Selection of psychotropics in dermatologic practice

There is an increased prevalence of psychiatric symptoms in dermatologic disorders. However, these are often underrecognized and undertreated contributing to suboptimal adherence and therapeutic outcomes. A working knowledge of psychotropic medications and their use in dermatology is essential for comprehensive management of psychodermatological conditions. The present review provides a framework for use of psychotropic agents in dermatological settings and is intended to serve as a ready reckoner for the dermatologist. We initially review the general considerations involved in prescribing psychotropic agents in skin conditions. Next, we discuss individual classes of psychotropic agents such as anti-depressants, mood stabilizers, antipsychotics, and anxiolytics focusing on preferred agents while prescribing. Finally, we discuss the common adverse cutaneous reactions reported with psychotropic agents.

A Case Report on Hemiplegia in a Patient with an Intracerebral Hemorrhage of the Basal Ganglia of the Corona Radiata Treated with Traditional Korean and Western Medicine

Objective: This study examined the case of a 63-year-old man with a history of hypertension and gout who had developed an intracerebral hemorrhage (ICH) of the right basal ganglia of the corona radiata.Methods: The patient was treated with herbal medicine (Boyanghwanoh-tang and powdered Oryeong-san extract), Western medicine (Anticonvulsants, antihypertensive drugs, psychotropic agents, and others), acupuncture, moxibustion, cupping, and rehabilitative therapy. Their effects were evaluated using the Manual Muscle Test (MMT), Korean version of the modified Barthel Index (K-MBI), National Institute of Health’s Stroke Scale (NIHSS), and Modified Rankin Scale (mRS).Results: After treatment, the MMT grade improved from 3/3+ to 4+/4+. Additionally, the K-MBI score improved from 62 to 77.Conclusion: The results suggest that combined traditional Korean and Western medicine can effectively treat patients with ICH.

Neuroleptic Malignant Syndrome Associated with Rhabdomyolysis Induced by Antipsychotic Agents: A Rare Occurrence

Neuroleptic Malignant Syndrome (NMS) is a medical emergency of infrequent presentation in Emergency department, which is associated with the use of psychotropic agents, classical and atypical antipsychotics. We report a case involving a 56-year-old male patient diagnosed with schizophrenia and depression for 30 years, who had been receiving Amisulpride, Trifluoperazine, Clozapine, and Amitryptiline as part of his treatment. This patient presented with symptoms of NMS with fever, muscle rigidity, altered mental state, elevated CPK, Urea, and S. Creatinine levels. NMS may be responsible for serious rhabdomyolysis, acute respiratory distress syndrome, and disseminated intravascular coagulation. We hypothesize the occurrence of acute renal failure precipitated by NMS. His treatment included the withdrawal of all psychotropic agents, Bromocriptine, and other supportive measures.

Loxapine in patient with clozapine-resistant psychosis

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.