scholarly journals 177 Management of Treatment-Resistant Schizophrenia With Clozapine Augmentation

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 102-102
Author(s):  
Pwint Phyu ◽  
Emelina Arocha ◽  
Juan D. Oms ◽  
Luxhman Gunaseelan ◽  
Golbon Foroughi ◽  
...  
Keyword(s):  
Physical Examination ◽  
Laboratory Tests ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Panic Attacks ◽  
Pharmacologic Therapy ◽  
Comorbid Conditions ◽  
Treatment Resistant ◽  
History Of ◽  
Funding Acknowledgements

AbstractA 44-year-old woman with a history of chronic schizoaffective disorder, epilepsy, social phobia, anxiety, and panic attacks presented with concern for “feeling anxious.” After a history, physical examination, and laboratory tests, the woman received a diagnosis of treatment-resistant schizophrenia. While clozapine is the standard therapy for schizophrenia, certain patients such as the woman in this case do not respond well to clozapine monotherapy, requiring clozapine to be augmented with other antipsychotics or antidepressants. This case outlines the unique challenges of managing patients with treatment-resistant schizophrenia, especially when they present with comorbid conditions such as epilepsy that can limit treatment options. A multipronged approach, including pharmacologic therapy as well as cognitive behavioral therapy, should also be considered.Funding AcknowledgementsNo funding.

Safety of a Clozapine Trial Following Quetiapine-Induced Leukopenia: A Case Report

2019 ◽  
Vol 14 (1) ◽  
pp. 80-83 ◽  
Author(s):  
Asma H. Almaghrebi
Keyword(s):  
Treatment Options ◽  
Young Female ◽  
Similar Reaction ◽  
Careful Monitoring ◽  
Treatment Resistant ◽  
Blood Cell Count ◽  
Antipsychotic Medications ◽  
Case Presentation ◽  
Clozapine Treatment ◽  
History Of

Background: The clozapine-derivative quetiapine has been shown in some cases to cause leukopenia and neutropenia. Case Presentation: We reported on a case of a young female diagnosed with treatment-resistant schizophrenia. After failed trials of three antipsychotic medications and despite a history of quetiapineinduced leukopenia, clozapine treatment was introduced due to the severity of the patient’s symptoms, the limited effective treatment options, and a lack of guidelines on this issue. Result: Over a ten-week period of clozapine treatment at 700 mg per day, the patient developed agranulocytosis. Her white blood cell count sharply dropped to 1.6 &#215; 10<sup>9</sup> L, and her neutrophils decreased to 0.1 &#215; 10<sup>9</sup> L. There had been no similar reaction to her previous medications (carbamazepine, risperidone, and haloperidol). Conclusion: The safety of clozapine in a patient who has previously experienced leukopenia and neutropenia with quetiapine requires further investigation. Increased attention should be paid to such cases. Careful monitoring and slow titration are advisable.

Consultation with the specialist

1992 ◽  
Vol 13 (7) ◽  
pp. 273-274
Author(s):  
Frederick H. Lovejoy
Keyword(s):  
Physical Examination ◽  
Case History ◽  
Laboratory Tests ◽  
Deep Inspiration ◽  
Deep Breathing ◽  
Logical Sequence ◽  
History Of ◽  
Difficult Challenge ◽  
Diagnostic Trial ◽  
Rapid Laboratory

Diagnosing poisoning by an unknown agent can be a difficult challenge. Five strategies of assessment may be used in logical sequence, however, to arrive at a diagnosis: (a) history, (b) physical examination, (c) rapid laboratory tests, (d) diagnostic trial, and (e) screening for toxins. This is illustrated by a case history, followed by discussion of a recommended approach and the utilization of these principles to arrive at a diagnosis in the case. Initial Case History A 41/2-year-old boy, with a history of onset of deep breathing following supper, is brought to your office by his mother. He had been alert and well all day, without fever, fully oriented, and without vomiting or diarrhea. He had been playing both in the house and garage in the morning and had spent the afternoon watching television. His temperature is 37.6°C, respiratory rate is 60 breaths per minute with deep inspiration and expiration, and pulse is 100 beats per minute and regular. He is without cyanosis. His pupils are midpoint, his lungs are clear, and his breath has no noticeable odor. What would you ask the mother in an effort to establish a diagnosis? History An unknown agent often can be suspected by history alone. The location of ingestion, if known, can offer clues.

scholarly journals Misdiagnosed Hypomanic Symptoms in Patients with Treatment-Resistant Major Depressive Disorder in Italy: Results from the Improve Study

2014 ◽  
Vol 10 (1) ◽  
pp. 42-47 ◽  
Author(s):  
Moro Maria Francesca ◽  
Lecca Maria Efisia ◽  
Ghillani M. Alessandra ◽  
Alacqua Marianna ◽  
Carta Mauro Giovanni
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Comorbid Conditions ◽  
Treatment Resistant ◽  
Major Depressive ◽  
Positive History ◽  
Bipolar Spectrum Disorder ◽  
Psychiatric Units ◽  
History Of ◽  
Depressive Episodes

Background: Undiagnosed and therefore inadequately treated hypomanic symptoms may be a leading cause of drug resistance in depression diagnosed as unipolar (major depressive disorder, MDD). The purpose of the IMPROVE study was to identify the rate of misdiagnoses in patients with treatment-resistant MDD by screening for the presence of previous hypomanic episodes, and to study the characteristics of those patients with a positive history of hypomania. Methods: Patients attending 29 psychiatric units throughout Italy with a diagnosis of MDD who were resistant to anti-depressant treatment were included in this multicentre, observational single visit study. The Hypomania Checklist 32 (HCL-32) was administered to detect underlying bipolarity. Results: Among the 466 enrolled patients, 256 (57.40%) were positive at screening for a previous hypomanic episode (HCL-32 ≥12), therefore suggesting a misdiagnosis. These patients scored higher than those with a negative history in both the “active/elated hypomania” (11.27±3.11 vs 3.57±3.05; P<0.0001) and “irritable/risk-taking hypomania” (2.87±2.03 vs 2.06±1.73; P<0.001) HCL-32 sub-scales. Patients with a positive history of hypomania were younger, had a higher number of previous depressive episodes and a higher frequency of comorbid conditions compared to those with a negative history. Conclusions: This study suggests that screening for hypomania in MDD-resistant patients facilitates identification of a notable proportion of undiagnosed cases of bipolar spectrum disorder. Patients with a positive history of hypomania at screening had a demographic/clinical bipolar-like profile that included young age, higher number of previous depressive episodes and higher frequency of comorbid conditions. They also had both higher active and irritable hypomania symptom scores.

scholarly journals Chronic Serotonergic Overstimulation Mimicking Panic Attacks in a Patient with Parkinson’s Disease Receiving Additional Antidepressant Treatment with Moclobemide

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Marc Praetner ◽  
Timo Schiele ◽  
Lukas Werle ◽  
Janina Kuffer ◽  
Sandra Nischwitz ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Case Report ◽  
Depressive Symptoms ◽  
Antidepressant Treatment ◽  
Treatment Options ◽  
Panic Attacks ◽  
Case Presentation ◽  
History Of ◽  
Serotonin Toxicity

Background. The pharmacological treatment options of Parkinson’s disease (PD) have considerably evolved during the last decades. However, therapeutic regimes are complicated due to individual differences in disease progression as well as the occurrence of complex nonmotor impairments such as mood and anxiety disorders. Antidepressants in particular are commonly prescribed for the treatment of depressive symptoms and anxiety in PD. Case Presentation. In this case report, we describe a case of a 62-year-old female patient with PD and history of depressive symptoms for which she had been treated with moclobemide concurrent with anti-Parkinson medications pramipexole, rasagiline, and L-DOPA+benserazide retard. An increase in the dosage of moclobemide 12 months prior to admission progressively led to serotonergic overstimulation and psychovegetative exacerbations mimicking the clinical picture of an anxiety spectrum disorder. After moclobemide and rasagiline were discontinued based on the hypothesis of serotonergic overstimulation, the patient’s psychovegetative symptoms subsided. Conclusions. The specific pharmacological regime in this case probably caused drug-drug interactions resulting in a plethora of psychovegetative symptoms. Likely due to the delayed onset of adverse effects, physicians had difficulties in determining the pharmacologically induced serotonin toxicity. This case report emphasizes the complexity of pharmacological treatments and the importance of drug-drug interaction awareness in the treatment of PD patients with complicating nonmotor dysfunctions such as depression.

scholarly journals MANUAL THERAPY AS AN ALTERNATIVE TREATMENT FOR PANIC ATTACKS

World Science ◽  
2019 ◽  
Vol 2 (8(48)) ◽  
pp. 21-28 ◽  
Author(s):  
Sergii Frank ◽  
Michael Frank ◽  
George Frank
Keyword(s):  
Panic Disorder ◽  
Cognitive Behavioral Therapy ◽  
Manual Therapy ◽  
Medical Practice ◽  
Alternative Treatment ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Panic Attacks ◽  
Treatment Resistant

In worldwide medical practice panic attacks are treated mainly by psychological methods and medication. Cognitive-behavioral therapy combined with selective serotonin reuptake inhibitors is considered to be the most effective method of their treatment. However, it has been proven that about a third of patients with panic attacks are treatment resistant. Such people continue experiencing panic attacks and various other symptoms of panic disorder even after receiving the aforementioned treatment. It is this group of patients who are being targeted by the proposed research – manual therapy as an alternative treatment for panic attacks.

The Medical Treatment of Obsessive-Compulsive Disorder and Anxiety

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S14) ◽  
pp. 37-46 ◽  
Author(s):  
Borwin Bandelow
Keyword(s):  
Anxiety Disorders ◽  
Obsessive Compulsive Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
First Line ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
History Of ◽  
Higher Doses

AbstractSelective serotonin reuptake inhibitors (SSRIs) are first-line pharmacotherapy treatments for obsessive-compulsive disorder (OCD). Clomipramine is effective in OCD but associated with more adverse events. Typically, higher doses of antidepressants are required for OCD. Up to 50% of patients do not respond to initial treatment of OCD. Treatment options for nonresponders include augmentation of antidepressants with atypical antipsychotics, among other strategies. First-line treatments for anxiety disorders include SSRIs, serotonin norepinephrine reuptake inhibitors, and pregabalin. Tricyclic antidepressants are equally effective as SSRIs, but are less well tolerated. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of dependency and tolerance. Other treatment options include irreversible and reversible monoamine oxidase inhibitors, the atypical antipsychotic quetiapine, and other medications. Cognitive-behavioral therapy has been sufficiently investigated in controlled studies of OCD and anxiety disorders and is recommended alone or in combination with the above medications.

Normal vaginal microbiota: patient’s subjective evaluation, physical examination and laboratory tests

2017 ◽  
pp. 39-42 ◽  
Author(s):  
E. S. Voroshilina ◽  
◽  
D. L. Zornikov ◽  
E. E. Plotko ◽  
◽  
...  
Keyword(s):  
Physical Examination ◽  
Laboratory Tests ◽  
Subjective Evaluation ◽  
Vaginal Microbiota

Diffuse idiopathic skeletal hyperostosis masquerading as asthma: case report

2019 ◽  
Vol 31 (2) ◽  
pp. 261-264
Author(s):  
Karim Mithani ◽  
Ying Meng ◽  
David Pinilla ◽  
Nova Thani ◽  
Kayee Tung ◽  
...  
Keyword(s):  
Pulmonary Function Tests ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Inhaled Corticosteroid ◽  
Treatment Resistant ◽  
Methacholine Challenge ◽  
Airway Reactivity ◽  
Cervical Osteophytes ◽  
History Of ◽  
Anterior Discectomy And Fusion ◽  
Asthma Case

A 52-year-old man with a 10-year history of treatment-resistant asthma presented with repeated exacerbations over the course of 10 months. His symptoms were not responsive to salbutamol or inhaled corticosteroid agents, and he developed avascular necrosis of his left hip as a result of prolonged steroid therapy. Physical examination and radiography revealed signs consistent with diffuse idiopathic skeletal hyperostosis (DISH), including a C7–T1 osteophyte causing severe tracheal compression. The patient underwent C6–T1 anterior discectomy and fusion, and the compressive osteophyte was removed, which completely resolved his “asthma.” Postoperative pulmonary function tests showed normalization of his FEV1/FVC ratio, and there was no airway reactivity on methacholine challenge. DISH is a systemic, noninflammatory condition characterized by ossification of spinal entheses, and it can present with respiratory disturbances due to airway compression by anterior cervical osteophytes. The authors present, to the best of their knowledge, the first documented case of asthma as a presentation of DISH.

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