Allergic Cutaneous and Visceral Angioedema Secondary to Clozapine: A Case Report

This report stresses on the occurrence of a rare adverse reaction to clozapine, i.e. allergic cutaneous and visceral angioedema, in a patient with treatment resistant schizophrenia (TRS). We report the case of a schizophrenic patient who was resistant to treatment and developed an allergic reaction involving her skin and gastro-intestinal system upon the commencement of clozapine. She was then treated with a combination pharmacotherapy which left some residual symptoms. The manifestation of allergic reactions to clozapine and its management strategies are discussed in the paper. There is a pressing need to develop a new psychotropic which is on par with clozapine.

‘I can’t pray’ – The spiritual needs of Malaysian Muslim patients suffering from depression

The mainstay of treatment of depression relies on pharmacological and psychological treatments. On top of that, evidence also recognizes the vital role of spirituality for human wellness which leads to growing interest in its utilization to treat depression. However, research on spirituality among Muslims in relation to depression is relatively scarce. The aim of this study is to explore the understanding of spirituality among Muslim patients with depression, and to explore their spiritual needs. Methods: This is a qualitative study conducted on 10 depressed Muslim patients at the UKM Medical Centre. Purposive sampling was done to ensure diversity of subjects. Individual in-depth interviews were conducted using semistructured questionnaire guidelines. The data were transcribed verbatim and analysed using a thematic approach. Result: Out of 10 patients, almost all of them expressed spiritual needs. Two major themes emerged in relation to the spiritual needs which are (i) religious needs; need for worship, religious knowledge and guidance, religious reminders, and (ii) existential needs; need for calmness, sensitivity and empathy, self-discipline, certainty, hope , physical help, ventilate and meaning of illness. These needs are essential for patients during the time of crisis. Conclusion: The majority of patients expressed spiritual needs which are required during the process of recovery and this provides an opportunity to incorporate spiritual approaches in the treatment of depression. However, more studies are needed to demonstrate its scientific basis and to design an effective psycho-spiritual treatment modality so that the ‘holistic’ or ‘biopsychosocial-spiritual’ treatment can be integrated by health care professionals to those in need.

A Case Report of a Patient Involved in an Alleged Homicide–Attempted Suicide Case - a Theoretical Discussion on the Theory of Homicide-Suicide

This case report stresses the role of depression in the manifestation of a homicideattempted suicide. We report the case of a man who allegedly murdered his partner and then attempted suicide. Previously, he had several failures and rejections in relationships in addition to work-related stress. He was diagnosed with major depressive disorder and treated with antidepressant. The scarcity of homicideattempted suicide as exemplified in this case could give an insight to the Psychiatrist for better understading and possible prevention.

Aggression Following Benzodiazepine Ingestion In A Forensic Psychiatric Patient: A Case Report

Objective: The incidence of benzodiazepine paradoxical reaction is uncommon. It may be implicated with crime as will be described in this case report. Method: We report a 37 year-old schizophrenia patient who was detained by the authority under Section 392/397 of Penal Code assaulting a lady using sharp weapon. He had history of illicit substance abuse and benzodiazepine dependence with significant history of aggression associated with benzodiazepine. Just prior to the incident, he took a significant amount of various types of benzodiazepine and suffered from amnesia of that event. During the time of the offense, he was in remission as far as schizophrenia is concerned. Result: He was under the forensic psychiatric care and observation at Hospital Bahagia Ulu Kinta (HBUK). He developed withdrawal symptoms of benzodiazepine in the ward. Conclusion: He was found by the expert team to be under the influence of benzodiazepine during the offence. The role of benzodiazepine and relevant factors leading to aggression will be discussed in this manuscript.

Managing ‘Schizophrenia in the Midst of Schizophrenia’- The Role of Assertive Community Treatment

This case report emphasizes the role of Assertive Community Treatment (ACT)in managing a family with four members suffering from mental illness, mainly schizophrenia. We report a case of middle-aged lady who was diagnosed with treatment resistant schizophrenia (TRS) living with two other family members with the same illness and their carer who developed major depression from shouldering the burden of caring for mentally ill family members. ACT, through its holistic approach, proved to have reduced hospitalizations and improve symptom control and quality of life in this family.

Clozapine Re-Challenge With Lithium Supplementation Following Clozapine-Induced Neutropenia

Objectives: This paper aims to report on a case in which re-challenging with clozapine in combination with lithium in a patient who developed neutropenia was carried out. Methods: The patient was treated with clozapine for treatmentresistant schizophrenia. After five weeks he showed much improvement but developed neutropenia. Withdrawal of clozapine brought on a relapse of psychotic symptoms. Subsequently, clozapine was reintroduced along with Lithium. The neutrophil count was monitored closely. Results: The neutrophil and white blood cell count were noted to return to normal upon re-challenging, and the patient’s clinical condition also improved. Conclusion: Simultaneous administration of lithium and clozapine to patients experiencing neutropenia on clozapine is a possible strategy. However, very close monitoring of the white count is needed.

Serum zinc concentration in Egyptian patients with chronic hepatitis C

The prevalence of HCV infection varies throughout the world, with the highest number of infections reported in Egypt. Zinc has been closely related to the pathogenesis of chronic hepatitis C. Zinc deficiency causes reduction in glutathione [GSH] which has been implicated in various cellular events. Zinc may play an important role as a negative regulator in HCV replication; zinc supplementation increases the therapeutic response of Interferon [IFN]. To detect serum zinc concentration in adult patients with chronic [compensated] hepatitis C prior to treatment with IFN, and correlate the levels with the degree of inflammation and stage of fibrosis. This study was conducted on 40 adult patients chronically infected with HCV as well as 10 healthy subjects serving as a control group. Participants were subjected to complete clinical and laboratory assessment, quantitative analysis of HCV RNA by PCR technique and abdominal ultrasonography, in addition to estimation of serum Zinc by Graphite Furnace Atomic Absorption Spectrometer. A significant negative correlation was found between the level of zinc and liver fibrosis. The mean value of zinc in patients was 39.5ug/dl, while in the control it was 75ug/dl [normal range: 70-80ug/dl]. There was a non significant negative correlation between serum zinc and serum AST, ALT, disease activity and level of viraemia. Our study suggested the possible important protective role of zinc in patients with chronic hepatitis C, as serum zinc levels showed negative significant correlation with the stage of liver fibrosis

Serum selenium concentrations in Egyptian chronic liver disease patients

Disturbance in the antioxidant system could play a role in pathogenesis of chronic liver disease. The most important defence mechanisms are associated with the activity of antioxidative enzymes, among which glutathione peroxidase [GSH-Px], belonging to so-called free radical scavengers, should be mentioned. Selenium, regarded as a bioelement, is present in GSH-Px. Involved in numerous redox reactions, it belongs to the factors protecting the organism from oxidative shock. To detect selenium concentrations in the serum of chronic liver disease patients whether compensated, decompensated or with hepatocellular carcinoma, and to correlate these levels with the progression of liver disease. This study was conducted on 20 patients with compensated liver disease [Group I], 20 patients with decompensated liver disease [Group II], and 10 patients with hepatocellular carcinoma [Group III], all compared with 20 healthy subjects serving as a control group. Participants were subjected to complete clinical and laboratory assessment, and abdominal ultrasonography. Estimation of serum selenium by Graphite Furnace Atomic Absorption Spectrometers was conducted on all samples. There was significant decrease in serum selenium level in hepatocellular carcinoma group compared to both decompensated and compensated groups [26.40 +/- 6.52ug/l, 42.35 +/- 6.12 ug/1 and 59.90 +/- 8.20 ug/1, respectively], when compared to control group [79.85 +/- 10.06 ug/1] [P < 0.01]. There was a significant positive correlation between serum selenium and albumin levels in the studied groups [P < 0.01]. A significant inverse correlation was found between serum selenium level and AST, total bilirubin and alkaline phosphatase in patients groups [P < 0.05]. No significant relationship was found between serum selenium level and age of patients. Serum selenium levels significantly decrease in relation to the progression of chronic liver disease. There is a potential need of selenium supplementation in these patients