scholarly journals Acute Mania and Catatonia in a Teenager Successfully Treated with Electroconvulsive Therapy and Diagnosed with Turner Syndrome and Bipolar Disorder

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Maria Ygland Rödström ◽  
Björn Axel Johansson ◽  
Beata Bäckström ◽  
Pouya Movahed ◽  
Carl-Magnus Forslund ◽  
...  
Keyword(s):  
Turner Syndrome ◽  
Electroconvulsive Therapy ◽  
Psychiatric Symptoms ◽  
Manic Episode ◽  
Acute Mania ◽  
Successful Outcome ◽  
Psychotic Symptoms ◽  
X Chromosomes ◽  
Efficient Treatment ◽  
Affective Symptoms

Background. Turner syndrome (TS) is an X-linked chromosomal abnormality with a global prevalence of 1/2000 live-born girls. The physiological symptoms of TS have been thoroughly characterized, but only a few studies have described associated psychiatric symptoms. We report a case of an adolescent girl who presented with acute mania with psychotic features and was successfully treated with electroconvulsive therapy (ECT). She was subsequently diagnosed with bipolar syndrome and TS. Case Presentation. A 17-year-old girl presented to us with manic symptoms, including disorganized speech, auditory hallucinations, and affect lability. Initially, she was treated with antipsychotics and benzodiazepines, whereby the positive affective symptoms declined. However, the psychotic symptoms progressed, and she developed a catatonic state. ECT was started 6 days after admission, with improvement after two treatments. When ECT was tapered after seven sessions, she relapsed, and the treatment was extended to twelve sessions, with successful outcome. Following discharge, she was diagnosed with TS with partial loss on one of the X-chromosomes (46X, del (X)(p21)), which might have contributed to the development of her sudden acute manic episode. Conclusions. This case demonstrates for the first time that ECT may be a safe and efficient treatment strategy for acute mania in adolescents with concomitant TS and that severely affected adolescents may require a prolonged series with gradual tapering of ECT. The present case also demonstrates a possible association between TS and bipolar syndrome and that the clinical presentation of a manic episode in a patient with this comorbidity could be more complex and the treatment response slower.

The Expanding Role of Antipsychotics

CNS Spectrums ◽  
2004 ◽  
Vol 9 (S1) ◽  
pp. 7-12
Author(s):  
Philip G. Janicak
Keyword(s):  
Bipolar Disorder ◽  
Manic Episode ◽  
Acute Mania ◽  
Psychotic Symptoms ◽  
Primary Therapy ◽  
Obsessive Compulsive ◽  
Stabilizing Agent ◽  
Compulsive Disorder ◽  
Bipolar Patients

Antipsychotics have been utilized in the treatment of bipolar disorder for many decades and were the mainstay of treatment before lithium was reintroduced in the late 1960s. Today, many bipolar patients who present with psychotic features are misdiagnosed and prescribed an antipsychotic for another disorder. Estimates of psychotic symptoms in bipolar disorder, particularly during a manic episode, are ≥50% by clinical assessment and even higher by individual reports. Thus, antipsychotics are frequently used: as first treatment for psychosis not recognized as bipolar disorder, and as an adjunct to a mood-stabilizing agent in bipolars with psychotic symptoms.Most recently, antipsychotics have been examined for their mood-stabilizing properties as well (Slide 9). One may conceptualize using a selective serotonin reuptake inhibitor (SSRI) antidepressant for disorders such as panic disorder or obsessive-compulsive disorder, and using an antiepileptic as a mood-stabilizing agent; however, it is more difficult to accept that an agent approved for treatment of psychosis can be a primary therapy for bipolar disorder. Data from the monotherapy trials suggest that second-generation antipsychotics (SGAs) are at least as effective as lithium and valproic acid for acute mania. There is a very large database indicating that SGAs can be utilized as monotherapy for acute mania. However, there is limited data on the role of these agents in prevention of relapse and recurrence and in their efficacy for depression in the context of bipolar disorder. More studies will be needed to clarify whether SGAs should be used as monotherapy or whether they would be best used as augmenting agents in severe and psychotically manic or depressed patients.

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.

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.

Sun lupus and energy. Systemic lupus erythematosus presenting as mania

2017 ◽  
Vol 41 (S1) ◽  
pp. s493-s493
Author(s):  
M.J. Gordillo Montaño ◽  
S. Ramos Perdigues ◽  
M.A. Artacho Rodriguez ◽  
S. Latorre ◽  
C. Merino del Villar ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Psychiatric Symptoms ◽  
Manic Episode ◽  
Immunosuppressive Drugs ◽  
Psychotic Symptoms ◽  
Systemic Lupus ◽  
Neuropsychiatric Manifestations ◽  
Competing Interest ◽  
High Doses

IntroductionSystemic lupus erythematosus is a chronic disease that can give neuropsychiatric episodes and systemic manifestations. About 57% of patients with SLE have neuropsychiatric manifestations in the course of their illness, however an initial presentation with neuropsychiatric clinic is rare.ObjectiveDescribe how patients receiving corticosteroids as part of their treatment can develop mental disorders but not only them.MethodIt will raise grounds with a case: 20-year-old woman recently diagnosed with SLE because of arthritis in his ankle. Treatment was initiated with prednisone 10 mg and chloroquine 200 MG. After 20 days the patient comes to the emergency after episode of turmoil at home with major affective clinical maniform. Presenting fever. The presence of fever downloads the possibility of a psychosis chloroquine or corticosteroids to be a small dose. Treatment was initiated with high doses of prednisone and immunosuppressants. In addition to associating specific anticonvulsant and antipsychotic drugs at usual doses for a manic episode.ResultsTreatment of psychosis in SLE is essentially empirical, and depends on the etiology. It usually responds to the use of high doses of corticosteroids combined with immunosuppressive drugs. Psychosis induced by corticosteroids requires lowering them. It is valid concomitant use of antipsychotics.ConclusionsThe presence of psychotic symptoms in a patient with systemic lupus erythematosus forces to distinguish between various etiological possibilities.Corticosteroids may cause a variety of psychiatric symptoms. And yet, in patients with SLE these syndromes are not always attributable to the use of corticosteroids.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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.

Psychiatric Aspects of Temporal Arteritis: A Case Report and Review of the Literature

1997 ◽  
Vol 10 (4) ◽  
pp. 142-145 ◽  
Author(s):  
Hazel Johnson ◽  
Walter Bouman ◽  
Gillian Pinner
Keyword(s):  
Temporal Arteritis ◽  
Psychiatric Symptoms ◽  
Corticosteroid Treatment ◽  
The Elderly ◽  
Psychotic Symptoms ◽  
Clear Cut ◽  
Full Remission ◽  
Affective Symptoms ◽  
Atypical Manifestations ◽  
Psychotic Features

Temporal arteritis may present with atypical manifestations that can hamper its diagnosis. We report a case presenting with predominantly psychiatric symptoms including psychotic features and affective symptoms both on a background of cognitive impairment. Such clear-cut psychotic symptoms have not been described previously in the literature. Corticosteroid treatment was followed by full remission of psychotic and affective symptoms; treatment with antipsychotic medication was unnecessary. Temporal arteritis should be considered in the differential diagnosis of psychosis and affective disorder in the elderly. The erythrocyte sedimentation rate is a valuable parameter in the assessment of old-age psychiatry patients presenting both with functional and neurologic disorders.

scholarly journals Atypical Creutzfeldt-Jakob Disease Evolution after Electroconvulsive Therapy for Catatonic Depression

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Iria Grande ◽  
Juan Fortea ◽  
Ellen Gelpi ◽  
Itziar Flamarique ◽  
Marc Udina ◽  
...  
Keyword(s):  
Electroconvulsive Therapy ◽  
Disease Duration ◽  
Psychiatric Symptoms ◽  
Psychiatric Admission ◽  
Disease Evolution ◽  
Clinical Recovery ◽  
Jakob Disease ◽  
Magnetic Resonance Imaging Mri ◽  
Electroencephalogram Eeg ◽  
Codon 129

We describe a case report of an 80-year-old woman who presented with symptomatology compatible with an episode of major depression with catatonia. After psychiatric admission, electroconvulsive therapy (ECT) was applied, but symptoms progressed with cognitive impairment, bradykinesia, widespread stiffness, postural tremor, and gait disturbance. After compatible magnetic resonance imaging (MRI), diffusion changes, and electroencephalogram (EEG) findings the case was reoriented to Creutzfeldt-Jakob disease (CJD). The genetic study found a methionine/valine heterozygosity at codon 129 of the prion protein gene PrPSc. On followup, a significant clinical recovery turned out. For this reason, EEG and MRI were repeated and confirmed the findings. The patient subsequently demonstrated progressive clinical deterioration and died 21 months later. The diagnosis was verified postmortem by neuropathology. The vCJD subtype MV2 is indeed characterized by early and prominent psychiatric symptoms and a prolonged disease duration however no frank clinical recovery has before been reported.

Cocaine Dependence Produce Psychiatric Symptoms - a Case Report

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
M. Stankovic ◽  
S. Vucetic-Arsic ◽  
S. Alcaz ◽  
J. Cvejic
Keyword(s):  
Clinical Features ◽  
Male Patient ◽  
Psychiatric Symptoms ◽  
Cocaine Dependence ◽  
Psychotic Symptoms ◽  
Personal Contact ◽  
Outpatient Unit ◽  
Special Hospital ◽  
First Time ◽  
The Brain

Aim:We want to present a polymorphic clinical features like: hallutinations, paranoid ideas, agitation and violence as a result of prolonged cocaine intranasal consumption.Methods:We exposed a 30-year old male patient with ICD-X diagnostic criteria for cocaine dependence (intranasal consumption) that treated in the outpatient unit of Special Hospital of Addicitons, Belgrade, Serbia from April to July 2008. We used the medical records, psychical examination, psychiatric interwievs, standard blood sampling and cocaine urine detections sample (positive).Results:Observations a specific and polymorphic clinical features with presence of psychotic symptoms after cocaine consumptions in our male patient, for the first time after 5 years of cocaine dependence: auditory hallucinations (two- voice speakers), paranoid persecution ideas and suspiciousness, agitation with appearance of vegetative symptomatology (palpitations, sweating, pupil dilatation), extremely violence behavior to other people, complete social reductions (“armed to the outside world”, refused any personal contact and isolated from friends and family, permanent outdoor checking). There was an intensive fear too and impaired judgment.Conclusions:Permanent cocaine consumption can result with produce a numerous of psychiatric symptoms and syndromes as our experience does. It is similar to the findings of other studies and papers reviewed. It is suppose that cocaine has numerous effects on important neurotransmitters in the brain, such as increase as well as the release of dopamine and it related with aggressiveness, hallucinations and other psychiatric symptoms.

scholarly journals Spontaneous seizures after ECT in a patient medicated with bupropion, sertraline and risperidone

2016 ◽  
Vol 38 (2) ◽  
pp. 111-113 ◽  
Author(s):  
Orlando von Doellinger ◽  
João Pedro Ribeiro ◽  
Ângela Ribeiro ◽  
Catarina Freitas ◽  
Bruno Ribeiro ◽  
...  
Keyword(s):  
Electroconvulsive Therapy ◽  
Major Depressive Episode ◽  
Slow Release ◽  
Psychotic Symptoms ◽  
Case Description ◽  
Major Depressive ◽  
Spontaneous Seizures ◽  
Clonic Seizures ◽  
Major Depressive Symptoms ◽  
Convulsive Threshold

Abstract Objective: To report a case of post-electroconvulsive therapy spontaneous seizures in a patient medicated with sertraline, bupropion and risperidone. Case description: A 53-year-old woman with recurrent major depression was admitted to our psychiatry department for a major depressive episode of 6 weeks' duration, with psychotic symptoms. She was already on 200 mg/day of sertraline and 2 mg/day of risperidone. After 8 weeks on 200 mg/day of sertraline, 4 mg/day of risperidone and slow release bupropion (titrated to 300 mg/day), with no objective improvements, the decision was taken to initiate a course of 8-10 electroconvulsive therapy (ECT) sessions. Two days after the first treatment, three generalized tonic-clonic seizures occurred within 6 hours. Phenytoin and sodium valproate were added to the patient's daily medication and no further spontaneous seizures were observed. After neurologic assessment and discussion of the case, phenytoin and bupropion were withdrawn at once (two days after the spontaneous seizures) and the decision was taken to resume the ECT treatment. No further spontaneous seizures occurred and, at discharge, the patient exhibited significant improvements and was free from major depressive symptoms. Comments: This report illustrates a case of post-ECT spontaneous seizures that might have been due to a specific pharmacological etiological pathway, namely, bupropion's proconvulsive properties, although both sertraline and risperidone also lower the convulsive threshold.

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