Takotsubo syndrome in bipolar affective disorder with alcohol withdrawal syndrome

2020 ◽  
Vol 13 (10) ◽  
pp. e236070
Author(s):  
Deshwinder Singh Sidhu ◽  
Richard Farrelly ◽  
John Lally
Keyword(s):  
Affective Disorder ◽  
Troponin I ◽  
Epigastric Pain ◽  
Bipolar Affective Disorder ◽  
Alcohol Withdrawal Syndrome ◽  
Takotsubo Syndrome ◽  
History Of ◽  
Alcohol Dependence Syndrome ◽  
Background History ◽  
St Elevation

A 40-year-old woman presented to the emergency department with epigastric pain and agitation. She recently separated from her husband and was consuming 30 units of alcohol daily for 5 days. She had a history of bipolar affective disorder, borderline personality disorder and alcohol dependence syndrome. Investigations revealed the following: elevated troponin I levels, ST elevation, early Q waves and prolonged QTc. Emergency angiogram confirmed Takotsubo’s appearance. Medications with QTc prolongation propensity were held. A multidisciplinary apporach was required. She was discharged 10 days later when medically stabilised. It was later discovered that she died unexpectedly the following month. Takotsubo syndrome is a rare but unique cause of cardiac failure. This case highlights the need to consider the differential of Takotsubo syndrome in people presenting with possible acute ischaemic events, particularly in those with a history of combined emotional and physical stressors and a background history of mood disorder.

scholarly journals Value of Cardiac Biomarkers in the Early Diagnosis of Takotsubo Syndrome

2020 ◽  
Vol 9 (9) ◽  
pp. 2985
Author(s):  
Charlotte Dagrenat ◽  
Jean Jacques Von Hunolstein ◽  
Kensuke Matsushita ◽  
Lucie Thebaud ◽  
Stéphane Greciano ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Troponin I ◽  
Early Stage ◽  
Cardiac Biomarkers ◽  
Takotsubo Syndrome ◽  
Gender History ◽  
Cardiac Biomarker ◽  
History Of ◽  
St Elevation ◽  
Bedside Diagnosis

Background: Bedside diagnosis between Takotsubo syndrome (TTS) and ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction remains challenging. We sought to determine a cardiac biomarker profile to enable their early distinction. Methods: 1100 patients (TTS n = 314, STEMI n = 452, NSTEMI n = 334) were enrolled in two centers. Baseline clinical and biological characteristics were compared between groups. Results: At admission, cut-off values of BNP (B-type natriuretic peptide)/TnI (Troponin I) ratio of 54 and 329 distinguished respectively STEMI from NSTEMI, and NSTEMI from TTS. Best differentiation was obtained by the use of BNP/TnI ratio at peak (cut-of values of 6 and 115 discriminated respectively STEMI from NSTEMI, and NSTEMI from TTS). We developed a score including five parameters (age, gender, history of psychiatric disorders, LVEF, and BNP/TnI ratio at admission) enabling good distinction between TTS and STEMI (77% specificity and 92% sensitivity, AUC 0.93). For the distinction between TTS and NSTEMI, a four variables score (gender, history of psychiatric disorders, LVEF, and BNP at admission) achieved a good diagnostic performance (89% sensitivity, 85% specificity, AUC 0.94). Conclusion: A distinctive cardiac biomarker profile enables at an early stage a differentiation between TTS and ACS. A four (NSTEMI) or five variables score (STEMI) permitted a better discrimination.

Lithium use in a patient on haemodialysis with bipolar affective disorder and lithium-induced nephropathy

2021 ◽  
Vol 14 (7) ◽  
pp. e242841
Author(s):  
Sam Topp ◽  
Emma Salisbury
Keyword(s):  
Affective Disorder ◽  
Bipolar Affective Disorder ◽  
Manic Episode ◽  
Dose Titration ◽  
Dialysis Session ◽  
Treatment Resistant ◽  
History Of ◽  
End Stage ◽  
Level Monitoring

Lithium is an effective mood stabiliser used to treat bipolar affective disorder (BPAD); however, it can also adversely affect the kidneys, causing acute toxic effects, nephrogenic diabetes insipidus, chronic renal dysfunction and end-stage kidney disease (ESKD) in a minority of patients. We describe the case of a man with a 34-year history of BPAD type-1 and a 2-year history of ESKD secondary to lithium-induced nephropathy who experienced a manic relapse. He previously responded well to lithium but, following a deterioration in kidney function, was switched to olanzapine and sodium valproate. This precipitated a period of instability, which culminated in a treatment-resistant manic episode requiring hospital admission. After a multidisciplinary team discussion, lithium therapy was restarted and provided remission. This was achieved safely through a reduced dosing schedule of three times a week post dialysis, slow dose titration and blood level monitoring prior to each dialysis session.

Cardiac cephalalgia: severe, non-exertional headache presenting as unstable angina

2018 ◽  
Vol 19 (2) ◽  
pp. 173-175
Author(s):  
Jonathan Lazari ◽  
Andrew Money-Kyrle ◽  
Benjamin R Wakerley
Keyword(s):  
Clinical Characteristics ◽  
Troponin I ◽  
Coronary Intervention ◽  
Severe Stenosis ◽  
Exertional Headache ◽  
Percutaneous Coronary ◽  
History Of ◽  
St Elevation ◽  
Cardiac Cephalalgia

Cardiac cephalalgia is a migraine-like headache that occurs during episodes of myocardial ischaemia. Clinical characteristics of the headache vary widely but are often severe in intensity, worsen with reduced myocardial perfusion and resolve with reperfusion. It can present along with typical symptoms of angina pectoris, although not always. We present a 64-year-old man with a 6-month history of severe, non-exertional headaches occurring with increasing frequency. A resting ECG showed ST elevation in the inferior leads. His serum troponin I was not elevated. Coronary angiography showed severe stenosis of his right coronary artery, which was successfully stented by percutaneous coronary intervention. He remains headache free at 2-year follow-up.

scholarly journals 59 “Lithium Damaged My Spine” Might not Be a Delusion After All

CNS Spectrums ◽  
2019 ◽  
Vol 24 (1) ◽  
pp. 206-207
Author(s):  
Muhammad Zaidi ◽  
Anurag Prabhu ◽  
Jose Perez Martell ◽  
Sakshi Dhir
Keyword(s):  
Affective Disorder ◽  
Schizoaffective Disorder ◽  
Patient Population ◽  
Bipolar Affective Disorder ◽  
Extensive Literature ◽  
Negative Effects ◽  
Mesh Terms ◽  
First Choice ◽  
History Of ◽  
Bipolar Affective Disorders

AbstractBackgroundLithium remains to be the drug of choice for treating BPAD for the past few decades. There is extensive literature showing the effectiveness of Lithium when used as a mood stabilizing agent in bipolar spectrum disorders. However significant number of articles show that a third of the patients who receive lithium for their symptomology not only do not show any response but also may show deterioration of their clinical symptoms. (However, research shows that Lithium may negatively affect a third of the patients depending on various factors). The side effect profile of Lithium and especially its neurotoxic effects were discussed in depth in literature over the last decade. Although Lithium remains first choice as maintenance treatment for bipolar affective disorder, about half of all individuals may stop their treatment at some point, despite its proven benefits concerning the prevention of severe affective episodes and suicide.MethodsThe authors performed a systematic literature review to recognize the significance of negative effects of Lithium in a minority of patient population and also comment on the factors influencing patient compliance. We ran a literature search on Pubmed using the following terms: “Lithium” AND (“schizoaffective disorder [MeSH terms]” OR “Bipolar Affective disorder [MeSH terms]” ). Our inclusion criteria were studies which have observed effects of Lithium in schizoaffective patient population or bipolar affective patient population. Studies with other concurrent diagnoses were excluded.Case presentationWe discuss a fifty nine year old male with a history of multiple admissions to a forensic hospital care setting. He initially endorsed a diagnosis of Psychotic disorder NOS which was later changed to schizoaffective disorder during his subsequent admissions. He presented with affective psychotic features where his mood was labile shifting from melancholic to euphoric and a concurrent history of auditory verbal hallucinations. He displayed paranoid non-bizarre persecutory delusions and also alleged that one of his doctors had hated him and put him on Lithium as a form of punishment. He claims that Lithium, as a result, has significantly affected him negatively and also damaged his nerves. This led the authors to explore the significance of use of Lithiumin people with schizoaffective disorders and also bipolar affective disorders. We also discuss the disease course in the patient and his clinical response to use of various psychotropic medications.ConclusionsThe case exemplifies the negative effects of Lithium when used as a mood stabilizer in patient population that is susceptible to its adverse effects due to various factors.

Cognitive impairment, clinical course and treatment history in out-patients with bipolar affective disorder: relationship to tardive dyskinesia

1989 ◽  
Vol 19 (4) ◽  
pp. 897-902 ◽  
Author(s):  
John L. Waddington ◽  
Katherine Brown ◽  
Jane O'Neill ◽  
Patrick McKeon ◽  
Anthony Kinsella
Keyword(s):  
Tardive Dyskinesia ◽  
Affective Disorder ◽  
Cognitive Flexibility ◽  
Clinical Course ◽  
Bipolar Affective Disorder ◽  
Involuntary Movements ◽  
Impaired Performance ◽  
Treatment History ◽  
Individual Vulnerability ◽  
History Of

SYNOPSISClinical, neuropsychological and psychopharmacological characteristics were investigated for their ability to distinguish individuals with and without involuntary movements (tardive dyskinesia), among a population of 40 out-patients with bipolar affective disorder and a history of exposure to neuroleptics and lithium. Impaired performance on a test of cognitive flexibility bore the primary association with both the presence and the severity of involuntary movements. The additional relationships identified emphasized further that individual vulnerability to involuntary movements appeared to be associated not with greater duration or dosage of treatment, but with features of the bipolar illness, including number and type of affective episodes, for which that treatment was prescribed.

scholarly journals Cigarette smoking and psychotic symptoms in bipolar affective disorder

2001 ◽  
Vol 179 (1) ◽  
pp. 35-38 ◽  
Author(s):  
Aiden Corvin ◽  
Ed O'Mahony ◽  
Myra O'Regan ◽  
Claire Comerford ◽  
Robert O'Connell ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Affective Disorder ◽  
Bipolar Affective Disorder ◽  
Psychotic Symptoms ◽  
Heavy Smoking ◽  
Ordinal Logistic Regression Analysis ◽  
History Of ◽  
Categorical Diagnosis ◽  
The Relationship

BackgroundAn association exists between smoking and schizophrenia, independent of other factors and related to psychotic symptomatology.AimsTo determine whether smoking is associated with psychosis in bipolar affective disorder.MethodSmoking data were collected from 92 unrelated patients with bipolar affective disorder. An ordinal logistic regression analysis tested the relationship between smoking severity and psychotic symptomatology, allowing for potential confounders.ResultsA significant relationship was detected between smoking/heavy smoking and history of psychosis (68.7%, n=44). Smoking was less prevalent in patients who were less symptomatic (56.5%, n=13) than in patients with a more severe psychosis (75.7%, n=31). Prevalence and severity of smoking predicted severity of psychotic symptoms (P=0.001), a relationship independent of other variables (P=0.0272).ConclusionA link between smoking and psychosis exists in bipolar affective disorder and may be independent of categorical diagnosis.

scholarly journals Hypercalcemia as a Cause of Kidney Failure: Case Report

2016 ◽  
Vol 4 (2) ◽  
pp. 283-286
Author(s):  
Olivera Stojceva-Taneva ◽  
Borjanka Taneva ◽  
Gjulsen Selim
Keyword(s):  
Renal Failure ◽  
Primary Hyperparathyroidism ◽  
Epigastric Pain ◽  
History Of ◽  
St Elevation ◽  
Multiple Myelomas ◽  
Serum Pth ◽  
Reduced Kidney Function ◽  
Common Manifestation ◽  
Pth Level

BACKGROUND: Hypercalcemia is a common manifestation in clinical practice and occurs as a result of primary hyperparathyroidism, malignancy, milk-alkali syndrome, hyper or hypothyroidism, sarcoidosis and other known and unknown causes. Patients with milk-alkali syndrome typically are presented with renal failure, hypercalcemia, and metabolic alkalosis caused by the ingestion of calcium and absorbable alkali. This syndrome is caused by high intake of milk and sodium bicarbonate.CASE PRESENTATION: We present a 28-year old male admitted to hospital with a one-month history of nausea, vomiting, epigastric pain, increased blood pressure and worsening of renal function with hypercalcemia. His serum PTH level was almost undetectable; he had mild alkalosis, renal failure with eGFR of 42 ml/min, anemia, hypertension and abnormal ECG with shortened QT interval and ST elevation in V1-V4. He had a positive medical history for calcium-containing antacids intake and after ruling out primary hyperparathyroidism, malignancy, multiple myelomas, sarcoidosis, and thyroid dysfunction, it seemed plausible to diagnose him as having the milk-alkali syndrome.CONCLUSION: Although milk-alkali syndrome currently may be more probably a result of calcium and vitamin D intake in postmenopausal women, or in elderly men with reduced kidney function taking calcium-containing medications, one should not exclude the possibility of its appearance in younger patients taking calcium-containing medications and consider it a serious condition taking into account its possibility of inducing renal insufficiency.

scholarly journals Noncompaction and Takotsubo Syndrome in a Neuromuscular Disorder

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Josef Finsterer ◽  
Claudia Stöllberger ◽  
Walter Benedikt Winkler
Keyword(s):  
Chest Pain ◽  
Beta Blockers ◽  
Liver Cyst ◽  
Neuromuscular Disorder ◽  
Sudden Onset ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Troponin Elevation ◽  
History Of ◽  
St Elevation

Background. Takotsubo syndrome (TTS) in patients with left ventricular hypertrabeculation/noncompaction (LVHT) has been reported in four patients, and a TTS plus LVHT plus a neuromuscular disorder (NMD) was only reported once so far. Here, we present the fifth patient with LVHT and TTS and the second patient with LVHT, TTS, and a NMD. Methods and Results. The patient is a 68 yo female hobby choir singer with a history of skin dermatofibroma, skin fibrokeratoma, arterial hypertension, hyperlipidemia, hypothyroidism, anemia, hyponatremia, diverticulosis, LVHT detected at age 60 y, five syncopes, a liver cyst, and carotid endarterectomy 2 months prior to admission because of sudden-onset chest pain. Workup revealed ST elevation, troponin elevation, and mild coronary artery sclerosis. Ventriculography and transthoracic echocardiography (TTE) showed the apical type of a TTS. ECG normalised within 10 w and TTE within 6 w under beta-blockers and ATII-blockers. The TTS was triggered by being offended of being unable to sing anymore after endarterectomy. Neurological workup suggested the presence of a NMD. Conclusions. This case shows that LVHT occurs in NMD patients and that patients with LVHT and a NMD may develop a TTS. Whether patients with LVHT and a NMD are particularly prone to develop a TTS requires further confirmation. NMD patients with LVHT should avoid stress not to trigger a TTS.

scholarly journals Evaluation of Psychiatric Disorders in Spouse of Patients with Alcohol Dependence Syndrome

2021 ◽  
pp. 1-5
Author(s):  
Mahesh Tilwani
Keyword(s):  
Alcohol Dependence ◽  
Psychiatric Disorders ◽  
Affective Disorder ◽  
Depressive Episode ◽  
Bipolar Affective Disorder ◽  
Psychiatric Morbidity ◽  
Adjustment Disorder ◽  
International Classification Of Diseases ◽  
Psychiatric Research ◽  
Alcohol Dependence Syndrome

Background and Aim: Alcohol Dependence Syndrome has deleterious consequences not only on the patient with Alcohol Dependence Syndrome but also on the members of his family. The psychopathology in wives of patients with Alcohol Dependence Syndrome is a largely neglected area in psychiatric research. Aim of the present study was to evaluate the frequency and nature of psychiatric disorders in wives of patients with Alcohol Dependence Syndrome. Materials and Methods: A total of 177 wives, 100 wives of patients with Alcohol Dependence Syndrome and 77 wives of patients with Bipolar Affective Disorder- current episode mania were evaluated. Tools used were ICD-10 AM symptom checklist and modules for assessment of psychiatric morbidity and diagnosis was made based on The International Classification of Diseases – (Diagnostic Research Criteria DCR-10). Results: Psychiatric disorders are diagnosed in 75% of the wives of patients with alcohol dependence syndrome out of which 45% have dysthymia, 12% have mild depressive episode, 8% have adjustment disorder- prolonged depressive reaction, 5% have moderate depressive episode and 5% have anxiety disorder unspecified. Conclusion: The present study concludes that the wives of patients with Alcohol Dependence Syndrome have significant psychiatric morbidity when compared to wives of patients with Bipolar Affective Disorder-current episode mania. The most common psychiatric disorder is dysthymia.

A Retrospective Case-Note Study of Bipolar Disorder in Old Age

1991 ◽  
Vol 158 (4) ◽  
pp. 485-490 ◽  
Author(s):  
John Snowdon
Keyword(s):  
Bipolar Disorder ◽  
Affective Disorder ◽  
Age Of Onset ◽  
Bipolar Affective Disorder ◽  
Manic Episode ◽  
Case Note ◽  
Retrospective Case ◽  
History Of ◽  
Study Case ◽  
Reason For Admission

In a replication of an earlier published study, case notes of 75 elderly in-patients with bipolar affective disorder were examined. Few of the patients had experienced a manic episode before the age of 40. Mean age of onset of affective disorder was 46 years, and first manic episode at 60 years. Cerebral insults before the first manic attacks were recorded in a substantial number of cases, and a family history of mental illness was less common among this group. Bipolar affective disorder is relatively common as a reason for admission of elderly patients.

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