scholarly journals Off-licence use of clozapine in patients with emotionally unstable personality disorder: a case series analysis

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S116-S116
Author(s):  
Declan Hyland ◽  
Alex Walmsley ◽  
Victoria Simpson
Keyword(s):  
Side Effects ◽  
Personality Disorder ◽  
Suicide Attempts ◽  
Symptom Control ◽  
Case Series ◽  
Community Support ◽  
Retrospective Case ◽  
Psychotherapeutic Treatment ◽  
Self Harm ◽  
Emotionally Unstable Personality Disorder

ObjectiveThis retrospective case series followed emotionally unstable personality disorder (EUPD) patients following initiation of clozapine on an off-licence basis, aiming to examine tolerance by determining side effect prevalence and treatment cessation frequency, as well as examining efficacy, by investigating number of hospital re-admissions and symptom control.Case reportThis case series captured the experiences of 11 EUPD patients under the care of Mersey Care NHS Foundation Trust, all of whom had, at some time in the past five years, been initiated on clozapine. All patients were white British females, with a median age of 31. The median daily dose of clozapine was 300 mg. Most patients had significant psychiatric comorbidities, as well as illicit substance and / or alcohol misuse.Whilst prescribed clozapine, patients were only admitted to hospital once on average and this was commonly for clozapine re-titration. Whilst in hospital, rates of self-harm were low, but ligaturing and suicide attempts showed higher prevalence. Patients still demonstrated self-harming behaviour out of hospital leading to A and E presentations. In the community, contacts with the police were minimal, with only two patients undergoing Section 136 assessments or arrests.All patients reported side effects from clozapine - usually hypersalivation, over-sedation and constipation. All 11 patients experienced sinus tachycardia. Eight patients temporarily ceased taking clozapine at some point. In three patients, discontinuation of clozapine was as a result of intolerable side effects. Three patients experienced neutropenia, which subsequently resolved. Only two patients had a body mass index within healthy range.DiscussionDespite patients reporting clozapine to provide symptomatic benefit for their EUPD, and improved their engagement with mental health services, prevalence of self-harm and of A and E presentations remained high, indicating the importance of community support and concomitant psychotherapeutic treatment. Patients with more robust community support showed greater adherence to clozapine.High prevalence of side effects and obesity in these patients, in addition to risk of developing neutropenia, highlights the importance of rigorous monitoring after initiating clozapine. It is reassuring that, despite development of neutropenia in some patients, this recovered quickly, and clozapine treatment could resume.ConclusionClozapine may be an effective pharmacological treatment for enabling EUPD patients to engage more therapeutically with services. Clozapine may be of greater benefit to those with more stable, less chaotic lives. Although diminished, patients still show self-harming behaviour and need for A and E admissions and re-hospitalisation. Side effects of clozapine are common and regular monitoring is required.

Levetiracetam monotherapy for treatment of structural epilepsy in dogs: 19 cases (2010–2015)

2017 ◽  
Vol 181 (15) ◽  
pp. 401-401 ◽  
Author(s):  
Darren Kelly ◽  
Francesca Raimondi ◽  
Nadia Shihab
Keyword(s):  
Side Effects ◽  
Seizure Control ◽  
Case Series ◽  
Poor Response ◽  
Response To Treatment ◽  
Seizure Freedom ◽  
Retrospective Case ◽  
Cluster Seizures ◽  
Structural Epilepsy

To evaluate the efficacy and tolerability of levetiracetam monotherapy in dogs with structural epilepsy. Retrospective case series. Nineteen client-owned dogs with structural epilepsy. Seizure frequencies after initiation of treatment were used to evaluate the efficacy of levetiracetam monotherapy. Seizure control was considered good if no seizures occurred within three months of starting treatment or poor if seizures returned within one month of starting treatment. Tolerability was evaluated by considering the occurrence and severity of any reported side effects. Ten of the 19 dogs were considered to have a good response to treatment with 7 achieving complete seizure freedom. Nine dogs were considered to have poor response to treatment. There was a statistically significant reduction in the percentage of patients experiencing cluster seizures from 68.4% to 15.8% (p=0.002). Side effects were noted in 8 of the 19 dogs but were considered mild in all cases. Follow-up times ranged from 12 days to 426 days. When used in conjunction with other appropriate therapies, levetiracetam may be an efficacious option for monotherapy in dogs with structural epilepsy. Its tolerability makes it a suitable option for use in a wide variety of patients.

scholarly journals Attenuated androgen discontinuation in patients with hereditary angioedema: a commented case series

2022 ◽  
Vol 18 (1) ◽  
Author(s):  
Marcus Maurer ◽  
Markus Magerl ◽  
Emel Aygören-Pürsün ◽  
Konrad Bork ◽  
Henriette Farkas ◽  
...  
Keyword(s):  
Side Effects ◽  
Hereditary Angioedema ◽  
Treatment Strategies ◽  
Case Series ◽  
Additional Patient ◽  
Type I ◽  
Retrospective Case ◽  
Androgen Withdrawal ◽  
Life Threatening ◽  
Attenuated Androgen

Abstract Background Hereditary angioedema (HAE) is characterized by potentially severe and life-threatening attacks of localized swelling. Prophylactic therapies are available, including attenuated androgens. Efficacy of attenuated androgens has not been assessed in large, randomized, placebo-controlled trials and can be associated with frequent, and sometimes severe, side effects. As better tolerated targeted therapies become available, attenuated androgen withdrawal is increasingly considered by physicians and their patients with HAE. Attenuated androgens withdrawal has not been systematically studied in HAE, although examination of other disorders indicates that attenuated androgen withdrawal may result in mood disturbances and flu-like symptoms. Standardized protocols for attenuated androgen discontinuation that continue to provide control of attacks while limiting potential attenuated androgen withdrawal symptoms are not established as the outcomes of different withdrawal strategies have not been compared. We aim to describe the challenges of attenuated androgen discontinuation in patients with HAE and how these may continue into the post-androgen period. Case presentation We present a retrospective case series of 10 patients with confirmed type I HAE who have discontinued prophylactic treatment with attenuated androgens. The most common reason for attenuated androgen discontinuation was side effects. Attenuated androgens were either immediately withdrawn, tapered and/or overlapped with another treatment. The major challenge of discontinuation was the management of an increased frequency and severity of HAE attacks in some patients. Conclusions Healthcare teams need to undertake careful planning and monitoring after attenuated androgens discontinuation, and modify treatment strategies if HAE control is destabilized with an increased number of attacks. Discontinuation of attenuated androgens is definitively an option in an evolving HAE treatment landscape, and outcomes can be favourable with additional patient support and education.

scholarly journals Systemic Minoxidil Accidental Exposure in a Paediatric Population: A Case Series Study of Cutaneous and Systemic Side Effects

2021 ◽  
Vol 10 (18) ◽  
pp. 4257
Author(s):  
Manuel Sánchez-Díaz ◽  
David López-Delgado ◽  
Trinidad Montero-Vílchez ◽  
Luis Salvador-Rodríguez ◽  
Alejandro Molina-Leyva ◽  
...  
Keyword(s):  
Side Effects ◽  
Treatment Time ◽  
Case Series ◽  
Paediatric Population ◽  
High Dose ◽  
Retrospective Case ◽  
Case Series Study ◽  
High Doses ◽  
Initial Zone ◽  
Series Study

Oral minoxidil is an approved treatment for high blood pressure which is also used as an off-label drug for alopecia. Knowledge about the effects of systemic minoxidil in the paediatric population is limited. A retrospective case series study of paediatric patients with history of systemic minoxidil intake due to contaminated sets of omeprazole was performed to describe side effects of high dose oral minoxidil intake in children. Twenty patients aged between 2 months and 13 years joined the study. They had received high doses of oral minoxidil (mean dose 0.90 mg/kg/day) during a mean time of 38.3 days. Hypertrichosis appeared in 65%, with a mean latency time of 24.31 days. Treatment time was associated with the appearance of hypertrichosis (p < 0.05). Most common initial zone of hypertrichosis was the face. Systemic effects developed in 15%, with no cases of severe disorders. The present study shows a novel insight into the side effects of high doses of oral minoxidil in children.

scholarly journals Eclectic Therapeutic Relationship with BPD Clients: Examining the Eclectic Therapeutic Relationship with Clients with Borderline Personality Disorder

2014 ◽  
Vol 13 (1) ◽  
pp. 53
Author(s):  
Preethi Anne Ninan ◽  
Sudeshna Biswas
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Therapeutic Relationship ◽  
Borderline Personality ◽  
Comprehensive Therapy ◽  
Eclectic Approach ◽  
Rapport Building ◽  
Self Harm ◽  
Integrated Or ◽  
Emotionally Unstable Personality Disorder

Borderline Personality Disorder (BPD) or Emotionally Unstable Personality Disorder (EUPD) clients are characterised by behavioural symptoms of acts of deliberate self-harm, difficulty controlling anger, and instability in relationships, besides others. While specific therapies address specific problem behaviours, an integrated or eclectic approach enables clinicians to adopt a comprehensive therapy plan (Livesley, 2008). Since the therapeutic relationship with BPD clients is characterised by frequent ruptures and fluctuations, it is necessary to understand how the eclectic stance approaches the therapeutic relationship with BPD clients. This study explores these questions through in-depth interviews with seven self-identified eclectic therapists who have worked with BPD clients. Using Thematic Network Analysis, it was found from the interviews that eclectic therapists choose the stance because of the flexibility it offers them, and because of definite client and setting factors. This stance, they suggested, helps in mutual decision-making and leads the therapist to make constant adjustments to the client‘s level. The process of rapport-building was seen to be an on-going process, where the therapist acts as a facilitator, and often works against resisting traits of the clients. Therapists also talked about ruptures in the relationship due to certain factors and identified means through which these can be repaired. Finally, they identified their reactions to BPD clients as consisting of both positive reactions, and negative and unconscious reactions, which require monitoring. The results of this study yield an understanding about the reasons behind the decision to take an eclectic stance, and how it affects the therapeutic relationship. Keywords: Borderline personality disorder, Eclectic therapy, Therapeutic alliance.

scholarly journals Remission of Suicidal Ideation in Emotionally Unstable Personality Disorder with Flupenthixol

2022 ◽  
Vol 2022 ◽  
pp. 1-3
Author(s):  
Daniel J. Chivers ◽  
Mohammed Shaffiullah
Keyword(s):  
Suicidal Ideation ◽  
Personality Disorder ◽  
Older Patients ◽  
Suicide Attempts ◽  
Later Life ◽  
Age Group ◽  
Pharmacological Treatments ◽  
Current Guidance ◽  
Emotionally Unstable Personality Disorder

There are currently no licensed pharmacological treatments for Emotionally Unstable Personality Disorder. This case report describes a 50-year-old male who two years previously had been brought to the attention of psychiatric services following an overdose with intention to end his life. He was subsequently diagnosed with Emotionally Unstable Personality Disorder (EUPD) and, following further suicide attempts and trials of mainstream pharmacological treatments, responded to flupenthixol IM 20 mg fortnightly, experiencing complete remission from his suicidal ideation. Clinicians should be aware of EUPD presenting in later life and should consider the role of typical antipsychotics, including flupenthixol, in the treatment of suicidal ideation in patients with EUPD. Age-specific guidance on EUPD management would be of use to clinicians, especially in the management of older patients, as current guidance is based on findings within a narrow age group.

Multiple Suicide-Attempts in Adolescence: Psychodynamic Understandings on the Process of Integration of Hallucinated Bodily Experiences

2017 ◽  
Vol 41 (S1) ◽  
pp. s775-s776
Author(s):  
G. Giacomini ◽  
P. Solano ◽  
M. Amore
Keyword(s):  
Suicide Attempts ◽  
Emotional Experience ◽  
The Body ◽  
Psychotherapeutic Treatment ◽  
Working Through ◽  
Gradual Process ◽  
Self Harm ◽  
Internal Objects ◽  
Competing Interest ◽  
The Mind

Introduction.Suicidal adolescents have a severely damaged body/mind relationship where issues pertaining to adolescence and psychache are tightly intertwined causing dissociation, hallucinations and concreteness. In this conundrum, the suffering mind swings from being identified and split from the body favouring self-harm and bodily together with visual hallucinations.Objectives.Investigating and working through suicidal concreteness together with the role and meaning of hallucinations in adolescents with a story of multiple suicide attempts.Aims.Achieving a first integration and appropriation of the emotional experience with the establishment of the boundaries between mind/body, inside/outside giving up hallucinations.Methods.Prolonged intensive psychodynamic work focusing on self-representation, the working through of persecutory internal objects causing rage, hostility and attacks on the affective links with the environment allowed a gradual process of integration of the self with the decrease of suicidiality.Results.The working through and containment of persecutory internal objects led to the possibility to unconsciously give up hallucinations and integrate the emotional experience in the mind together with the development of first effective boundaries between inside/outside.Conclusions.An intense work of containment and working through of persecution and rage in the early stages of the psychotherapeutic treatment of adolescent multiple attempters can significantly favour the relinquishment of hallucinatory mechanisms and self-harm as a way to cope with intolerable anguish and psychache. This favours the process of in dwelling of the psyche in the soma as described by Winnicott.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Effectiveness of Nortriptyline and Tolerability of Side Effects in Neurogenic Cough Patients

2020 ◽  
pp. 000348942097023
Author(s):  
Sungjin A. Song ◽  
Kanittha Choksawad ◽  
Ramon A. Franco
Keyword(s):  
Side Effects ◽  
Case Series ◽  
Clinical History ◽  
Demographic Information ◽  
Retrospective Case ◽  
Exclusion Criteria ◽  
Level Of Evidence ◽  
Medication Dosage ◽  
Lost To Follow Up

Objective: To determine the effectiveness of nortriptyline and tolerability of side effects in the treatment of neurogenic cough. Secondary goal is to evaluate the association between laryngeal asymmetry and clinical response to nortriptyline. Study Design: Retrospective case series. Materials and Methods: Consecutive patients diagnosed with neurogenic cough at a quaternary care specialty hospital from 2001 to 2020 were identified. Subjects <18 years old, not treated with nortriptyline, did not have a nasolaryngoscopic examination and were lost to follow-up were excluded. Charts were reviewed for demographic information, clinical history, nasolaryngoscopic findings, medication dosage, side effects, and follow-up time. Results: Forty-two patients met inclusion and exclusion criteria, 7 males and 35 females with an average age of 56.5 (±13.1) years. There were 26/36 (72.2%) responders and 10/36 (27.8%) non-responders; 6 patients stopped nortriptyline due to side effects and were not included in the response comparison. Laryngeal asymmetry was present in 36/42 (85.7%) patients. No factors related to laryngeal asymmetry were significantly different between responders and non-responders. Medication tolerance was observed in 3/42 (7.1%) patients. Side effects were reported in 16/42 (38.1%) patients. The most common side effects were sedation 9/42 (21.4%) and xerostomia 3/42 (7.1%). Conclusion: Nortriptyline is effective for treating neurogenic cough with 72% of patients reporting improvement in cough. Evidence of laryngeal asymmetry was not associated with better treatment response. Although 38% experienced side effects, the majority of patients continued nortriptyline despite side effects. Level of Evidence: 4

scholarly journals Iatrogenic Complications of Compulsory Treatment in a Patient Presenting with an Emotionally Unstable Personality Disorder and Self-Harm

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Charlotte Burrin ◽  
Natasha Faye Daniels ◽  
Rudolf N. Cardinal ◽  
Catherine Hayhurst ◽  
David Christmas ◽  
...  
Keyword(s):  
Emergency Department ◽  
Suicidal Ideation ◽  
Personality Disorder ◽  
Ethical Dilemma ◽  
Attempted Suicide ◽  
Compulsory Treatment ◽  
Multiple Factors ◽  
Iatrogenic Complications ◽  
Self Harm ◽  
Emotionally Unstable Personality Disorder

Attempted suicide and deliberate self-harm are common and challenging presentations in the emergency department. A proportion of these patients refuse interventions and this presents the clinical, legal, and ethical dilemma as to whether treatment should be provided against their will. Multiple factors influence this decision. It is difficult to foresee the multitude and magnitude of complications that can arise once it has been decided to treat individuals who do not consent. This case illustrates a particularly complex chain of events that occurred after treating someone against their will who presented with self-harm and suicidal ideation. These consequences are contrasted with those of not intervening when similar situations arose with the same patient.

scholarly journals A descriptive, retrospective case series of patients with factitious disorder imposed on self

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Antoine Bérar ◽  
Guillaume Bouzillé ◽  
Patrick Jego ◽  
Jean-Sébastien Allain
Keyword(s):  
Suicide Attempts ◽  
Case Series ◽  
Healthcare Services ◽  
University Hospital ◽  
Factitious Disorder ◽  
Retrospective Case ◽  
Medical Interventions ◽  
Health Related ◽  
History Of ◽  
Patient Refusal

Abstract Background Despite cases of factitious disorder imposed on self being documented in the literature for decades, it appears to remain an under-identified and under-diagnosed problem. The present study aimed to explore factitious disorder imposed on self in a series of French patients. Methods Patients 18 years old and over with factitious disorder imposed on self were retrospectively included by two independent reviewers according to DSM-5 criteria in Rennes University Hospital for the period 1995 to 2019. Patients were identified from a clinical data warehouse. Results 49 patients with factitious disorder imposed on self were included. Among them, 36 (73.5%) were female. The average age at diagnosis was 38.4 years. The 16 patients with a health-related profession were all female. Direct evidence of falsification was found in 20.4% of cases. Falsification was mainly diagnosed on the basis of indirect arguments: history of factitious disorder diagnosed in another hospital (12.2%), extensive use of healthcare services (22.4%), investigations that were normal or inconclusive (69.4%), inconsistent or incomplete anamnesis and/or patient refusal to allow access to outside information sources (20.4%), atypical presentation (59.2%), evocative patient behaviour or comments (32.7%), and/or treatment failure (28.6%). Dermatology and neurology were the most frequently involved specialities (24.5%). Nine patients were hospitalized in intensive care. Some of them received invasive treatments, such as intubations, because of problems that were only reported or feigned. The diagnosis of factitious disorder imposed on self was discussed with the patient in 28 cases (57.1%). None of them admitted to making up the disorder intentionally. Two suicide attempts occurred within 3 months after the discussion of the diagnosis. No deaths were recorded. 44.9% of the patients returned to the same hospital at least once in relation to factitious disorder imposed on self. Conclusions The present study reinforces data in favour of a predominance of females among patients with factitious disorder imposed on self. This diagnosis is difficult and is based on a range of arguments. While induced cases can be of low severity, cases that are only feigned can lead to extreme medical interventions, such as intubation.

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