Psychopathological conditions and somatic consequences of a suicide attempt with a corrosive substance in a patient suffering from long-lasting paranoid schizophrenia - a case study

Background: Schizophrenia is a chronic mental illness that affects 20 million people worldwide. Patients diagnosed with paranoid schizophrenia are characterized by cognitive deficits and the so-called negative symptoms, which significantly lower their quality of life and have implications for their independence and ability to fulfill various social roles. Aim: This study aims to present the case of a 49-year-old woman who has been suffering from schizophrenia for a long time and, due to a psychotic exacerbation with delusions and auditory hallucinations in the form of ordering voices, attempted suicide by ingesting a highly corrosive chemical agent used for unblocking pipes (the so-called “mole”). Case report: The patient was admitted to the 1st Department of Psychiatry, Psychotherapy and Early Intervention of SPSK 1 in Lublin for psychiatric treatment, after being transferred from the SPSK 1 Surgery Clinic, where she was initially admitted after the suicide attempt. Discussion: The psychotic exacerbation in the patient could have resulted from sensory deprivation due to her feeling of loneliness and deep social isolation.

Efficacy and safety of dopamine agonists in patients treated with antipsychotics and presenting a macroprolactinoma

Context In patients treated with antipsychotics, the rare occurrence of a macroprolactinoma represents a therapeutic challenge. Objective Our aim was to evaluate the efficacy and psychiatric safety of dopamine agonists (DAs) prescribed for large macroprolactinomas in patients with psychosis treated with antipsychotics. Design This was a multicenter (France and Belgium) retrospective study. Patients Eighteen patients treated with antipsychotics were included. Results Under DA, median PRL levels decreased from 1247 (117–81 132) to 42 (4–573) ng/mL (P = 0.008), from 3850 (449–38 000) to 141 (60–6000) ng/mL (P = 0.037) and from 1664 (94–9400) to 1215 (48–5640) ng/mL (P = 0.56) when given alone (n = 8), before surgery (n = 7), or after surgery (n = 6), respectively. The prolactinoma median largest diameter decreased by 28% (0–57) in patients under DAs alone (P = 0.02) but did not change when given after surgery. Optic chiasm decompression was achieved in 82% of patients. Five patients (28%) were admitted for psychotic relapse while receiving DAs (but three of them had stopped antipsychotic treatment at that time). A more severe underlying psychosis, rather than the DA treatment itself, may explain such psychiatric admissions. Conclusion Even if the DA efficacy on PRL levels and tumor volume in patients with macroprolactinoma under antipsychotic drugs is less impressive than that typically observed, it may be considered satisfactory for half of our patients, particularly in cases of optic chiasm compression. Psychotic exacerbation was unusual in these patients, occurring mostly in those with the most severe psychotic forms. DAs may therefore be used as antitumor treatment for macroprolactinoma in patients with visual involvement, severe headaches or invasion into the skull base who receive antipsychotics.

Resolution without discontinuation: heart failure during clozapine treatment

Clozapine is an atypical antipsychotic recommended for patients with treatment-resistant schizophrenia whose illness has not responded adequately to treatment despite the sequential use of at least two different antipsychotic drugs at therapeutic doses. Unfortunately, clozapine is frequently discontinued due to both real and perceived serious, and potentially life-threatening, adverse effects, contributing to the underutilisation of the most effective treatment in refractory psychotic disorders. Here, we present the case of a 51-year-old man with treatment-resistant schizoaffective disorder, who was admitted to a locked rehabilitation unit for a clozapine rechallenge. Within 6 months after the clozapine rechallenge, he was diagnosed with heart failure likely secondary to his antipsychotic treatment. Clozapine-induced heart failure usually prompts immediate cessation of treatment. However, in this case, clozapine was continued with cardiology consultation. Ramipril and bisoprolol were initiated and the patient’s cardiac condition progressively improved over time. Clozapine-induced heart failure is a serious cardiovascular complication of treatment, usually resulting in discontinuation of treatment. Although there are cases of successful rechallenge, temporary cessation of treatment can lead to severe psychotic exacerbation and non-engagement with cardiac specialists. More evidence is required for continued use of clozapine in a patient with clozapine-induced cardiac complications.

Foreign Accent Syndrome Secondary to Medication Withdrawal: A Case Report

Objective: The purpose of this case report is to demonstrate a possible alternative etiology related to dopamine may exist for foreign accent syndrome (FAS). Methods: A 79-year-old, 205 pound, Caucasian woman originally presented to the department of Neurology for treatment and subsequently to the pharmacist pharmacotherapy service for evaluation of bilateral upper extremity tremor of high amplitude but was found to also exhibit FAS. Discussion: This case report contributes to the limited literature regarding foreign accent syndrome and adds to the few case reports of psychogenic origin, as opposed to the majority, which are of neurogenic origin. This also represents the first case that seems related to withdrawal of medication rather than psychotic exacerbation and ranks a six on the Naranjo algorithm. Conclusion: FAS is a rare disorder and little is understood about it. This case presentation also suggests that chronic use of high-dose dopamine and/or anticholinergic agents may alter pathways in the brain, which in this case, may have potentially contributed to the development of FAS. There remain many unanswered questions regarding FAS, but hopefully more clarity may be found as more cases are discovered and published. Conflict of Interest I declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties. Type: Case Study

Objectively measurable equilibriometric locomotor ataxia in schizophrenia

IntroductionThe basic role of cerebellar dysfunctions in schizophrenia pathophysiology is already well-known. Importantly, cerebellar signs such as gait and balance coordination deficits are objectively manifested and measurable. However, both early detection and treatment monitoring of the illness are still-based mainly on subjective psychopathological symptoms.AimsTo introduce an objective and quantitative approach to the cerebellar gait and balance disorders in schizophrenia.MethodsAn original (internationally patented) method for objective equilibriometric quantification of stepping locomotion (a kind of motion analysis system) was developed and then applied repetitively in 230 schizophrenic patients and 230 well-matched healthy controls.ResultsSubclinical but objectively measurable equilibriometric locomotor ataxia (ELA) was identified in a large proportion of the investigated patients. Its severity fluctuated along with the changes in the clinical state. As a rule, the degree of ELA transiently increases during psychotic exacerbation and gradually returns to its prepsychotic level during therapeutic remission. Data analysis revealed that the basic (prepsychotic and postpsychotic) ELA could be viewed as a new schizotaxic biomarker (trait-marker) for schizophrenia, while the degree of its severity could serve as a new objectively measurable state-marker for psychosis. Besides, its dynamics during antipsychotic treatment might be used as an objective measure of the therapeutic response (a kind of surrogate pharmacodynamic biomarker).ConclusionsObjective quantification of the ELA allows for early detection of subclinical signs of cerebellar ataxia (or schizotaxia) in individuals at high-risk for schizophrenia, whereas in psychotic patients it permits their objective antipsychotic-treatment monitoring.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Foreign Accent Syndrome, a Rare Presentation of Schizophrenia in a 34-Year-Old African American Female: A Case Report and Literature Review

Foreign Accent Syndrome (FAS) is a rare phenomenon where speech is characterized by a new accent to the patient’s native language. More than 100 cases with the syndrome have been published, the majority of which were associated with observed insults of the speech center. Some other cases have been described without identifiable organic brain injury, especially in patients with psychiatric illness. This paper presents a patient with schizophrenia and FAS, without any evidence of organic brain injury. FAS recurred during psychotic exacerbation and did not reverse before transfer to a long-term psychiatric facility. The case is discussed in the context of a brief review of the syndrome.