scholarly journals 319 - Challenges in the diagnosis and treatment of dementia in schizophrenic patients: on the behalf of a clinical case

2020 ◽  
Vol 32 (S1) ◽  
pp. 77-77
Author(s):  
Carolina Ribeiro Machado ◽  
Bárbara Almeida ◽  
Cristina Fragoeiro ◽  
Margarida Passos
Keyword(s):  
Clinical Case ◽  
Daily Activities ◽  
Antipsychotic Treatment ◽  
Psychomotor Slowing ◽  
Alzheimer Dementia ◽  
Spatial Disorientation ◽  
Mesh Terms ◽  
Abnormal Gait ◽  
Pubmed Search ◽  
Schizophrenic Patients

Studies have been showing that schizophrenia is significantly associated with the risk of all-cause dementia. The neurobiological mechanisms underlying this association are not clarified, as well as, the role of antipsychotics mediating the risk of dementia.The main aim of this work is, through the presentation of a clinical case, to show the evolution from symptoms of schizophrenia to dementia. The second aim is to present the challenges in the diagnosis and management of dementia in schizophrenic patients.Along with the description of the clinical case we present a brief summary of a Pubmed search with the Mesh terms “schizophrenia” and “risk” and “dementia”. We selected clinical trials and review articles published in the last 5 years. From a total of 132 articles, we selected those who matched better our aims.The patient is a 66-year-old man with a diagnosis of schizophrenia since the age of 40. In 2017 he began to develop episodes of temporal and spatial disorientation, followed by difficulties in naming and eventually functional impairment for daily activities. The initial mini mental test quoted 26/30, halving in less than two years.The lumbar puncture revealed a Tau/Amyloid beta42 ratio compatible with Alzheimer dementia. Since language was clearly the first domain affected, it was diagnosed a logopenic variant of Alzheimer dementia.We associated to the antipsychotic treatment galantamine 10mg and then raised it to 16mg. The loss of language was progressive, and the patient started to show psychomotor slowing and abnormal gait. We reduced paliperidone from 75mg/ml 50mg/ml but after two years of functional deterioration and apathy we eventually stopped the antipsychotic.In the last six months the patient has been stable with galantamine 16mg, memantine 20mg, although dependent for daily activities.Whether schizophrenia independently increases dementia incidence, or whether this correlation is confounded by traditional dementia predispositions (cerebrovascular disease, substance abuse and others) is unclear as studies have shown inconsistent results. On the other side, the cumulative use of antipsychotics for schizophrenia patients was related to cognitive decline in an observational follow-up study.Further studies should explore whether treating schizophrenia is a potentially modifiable risk factor for dementia.

scholarly journals 416 - Risk of Mortality Associated with Antipsychotics in Alzheimer's Disease

2020 ◽  
Vol 32 (S1) ◽  
pp. 132-132
Author(s):  
Liliana P. Ferreira ◽  
Núria Santos ◽  
Nuno Fernandes ◽  
Carla Ferreira
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Adverse Events ◽  
Mortality Risk ◽  
Antipsychotic Treatment ◽  
Serious Adverse Events ◽  
Risk Of Death ◽  
Mesh Terms ◽  
Risk Of Mortality ◽  
Increased Risk

Objectives: Alzheimer's disease (AD) is the most common cause of dementia and it is associated with increased mortality. The use of antipsychotics is common among the elderly, especially in those with dementia. Evidence suggests an increased risk of mortality associated with antipsychotic use. Despite the short-term benefit of antipsychotic treatment to reduce the behavioral and psychological symptoms of dementia, it increases the risk of mortality in patients with AD. Our aim is to discuss the findings from the literature about risk of mortality associated with the use of antipsychotics in AD.Methods: We searched Internet databases indexed at MEDLINE using following MeSH terms: "Antipsychotic Agents" AND "Alzheimer Disease" OR "Dementia" AND "Mortality" and selected articles published in the last 5 years.Results: Antipsychotics are widely used in the pharmacological treatment of agitation and aggression in elderly patients with AD, but their benefit is limited. Serious adverse events associated with antipsychotics include increased risk of death. The risk of mortality is associated with both typical and atypical antipsychotics. Antipsychotic polypharmacy is associated with a higher mortality risk than monotherapy and should be avoided. The mortality risk increases after the first few days of treatment, gradually reducing but continues to increase after two years of treatment. Haloperidol is associated with a higher mortality risk and quetiapine with a lower risk than risperidone.Conclusions: If the use of antipsychotics is considered necessary, the lowest effective dose should be chosen and the duration should be limited because the mortality risk remains high with long-term use. The risk / benefit should be considered when choosing the antipsychotic. Further studies on the efficacy and risk of adverse events with antipsychotics are needed for a better choice of treatment and adequate monitoring with risk reduction.

scholarly journals Intensity of Task-Specific Training for Functional Ability Post-stroke: Protocol for a Systematic Review

2021 ◽  
Author(s):  
Rabiu Ibrahim ◽  
Isa Usman Lawal ◽  
Conran Joseph
Keyword(s):  
Systematic Review ◽  
Literature Search ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Specific Training ◽  
Medical Subject Headings ◽  
Mesh Terms ◽  
Pubmed Search ◽  
Evidence Database

Abstract Background This study aimed to describe and present detailed protocol of a systematic review aimed at determining available research evidence regarding the intensity, and frequency of task-specific training ( TST ) that can best result in improved motor function and mobility outcomes in both upper and lower extremities in acute, sub-acute and chronic stroke survivors. Methods Literature search strategies were developed using Medical Subject Headings (MeSH) terms and text key words related to stroke rehabilitation and the use of TST to search for relevant randomized controlled trials (RCTs). The Cochrane Central Register of Controlled Trials, MEDLINE (PubMed search engine), Excerpta Medica dataBASE (EMBASE), Physiotherapy Evidence Database (PEDro), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar were searched for eligible articles published from inception to date. Two reviewers independently screened the titles, selected appropriate abstract/studies and extracted relevant data as yielded by the search based on the study inclusion criteria. Assessment of the study risk of bias and quality of included studies were appraised using the Cochrane’s tool for assessing risk of bias or other appropriate tools. Discussion This paper presented the description of the systematic review methods, and it is expected to guide researchers in conducting systematic review in similar fields of research. Sources of literature search terms and reviewers have been determined. Systematic review registration The study protocol has been registered with PROSPERO (130991)

scholarly journals S206. ARIPIPRAZOLE LONG-ACTING INJECTABLE IN SCHIZOPHRENIA DURING PREGNANCY: A CASE REPORT

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S117-S117
Author(s):  
Eva Sole ◽  
Juan Ignacio Duran ◽  
Sara Lera ◽  
Anna Torres ◽  
Susana Andres ◽  
...  
Keyword(s):  
Case Report ◽  
Mental Disorder ◽  
Clinical Case ◽  
Psychotic Disorders ◽  
Hospital Admissions ◽  
Treatment Compliance ◽  
Antipsychotic Treatment ◽  
Pregnancy And Postpartum ◽  
Long Acting ◽  
Psychiatric Complications

Abstract Background Long-acting injectable (LAI) antipsychotics provide some advantages in treatment compliance of psychotic disorders. However, information about their effects during pregnancy is still very limited. We expose a clinical case of aripiprazole LAI use in a pregnant woman diagnosed of schizophrenia. Methods A non-systematic review using Pubmed was conducted using the following terms: schizophrenia, pregnancy, aripiprazole and aripiprazole LAI. A clinical record review was performed for the clinical case report. Results We report the case of a 30-year-old woman diagnosed of schizophrenia. She required several hospital admissions in the past because of the mental disorder and the lack of treatment adherence, what was the consequence of having no insight of illness and her pregnancy desires. She was initially treated with risperidone, suffering from some adverse effects like prolactine elevation and amenorrhea. In the last hospital admission, she started treatment with aripiprazol 20mg, having a good tolerability and being finally changed into aripiprazole LAI 400mg/28days. No incidences were reported and stability was achieved. After five months, she became pregnant and started being followed up in the Perinatal Mental Health Unit that belongs to the same hospital. The severity of the mental disorder and her stability at that moment made psychiatrists; obstetricians and patient decide to keep the antipsychotic treatment with subsequent appointments. The goal was to supervise psychopathology and blood tests during pregnancy. Prolactine was in physiologic levels and there were no obstetric complications. She finally delivered at 41 gestational weeks to a 3465g baby girl (Apgar 1’: 9 Apgar 5’: 10). No neonatal complications were reported. The Stafford interview was also administered in order to explore her social, obstetric and psychological background as well as possible psychiatric complications due to pregnancy and puerperium. No psychiatric complications were reported. Postpartum Bounding Questionnaire was also administered. No bounding disorder was detected. Discussion Pregnancy and postpartum are periods that carry a high risk of illness onset or recurrence in women with severe mental disorders, such as schizophrenia. Having a good control of the symptoms may prevent from risks to both patient and child, due to the important influence that exists on the development of the baby and the mother-infant relationship.

scholarly journals Metabolic Issues in Schizophrenic Patients Receiving Antipsychotic Treatment

2014 ◽  
Vol 29 (2) ◽  
pp. 196-201 ◽  
Author(s):  
Aditi Gupta ◽  
Gora Dadheech ◽  
Dharamveer Yadav ◽  
Praveen Sharma ◽  
Shiv Gautam
Keyword(s):  
Antipsychotic Treatment ◽  
Schizophrenic Patients

Antipsychotic injectable treatment in patients with involuntary ambulatory treatment

2011 ◽  
Vol 26 (S2) ◽  
pp. 1230-1230
Author(s):  
L. Borreda Belda ◽  
L. Borreda ◽  
R. Maravall ◽  
J.F. Perez ◽  
M. Grau ◽  
...  
Keyword(s):  
Oral Treatment ◽  
Demographic Variables ◽  
Antipsychotic Treatment ◽  
Adherence To Treatment ◽  
Ambulatory Treatment ◽  
Injectable Treatment ◽  
Psychiatric Outpatient Clinic ◽  
Schizophrenic Patients ◽  
Long Acting ◽  
Seriously Ill Patients

IntroductionInvoluntary Ambulatory Treatment (IAT) is a judicial measure existing in Spain. Its aim is to ensure the adherence to treatment of seriously ill patients, with poor insight and repeated hospitalization. This is done by means of the regular and involuntary administration of antipsychotic intramuscular medication.ObjectivesTo assess the treatment used in patients undergoing IAT in a local clinic, to assess the type of medicaments and their dosage and to verify adherence to treatment and evolution.Material and methodA revision was made of the clinical backgrounds of all the patients of a psychiatric outpatient clinic who have been submitted to IAT (n = 37). A note was made of socio-demographic variables as well as psychiatric diagnoses according to DSM-IV-TR criteria and the number of hospitalizations and treatments used.ResultsAll but one patient had been hospitalized and average of 3.53 times before IAT. Since undergoing IAT only 6 patients have been admitted (16%). Four of them relapsed having abandoned treatment.In seven cases (19%) the patients gained insight and the antipsychotic treatment was changed from injectable to oral treatment at the patients’ request. In these cases IAT was ceased.The antipsychotic prescribed in 59% of the cases was Long-Acting Injectable Risperidone. This percentage was higher in non- schizophrenic patients (84%).ConclusionsIn our environment IAT could be an effective tool for severe patients with nil insight, since it can bring about an improvement in treatment adherence and evolution, as well as insight.

Cannabis use and age of diagnosis of schizophrenia

2009 ◽  
Vol 24 (5) ◽  
pp. 282-286 ◽  
Author(s):  
Gisela Sugranyes ◽  
Itziar Flamarique ◽  
Eduard Parellada ◽  
Immaculada Baeza ◽  
Javier Goti ◽  
...  
Keyword(s):  
Age Of Onset ◽  
Peak Frequency ◽  
Cannabis Use ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Episode Psychosis ◽  
Schizophrenic Patients ◽  
Age Of Diagnosis ◽  
History Of ◽  
Post Hoc

AbstractBackground and objectivesObservational studies have reported earlier onset of psychosis in schizophrenic patients with a history of cannabis use. Earlier age of onset of schizophrenia has been associated with a poorer outcome. We aimed to examine whether cannabis use determined an earlier onset of schizophrenia in a sample of first episode patients, in an area with one of Europe's highest rates of cannabis use.Methods116 subjects with first episode psychosis and subsequent diagnosis of schizophrenia (after a 12-month follow-up) were included Age at first antipsychotic treatment (A1T) was used as proxy for age of psychosis onset, and acted as dependent variable for the statistical analysis. Cannabis use was evaluated retrospectively, and divided into three groups according to peak frequency (never, sporadic/frequent, daily).Results46 (39.7%) subjects had never used cannabis, 23 (19.9%) had done so sporadically/frequently, and 47 (40.5%) daily. A1T differed between the three groups (mean, in years and [SD]: 27.0 [4.94]; 25.7 [4.44] and 24.5 [4.36]; p = 0.033) and diminished as cannabis use increased (linear tendency; p = 0.009). Post-hoc analysis showed that cannabis use (irrespective of frequency) was significantly associated with decrease in A1T (p = 0.033), as shown by the first contrast [1 −1/2 −1/2]. Post-hoc contrast showed that cannabis users had a significantly lower age of onset of psychosis (mean decrease, in years: 1.93; CI (confidence interval) 95%: 0.17–3.70; p = 0.033).ConclusionsCannabis use was significantly associated with a decrease in age of onset of schizophrenia. Age of onset of the disease correlated with frequency of cannabis use.

P.3.c.027 Metabolic syndrome, cardiovascular risk and antipsychotic treatment in schizophrenic patients

2008 ◽  
Vol 18 ◽  
pp. S419
Author(s):  
J. Castaño ◽  
B. Diaz ◽  
C. Garnier ◽  
R. Sanchis ◽  
A. Horta ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Cardiovascular Risk ◽  
Antipsychotic Treatment ◽  
Schizophrenic Patients

scholarly journals Noncholesteatomatous Cyst of the Tympanic Membrane: A Nonpublished Entity?

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Rafael Ramírez-Camacho ◽  
Isabel Salas ◽  
Almudena Trinidad ◽  
Ithzel Maria Villarreal
Keyword(s):  
Hearing Loss ◽  
Physical Examination ◽  
Tympanic Membrane ◽  
Clinical Case ◽  
Pubmed Search ◽  
The Right ◽  
Positive Results ◽  
Inferior Quadrant ◽  
Serous Cyst

Introduction. The presence of a serous cyst in the tympanic membrane implies the description of a new or unpublished entity based on our knowledge whose origin may be very unlikely explained on actual embryologic and anatomic background.Clinical Case. We present a case of a 45-year-old woman with progressing right hearing loss. Physical examination revealed a whitish, round-shaped malformation in the posterior-inferior quadrant of the right tympanic membrane. The cyst was removed with a transcanal tympanoplasty.Discussion. A thorough PubMed search that involved the terms tympanic membrane gland, epithelial inclusion cysts, mucous-secreting cyst, and tympanic cyst has shown no positive results. The first description of an unknown entity, such as a tympanic membrane serous cyst, may be the key for clinicians to start paying attention to patients who suffer from similar pathologies and may pass unnoticed because of their rarity or peculiarity.

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