PREGABALIN INDUCED MOOD ELEVATION IN BIPOLAR PATIENTS: CASE-REPORTS

The use of cardiovascular medications can have a variety of neuropsychiatric consequences. Many cardiovascular agents cause higher rates of fatigue and sedation than placebo, and case reports of medication-induced mood syndromes, psychosis, and cognitive disturbances exist for many cardiovascular drugs. Depression has been associated with P3-blockers, methyldopa, and reserpine, but more recent syntheses of the data have suggested that these associations are much weaker than originally believed. Though low cholesterol levels have been associated with depression and suicide, lipid-lowering agents have not been associated with these adverse effects. Finally, cardiovascular medications may have beneficial neuropsychiatric consequences; for example, the use of clonidine in patients with attention deficit-hyperactivity disorder, the use of prazosin for patients with post-traumatic stress disorder; and the use of propranolol for performance anxiety and akathisia.

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Bipolar Patients and Bullous Pemphigoid after Risperidone Long-Acting Injectable: A Case Report and a Review of the Literature

Brain Sciences ◽

10.3390/brainsci11111386 ◽

2021 ◽

Vol 11 (11) ◽

pp. 1386

Author(s):

Michele Fabrazzo ◽

Mariangela Boccardi ◽

Salvatore Cipolla ◽

Raffaele Galiero ◽

Claudia Tucci ◽

...

Keyword(s):

Bullous Pemphigoid ◽

Psychiatric Patients ◽

Case Reports ◽

Clinical Manifestations ◽

Bipolar Patient ◽

Self Tolerance ◽

Blistering Disease ◽

Inducing Factors ◽

Long Acting ◽

Bipolar Patients

Neuropsychiatric disorders are found to be associated with bullous pemphigoid (BP), an autoimmune subepidermal blistering disease. Antipsychotics have emerged as possible inducing factors of BP. However, large sample studies concerning BP associated with antipsychotics, as well as with specific mental disorders, are still lacking. Our review retrieved a few clinical studies and case reports on the topic, producing controversial results. We report for the first time a bipolar patient case presenting BP following five-month therapy with risperidone long-acting injectable (LAI). We hypothesize that the dermatological event is associated with the medication administered. The issue emerged during psychiatric consultation and was confirmed by histological examination, direct and indirect immunofluorescence studies, plus positive plasma and cutaneous BP180 and BP230 IgG. Neurodegeneration or neuroinflammation might represent a primary process leading to a cross-reactive immune response between neural and cutaneous antigens and contributing to self-tolerance failure. Furthermore, the time sequence of the shared biological mechanisms leading to clinical manifestations of the neuropsychiatric disorder and BP remains undefined. BP comorbid with bipolar disorder might occasionally represent a serious health risk and affect patients’ physical and psychosocial quality of life. Thus, clinicians treating psychiatric patients should consider BP as a possible adverse effect of psychotropic medications.

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Modafinil Induced Psychosis in a Patient with Bipolar 1 Depression

Case Reports in Psychiatry ◽

10.1155/2018/3732958 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Alexander A. DiSciullo ◽

Clayton D. English ◽

William T. Horn

Keyword(s):

Bipolar Depression ◽

Case Reports ◽

Mood Stabilizers ◽

Schizophrenic Patients ◽

Bipolar Patients

Modafinil has been used as an adjunctive medication in the treatment of bipolar 1 depression with reported success. Case reports have been published demonstrating modafinil induced mania in bipolar patients and modafinil induced psychosis in schizophrenic patients. To our knowledge, we report the only case of modafinil induced psychosis in a patient with bipolar depression treated with both mood stabilizers and antipsychotics. In addition, it is the quickest onset to psychosis (2 days) at the lowest dosage of modafinil (100 mg/day) reported in the literature. Although favorable outcomes using modafinil for treatment of bipolar depression have been reported in literature, clinicians should remain cautious of the potential to rapidly induce psychosis with modafinil at low dosages in patients with bipolar depression despite being treated with mood stabilizers and antipsychotics.

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Lithium and EKG abnormalities. A review

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1394 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S750-S750

Author(s):

A. Ballesteros ◽

Á.S. Rosero ◽

H. Sáiz ◽

E. García-Parreño ◽

G. Carlos ◽

...

Keyword(s):

Therapeutic Range ◽

Case Reports ◽

Sinus Node ◽

Serum Levels ◽

Lithium Therapy ◽

Cardiac Complications ◽

General Terms ◽

Wave Morphology ◽

Competing Interest ◽

Bipolar Patients

IntroductionThe literature concerning possible cardio-toxic effects of lithium therapy in man is reviewed.MethodologyA review was conducted to clarify the mechanisms associated with the occurrence of conducting abnormalities when using lithium and investigating (if so) whether these alterations depend on the dose. The literature search was conducted in PubMed data reviewing articles between 1982 and 2015.Results(1) Related to pathopsychiology/risk factors: reports indicate T wave morphology changes with lithium therapy. Of particular concern are cases of sinus mode dysfunction or sinoatrial block and the appearance or aggravation of ventricular irritability. The incidence of cardiac complications, in general terms, may increase with age. Recent findings (a retrospective study of bipolar patients) of lithium-associated hypocalcaemia showed that hypocalcaemia resulting from medical diseases and bipolar patients with lithium-associated hypocalcaemia had significantly higher frequencies of conduction defects. (2) Related/unrelated to dose: therapeutic and toxic levels of lithium have infrequently been associated with serious cardiac dysfunction. Several case reports demonstrate two important points about Brugada syndrome unmasking: electrocardiograph abnormality severity may correspond to lithium levels and unmasking may occur in the therapeutic range of lithium. Other report shows a case of lithium induced sinus-node dysfunction in a patient with serum lithium levels in therapeutic range.ConclusionsLithium abnormalities are rare and mostly not related to dose. Conducting heart anomalies may occur, especially when several factors are present (such as age or co-morbid illnesses that affect calcium serum levels).Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Anticonvulsant and antipsychotic medications in the pharmacotherapy of panic disorder: a structured review

Therapeutic Advances in Psychopharmacology ◽

10.1177/20451253211002320 ◽

2021 ◽

Vol 11 ◽

pp. 204512532110023

Author(s):

Vasilios G. Masdrakis ◽

David S. Baldwin

Keyword(s):

Panic Disorder ◽

Remission Rate ◽

Case Reports ◽

Supporting Evidence ◽

Short Term ◽

Level Of Evidence ◽

Panic Symptoms ◽

Bipolar Patients ◽

New Onset

Background: As the remission rate of panic disorder (PD) achieved with conventional pharmacotherapy ranges between 20% and 50%, alternative psychopharmacological strategies are needed. We aimed to firstly review data regarding use of antipsychotic and non-benzodiazepine anticonvulsant medication in PD patients with or without comorbidities; secondly, to review data concerning reduction of panic symptoms during treatment of another psychiatric disorder with the same medications; and thirdly, to examine reports of anticonvulsant- or antipsychotic-induced new-onset panic symptomatology. Methods: We performed a PubMed search (last day: 28 April 2020) of English-language studies only, combining psychopathological terms (e.g. ‘panic disorder’) and terms referring either to categories of psychotropic medications (e.g. ‘anticonvulsants’) or to specific drugs (e.g. ‘carbamazepine’). All duplications were eliminated. All studies included in the review met certain inclusion/exclusion criteria. The level of evidence for the efficacy of each drug was defined according to widely accepted criteria. Results: In treatment-resistant PD, beneficial effects have been reported after treatment (mostly augmentation therapy) with a range of anticonvulsant (carbamazepine, gabapentin, lamotrigine, levetiracetam, oxcarbamazepine, valproate, vigabatrin, tiagabine) and antipsychotic (aripiprazole, olanzapine, risperidone, sulpiride) medications: overall, most medications appear generally well tolerated. Additionally, bipolar patients receiving valproate or quetiapine-XR (but not risperidone or ziprasidone) demonstrated reductions of comorbid panic-related symptoms. There are case reports of new-onset panic symptoms associated with clozapine, haloperidol, olanzapine and topiramate, in patients with conditions other than PD. The small-to-modest sample size, the lack of control groups and the open-label and short-term nature of most of the reviewed studies hinder definitive conclusions regarding either the short-term and long-term efficacy of antipsychotic and anticonvulsant medications or their potential long-term side effects. Conclusion: Some atypical antipsychotic and anticonvulsant medications may have a role in the treatment of some PD patients, mostly when more conventional approaches have not been successful, but the quality of supporting evidence is limited.

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Subcutaneous Ketamine in Depression: A Systematic Review

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.513068 ◽

2021 ◽

Vol 12 ◽

Author(s):

Vitor Breseghello Cavenaghi ◽

Leandro Paulino da Costa ◽

Acioly Luiz Tavares Lacerda ◽

Edson Shiguemi Hirata ◽

Eurípedes Constantino Miguel ◽

...

Keyword(s):

Systematic Review ◽

Randomized Clinical Trials ◽

Case Reports ◽

Dose Range ◽

Risk Of Bias ◽

Dose Titration ◽

Antidepressant Effect ◽

Multiple Doses ◽

Racemic Ketamine ◽

Bipolar Patients

Background: Ketamine has been shown to produce a rapid and robust antidepressant effect. Though numerous routes of administration have been studied, subcutaneous (SC) has proven to be a convenient and cost-effective route making its use particularly relevant in developing countries. Here we provide a systematic review covering the use of SC racemic ketamine and esketamine in depression, including its efficacy, safety and tolerability.Methods: A systematic literature search was carried out, from inception through March, 2021, using PubMed/MEDLINE, EMBASE and Web of Science, with no limits of language. After identifying 159 potentially relevant articles, 12 articles were selected after applying our inclusion/exclusion criteria. These comprised two randomized clinical trials, five case-reports and five retrospective studies. Given the small number of studies found and their heterogeneous nature, a meta-analysis was not considered appropriate. Here we provide a synthesis of these data including participant characteristics, dose range, efficacy, safety/ tolerability. Risk of bias was accessed using the Cochrane risk of bias tool.Results: SC Ketamine was administered to unipolar and bipolar patients a single or multiple doses, weekly or twice-weekly, a dose-titration approach was made in major studies, dose ranged from 0.1 to 0.5 mg/Kg of racemic ketamine and 0.5–1 mg/Kg of esketamine. Across all studies, SC ketamine showed a rapid and robust antidepressant effect, with response/ remission rates from 50 to 100% following both single or multiple doses, with transitory side effects.Conclusion: SC racemic ketamine and esketamine in depression is a promising strategy showing beneficial efficacy and tolerability. Future studies exploring the SC route, its cost-effectiveness, and a direct comparison with IV and intranasal (IN) protocols are warranted.Systematic Review Registration: CRD42019137434

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Electroconvulsive therapy in treatment-resistant mania: case reports

Revista do Hospital das Clínicas ◽

10.1590/s0041-87812002000100006 ◽

2002 ◽

Vol 57 (1) ◽

pp. 31-38 ◽

Cited By ~ 2

Author(s):

Marcia Britto de Macedo Soares ◽

Ricardo Alberto Moreno ◽

Doris Hupfeld Moreno

Keyword(s):

Electroconvulsive Therapy ◽

Rating Scales ◽

Rating Scale ◽

Case Reports ◽

Large Body ◽

Treatment Resistant ◽

Young Mania ◽

Psychiatric Rating ◽

Psychiatric Rating Scale ◽

Bipolar Patients

Electroconvulsive therapy is known to be effective in the treatment of mood disorders, more specifically for depression and mania. Although a large body of evidence confirms the efficacy of electroconvulsive therapy in the treatment of mania, few prospective studies have been done to assess its effectiveness in treatment-resistant manic episodes. These case reports describe the initial results of a study that is being conducted to evaluate the efficacy of Electroconvulsive therapy among treatment-resistant bipolar patients. METHODS: Three manic patients (according to DSM-IV criteria) who were considered treatment-resistant underwent a series of 12 bilateral Electroconvulsive therapy sessions. Before the treatment and then weekly, they were evaluated with the following rating scales: Young Mania Rating Scale, Hamilton Rating Scale for Depression, Brief Psychiatric Rating Scale, and Clinical Global Impressions-Bipolar Version. RESULTS: The 3 patients showed a satisfactory response to Electroconvulsive therapy, although some differences in the course of response were observed. CONCLUSION: These case reports suggest that Electroconvulsive therapy needs further evaluation for the treatment of resistant bipolar patients.

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