features in patients taking ropinirole for RLS or PD. Methods: Patients were identified from a computerized database search of outpatients being treated with ropinirole for 1 of 2 medical conditions: PD or RLS. Data were collected in a retrospective manner from 95 patients who were tracked over the course of their therapy to determine whether psychosis or associated behavioral symptoms developed as a result and whether an intervention was needed to adjust ropinirole dosing or if additional medications had to be added to control features associated with psychosis. Results: A total of 284 patients being treated for RLS or PD were identified; of this group, 95 patients were identified as being treated for PD or RLS with ropinirole. Of the 95 patients being treated with ropinirole, 13 developed psychotic features that required therapeutic intervention with either the use of an antipsychotic or dose adjustment of ropinirole. PD patients included in this study were numerically more likely to develop psychotic features compared with RLS patients; however, the difference was not statistically significant (p = 0.122). The results do suggest that this risk is increased when ropinirole is used as part of a dual therapy approach with dopamine agonists in the treatment of either PD or RLS (p = 0.003). Discussion: Dopamine agonists have long been used as preferred treatment in the management of PD and RLS. When treating either PD or RLS in the psychiatric population, the concern arises that increased activity at dopamine receptors may induce or exacerbate psychiatric features. A potential clinical concern with the use of ropinirole is the potential for patients to develop psychiatric features, although there are few data available to demonstrate whether stimulation of targeted individual dopamine receptors is linked to the development or exacerbation of psychotic features. It is also undetermined whether concurrent antipsychotic treatment provides any protective benefit against psychosis, especially in patients already being treated for psychotic symptoms. Conclusions: Our findings suggest that ropinirole may play a role in inducing or exacerbating psychosis and its associated features, although a number of confounding variables prevent the determination of a clear association and suggest that further investigation is warranted in controlled clinical trials.

Bipolar illness

2013 ◽  
pp. 301-350
Keyword(s):  
Affective Disorder ◽  
Historical Perspective ◽  
Bipolar Affective Disorder ◽  
Manic Episode ◽  
Spectrum Disorder ◽  
Bipolar Illness ◽  
Clinical Notes ◽  
Bipolar Spectrum Disorder ◽  
Hypomanic Episode ◽  
Depressive Episodes

Introduction Historical perspective Mania/manic episode Hypomania/hypomanic episode Bipolar spectrum disorder Bipolar (affective) disorder 1: classification Bipolar (affective) disorder 2: clinical notes Bipolar (affective) disorder 3: aetiology Bipolar (affective) disorder 4: management principles Other issues affecting management decisions Treatment of acute manic episodes Treatment of depressive episodes...

Risk of bipolar disorder and psychotic features in patients initially hospitalised with severe depression

2014 ◽  
Vol 27 (2) ◽  
pp. 113-118 ◽  
Author(s):  
Kimiya Nakamura ◽  
Junichi Iga ◽  
Naoki Matsumoto ◽  
Tetsuro Ohmori
Keyword(s):  
Bipolar Disorder ◽  
Severe Depression ◽  
Psychotic Symptoms ◽  
Primary Disorder ◽  
Icd 10 ◽  
History Of ◽  
Physical Diseases ◽  
The Stability ◽  
Psychotic Features ◽  
Depressive Episodes

ObjectiveSevere depression may be a risk factor for diagnostic conversion into bipolar disorder (BD), and psychotic depression (PD) has been consistently associated with BD. The aims of the present study were to investigate the stability of the diagnosis of severe depression and the differences between PD and non-psychotic severe depression (non-PD), as well as to assess the effectiveness of electroconvulsive therapy (ECT).MethodsPatients who were hospitalised for severe depression (diagnosed according to ICD-10) both with and without psychotic symptoms (n=89; mean age=55.6 years, SD=13.9) from 2001 to 2010 were retrospectively assessed.ResultsBy the 75th month of follow-up assessments, 11(12.4%) patients had developed BD. Among these 11 converters, nine had developed BD within 1 year after admission. Only sub-threshold hypomanic symptoms were significantly related to developing BD. The number of depressive episodes and history of physical diseases were significantly increased in non-PD compared with PD patients, whereas ECT was significantly increased in PD compared with non-PD patients. There was a significant association between length of stay at the hospital and the number of days between admission and ECT.ConclusionSub-threshold hypomanic symptoms may represent a prodrome of BD or an indicator of an already manifest phenotype, especially in older patients, which suggests cautious use of antidepressants. In severe depression, non-PD may often occur secondary to physical diseases and patients may experience increased recurrences compared with PD patients, which may be a more ‘primary’ disorder and often requires ECT treatments. ECT is effective for severe depression regardless of the presence of any psychotic feature; the earlier ECT is introduced, the better the expected treatment outcome.

Eighteen-year patient observation with very early onset of bipolar disorder

2020 ◽  
Vol 35 (3-4) ◽  
pp. 201-209
Author(s):  
Agnieszka Słopień
Keyword(s):  
Affective Disorders ◽  
Bipolar Affective Disorder ◽  
Lithium Carbonate ◽  
Moderate Intensity ◽  
Psychotic Symptoms ◽  
Rapid Cycling ◽  
Pubertal Onset ◽  
Developmental Age ◽  
Bipolar Affective Disorders ◽  
Depressive Episodes

A clinical picture of bipolar affective disorders in children and adolescents is variable and dependent on the specificity of developmental age. From diagnostic and therapeutic point, especially difficult are cases with the pre-pubertal onset. In the article, a case report of 18-year observation of male patient with the onset of bipolar affective disorder at 11 years of age is presented. This very early pre-pubertal onset of the illness was manifested with rapid cycling, depressive episode with psychotic symptoms and the classic symptoms of mania. The use of lithium carbonate appeared effective and safe. Lithium was used for two years in combination with valproates, and in following years as monotherapy. In recent two years, due to depressive episodes of moderate intensity, the patients also received fluoxetine on periodic basis. No adverse effects of the treatment were observed.

Antipsychotic and anticholinergic drugs

2012 ◽  
pp. 1208-1231
Author(s):  
Herbert Y. Meltzer ◽  
William V. Bobo
Keyword(s):  
Atypical Antipsychotic ◽  
Antipsychotic Drugs ◽  
Antipsychotic Agents ◽  
Psychotic Symptoms ◽  
Anticholinergic Drugs ◽  
Typical Antipsychotic ◽  
Drug Induced ◽  
Atypical Antipsychotic Drugs ◽  
Normal Limits ◽  
Psychotic Features

The discovery by Delay and Denicker in 1953 that chlorpromazine was highly effective in alleviating delusions, hallucinations, and disorganized thinking, was the seminal breakthrough in the treatment of schizophrenia, the first agent to produce sufficient relief of core psychotic symptoms to permit life outside of institutions for many patients with schizophrenia, and even a return to a semblance of function within normal limits. Chlorpromazine and the other related typical antipsychotic drugs which were introduced over the next 30 years have proven to be of immense benefit to vast numbers of people who experience psychotic symptoms as a component of a diverse group of neuropsychiatric and medical disorders, as well as drug-induced psychoses. These drugs have been invaluable in providing clues to the aetiology of schizophrenia and other forms of mental illness with psychotic features and as tools in understanding fundamental neural processes, especially those involving dopamine, a key neurotransmitter involved in psychosis. This class of drugs has now been supplanted by the so-called atypical antipsychotic drugs, of which clozapine is the prototype. This chapter will describe the various classes of antipsychotic agents, with emphasis on the atypical antipsychotic drugs, their benefits and adverse effects, recommendations for use in clinical practice, and mechanism of action. The drugs used to treat the extrapyramidal side-effects (EPS) produced mainly by the typical antipsychotic drugs are also considered.

Atypical onset of a manic episode in adolescence – case report

2017 ◽  
Vol 41 (S1) ◽  
pp. S441-S441
Author(s):  
A. Isac ◽  
P. Bianca
Keyword(s):  
Valproic Acid ◽  
Clinical Practice ◽  
Complete Remission ◽  
Antipsychotic Medication ◽  
Clinical Picture ◽  
Manic Episode ◽  
Psychotic Symptoms ◽  
Psychotic Episode ◽  
Antipsychotic Treatment ◽  
Affective Symptoms

IntroductionThe clinical practice and available literature attest the presence of affective symptoms in psychosis and affective disorders with psychotic elements, allowing their conceptualization as entities of the same nosologic spectrum.ObjectiveThe description of a clinical picture that is part of the aforementioned pathology, installed under a treatment that has indication in the spectrum, which leads to supporting different pathophysiological mechanisms of those pathologies.AimPresentation of an atypical onset of a manic episode in adolescence.MethodAt the age of 14, a male adolescent had an acute psychotic episode, in complete remission after three months of treatment with risperidone. The antipsychotic treatment continued for seven months, when the adolescent had a decompensation consisting in a manic episode.ResultsConsidering the mode of onset of the manic episode, we have assumed a lack of compliance with the antipsychotic medication. The mother denies this possibility. We have continued the treatment with risperidone, which had no effect over the manic clinical picture, and we added valproic acid, failing to alleviate the symptoms. The clinical picture improved, with complete remission, under treatment with aripiprazole and valproic acid. After a month in which he refused to take the medication, the patient had another decompensation in the form of a manic episode with psychotic symptoms. This time we have decided to start long-acting injectable antipsychotic medication.ConclusionThrough this case study, the authors wish to bring into notice the surprises that the clinical practice still offers and the necessity to research the underlining pathophysiological aspects of the disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

First manic episode in a patient with a frontal meningioma

2016 ◽  
Vol 33 (S1) ◽  
pp. S339-S340
Author(s):  
M. Queirós ◽  
J. Caseiro
Keyword(s):  
Psychiatric Symptoms ◽  
Medical Condition ◽  
Benign Lesion ◽  
Brain Mri ◽  
Manic Episode ◽  
Major Depressive ◽  
Pubmed Database ◽  
Psychotic Features ◽  
Major Depressive Episodes ◽  
Depressive Episodes

IntroductionPsychiatric symptoms are common among brain tumor patients. Meningiomas are the most common benign brain tumors accounting for 13 to 26% of all intracranial tumors and might present exclusively with psychiatric symptoms. To diagnose a manic episode according to DSM-5 criteria the episode must not be attributable to the physiological effects of a substance or to another medical condition.Objectives/aimsDescribe a case of first manic episode with a frontal meningioma along with a brief review of available literature.MethodsThe case we report is based on information collected from interviews with the patient and the family members as well as from the clinical files. The literature review was performed using the PubMed database.ResultsWe describe the case of a 58-year-old woman presenting with symptoms of a first manic episode with psychotic features. There were no previous hypomanic or major depressive episodes. In order to exclude organic causes a brain CT scan was performed that revealed a possible frontal lesion. A brain MRI confirmed the presence of a frontal meningioma with an approximate diameter of 1.4 cm.ConclusionsThe majority of the cases described in the literature refer to large tumors presenting with major depressive symptoms. Given the absence of similar cases in the literature, it seems unlikely that such a small benign lesion may cause a manic episode with psychotic features. Nevertheless, we cannot exclude that possibility.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Early and late effects of electroconvulsive therapy associated with different temporal lobe structures

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Shimpei Yamasaki ◽  
Toshihiko Aso ◽  
Jun Miyata ◽  
Genichi Sugihara ◽  
Masaaki Hazama ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Electroconvulsive Therapy ◽  
Gray Matter Volume ◽  
Psychotic Symptoms ◽  
Therapeutic Effects ◽  
Voxel Based Morphometry ◽  
Major Depressive ◽  
Antidepressant Effects ◽  
Left Hippocampus ◽  
Psychotic Features

Abstract Recent studies examining electroconvulsive therapy (ECT) have reported that early sessions can induce rapid antidepressant and antipsychotic effects, and the early termination of ECT was reported to increase the risk of relapse. We hypothesized that different neural mechanisms associated with the therapeutic effects of ECT may be involved in the different responses observed during the early and late periods of ECT treatment. We investigated whether these antidepressant and antipsychotic effects were associated with temporally and spatially different regional gray matter volume (GMV) changes during ECT. Fourteen patients with major depressive disorder, with or without psychotic features, underwent 3-Tesla structural magnetic resonance imaging scans before (time point [Tp] 1), after the fifth or sixth ECT session (Tp2), and after ECT completion (Tp3). We investigated the regions in which GMV changed between Tp1 and Tp2, Tp2 and Tp3, and Tp1 and Tp3 using voxel-based morphometry. In addition, we investigated the association between regional GMV changes and improvement in depressive or psychotic symptoms. GMV increase in the left superior and inferior temporal gyrus during Tp1–Tp2 was associated with improvement in psychotic symptoms (P < 0.025). GMV increase in the left hippocampus was associated with improvement of depressive symptoms in Tp2–Tp3 (P < 0.05). Our findings suggest that different temporal lobe structures are associated with early antipsychotic and late antidepressant effects of ECT.

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