Electroconvulsive therapy for trichotillomania in a bipolar patient

2019 ◽  
Vol 83 (1) ◽  
pp. 97-104
Author(s):  
Leonardo F. Fontenelle ◽  
Samara dos Santos-Ribeiro ◽  
Juliana Kalaf ◽  
Murat Yücel
Keyword(s):  
Bipolar Disorder ◽  
Case Report ◽  
Electroconvulsive Therapy ◽  
Specific Effect ◽  
Severe Depression ◽  
Bipolar Patient ◽  
Hair Pulling ◽  
Obsessive Compulsive ◽  
History Of

A recent review on the use of electroconvulsive therapy (ECT) in obsessive-compulsive–related disorders (OCRDs) identified reports of trichotillomania (TTM) in only three patients, but it did not describe the specific effect of ECT on hair-pulling behaviors. The authors present a case report of Mrs. A, a 77-year-old widowed housewife with a lifelong history of episodic TTM and bipolar disorder who was effectively treated with ECT. However, on each attempt to withdraw ECT, her condition deteriorated. Eventually, a decision was made to maintain ECT (one session every week), which resulted in no further relapse over the followup period. ECT shows some potential promise for reducing hair-pulling behaviors in the context of severe depression.

scholarly journals 508 - LATE ONSET BIPOLAR DISORDER: CASE REPORT AND LITERATURE REVIEW

2021 ◽  
Vol 33 (S1) ◽  
pp. 60-60
Author(s):  
Joana Regala ◽  
João Reis
Keyword(s):  
Bipolar Disorder ◽  
Case Report ◽  
Electroconvulsive Therapy ◽  
Late Onset ◽  
Diffuse Axonal Injury ◽  
First Episode ◽  
Triggering Factors ◽  
History Of ◽  
Secondary Mania ◽  
Depressive Episodes

Background:Late-onset bipolar disorder (LOBD) remains an incompletely understood nosological entity, in reason of its complexity and the paucity of research in this issue. It is not yet clear whether LOBD is a “phenocopy” of the classic early-onset bipolar disorder (EOBD), sharing symptoms but having a different aetiology, or whether both have a common underlying vulnerability that interacts with age-specific triggering factors. Some authors have proposed that LOBD is a heterogeneous entity, comprising secondary mania (including organic brain disease), bipolarity in the context of dementia-like processes (BD type VI), and LOBD as expression of a lower vulnerability to bipolarity.Case Report:Female patient with previous medical history of hypertension and dyslipidaemia, and psychiatric history of recurrent severe depressive episodes since early age, with melancholic and psychotic features, had a first hypomanic episode at 76 years-old, under treatment with tricyclic antidepressant and electroconvulsive therapy. Meanwhile, she suffered a traumatic brain injury (TBI) complicated with subdural and subarachnoid hematoma, as well as intraventricular haemorrhage, which is an indirect sign of diffuse axonal injury (DAI). Later, at 79 years-old, she presented a mixed episode characterized by racing thoughts, flight of ideas, non-systematized persecutory and ruin delusions, hyposomnia, and ultradian alternation between dysphoric and depressive mood, psychomotor agitation and retardation, emotional lability, hypersyntonic contact and hostility. Medical conditions that could account for secondary mania were ruled out. This clinical picture subsided within few weeks under treatment with olanzapine and electroconvulsive therapy. After recovery memory deficits were noticed.Concluding remarks:This case illustrates a “latent” BD, in a patient with previous recurrent depressive disorder, manifesting the first episode of mania in late life. Several triggering factors may have contributed to this longitudinal evolution, lowering the threshold to manifest mania, namely cerebrovascular risk factors, a possible underlying degenerative process and DAI secondary to TBI, which through structural dysconnectivity also contributes to cognitive dysfunction. The deleterious effect of recurrent and severe depressive episodes on cognition is well documented. The question of whether some forms of LOBD could constitute a special risk factor for developing dementia deserves further investigation.

scholarly journals Catatonia Development in a Patient with Bipolar Disorder Following Electroconvulsive Therapy: A Case Report

2019 ◽  
Author(s):  
Azadeh Mashayekhi ◽  
Alireza Ghayoumi
Keyword(s):  
Bipolar Disorder ◽  
Case Report ◽  
Electroconvulsive Therapy ◽  
Case Reports ◽  
Precipitating Factors ◽  
Psychotic Feature ◽  
History Of ◽  
B12 Deficiency ◽  
Major Treatment ◽  
Long Acting

Objective: Electroconvulsive therapy (ECT) is a major treatment of catatonia; and catatonia development during electroconvulsive therapy is a highly surprising phenomenon. We present a patient with bipolar disorder who developed catatonia during ECT. Case Reports: A 21-year-old woman, with a known case of bipolar disorder in manic phase without psychotic feature, history of long acting antipsychotic use, and severe B12 deficiency, was treated with ECT. Full catatonia syndrome developed after the fifth session of ECT. Conclusion: In rare cases, catatonia can develop during ECT course in the presence of some precipitating factors. Thus, these precipitating factors should be eliminated as much as possible before the start of ECT course to prevent catatonia development.

scholarly journals “This Is Not the Original Timeline”: A Case Report of an Extended Dissociative Episode in a Healthy Young Male Accompanied with Severe Decline in Mental State

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Godwin Tong ◽  
Kieran Groom ◽  
Louisa Ward ◽  
Muhammad Naeem
Keyword(s):  
Case Report ◽  
Mental State ◽  
Young Male ◽  
Obsessive Compulsive ◽  
Psychiatric Admission ◽  
Compulsive Disorder ◽  
Psychiatric Setting ◽  
Patient Reported ◽  
History Of ◽  
Core Symptoms

Dissociation is a disconnection between a person’s thoughts, memories, feelings, actions, or sense of who he or she is. Dissociative disorders can be described and understood using the combination of five core symptoms: amnesia, depersonalisation, derealisation, identity confusion, or identity alteration. They are frequently associated with previous experience of trauma. The challenge in diagnosis and the lifetime prevalence of approximately 10% in the general population and clinical psychiatric setting ensures the relevance of this case. We write about a 21-year-old gentleman with history of autism and obsessive compulsive disorder, but no significant medical history was presented to the emergency department with increased anxiety, subsequently progressing to agitation, pacing, and becoming nonverbal. No significant findings were uncovered on laboratory blood testing (other than prolactin 737 mu/L and phosphate 0.35 mmol/L), lumbar puncture, or brain imaging. Consequently, he was admitted to a psychiatric unit for assessment. The patient continued to present with severe disorientation, limited speech, and altered state of consciousness with occasional spastic-like movements. Antipsychotic and benzodiazepine medication was initiated, with no significant change in presentation. The patient continued to be witnessed wandering and having incoherent speech. First signs of improvement came 21 days postadmission with brief conversation and lucidity. This continued to improve over the next 7 days where he was reported to be at his baseline mental state. Environmental stressors including university examinations, the COVID-19 pandemic, and recent contact with his estranged father were possible precipitants to the episode. The patient reported almost complete unawareness of the psychiatric admission. A diagnosis of dissociative disorder, unspecified, was given. This case shows the management and diagnostic challenges of patients presenting with the aforementioned symptoms. There are no formal guidelines for the management of treating dissociative episodes, and this case report suggests the possible benefits of a drug-free period of watchful waiting upon admission.

Hassle Faced with Induced Mania in Elderly Female While Treating for OC Symptoms. A Case Report.

2020 ◽  
Author(s):  
POONAM BHARTI ◽  
Angad harshbir singh ◽  
Parul Gupta
Keyword(s):  
Bipolar Disorder ◽  
Case Report ◽  
Index Case ◽  
Opportunity To Learn ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Elderly Female ◽  
Co Morbidity ◽  
The Common ◽  
Treatment Aspect

Abstract Background- Obsessive-compulsive disorder (OCD) is one of the most frequently associated comorbidities in bipolar disorder (BD). While this presents a challenge in understanding the phenomenology and also the treatment aspect of co occurrence of mania with OCD. Case history- The index case is of an elderly female who presented with OC symptoms and while on treatment had mania episodes. The mania episodes presented challenges while managing underlying OC symptoms. Conclusion- The common neurobiological mechanism for the co-morbid illness and treatment lacunae are discussed. The serotonin, dopamine, and glutamate having important role in BD-OCD were evaluated to understand the neurobiological basis of BD-OCD. The index case presented with the challenge of understanding the phenomenology of the illness but also presented with opportunity to learn and successfully manage patients with such co-morbidity. Divalproex and risperidone combo was found to be effective in controlling mania in OCD patients.

Risk of bipolar disorder and psychotic features in patients initially hospitalised with severe depression

2014 ◽  
Vol 27 (2) ◽  
pp. 113-118 ◽  
Author(s):  
Kimiya Nakamura ◽  
Junichi Iga ◽  
Naoki Matsumoto ◽  
Tetsuro Ohmori
Keyword(s):  
Bipolar Disorder ◽  
Severe Depression ◽  
Psychotic Symptoms ◽  
Primary Disorder ◽  
Icd 10 ◽  
History Of ◽  
Physical Diseases ◽  
The Stability ◽  
Psychotic Features ◽  
Depressive Episodes

ObjectiveSevere depression may be a risk factor for diagnostic conversion into bipolar disorder (BD), and psychotic depression (PD) has been consistently associated with BD. The aims of the present study were to investigate the stability of the diagnosis of severe depression and the differences between PD and non-psychotic severe depression (non-PD), as well as to assess the effectiveness of electroconvulsive therapy (ECT).MethodsPatients who were hospitalised for severe depression (diagnosed according to ICD-10) both with and without psychotic symptoms (n=89; mean age=55.6 years, SD=13.9) from 2001 to 2010 were retrospectively assessed.ResultsBy the 75th month of follow-up assessments, 11(12.4%) patients had developed BD. Among these 11 converters, nine had developed BD within 1 year after admission. Only sub-threshold hypomanic symptoms were significantly related to developing BD. The number of depressive episodes and history of physical diseases were significantly increased in non-PD compared with PD patients, whereas ECT was significantly increased in PD compared with non-PD patients. There was a significant association between length of stay at the hospital and the number of days between admission and ECT.ConclusionSub-threshold hypomanic symptoms may represent a prodrome of BD or an indicator of an already manifest phenotype, especially in older patients, which suggests cautious use of antidepressants. In severe depression, non-PD may often occur secondary to physical diseases and patients may experience increased recurrences compared with PD patients, which may be a more ‘primary’ disorder and often requires ECT treatments. ECT is effective for severe depression regardless of the presence of any psychotic feature; the earlier ECT is introduced, the better the expected treatment outcome.

Tramadol-associated mania: A case report

2017 ◽  
Vol 13 (3) ◽  
pp. 197 ◽  
Author(s):  
Jamaluddin Nimah, MD ◽  
Alexander Chen, BA ◽  
Kelly N. Gable, PharmD, BCPP ◽  
Alan R. Felthous, MD
Keyword(s):  
Oxidative Stress ◽  
Bipolar Disorder ◽  
Case Report ◽  
Mood Disorder ◽  
Tricyclic Antidepressants ◽  
Unusual Case ◽  
Underlying Mechanism ◽  
Induced Mood ◽  
History Of

A variety of medications, most notably tricyclic antidepressants, and other antidepressants including venlafaxine have been reported to have triggered manic episodes in patients with bipolar disorder. The synthetic opioid tramadol has also been associated with mania activation. This report describes an unusual case of tramadol-associated mania in a patient without a charted diagnosis of bipolar disorder. However, she had a history of two prior episodes of mania following administration of tramadol that were also believed to be related to medication-induced mood disorder rather than underlying bipolar disorder. We hypothesize that tramadol-associated mania may have an underlying mechanism involving monoamine neurotransmission and increased oxidative stress.

Self-Monitoring, Competing Response and Response Cost in the Treatment of Trichotillomania: A Case Report

1997 ◽  
Vol 25 (3) ◽  
pp. 281-290 ◽  
Author(s):  
Paul Rogers ◽  
Simon Darnley
Keyword(s):  
Case Report ◽  
Female Patient ◽  
Successful Treatment ◽  
Response Cost ◽  
Hair Pulling ◽  
Self Monitoring ◽  
History Of ◽  
Competing Response

Self-monitoring, a competing response and response cost were used in the successful treatment of a 49 year old female patient with a 19 year history of trichotillomania. Self-monitoring and a competing response produced significant decreases in hair-pulling, but still continued as the patient found it pleasurable at times of stress. The addition of response cost procedures overcame this.

scholarly journals Kidney Transplant Recipient with Conversion Disorder Treated with Electroconvulsive Therapy

2020 ◽  
Vol 7 ◽  
pp. 21-23
Author(s):  
Rachel Beeson ◽  
Stavros Stefanopoulos ◽  
Daniel Rapport ◽  
Jorge Ortiz
Keyword(s):  
Clinical Outcome ◽  
Kidney Transplant ◽  
Electroconvulsive Therapy ◽  
Kidney Transplant Recipient ◽  
Previous History ◽  
Severe Depression ◽  
Conversion Disorder ◽  
Functional Improvement ◽  
Good Clinical Outcome ◽  
History Of

We describe the case of a patient with refractory post-operative conversion disorder successfully treated with electroconvulsive therapy (ECT) with good clinical outcome. A 66-year-old Caucasian male presented to the emergency department (ED) with altered mental status and was nonverbal three days after undergoing an uncomplicated incisional hernia repair. He had a past medical history of major depression with psychotic features and generalized anxiety disorder as well as a kidney transplant. He had multiple previous psychiatric hospitalizations in the 1980s for severe depression with suicidality treated successfully with ECT. The patient was admitted, and a diagnosis of conversion disorder was made. His condition deteriorated over 21 days of inpatient management and he failed to respond to methylphenidate, aripiprazole, haloperidol, and lorazepam. Bilateral ECT treatment was initiated and the patient demonstrated a dramatic functional improvement after the first treatment. He was discharged home after receiving 6 total treatments and continued outpatient treatments with good clinical outcome. ECT may be considered in patients with refractory conversion disorder with a previous history of successful treatment.

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