Psiquiatria Biologica最新文献

The catatonic syndrome present multiple etiologies, both medical and psychiatric, with a variety of symptoms that often escape the clinical eye; therefore, it is currently an underdiagnosed syndrome. A multidisciplinary and global approach is necessary in these patients, due to the wide range of pharmacological, toxic and organic predisposing factors and the high morbidity and mortality of this syndrome. That is why we show a clinical case of an inhibited catatonic syndrome in a 37-year-old patient diagnosed with hebephrenic schizophrenia who presents a clinical picture of stupor, mutism and negativism.

In-depth training for clinicians and the application of up-to-date diagnostic scales and criteria are of vital importance for diagnosis, evolution and treatment of these patients. The use of benzodiazepines and early electroconvulsive therapy are the first-line treatments, always associated with support measures and prevention of complications.

Objective

Present a clinical case report on the use of tiapride for alcohol detoxification in a patient with a diagnosis of severe alcohol use disorder 303.90 (F10.20).

Clinical case report

50 year-old female, under follow-up in the Addictive Behavior Unit from September 2016 to present, with diagnoses of adjustment disorder 309.4 (F43.25)

Mixed disturbance of emotions or behavior, severe alcohol use disorder 303.90 (F10.20) and severe decompensation, who is treated with tiapride.

Results

The studies consulted demonstrate the efficacy and safety of tiapride for alcohol withdrawal syndrome in both outpatient and inpatient settings, in monotherapy or in polytherapy with benzodiazepines and/or antiepileptics, being also used in agitation and/or psychotic symptomatology.

Conclusions

In alcohol withdrawal syndrome, tiapride has been found to be effective and can even be considered as an adjunctive treatment to benzodiazepines or anticonvulsants. With a view to the future, pharmacogenetics affecting alcohol use disorder should be taken into account, so that individualized personalized therapy could benefit from fewer adverse effects.

Objective

Olanzapine is widely used throughout the world to treat patients with schizophrenia and bipolar disorder. Olanzapine has numerous side effects, but respiratory depression has not been reported with doses as low as 5 mg.

Clinical case

An elderly woman presented with severe hypercarbia, hypoxia, and impaired consciousness possibly due to low doses of oral olanzapine. There is no accepted antidote for the side effects of olanzapine, so we followed the patient with respiratory support and electrolyte correction. Symptoms improved after 2 weeks and did not recur.

Results and conclusions

Elderly patients, women, and non-smokers may have elevated olanzapine concentrations and may do better with lower than usual doses. If somnolence is observed in a patient taking olanzapine, a blood gas should be obtained and appropriate respiratory care should be provided. We expect that this case report will add to the existing body of literature on the appropriate use of olanzapine.

Introduction

Posttraumatic stress disorder (PTSD) is extremely frequent in war veterans and has been widely studied. However, the efficacy of currently available pharmacological and psychotherapeutic treatments of war PTSD and other causes of PTSD is very limited.

Method

We present a case of war PTSD with delayed expression, with a good response to complementation with methylphenidate after a failed treatment with venlafaxine and risperidone.

Results

We review the role of dopamine in the pathophysiology of PTSD and the scarce studies in the treatment of PTSD with dopaminergic drugs that show an improvement in re-experimentation and in affective symptoms, especially anhedonia and cognitive impairment.

Conclusions

We conclude that the use of methylphenidate and other dopaminergic drugs can be a promising treatment for PTSD, a high prevalent disease with a high resistance to treatment, for which we encourage the use of large sample studies.

Olanzapine, a second-generation antipsychotic marketed in Europe since late 1996, continues to be one of the most widely used molecules in Spain today. However, its high rate of adverse metabolic events and its use in some clinical settings are still controversial. The objective of this study was to explore the knowledge, attitudes, and practices of use of this medication among Spanish psychiatrists. A self-filled questionnaire was designed and distributed. Dosage, experience, and trends of use in different contexts were explored, as well as future expectations. Data were tabulated and a descriptive analysis was performed. 129 practicing psychiatrists throughout the Spanish territory participated in the study, with an average age of 45.46 years (SD = 9.57) and a female: male ratio of 1.04:1. After more than 25 years on the market, Olanzapine continues to be an antipsychotic widely used in different clinical settings, both in Schizophrenia and other mental disorders (preferably at doses between 5 and 10 mg/day). Spanish psychiatrists are familiar with the need to establish pharmacological and non-pharmacological strategies for the metabolic control of patients using this drug.

Introduction

Alcohol is the most consumed substance in Western culture and its consumption is a causal factor in more than 200 diseases and disorders. The objective was to determine the relationship between the amount and type of alcohol (distilled or fermented) consumed, in individuals over 60 years of age, and the appearance of cognitive deterioration compatible with a dementia syndrome as a consequence of excessive and prolonged consumption.

Development

Search in Medline, PsycInfo and Web of Science databases. The search was limited to articles published between 2010 and 2021, based on the combination of various terms related to dementia, alcohol consumption and type, and old age. 157 articles were obtained, those repeated and those not related to the topic were eliminated, leaving a total of 9 articles. This systematic review has been carried out in accordance with the criteria of the PRISMA statement.

Conclusions

Most of the studies found (7 out of 9) suggested an association between alcohol consumption and the onset of dementia. Regarding the type of beverages, everything and the objectification of some inconclusive results, in general it is suggested that the consumption of wine (fermented beverage) is associated with a decrease of cognitive deterioration and the consumption of liquor (distilled beverage) to a increased cognitive decline; the role of beer is not clear. Therefore, it can be concluded that the association between alcohol consumption and greater or lesser cognitive impairment depends both on excessive and prolonged consumption, as well as on the type of beverages consumed (distilled or fermented).

Introduction

Some populations have an intellectual disability frequency of nearly 18%. Among, the diverse genetic causes are single nucleotide variants and copy number variations, detected with second-generation sequencing and chromosomal microarray analysis, respectively. Nevertheless, other variants such as structural variants, trinucleotide repeat or imprinting disorders, cannot be detected by these tests and require different specific techniques. Third-generation sequencing have a power of found all variants. The purpose is to stablish the benefits of using third generation sequencing above second-generation sequencing in the diagnosis of patient with intellectual disability.

Material and methods

A rapid systematic review was performed on the Medline using thesaurus terms MESH of “intellectual disability” and “second-generation sequencing”; as well as using the term “third-generation sequencing”.

Results

31 articles were selected in total. Of those, nine used third-generation sequencing in patients with previously genomic test, and founded structural variants in 40% of cases, all these variants were corroborated with other gold standard tests. Twenty-two studies used second-generation sequencing (n = 22) and showed through metanalysis, that 29,8% and 9,2% of these cases are due a single nucleotide variant and copy number variations, respectively.

Conclusions

Third-generation sequencing can find structural variants, uniparental disomies, trinucleotide repeat and single nucleotide variation. Therefore, it would allow a broader and better study of the etiology of intellectual disability. Nevertheless, more research with larger representative samples in patients and healthy population is needed.

Cotard syndrome is a mysterious and severe disorder. Many therapeutic interventions are reported as potentially efficacious mostly when an underlying psychotic depression or melancholia is diagnosed. However, the classification of depression has long been a contentious issue. Even though the major guide for therapeutic choice is severity, the binary model between endogenous and reactive depression is still widely employed in clinical practice. These considerations impact most clearly in in-between presentations. The authors present the case of R., a 64 year old woman, who was admitted with a major depressive episode with psychotic features, captured as a Cotard-like syndrome. After a two-months inpatient period and apparent clinical remission with high dose antidepressants and antipsychotic combination, she displayed an acute worsening leading to a re-admission just a day after discharge. The management in this second admission was tortuous, due to SARS-CoV2 related contingencies, the refractoriness of the presentation and iatrogenic intercurrences. The authors expose the course and treatment options employed, while reflecting on the question endogenous v. reactive, concluding that even seemingly clear clinical presentations may resist our different conceptualizations.