scholarly journals Loxapine in patient with clozapine-resistant psychosis

2021 ◽  
Vol 11 (4) ◽  
pp. 263-266
Author(s):  
Jennifer Erley ◽  
Sarah Goldsborough ◽  
Amy VandenBerg ◽  
Alexandra Audu
Keyword(s):  
Adverse Effects ◽  
Clinical Improvement ◽  
Receptor Binding ◽  
First Generation ◽  
Paranoid Schizophrenia ◽  
Severe Neutropenia ◽  
Drug Of Choice ◽  
Psychotropic Agents ◽  
History Of ◽  
Treatment Refractory

Abstract Clozapine is recognized as the drug of choice for treatment-refractory schizophrenia, but use may be limited because of strict monitoring requirements and adverse effects including severe neutropenia, seizures, and myocarditis. Loxapine is a first-generation antipsychotic with similarities to clozapine in both structure and receptor binding. This case describes a 57-year-old male with a history of severe paranoid schizophrenia despite treatment with clozapine and other psychotropic agents, who experienced clinical improvement after a cross titration from clozapine to loxapine. Loxapine may be a reasonable alternative in patients with treatment-refractory schizophrenia who do not tolerate or respond to clozapine.

scholarly journals Concomitant Use of Topiramate Inducing Neutropenia in a Schizophrenic Male Stabilized on Clozapine

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Pravesh Sharma ◽  
Jeffrey Davis ◽  
Vivekananda Rachamallu ◽  
Manish Aligeti
Keyword(s):  
African American Male ◽  
Paranoid Schizophrenia ◽  
Severe Neutropenia ◽  
Psychotic Symptoms ◽  
Rapid Decline ◽  
Dependent Manner ◽  
Gradual Decline ◽  
History Of ◽  
Leukocyte Counts ◽  
Dose Dependent

This is a case of a 23-year-old African American male with a history of paranoid schizophrenia that developed neutropenia on a clozapine-topiramate therapy. Clozapine had well addressed the patient’s psychotic symptoms, while topiramate was used as a weight-lowering agent. The patient had fairly stable leukocyte counts for eight months on clozapine 300 mg and topiramate 100 mg daily. Doubling the dosage of topiramate led to severe neutropenia after two months. Reviewing the patient’s laboratory reports showed a gradual decline of neutrophils occurring at a lower dosage, followed by a rapid decline after an increased dosage. In this case, we report that not only did topiramate act as the neutropenic agent, but also it might have done so in a dose-dependent manner.

scholarly journals Second-Generation Antipsychotics and Extrapyramidal Adverse Effects

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Nevena Divac ◽  
Milica Prostran ◽  
Igor Jakovcevski ◽  
Natasa Cerovac
Keyword(s):  
Adverse Effects ◽  
First Generation ◽  
Second Generation ◽  
Great Expectations ◽  
Extrapyramidal Syndrome ◽  
Generation Agent ◽  
Second Generation Antipsychotics ◽  
History Of ◽  
High Doses ◽  
First And Second Generation

Antipsychotic-induced extrapyramidal adverse effects are well recognized in the context of first-generation antipsychotic drugs. However, the introduction of second-generation antipsychotics, with atypical mechanism of action, especially lower dopamine receptors affinity, was met with great expectations among clinicians regarding their potentially lower propensity to cause extrapyramidal syndrome. This review gives a brief summary of the recent literature relevant to second-generation antipsychotics and extrapyramidal syndrome. Numerous studies have examined the incidence and severity of extrapyramidal syndrome with first- and second-generation antipsychotics. The majority of these studies clearly indicate that extrapyramidal syndrome does occur with second-generation agents, though in lower rates in comparison with first generation. Risk factors are the choice of a particular second-generation agent (with clozapine carrying the lowest risk and risperidone the highest), high doses, history of previous extrapyramidal symptoms, and comorbidity. Also, in comparative studies, the choice of a first-generation comparator significantly influences the results. Extrapyramidal syndrome remains clinically important even in the era of second-generation antipsychotics. The incidence and severity of extrapyramidal syndrome differ amongst these antipsychotics, but the fact is that these drugs have not lived up to the expectation regarding their tolerability.

Minocycline-Induced Agranulocytosis Presenting as Ecthyma Gangrenosum

2017 ◽  
Vol 1 (3) ◽  
pp. 161-164 ◽  
Author(s):  
Katherine Nolan ◽  
Reema Ishteiwy ◽  
John Alexis ◽  
Martin Zaiac ◽  
Anna Nichols
Keyword(s):  
Care Facility ◽  
Urgent Care ◽  
Severe Neutropenia ◽  
Dramatic Improvement ◽  
Therapy Discontinuation ◽  
Incision And Drainage ◽  
Ecthyma Gangrenosum ◽  
Minimal Improvement ◽  
History Of ◽  
Acute And Chronic Inflammation

A 51-year-old female with a history of rheumatoid arthritis was admitted for progressive fevers, chills and malaise. Five weeks prior, she started minocycline for an RA exacerbation. Two weeks after starting minocycline she developed an abscess on her right ankle that was treated at an urgent care facility with ceftriaxone and trimethoprim-sulfamethoxazole. She had minimal improvement so was switched to clindamycin. She developed additional abscesses on her right ankle and right axilla and spiking fevers so she was treated with incision and drainage under general anesthesia. Routine blood work obtained prior to surgery revealed severe neutropenia (0.74 103/ul) and the patient was urgently referred to the emergency department.  Skin biopsy was obtained on admission and revealed ulceration, necrosis, acute and chronic inflammation, vasculitis with vascular thrombosis and rod-shaped bacteria in blood vessel walls and lumina consistent with ecthyma gangrenosum. The following day tissue and blood cultures confirmed the growth of Pseudomonas aureginosa. Bone-marrow biopsy showed decreased granulopoiesis and hematopoiesis, and a diagnosis of minocycline-induced agranulocytosis presenting as ecthyma gangrenosum was made.  The patient had dramatic improvement with appropriate antibiotic therapy, discontinuation of minocycline and initiation of filgrastrim. She has remained healthy without recurrence for 17 months.    

Salicylate toxicity from chronic bismuth subsalicylate use

2020 ◽  
Vol 13 (11) ◽  
pp. e236929
Author(s):  
Sheliza Halani ◽  
Peter E Wu
Keyword(s):  
Emergency Department ◽  
Adverse Effects ◽  
Hearing Impairment ◽  
Reference Range ◽  
The Elderly ◽  
Intravenous Fluids ◽  
Over The Counter ◽  
Bismuth Subsalicylate ◽  
Salicylate Concentration ◽  
History Of

A 79-year-old man presented to the emergency department with a 1-week history of worsening confusion, falls and hearing impairment. An initial workup for infectious, metabolic and structural causes was unrevealing. However, further history discovered that he had been ingesting one to two bottles of Pepto-Bismol (bismuth subsalicylate) daily for gastro-oesophageal reflux symptoms. On his second day of admission, the plasma salicylate concentration was 2.08 mmol/L (reference range 1.10–2.20 mmol/L), despite no sources of salicylate in hospital. He was diagnosed with chronic salicylate toxicity and Pepto-Bismol use was discontinued. The patient was treated supportively with isotonic intravenous fluids only and plasma salicylate concentration fell to less than 0.36 mmol/L. Concurrently, all his symptoms resolved. This case highlights the potential adverse effects of over-the-counter medications. The diagnosis of chronic salicylate toxicity is challenging, specifically in the elderly and in undifferentiated presentations, as it can be missed if not suspected.

scholarly journals Strategies for Gaining Full Citizenship in the First Generation of Indochinese Students

2021 ◽  
Vol 10 (4) ◽  
pp. 129
Author(s):  
Brice Fossard
Keyword(s):  
Physical Education ◽  
First Generation ◽  
Physical Activities ◽  
Student Community ◽  
History Of ◽  
Legal Equality ◽  
Young Students

The history of the acquisition of French citizenship by Indochinese university élites remains yet to be written because few researchers have looked at the role played by sport and physical education in developing the Vietnamese élite. These young students discovered such physical activities at school and many of them claimed judicial/legal equality with the French. This article will demonstrate that sports and physical education were the key stages in a strategy for certain Indochinese students to become French citizens. At the same time, this tactic generated much tension within the Vietnamese student community between the two world wars.

KOREA'S FIRST-GENERATION DIVIDED FAMILIES: The End of the Line?

World Affairs ◽  
2021 ◽  
pp. 004382002110247
Author(s):  
James Alexander Foley
Keyword(s):  
First Generation ◽  
Korean War ◽  
Family Members ◽  
Red Cross ◽  
Family Separation ◽  
The Korean War ◽  
History Of ◽  
Successes And Failures

This article describes and analyzes the desperate situation of Korean first-generation divided family members who are still separated from their relatives nearly 70 years since the end of the Korean War (1950–1953). I aim to provide the reader with a reasonable quantification of the problem and make projections as to this first generation's likely future survival. The elements of the approach adopted to resolve the issue of family separation by the humanitarian bodies charged with addressing the problem, the Red Cross Societies of the two Koreas are described, and suggestions are made for improvement. The reunion program's successes and failures are critically assessed as is the key role played by the Red Cross Talks in the history of inter-Korean relations. Finally, conclusions are drawn as to the practical measures which may contribute to a resolution to the problem before the final disappearance of Korea's first generation of aged, separated family members.

Purulent Otitis Media: Differences Between Populations in Different Environments

PEDIATRICS ◽  
1974 ◽  
Vol 53 (2) ◽  
pp. 135-136
Author(s):  
Patrick Manning ◽  
Mary Ellen Avery ◽  
Alan Ross
Keyword(s):  
Hearing Loss ◽  
Adverse Effects ◽  
Language Development ◽  
Otitis Media ◽  
Early Life ◽  
Educational Programs ◽  
Previous Issue ◽  
High Incidence ◽  
History Of ◽  
Tympanic Membranes

The paper by Kaplan and colleagues in a previous issue starts by emphasizing the unusually high incidence of otitis media among Eskimo children. Forty-one percent of their cohort of 489 Alaskan Eskimo children, followed for ten years, had perforations or scars of the tympanic membranes; significant hearing losses were present in 16% of the group. Among the 374 children with a history of otorrhea, 291 (78%) had their first attack before their second birthday. The adverse effects of hearing loss in early life on language development were underscored by the authors, who quite properly point out the need for special educational programs.

Seksueel onaangepast gedrag bij een patiënt met dementie: literatuurreview en casusrapport

2021 ◽  
Author(s):  
C. SEAUX ◽  
K. GOEDSEELS ◽  
J. DE LEPELEIRE
Keyword(s):  
Case Studies ◽  
Randomised Controlled Trials ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Controlled Trials ◽  
Pharmacological Treatments ◽  
Pharmacological Interventions ◽  
Drug Of Choice ◽  
Cochrane Database ◽  
History Of ◽  
Randomised Controlled

Sexually inappropriate behaviour in a patient with dementia: literature review and case report In this paper, the medical history of a 75-year-old man with dementia and sexually inappropriate behaviour (SIB) is described. An overview of the literature regarding the approach and treatment of SIB in persons with dementia was performed. PubMed, Web of Science and the Cochrane database were consulted, and thirteen articles selected. There are no randomised controlled trials available. The literature is limited to case studies and reviews of case studies. Non-pharmacological treatments are perceived to be the first step, although they are rarely studied. There is no consensus regarding a pharmacological approach. However, all studies suggest the paradigm of “start low and go slow”. A variety of drugs have been described. When starting a pharmacological treatment, it is recommended to keep in mind comorbidities and possible side-effects. Selective serotonin reuptake inhibitors (SSRIs) seem to be the preferred first line treatment if the behaviour is not too harmful. If the behaviour is intrusive, anti-androgens seem to be the drug of choice. Further research is needed: a consensus regarding the definition and the development of a screening tool could support randomised controlled trials concerning pharmacological and non-pharmacological interventions. Research concerning ethical dilemmas should, however, not be neglected.

scholarly journals THE SILENT HALF SPEAKS

2017 ◽  
Vol 2 (1) ◽  
pp. 203-210
Author(s):  
Shellen Wu
Keyword(s):  
Social History ◽  
First Generation ◽  
Modern China ◽  
Chinese Revolution ◽  
Late Qing ◽  
Liang Qichao ◽  
History Of ◽  
Kang Youwei ◽  
History Of Modern China ◽  
Qiu Jin

It wasn't so long ago that histories of China's rocky transition to modernity featured a small and entirely male cast of characters. In the works of the first generation of American Sinologists, from John King Fairbank to his most famous students such as Joseph Levenson, a few men, from late Qing statesman Li Hongzhang 李鴻章 to reformers and revolutionaries like Kang Youwei 康有為, Sun Yatsen 孫中山, and Liang Qichao 梁啟超, loomed large over the narrative of the Chinese revolution. Into this lacuna Mary Rankin's rediscovery of the late Qing female martyr Qiu Jin 秋瑾 came as a thunderbolt. Her work opened up the possibility that perhaps the problem wasn't the absence of women in China's revolution but the failure of scholars to look for their contribution. Rankin's 1968 article on “The Tenacity of Tradition,” and her subsequent bookEarly Chinese Revolutionariespaved the way for a far more nuanced and complicated new social history of modern China.

scholarly journals The Role of Bruton’s Kinase Inhibitors in Chronic Lymphocytic Leukemia: Current Status and Future Directions

2021 ◽  
Author(s):  
Tadeusz Robak ◽  
Magda Witkowska ◽  
Piotr Smolewski
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Adverse Effects ◽  
Kinase Inhibitors ◽  
Clinical History ◽  
Lymphocytic Leukemia ◽  
Current Status ◽  
Covalent Inhibitors ◽  
History Of ◽  
Reduced Toxicity ◽  
Btk Inhibitors

The use of the Bruton’s tyrosine kinase (BTK) inhibitors has changed the management and clinical history of patients with chronic lymphocytic leukemia (CLL). BTK is a critical molecule that interconnects B-cell antigen receptor (BCR) signaling. BTKIs are classified into two categories: irreversible (covalent) inhibitors and reversible (non-covalent) inhibitors. Ibrutinib is the first irreversible BTK inhibitor approved by the U.S. Food and Drug Administration in 2013 as a breakthrough therapy in CLL patients. Subsequently, several studies evaluated the efficacy and safety of new agents with reduced toxicity when compared with ibrutinib. Two other irreversible, second-generation BTK inhibitors, acalabrutinib and zanubrutinib, were developed to reduce ibrutinib-mediated adverse effects. Additionally, new reversible BTK inhibitors are currently under development in an early phase studies to improve their activity and to diminish adverse effects. This review summarizes the pharmacology, clinical efficacy, safety, dosing, drug-drug interactions associated with the treatment of CLL with BTK inhibitors, and examines its further implications.

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