Clinical Outcome in a Randomized 1-Year Trial of Clozapine Versus Treatment as Usual for Patients With Treatment-Resistant Illness and a History of Mania

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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Faculty Opinions recommendation of 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1115297.619009 ◽

2009 ◽

Author(s):

Ruth Lanius ◽

Camelia Garofeanu

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Borderline Personality ◽

Treatment As Usual ◽

Versus Treatment

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

Current Drug Safety ◽

10.2174/1574886313666180807094654 ◽

2019 ◽

Vol 14 (1) ◽

pp. 80-83 ◽

Cited By ~ 3

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 × 10<sup>9</sup> L, and her neutrophils decreased to 0.1 × 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.

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A prospective study to determine the clinical utility of pharmacogenetic testing of veterans with treatment-resistant depression

Journal of Psychopharmacology ◽

10.1177/02698811211015224 ◽

2021 ◽

pp. 026988112110152

Author(s):

Michael J McCarthy ◽

Yucui Chen ◽

Anna Demodena ◽

Susan G Leckband ◽

Eileen Fischer ◽

...

Keyword(s):

Social Stress ◽

Risk Groups ◽

Adverse Outcomes ◽

Treatment Resistant Depression ◽

Post Traumatic Stress ◽

Treatment Resistant ◽

Treatment As Usual ◽

Resistant Depression ◽

The Difference ◽

A Prospective Study

Background: Pharmacotherapies for depression are often ineffective and treatment-resistant depression (TRD) is common across bipolar disorder (BD), major depressive disorder (MDD), and post-traumatic stress disorder (PTSD). Patient genetic information can be used to predict treatment outcomes. Prospective studies indicate that pharmacogenetic (PGX) tests have utility in the treatment of depression. However, few studies have examined the utility of PGX in other diagnoses typified by depression, or in veterans, a cohort with high rates of medical comorbidity, social stress, and suicide. Aim: To determine the efficacy of genetically guided pharmacological treatment of TRD. Methods: We conducted an 8-week, prospective, multisite, single-blind study in 182 veterans with TRD including patients with BD, MDD, and PTSD. Subjects were randomly assigned to PGX-guided treatment in which the clinician incorporated PGX information into decision-making, or treatment as usual (TAU). Results: Overall, the PGX group improved marginally faster compared to TAU, but the difference was not statistically significant. Secondary analyses revealed that only PTSD patients showed a potential benefit from PGX testing. Patients predicted by PGX testing to have moderate levels of genetic risk showed a significant benefit from the PGX-guided treatment, whereas other risk groups demonstrated no benefit. Clinicians generally found the PGX test was useful, particularly in more depressed patients and/or those with more warnings for significant or serious adverse outcomes. Clinicians more often used the results to select a drug, but only rarely to adjust dosing. Conclusions: The data reveal possible group differences in the utility of PGX testing in veterans with TRD. ClinicalTrials.gov Identifier: NCT04469322.

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

BMJ Case Reports ◽

10.1136/bcr-2021-242841 ◽

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.

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Clinico-Pathological Findings of Bangladeshi Covid 19 Patients with their Clinical Outcome: Study of A Cohort of 201 Cases

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v38i0.47346 ◽

2020 ◽

pp. 37-42

Author(s):

Nasir Uddin Ahmed ◽

Md Azizul Islam ◽

Md Anwarul Kabir ◽

Md Habibur Rahman ◽

SM Anwar Sadat

Keyword(s):

Clinical Outcome ◽

Respiratory Distress ◽

Sore Throat ◽

Respiratory System ◽

Clinical Presentation ◽

Severe Disease ◽

Age Groups ◽

Military Hospital ◽

Human Beings ◽

History Of

Introduction: COVID-19 is a major threat to human beings. Clinical characterization, rapid identification of cases and isolation are vital for containments of rapidly spreading disease. The objectives of the study were to evaluate the clinico pathologic profile of Covid 19 positive Bangladeshi patients and also to see their clinical outcome within defined period. Methods: This cohort study on 201 Bangladeshi cases was done in Combined Military Hospital, a tertiary level hospital in Dhaka, Bangladesh from April 2020 to May 2020. Total 201 COVID-19 cases were enrolled after getting the result positive for RT-PCR. After collection, data were analysed to show the characteristics of Covid 19 and their outcome after treatment. Results: Among 201 cases, 180 (90%) were male and 21 (10%) were female. The most prevalent affected age groups were 71 (35.5%) patients in 26-35 years age, 54 (27%) in 16- 25 years, 49 (24.5%) in 35-45 years. Mean age is 32.2±2. Among the total cases, 146 (73%) have positive history of contact, 37 (18.5%) have no history of any contact, 8 (4%) denied any contact with COVID-19 patients. Regarding clinical presentations, 67 (33.5%) patients presented with only one symptoms, 125 (62.5%) had multiple symptoms and 9 (4.5%) cases were asymptomatic. 154 (77%) patients presented with fever. Other presentations were cough 71 (35.5%), headache 27 (13.5%), myalgia 25 (12.5%), sore throat 25 (12.5%), malaise 15 (7.5%), respiratory distress 11 (5.5%). Respiratory system was the dominant domain of clinical presentation. Leukopenia was presented by 12 patients and 12 had lymphopenia. 18 patients had mild thrombocytopenia. Pulse oxymetry showed oxygen saturation below 88% in 12 cases. After oxygen therapy 7 cases were improved and 5 cases were shifted to Corona ICU as their saturation fell below 70. These 5 patients are categorised as severe disease, rest 196 patients were mild in nature. Conclusion: COVID 19 affects male more than female. Common symptoms are fever, cough, headache, myalgia, sore throat, malaise, respiratory distress. Respiratory system is the dominant domain of clinical presentation. ICU support was needed in 2.5 % cases and death rate was 1% which was associated with comorbidity of CKD. J Bangladesh Coll Phys Surg 2020; 38(0): 37-42

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