bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dynamics of emotional disorders in students of medical university in the context of the covid-19 pandemic
Authors: Mozgova T. , Leshchyna I. , Tieroshyna I. , Kozhyna H. , Fedorchenko S. , Gaichuk L. , Zelenska K. , Strelnikova I. 
Published: September 2022

IntroductionThe covid-19 pandemic is having a significant impact on the mental health of the entire population.ObjectivesTo determine the dynamics of emotional disorders in medical students in the context of the covid-19 pandemic.MethodsMethods of research. An online survey of medical university students was conducted during the covid-19 pandemic. The Beck scale was used.ResultsResults and its discussion. According to a dynamic study of emotional disorders in medical students, which was held during 12 months of covid-19 pandemic, emotional disturbance in the form of depressive manifestations associated with the covid-19 pandemic did not reduced. In addition, the results of the study indicated a change in the structure of depressive manifestations in the surveyed in favor of milder depressive manifestations (27.2%; 24.0%) and a decrease in the prevalence of moderate and severe manifestations of depression (3.0%; 5.3%).ConclusionsThe long-covid pandemic has a negative effect on the mental health of medical students and lead to emotional disturbances in the form of depressive manifestations of varying severity. The compensatory possibilities of mental activity proceed unilaterally with a change in the structure of emotional disorders; adaptation to a stress factor is not formed. Disclosure of interest.– The authors have not supplied a conflict of interest statement.DisclosureNo significant relationships.
Lithium-Renal and brain induced toxicity
Authors: Zrelli M. , Bergaoui E. , Staali N. , Souabni K. , Melki W. 
Published: September 2022

IntroductionLithium can induce renal and neurotoxic effects, particularly if it is combined with a neuroleptic or if there is an intercurrent condition. The neurological sequelae may be irreversible.ObjectivesTo show the renal and neurotoxic effects of lithium and the risk of its association with haloperidol.MethodsA case of irreversible lithium neurotoxicity wih renal sequelae.ResultsThis case report is about a 57-year-old patient with a bipolar disorder type 1. She was well stabilized on lithium.On December 2020, the patient had an increased level of creatinine, therefore her medication was stopped. She developed a manic episode then she was switched on Haldol 25mg and lithium. After 4 days, she had a neuroleptic malignant syndrome with renal and neurological sequelae.. She was referred to us after her discharge from intensive care. The patient was agitated, anxious, sad with a superficial contact and a well-structured speech. She had delusional ideas of prejudice about her husband. On physical examination, she had a parkinsonian syndrome, moderate organic renal failure with a clearance of 45.93 ml/min. On the cerebral MRI, she had a diffuse cotico-subcortical atrophy with bilateral frontal predominance and vascular leukopathy. The most probable cause was the iatrogenic effects of the association of lithium and haloperidol. We decided to stop all medications and the patient got better.ConclusionsRecognizing the neurotoxic effect of lithium and making an early diagnosis is a crucial determinant in the evolution of the disease and its irreversibility. Polypharmacy and comorbidities appear to be important precipitating factors for lithium toxicity.DisclosureNo significant relationships.
Patterns of clozapine use, misuse and disuse in a mental health area in southern Spain
Authors: Muñoz-Manchado L.I. , Mongil-Sanjuan J.M. , Pascual Paño J.M. , Rodríguez-Gómez C. , Torrecilla-Olavarrieta R. , Pérez-Revuelta J.I. , González-Saiz F. , Villagrán-Moreno J.M. 
Published: September 2022

IntroductionEvidence supports clozapine as the best treatment in terms of efficacy, effectiveness and well-being, and as the gold standard in treatment-resistant psychotic disorders. Clozapine remains still underused, suffering initiation delays from 1.1 to 9.7 years. Furthermore, there is a scarcity of data about patterns of use, showing high variability worldwide (0.6-189.2/100. 000 inhabitants).ObjectivesThe main objective of this work is to carry out an analysis of the use of clozapine in our mental health catchment area. Thus, off-label use, the percentage of patients with clozapine depending on diagnosis, age and sex, and its use in mono and polytherapy are established. Besides, dosage and time between the first contact and the start of treatment with clozapine are recorded.MethodsA descriptive study has been developed on the patients with clozapine who consulted in the catchment area of the Jerez Mental Health Service between 2018 and 2019. Data were extracted from medical records.ResultsFrom our population of 456.752 inhabitants, 449 patients received clozapine. 278 (61.9%) had a schizophrenia diagnosis; 33 (7.3%) delusional disorder and 34 (7,6%) schizoaffective disorder. The off-label use of clozapine was 19,1 %. The average mean dose used was 246,2 mg/day and 59% of the patients on clozapine were on polytherapy. Only 14,7% of these patients had a previous trial with clozapine on monotherapy.ConclusionsRates of polytherapy, previous trials of clozapine monotherapy, off label use, rates of discontinuation and other variables are to be considered to precisely map the adequate use of clozapine in clinical settings.DisclosureNo significant relationships.
Treating Patients with Aripiprazol: A Safe Gamble?
Authors: Leal B. , Vila-Chã D. , Garcia S. , Pinto I. , Mateiro R. , Avelino M. , Martins M. , Salgado J. 
Published: September 2022

IntroductionAripiprazole (ARI) is an atypical antipsychotic drug with D2 partial agonist properties, usually prescribed to treat mood disorders (major depression or bipolar disorder) and schizophrenic disorder (schizophrenia or schizoaffective disorder). Dopamine receptor agonists, as is ARI, have been implicated in some cases of impulse-control problems, such as gambling disorder (GD), increased spending, hypersexuality and compulsive eating.ObjectivesCurrently, it is hypothesized that aripiprazole may cause impulse-control problems because it can produce a hyperdopaminergic state in the mesolimbic pathway (reward system) through its predominant action on dopamine D3 receptors. We intend to do a non-systematic review of the scientific information regarding this subject.MethodsThe authors revised the published literature about this topic, selecting relevant articles, systematic reviews and case reports, with the topic words: “aripiprazol”, “gambling disorder” and “dopamine receptor” in scientific data base.ResultsOverall, a few cases of ARI-induced pathological gambling as well as ARI-induced hypersexuality have been reported. In one study it was verified that comorbid psychiatric and substance use disorders were common among those who have experienced GD or worsened GD after beginning ARI treatment. In another study, it was verified that the group of patients who reported this alleged side-effect were mostly young (mean age, 33.6 years), mostly men (88.2%) and most lived alone.ConclusionsAttributing to dopamine agonists the only factor that can explain the onset of GD is simplistic and dangerous. Many other potential risk factors, including individual vulnerability factors (temperament, genetics) as well as environmental factors, must be considered.DisclosureNo significant relationships.
Therapeutic use of ayahuasca: a review of the evidence of its use in approaching depressive disorders
Authors: Simões G. , Jesus S. , Silva R. 
Published: September 2022

IntroductionAyahuasca (AYA) is a psychotropic plant from South America used for religious purposes by indigenous people of the Amazon. Increasing evidence indicates that AYA may have therapeutic potential in the treatment of mental health disorders like depression – a common life-disrupting, highly recurrent disorder – that is among the leading causes of disability worldwide.ObjectivesThe aim of this exploratory study is to gather and assess scientific evidence about clinical effects of AYA in the treatment and symptomatological expression of patients with depression.MethodsA literature research was conducted on PubMed, starting from the MeSH terms: “Banisteriopsis” and “Depression”. Results corresponding to investigations using AYA, and based on an adult population with depressive disorders, were selected for our analysis.ResultsThe research provided 8 results, of which 6 met the defined criteria. Different types of studies with variable samples were considered, including retrospective and prospective observational studies, meta-analysis and a narrative review. Overall, evidence about the use of AYA in depressive disorders is associated to reductions in depression scales, to significant antidepressant effects and in mediating improvement of grief symptoms. AYA administration increased introspection and positive mood, self-acceptance, empathy, openness and potentiated improvements in emotional processing. The underlying potential mechanisms, adverse effects and the current limitations related to its study and use are analysed and discussed.ConclusionsThe use of AYA in depression shows promising results that should be further explored in controlled trials with larger sample sizes, in order to better evaluate its clinical effects, safety profile and related short and long-term effects.DisclosureNo significant relationships.
Rare occurence of amennorrhea associated with olanzapine : a case report
Authors: Khivsara A. , Goya D. , Nebhinani N. 
Published: September 2022

IntroductionAmenorrhea secondary to hyperprolactinemia is one of the frequent adverse effects associated with the use of atypical antipyschotics. It is often neglected but can interrupt the compliance of treatment. Several studies indicate that olanzapine does not significantly affect serum prolactin levels in the long term, although contrary has been observed in few case reports.ObjectivesTo report a case of olanzapine-induced amenorrhea due to hyperprolactinemia.MethodsA 27-year-old woman with history of stillbirth 5 months prior, presented to OPD with hallucinatory behaviour and socio-occupational dysfunction for 5 months. She was on tianeptine 12.5 mg, escitalopram 10 mg and alprazolam 0.5 mg at presentation and was having regular menses. On assessment, she was diagnosed with unspecified psychosis. Her ongoing medications were stopped and she was started on Olanzapine (optimized to 20 mg/day) after which she reported significant improvement however developed amenorrhea within next 2 months hence advised to consult Obgyn. Urine pregnancy test came out negative and prolactin level was found to be 64.2 ng/ml. Other investigations including MRI were within normal limit. Olanzapine was cross tapered with Aripiprazole (maintained at 10 mg/day). Clonazepam was advised SOS for anxiety.ResultsAfter 1 month of aripiprazole treatment, monthly menses resumed and prolactin level returned to normal range. No biological dysfunction or other side effects were reported by the patient.ConclusionsOlanzapine-induced amennorhea secondary to hyperprolactinemia, is a rare but possible event. We report a case in which olanzapine induced amenorrhea normalized after switching to aripiprazole. Baseline prolactin level should be obtained as they help in the management of patients with neuroleptic-induced hyperprolactinemia.DisclosureNo significant relationships.
Monitoring sertraline and clozapine levels
Authors: Rodriguez Campos A. , Rodriguez Andrés L. , Medina Ojeda G. , Santos Carrasco I. , Gonçalves Cerejeira J. , Gonzaga A. 
Published: September 2022

IntroductionOne of the most frequent side effects seen when prescribing sertraline and clozapine together is the appearance of a seizure crisis. This event is usually related to an increase of plasmatic concentration due to interactions of these drugs with blood components.ObjectivesTo investigate the effects of clozapine when combined with other drugs, especially its effects increasing plasmatic concentration.MethodsA patient was treated sith 300 mg/day of clozapine followed by a treatment with sertraline 50 mg/day, which increases plasmatic concentration. The combination of these treatments produced seizures. Other works published about interactions are reviewed.ResultsIt is important to monitor clozapine dosages to avoid increasing plasmatic concentration, especially if other drugs that have this effect are also administered.ConclusionsIt is important to monitor clozapine dosages to avoid increasing plasmatic concentration, especially if other drugs that have this effect are also administered.DisclosureNo significant relationships.
Dopamine dysregulation syndrome after prescription of dopamine agonists: a case report
Authors: Costa M.L. , Cerame A. 
Published: September 2022

IntroductionWe present the case of a 65-year-old woman with multiple and chronic psychosomatic symptoms. Due to motor impairments she was diagnosed in 2009 with Parkinson’s Disease (PD) by the neurology department and empirical treatment with levodopa was prescribed. However, the patient increased her levodopa intake by three times the recommended dose. The patient presented many adverse effects, including psychotic symptoms, that were interrupted after the levodopa intake was ended during a two month internament in a psychiatric unit. Dopamine dysregulation syndrome (DDS) is a condition in which patients with PD increase their levodopa intake without an objective worsening of motor symptoms. Higher-than-prescribed doses are taken by patients who develop tolerance and dependence to dopaminergic agonists.ObjectivesTo analyse the prevalence of DDS, its diagnosis and treatment as well as the identification of risk factors.MethodsA case report is presented alongside a review of the relevant literature regarding DDS.ResultsThe available evidence suggests that the main risk factors for DDS are a history of mood disorders and behavioural disorders, but more studies are needed. Given that DDS is considered a rare adverse effect, physicians usually overlook voluntary dose increase by patients.ConclusionsDDS, even though uncommon, has severe adverse effects such as dependence and acute psychosis. Before prescription of dopamine agonists, individual risk factors (such as psychiatric comorbidities or history of substance abuse) should be assessed. Also, patients and families should be informed and trained in alarm signs detection. Further studies would be justified to determine DDS prevalence, early diagnosis and treatment.DisclosureNo significant relationships.
Telepsychiatry for the Elderly
Authors: Stoppe G. 
Published: September 2022

For many old people with mental health problems, access to psychotherapeutic and psychiatric help is often difficult. This is partly because going to a psychiatrist is still stigmatised, especially among the older generation. On the other hand, therapists with an interest in and competence for older people are often not sufficiently available even in the well-supplied western countries. In this situation, digitalisation offers various opportunities. Basically, the internet is a good way to promote health literacy. Classic psychoeducation can certainly be offered on the internet. And psychotherapy can also be administered with the help of the internet. Especially in the COVID-19 pandemic, the possibilities of internet-based therapies, for example Zoom or other techniques, were practised. This means that people with limited mobility can also receive therapy over long distances. This technology also makes it possible, for example, for the migrant population to receive therapy in their national language. All these possibilities are under development, but may become routine in the future. With the help of the digital possibilities, it is possible to organise helper conference. The professional exchange between relatives, family doctors, psychiatrists and other people in the help system can be easily organised in this way. The method also saves travel time, which is often not reimbursed in the health systems.DisclosureNo significant relationships.
Valproate-induced hyperammonemic encephalopathy. A case report
Authors: Cerame A. , Franco Soler A. , Coucheiro P. , De Hita R. , Costa M.L. 
Published: September 2022

IntroductionHyperammonemic encephalopathy is an unusual side-effect of the treatment with valproic acid. According to several sources, this side effect could be underdiagnosed and underreported.ObjectivesWe present the case of a 54-year-old patient institutionalized in a psychiatric hospital who was referred to a general hospital after an episode of delirium of unknown etiology. The patient had been diagnosed with Schizoaffective disorder 26 years prior to his admittance and had started treatment with valproic acid the previous month.MethodsA case report is presented alongside a review of the relevant literature regarding valproate-induced hyperammonemic encephalopathy, its differential diagnosis and treatment.ResultsDuring his hospital stay, the patient underwent a complete panel of tests including CT Scan, EEG, toxic panel and complete blood tests. In them the only altered parameter was hyperammonemia, therefore valproic acid was removed and was treated with lactulose and rifaximin to reduce ammonium levels.ConclusionsHyperammonemic encephalopathy in the context of the treatment with valproic acid is a side-effect which is more prevalent than what was thought in the past. Valproate could reduce ammonium elimination therefore increasing the levels of the molecule. It should be administered carefully in cases where the patient may be presenting with other causes of increased ammonium metabolism or decreased elimination. It is important to bear in mind this possible side-effect to increase patient’s safety.DisclosureNo significant relationships.
Psychocardiology in a heartbeat: cardiac complications to consider in psychopharmacology
Authors: Conde Moreno M. , Ramalheira F. , Amador R. 
Published: September 2022

IntroductionAntidepressants and antipsychotics have a wide range of cardiac side effects. Although the absolute risk is considered low, some are potentially life-threatening.ObjectivesWe aim to review the main cardiological complications of antidepressants and antipsychotics and their management. We will consider 1) QTc prolongation and arrhythmia 2) heart rate 3) blood pressure 4) myocarditis.MethodsReview of cardiological complications of antidepressants and antipsychotics.ResultsQtc prolongation is correlated with arrhythmia risk. QTc is obtained with Bazett’s formula, which has limitations. All inpatients and some outpatients starting antipsychotic should undergo ECG. Increased QTc can result in different approaches, depending on severity. Most antidepressants do not significantly affect QTc, except for escitalopram and tricyclics, mostly in overdose. Sinus tachycardia can occur with most antipsychotics. Tricyclics can also produce this effect. Other causes should be excluded, and management can be achieved with bisoprolol. Other antidepressants most commonly produce a slight decrease in heart rate or have a minimal to no effect. Antipsychotics can cause hypertension or hypotension depending on the degree of affinity to specific adrenergic receptors. Tricyclics can lead to postural hypotension. Antidepressants interfering with noradrenaline can cause hypertension. Myocarditis is mostly associated with clozapine. Patients should be screened for clinical signs and laboratory findings - especially in the presence of risk factors. Suspicion should prompt echocardiological examination and confirmation leads to cardiology referral.ConclusionsWeighing the risks and benefits of these medications is a continuous process. Management of cardiological complications is possible and may involve a multidisciplinary approach.DisclosureNo significant relationships.
Clinical difficulties in the treatment of restless legs syndrome: it is the dose that makes poison
Authors: Petrykiv S. , Arts M. , Jonge L. 
Published: September 2022

IntroductionPolyfarmacy and unjustified use of high dosages of medicaments represent an unmet need in modern psychiatry. Therefore, tidal medication review of hospitalized geriatric patients is an essential step of the disease management as it can be often of vital importance and, as illustrated by current case, can exhibit a tremendeus impact on their quality of life.ObjectivesA case rapport on geriatric patient with iatrogenic damage due to ultra high dosage of ropinirole as a treatment for restless legs syndromeMethodsAuthors of current paper address pharmacodynamic particularities of psychopharmaca and their reasonable choice in context to RLSResultsA clinical case of a 72 y.o. patient, known with chronic minor depressive symptomes over the past decades. Since few years he did not take any medicaion, except ropinirol for RLS. Because of the worsening of RLS symptomes, he decided on his own to increase the dose of ropinirol up to 12 mg/day. Two moths later he has been admitted to the psychiatric ward with major depression symptomes, suicidal plans, insomnia and profound edema of his both lower legs.ConclusionsCurrent case demonstrates that high dose of ropinirole led to tremendous decrease of quality of life of the patient, and pushed him towards concrete suicidal plans. We advocate for careful assessing of the dose of every drug used; avoiding of polypharmacy by any means and for keeping in consideration that the majority of psychopharmaca leads to deterioration of RLS symptoms through modulation of dopamine pathways.DisclosureNo significant relationships.
Idiopathic serontonin syndrome. Can we prevent it?
Authors: Gallardo Borge L. , Santos Carrasco I.D.L.M. , Marqués Cabezas P. , Rodriguez Andrés L. , Rodriguez Campos A. 
Published: September 2022

IntroductionSerotonin syndrome is a mild to potentially life-threatening syndrome associated with excessive serotonergic activity within the central nervous system. Serotonin syndrome is associated with medication use, drug interactions and overdose. All drugs that increase central serotonin neurotransmission at postsynaptic 5-HT1A and 5-HT 2A receptors can produce SS.ObjectivesClinical case and literature review.MethodsA 74-year-old female, married, diagnosed of major depressive disorder. Treated with: lithium 600 mg, quetiapine 50 mg, venlafaxine 300 mg. The doses had been maintained for the last months. Lithium levels in the normal range.ResultsIn an emergency room, she received a tramadol injection because of strong backpain. After a few hours, she felt an overall worsening, sleepiness and lack of response to external stimuli. Given the persistence of the symptoms and decreased appetite along with decreased water intake, she attended to Hospital. She had a high fever, rigidity and myoclonus. Her language was incoherent. Blood tests showed high CK, and high AST and ALT.ConclusionsSS is a potentially fatal iatrogenic complication of serotonergic polypharmacy. Considered idiopathic in presentation, it appears tipically after initiation or dose escalation of the offending agent to a regimen including other serotonergic agents. While serotonin syndrome is often associated with the use of selective serotonin inhibitors (SSRI), an increasing number of reports are being presented involving the use of tramadol. It is vital that clinicians are aware of the potential for SS when psychotropic and non-psychotropic agents are co-administered to certain patients, such as those with both depression and pain.DisclosureNo significant relationships.