bluuebunny/crossref_metadata_2025_split huggingface dataset:
A 39-year-old man with a generalized rash with bupropion XL administration
Authors: Ates M.A. , Cetin M. , Ebrinc S. , Basoglu C. , Algul A. 
Published: May 2011

IntroductionAn once-daily formulation, bupropion XL, was developed with the goal of further improving tolerability and compliance (1). Common adverse effects contain dry mouth, nausea, constipation, headache, agitation and skin rash (2).ObjectiveA case of skin rash caused by bupropion XL used for depression is discussed.ResultsA 39-year-old man with depression developed a rash on his extremities 13 days after the initiation of bupropion XL followed by pruritus of the arms, feet, and face.ConclusionsTo our knowledge, this is the first reported case of skin rash and urticaria induced by bupropion XL therapy. The most common cutaneous side-effect is urticaria and rash by bupropion XL. This develops from between 8 and 21 days after taking the medicine (3). In our case dermatological side effects developed on 13 days. On discontinuation of bupropion XL, there was whole resolution of symptom. We report this case to notify clinicians of the potential dermatological side effects that can occur with extended release bupropion therapy.
A case clozapine induced palilalia
Authors: Lopes R. , Azevedo J. , Curral R. , Esteves M. , Coelho R. 
Published: May 2011

IntroductionPalilalia is an acquired speech disorder characterized by involuntary and spontaneous repetition of words or phrases two or more time in a row. Palilalia can occur in a variety of disorders including postencephalic parkinsonism, advanced Parkinson disease, as well as in schizophrenia, and in Gilles de la Tourette syndrome. There is one report of palilalia induced by neuroleptics.AimsTo review the literature related to palilalia. Clinical case: We described a case of a 28 years-old man with refractory schizophrenia that demonstrated palilalia with 300 mg of clozapine.DiscussionIn the patient evaluation we just found unspecific alterations in the electroencephalogram. Palilalia disappeared with lowering doses of clozapine.ConclusionPalilalia can have several causes. The appearance of palilalia induced by clozapine is a rare side effect.
Treatment of cycloserine induced psychosis - a case series
Authors: Bangar S. 
Published: May 2011

IntroductionCycloserine is a highly effective second line anti-tuberculosis medication, the use of which has increased in recent times due to emergence of multi-drug resistance. One of the side-effects is psychosis characterized by paranoia, hallucinations and affective instability. These symptoms are usually reported within the first 2 weeks of therapy in 30–50% of patients receiving Cycloserine 500 mg. At a dose of 100mg and above it leads to a hyperdopaminergic state which in turn could lead to psychosis. However, as this is a very effective treatment in people with multi-drug resistant tuberculosis, it is not always possible to omit treatment due to remergence of life threatening illness. We present findings from few patients on this medication who were referred to us for management of psychotic symptoms.Aims and objectivesTo treat the psychotic symptoms with anti-psychotic which would enable patient to continue Cycloserine. Also to monitor the response to an anti-psychotic.MethodsData was collected from the patient’s case notes, full psychiatric assessment and interviewing the relative. Patient was followed up in the out-patient clinic to monitor response to anti-psychotic medication.ResultsPatients were treated with both typical and atypical medication with good response and it was possible to continue with Cycloserine in one case.ConclusionCycloserine induced psychosis can mimic any other psychotic illness and can be effectively treated with anti-psychotics.
Clozapine in the treatment of patients with autsim spectrum disorder and severe disruptive behaviours
Authors: Béhérec L. , Lambrey S. , Quilici G. , Rosier A. , Falissard B. , Guillin O. 
Published: May 2011

Autism spectrum disorder (ASD) is a serious childhood-onset disorder that affects all areas of development and is associated with disruptive symptoms including aggression and self injury. In ASD, risperidone and aripiprazole are the only second generation antipsychotic drugs (SGA) that have shown to decrease disruptive behaviours in controlled double-blind studies. However, some patients are not improved by these drugs. Clozapine, a SGA known to be effective to treat aggressiveness in schizophrenia, has received little attention in ASD. We conducted a retrospective analysis of the changes in disruptive for all patients with ASD who were treated with clozapine from 2002 to 2010. Disruptive behaviours were monitored during the 4 to 6 months before and after the initiation of clozapine, and long term tolerance (10 months to 7 years) was also assessed. The relationship between disruptive behaviours and periods of treatment was studied with a generalized linear marginal model. Clozapine resulted in a significant 2 fold decrease in the number of the days with aggression, a decrease of the number of psychotropic drugs and the dose of the antipsychotic drugs. The long term tolerance (white blood cell count, extrapyramidal effects) was good with the exception for a significant weight gain (of 22.3% +/- 18,2%), the occurence of metabolic syndrome in one patient and tachycardia in another patient.These results suggest that clozapine should be considered for the management of disruptive behaviours in patients with ASD not improved by first line antipsychotic drugs.
Levetiracetam showed lower depression, insomnia and mood instability incidence than phenytoin after supratentorial tumour neurosurgery
Authors: Bellido I. , Dominguez M. , Bellido V. , Gómez-Luque A. 
Published: May 2011

BackgroundPhenytoin used to prevent seizures linked to brain cancer neurosurgery has shown many undesirable side effects and drug interactions with chemotherapy.AimTo evaluate the incidence of depression, insomnia, mood instability and early post surgery seizures, after Phenytoin (PHE) vs. Levetiracetam (LEV) monotherapy in patients with brain tumour subjected to a supratentorial brain tumour resection.MethodsA prospective study in patients with supratentorial cancer diagnosis subjected to neurosurgery of resection was done. Patients were consecutive randomized to be treated with PHE (n = 26) 15 ml/kg IV-bolus, 125 mg/8 h IV x48 h, 100 mg/8 h O x7 days or with LEV (n = 34) 500 mg/12 h IV x48 h, 500 mg/12 h O x 7 days. Clinical, histological, TAC, EEG, seizures and undesirable side effects were analyzed.Results and discussion60 patients (53% male, aged 52.5 ± 20 years) with glioblastoma multiform 45%, meningioma 43%, Ewing's sarcoma 6.7%, others 5.3% (size between 3–6 cm, in the right brain site-65.2%, in the frontal lobe-56.2%) were subjected to followed for a week after tumour resection. Undesirable side effects (USE) were (%LEV/%PHE): total (7.3%/31.5%), somnolence (0%/32.8%), headache (6.1%/22.3%), dizziness (0%/25.6%), difficulty with coordination (0%/23.5%), depression (6.2%/18.7%), lack of energy/strength (12.5%/33.8%), insomnia (11.3%/37.9%), mood instability (12.5%/22,6%), leukopenia (0%/16.9%) after surgery (p < 0.05). None of the patients taking Levetiracetam vs. 4 of the patients taking Phenytoin (0% vs. 15.3%) had seizures after surgery (p < 0.05).ConclusionLevetiracetam showed lower depression, insomnia, mood instability and seizures incidence than Phenytoin after supratentorial tumour neurosurgery.
Antipsychotic injectable treatment in patients with involuntary ambulatory treatment
Authors: Borreda Belda L. , Borreda L. , Maravall R. , Perez J.F. , Grau M. , Hernandez M. 
Published: May 2011

IntroductionInvoluntary Ambulatory Treatment (IAT) is a judicial measure existing in Spain. Its aim is to ensure the adherence to treatment of seriously ill patients, with poor insight and repeated hospitalization. This is done by means of the regular and involuntary administration of antipsychotic intramuscular medication.ObjectivesTo assess the treatment used in patients undergoing IAT in a local clinic, to assess the type of medicaments and their dosage and to verify adherence to treatment and evolution.Material and methodA revision was made of the clinical backgrounds of all the patients of a psychiatric outpatient clinic who have been submitted to IAT (n = 37). A note was made of socio-demographic variables as well as psychiatric diagnoses according to DSM-IV-TR criteria and the number of hospitalizations and treatments used.ResultsAll but one patient had been hospitalized and average of 3.53 times before IAT. Since undergoing IAT only 6 patients have been admitted (16%). Four of them relapsed having abandoned treatment.In seven cases (19%) the patients gained insight and the antipsychotic treatment was changed from injectable to oral treatment at the patients’ request. In these cases IAT was ceased.The antipsychotic prescribed in 59% of the cases was Long-Acting Injectable Risperidone. This percentage was higher in non- schizophrenic patients (84%).ConclusionsIn our environment IAT could be an effective tool for severe patients with nil insight, since it can bring about an improvement in treatment adherence and evolution, as well as insight.
Opioidergic system and N-methyl D-aspartate receptor (NMDA-R) hypofunction: Translational implications for the pathophysiology of psychosis and drug addiction
Authors: Buonaguro E.F. , Marmo F. , Avvisati L. , Latte G. , Rossi R. , Patrì A. , Sarappa C. , Iasevoli F. , Aloj L. , de Bartolomeis A. 
Published: May 2011

Enkephalin is an opioidergic neuromodulator that has been implicated in long-term behavioural sensitization after administration of drugs of abuse. Enkephalin is also a molecular marker of GABAergic neurons in the striato-pallidal pathway that is involved in sensory-motor gating and has been considered dysfunctional in the pathophysiology of psychosis.In this study we investigated in male Sprague Dawley rats putative changes in Enkephalin transcripts by in situ hybridization after acute or subchronic administration of ketamine in either high or low subanaesthetic doses (50 mg/kg and 12 mg/kg respectively). Ketamine is a non-competitive NMDA-R antagonist that perturbs glutamate neurotransmission and provides a preclinical model of psychosis-like behaviour in rats.In the acute paradigm the expression of Enkephalin was reduced in the motor, premotor, somatosensory cortices as well as in anterior cingulate. In the subchronic paradigm Enkephalin expression was reduced in the premotor cortex, in the ventromedial caudate-putamen and in the shell of nucleus accumbens. Comparative analysis showed that the relative decrement in gene expression was not significantly different between the acute and subchronic paradigm for each region of interest.Changes in distribution of Enkephalin expression and correlation analysis of functionally related brain regions suggest that Enkephalin transcripts reduction may be implicated in the motivational aspects of drug addiction and may help explaining some aspects of the pathophysiology in ketamine-induced psychosis.
Sudden death and antipsychotic treatment: Typical and atypical antipsychotic drugs’ safety in the real world
Authors: Cattaneo C.I. , Verde A. , Castignoli G. 
Published: May 2011

The most up-to-date guidelines recommend to use atypical antipsychotic drugs (APDs). This is due to their better tolerability and safety, especially as far as the risk of sudden death is concerned. Nevertheless, in clinical practice several patients are still treated with typical APDs. Aim of this study is to evaluate the QTc in the real world, where psychotic Pts are still treated with typical APDs. 169 consecutive acute psychotic inpatients (mean age 39 ± 12.5, 84 female), hospitalized in psychiatric ward from January 2005 to December 2007, and treated for at least 6 months with APDs (haloperidol n = 43, risperidone n = 41, aripiprazole n = 42, olanzapine n = 43) underwent ECG recording. Pts with family history of SD or treated with QTc altering drugs were excluded. Three different cardiologists performed blinded QTc measurement for all Pts in order to asses the risk of SD. There were no statistical differences among the QTc values measured by the three cardiologists. 2 out of 169 Pts showed borderline QTc. 2 out of 169 Pts had a high risk QTc. Female gender and age were well distributed in the treatment groups as well as serum electrolytes were in normal range.ANOVA test showed no consistent statistical differences in the QTc between the use of Haloperidol or other atypical APDs. In our experience, the cohorts of Pts treated with Haloperidol or other atypical APDs have no differences in QTc and therefore the risk of SD dose not depend on the choice of the antipsychotic drug.
Improving physical health of patients with mental health problems
Authors: Cheema F. , Graham J. , Moffat D. , Gordon C. 
Published: May 2011

It is well recognised that individuals with severe mental health difficulties have increased risks of significant physical health problems and that some of the treatments for mental health problems can cause physical health difficulties as side effects. It is also known that people with mental health difficulties do not present themselves regularly for physical health monitoring as suggested by national and international guidelines. We show how a secondary care community mental health service cooperated with primary care general medical services to increase the take up of physical health monitoring by patients with severe and enduring mental health problems.Staff in the community mental health team which served a rural/small urban population identified patients with severe and enduring mental health difficulties or those patients on medications linked to physical problems and contacted the primary care physicians responsible for the patients’ general care with patient details and encouraged patient attendance for physical health monitoring. Physical monitoring included blood pressure, ECG, glucose, thyroid, lipids, height and weight. Post-intervention attendance figures show an increase of 30% in patients attending physical health reviews compared with pre-intervention figures. The intervention has been now rolled out to a larger catchment area of 25000 persons.[Physical health monitoring by individual parameter]
Neuroleptic malignant syndrome
Authors: Cruz A. 
Published: May 2011

IntroductionNeuroleptic malignant syndrome (NMS) is a rare and potentially fatal idiosyncratic drug reaction usually defined as a complication of treatment with antipsychotics. It is manifested by altered mental status, hyperpyrexia, rigidity and autonomic instability. This syndrome occurs in response to administration of drugs that induce dopamine blockage.ObjectivesStudy the risk factors, diagnosis, treatment and complications of NMS, by performing a literature review.AimsSummarize the main aspects of NMS that may have importance in usual clinical practice.MethodsPubMed was used to identify NMS articles published after 2000, associated with the MeSH terms “neuroleptic malignant syndrome” and “antipsychotic agents”.ResultsNMS is not dose-related and its aetiology is still unknown. There are many risk factors associated with the syndrome, such as demographic, individual, genetic and environmental factors and medication. In order to evaluate the medical situation, an accurate clinical history and physical examination should be fulfilled. NMS is also characterized by changes in laboratory investigation. There are no patognomonic findings, thus other different diagnosis should be considered. Specific treatment remains controversial. Treatment should be individualized for each patient, regarding characteristics, duration and severity of the clinical signs and symptoms. Resolution is usually verified in one to two weeks. Though there are cases in which the symptoms persist and comorbid process may occur.ConclusionsAlthough NMS is a rare complication of antipsychotic therapy, early diagnosis and treatment is essential to improve prognosis.
Antipsychotics in obsessive-compulsive disorder - an auspicious approach for treatment-resistant patients?
Authors: Dold M. , Aigner M. , Lanzenberger R. , Kasper S. 
Published: May 2011

IntroductionBecause only 40 – 60% of all patients with obsessive-compulsive disorder (OCD) respond to selective serotonin reuptake inhibitors (SSRIs), the evaluation of alternative therapy methods in the presence of treatment resistance has high clinical relevance. In this context, many studies have examined additive medication with antipsychotics.MethodAll double-blind randomised controlled trials (DBRCTs) that evaluated the efficacy of a combination therapy of antipsychotics and SSRIs in treatment-resistant OCD were covered by systematic literature searches.ResultsA total of ten DBRCTs were identified (four for quetiapine, three for risperidone, two for olanzapine and one for haloperidol) with a participant collective comprising in total 316 treatment-resistant OCD patients. After the augmentation therapy, significantly more subjects in the intervention group (antipsychotic + SSRI), 32% of the patients, fulfilled the response criterion (reduction in the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) ≥ 35%) than in the control group (placebo + SSRI) (relative risk (RR) = 2.08; 95% CI: 1.3 – 3.32). The standardised mean difference (SMD) of the Y-BOCS reduction between the pooled two study-groups revealed an effect size of 0,62. The sub-group analyses showed significant efficacy only for haloperidol and risperidone. Further significant differences existed regarding the duration of SSRI medication before the augmentation phase.Conclusion / DiscussionBased on the favourable benefit-risk-ratio, risperidone can be regarded as the agent of first choice for augmentation treatment with an SSRI. Overall, about one third of patients benefit from this therapy option. However, further scientific studies are needed before sufficiently empirically secured pharmacological treatment recommendations can be expressed.
The portuguese psychiatry in the european setting: Study of a hospital drug formulary in the beginning of the 20th century
Authors: Pita J.R. , Pereira A.L. , Ferreira J.S. , Morgado J. 
Published: May 2011

The results of an investigation conducted on the Formulario Especial dos Medicamentos para o Hospital de alienados em Rilhafoles (1901), a mental disease drug formulary for the oldest Portuguese psychiatric hospital, are presented. The study considered the Portuguese situation within the European setting.This study quantifies the number of drugs and pharmaceutical forms and establishes a comparison with the most commonly used international psychiatric medication at the time. The present study aims at contributing to the history of psychiatric drug therapy before the advent of psychoactive drugs. The most commonly used pharmaceutical forms and therapeutic groups in psychiatry are evaluated. Furthermore, we also wish to contribute to the evaluation of how Portugal received and implemented innovations in drug therapy.Quantitative and qualitative document analysis of the above mentioned formulary, using the comparative method.The edition of this formulary arose from the need to standardize specific medication for mental patients. In the Formulario, 61 medicinal products are proposed. There were 8 different pharmaceutical forms. The potions were the most commonly referred (32). Hypnotics represented approximately half of the medicinal products (28), followed by hypokinetics (9), and analgesics and antipyretics (8).The formulary was in line with foreign scientific innovations. Pharmacotherapeutic variety of drugs was short and resorting to non-drug therapies was also usual. The edition of this formulary was mainly due to the work conducted by the psychiatrist Miguel Bombarda (1851–1910), a prominent public figure in medicine and in the political and cultural arena.
P03-69 The introduction of psychoactive drugs in portugal in the 1950's
Authors: Pita J.R. , Pereira A.L. , Ferreira J.S. , Gaio R. 
Published: May 2011

The authors present some results of an ongoing research on the introduction of psychoactive drugs in Portugal during the 1950's.This study analyses medical papers published in the 1950s on the issue of psychoactive drugs in Portugal. Our research focused on some of the main medical journals and articles published by some of the most important Portuguese psychiatrists. Discussions on the validity of psychoactive drugs and the introduction of psychoactive drugs in therapy are analysed.We aim at contributing to the history of psychoactive drugs in therapy, as well as to the history of psychoactive drug reception in Portugal and its relation with the problem of deinstitutionalization.Qualitative documental analysis of medical papers published in Portuguese general medicine journals, such as A Medicina C-rânea, O Médico, Jornal do Médico, as well as in some specialized psychiatry journals. Systematization of confronting arguments. The introduction of psychoactive drugs in Portugal underwent several discussions on their validity, efficacy, safety and effects in the process of patient deinstitutionalization.In Portugal, the reception of psychoactive drugs proceeded quickly after its industrialization, and was accompanied by some theoretical discussions. In the beginning of the 1960s, the use of psychoactive drugs is clearer and discussions are less divergent.
Meta-analysis on the dissection table
Authors: Friedrich M.-E. , Kasper S. 
Published: May 2011

IntroductionDetermination of the best evidence involves a systematic, comprehensive review and synthesis of the research literature as performed in high-quality meta-analysis. In a recently published multiple-treatment meta-analysis by Cipriani and collegues (Lancet, 2009) the authors finally concluded to favour sertralin over escitalopram due to lower costs.Objectives/aimsBased on the example published by Cipriani et al. we tried to highlight possible pitfalls, the clinican with limited time might not be able to spot easily whilst skimming the results of meta-analysis.ResultsEscitalopram had the best efficacy and tolerability profile in the study. Sertraline was recommanded as first choice because of the most favourable balance between benefits, acceptability and acquisition costs. Analyzing study-design, statistical procedures and knowledge such as the early launching of generics of escitalopram lead to a different view of the interpretation by Cipriani and collegues.ConclusionsWe concluded that the findings of Cipriani et al. have limited generalizability due to problematic study design issues including statistical concerns. Despite the fact that meta-analysis might provide best evidence-based information, the findings of the latter should always be interpreted with caution as the quality of them can only be as good as the studies included and the study design implemented.