Eating disorders and psychosis: a review and case report

SUMMARY INTRODUCTION: The interplay between eating disorders and psychosis is a challenging field to which little attention has been paid. Its study raises conceptual and methodological questions in both areas, making the diagnosis and management of patients difficult. Such questions are addressed and illustrated with a review and case report. METHODS: The authors present the case of a woman with Anorexia Nervosa and with comorbid Shared Psychotic Disorder, based on a literature review regarding the comorbidity between eating disorders and psychosis. The authors conducted a non-systematic review by searching the PubMed database, using the Mesh Terms "anorexia nervosa", "bulimia nervosa", "comorbidity" and "psychotic disorders". RESULTS: The findings suggest that studies on the subject are limited by issues regarding data on the prevalence of comorbidities, phenomenological aspects of eating disorders, and the interface and integration with psychotic symptoms. CONCLUSIONS: The case presented illustrates the difficulties in managing a patient with a comorbid eating disorder and psychosis. In order to ensure a rigorous assessment of both psychotic and eating disorder symptoms, the focus should be on the pattern of appearance or emergence of symptoms, their phenomenology, clinical and family background of the patient, and clinical status on follow-up.

RESUMO INTRODUÇÃO: A interface entre perturbação do comportamento alimentar e psicose é um campo desafiador para o qual pouca atenção foi direcionada. O seu estudo levanta algumas questões conceituais e metodológicas em ambas as áreas, dificultando o diagnóstico e o manejo dos pacientes. Essas questões são abordadas e ilustradas neste trabalho com uma revisão e um relato de caso. MÉTODOS: Os autores apresentam o caso de uma mulher com anorexia nervosa e perturbação psicótica partilhada comórbida, com base numa revisão da literatura sobre a comorbilidade entre perturbação do comportamento alimentar e psicose. Os autores realizaram uma revisão não sistemática, por meio de pesquisa no banco de dados PubMed, utilizando os termos "anorexia nervosa", "bulimia nervosa", "comorbilidade" e "perturbações psicóticas". RESULTADOS: Os resultados sugerem que os estudos sobre o tema são limitados por questões inerentes a escassos dados sobre prevalência de comorbilidades, aspectos fenomenológicos das perturbações alimentares, e sua interface e integração com sintomas psicóticos. CONCLUSÕES: O caso apresentado ilustra as dificuldades no manejo de uma paciente com perturbação alimentar e psicose. A fim de garantir uma abordagem rigorosa dos sintomas psicóticos e alimentares, a avaliação do paciente deve focar o padrão de emergência dos sintomas, a sua fenomenologia, antecedentes clínicos e familiares e o seu status clínico.

Reinserción social en la unidad de Psiquiatría Forense en Sancti Spíritus / Social reintegration in the Forensic Psychiatry unit in Sancti Spíritus

RESUMEN Fundamento: la Psiquiatría Forense es la aplicación de los conocimientos psiquiátricos al proceso de administración de justicia. Objetivo: describir el comportamiento de la reinserción social en la Unidad de Psiquiatría Forense de Sancti Spíritus. Métodos: se comunican los resultados del estudio del comportamiento de los asegurados en la Unidad de Psiquiatría Forense de Sancti Spíritus 2016 al 2018. Resultados: predomina el grupo etáreo entre 24 a 35 años, sexo masculino, la esquizofrenia paranoide con los neurolépticos atípicos como modalidad de tratamiento psico farmacológico más utilizado. Se lograron cambios positivos, que ayudó a la solicitud de cese de medida con su posterior reinserción social. Conclusiones: con la aplicación integral de terapias, se logran cambios que permiten la reinserción social, disminuye el riesgo de que puedan delinquir o violentarse en un futuro.

ABSTRACT Background: Forensic Psychiatry is the application of psychiatric knowledge to the justice administration process. Objective: to describe the behavior of social reintegration in the Forensic Psychiatry Unit of Sancti Spiritus. Methods: the results of the study of the behavior of the insured in the Forensic Psychiatry Unit of Sancti Spiritus 2016 to 2018 are communicated. Results: it predominates the age group between 24 to 35 years, male sex, paranoid schizophrenia with atypical neuroleptics as modality of most commonly used psycho-pharmacological treatment. Positive changes were achieved, which helped the request to cease the measure with its subsequent social reintegration. Conclusions: with the integral application of therapies, changes are achieved that allow social reintegration, reducing the risk that they may commit crimes or be violent in the future.

An Unusual Case of Delirium after Restarting Clozapine

Clozapine is a gold standard medication and drug of choice in refractory schizophrenia. Among many of its fatal side effects, delirium is less reported and inconsistently recognized by clinicians. We here present a case of delirium which emerged during retreatment with clozapine in a patient of paranoid schizophrenia. A patient diagnosed with paranoid schizophrenia, was restarted on clozapine after he left medications and became symptomatic. He was delirious on 22nd day after clozapine was restarted. Clozapine was stopped and the patient was managed with standard treatment for delirium. After one week interval, clozapine was restarted. Delirium was not noted till 6 weeks of his hospital stay. Clozapine induced central anticholinergic toxicity or clozapine induced seizure might cause delirium in index case. Limited literature exist delirium with clozapine. Clinicians must have high index of suspicion to detect delirium during clozapine therapy. More researches should focus to explore the association between delirium and clozapine.

Effect of discontiguous naikan cognitive therapy combined with antipsychotic agent on the patients who had been in the recovery status of paranoid schizophrenia / 中华行为医学与脑科学杂志

ObjectiveTo explore the influence of clinical symptoms and applicability of discontiguous naikan cognitive therapy(DNCT) among convalescent schizophrenic patients.MethodsApplying DNCT,100 convalescent paranoid schizophrenic patients with convalescent clinical state were consecutively recruited.All the patients were randomly divided into DNCT group and control group and were pretreated with antipsychotic agent therapy,40 patients in DNCT group and 49 patients in control group entered the statistic analysis,11 lost.In DNCT group,the patients received DNCT for successive 28 days.In control group,the patients only received antipsychotic agent therapy.Positive and Negative Syndrome Scale (PANSS),Nurses'Observation Scale for Inpatient Evaluation (NOSIE) were administered to all subjects pre- and post-treatment.ResultsAfter treatment,in the study group,total PANSS scales ( (54.00 ± 10.19 ) vs (45.05 ± 5.28 ),t =5.430,P ＜ 0.01 ),the positive symptom item ((11.00±3.33) vs (9.53 ±1.85),t=3.670,P=0.01),negative symptoms item((12.15 ±4.38) vs (9.40± 2.15 ),t =4.371,P ＜ 0.01 ),general psychopathology item ( (26.90 ± 5.66) vs (22.65 ± 3.07 ) 分,t =4.494,P＜0.01 ) scored lower than before,The difference was statistically significant.PANSS study group after treatment,total scores( (45.05 ±5.28 ) vs (52.04 ± 10.36),t=-3.876 P＜0.01 ),negative symptom item score( t =- 3.789,P ＜ 0.01 ),composite item ( t =2.251,P =0.027 ),the general psychopathology item ( t =- 3.336,P =0.01 ),score significantly lower than the control group.After twelve weeks follow-up study,in the study group,PANSS total scores ( t =4.764,P ＜ 0.01 ),item score of positive symptoms ( t =2.335,P =0.025 ),negative symptoms item score( t =3.083,P =0.004) ),genial psychopathology item score ( t =4.325,P ＜ 0.01 ) was still significantly lower than before treatment,the difference was statistically significant.In study group,after treatment,NOSIE Scale total negative factors scores( t =3.083,P =0.004) were significantly lower than before,total positive factors( t =-2.446,P=0.019),the total estimated factor in the disease scores ( t =-4.730,P ＜ 0.001 )were significantly higher than before treatment.After treatment,in the study group,negative factors ( t =-3.953,P=0.000) were significantly lower than the control group,twelve weeks follow-up,study group total negative factors of NOSIE scale score( t =2.126,P =0.040) was still lower than before treatment,the difference was statistically significant,total positive factor( t =- 2.054,P =0.047 ) still higher than before treatment,the difference was statistically significant.ConclusionDNCT can possibly improve part clinical symptoms of patients with convalescent schizophrenia to a certain extent,especially negative symptom,and the impact remained to the twelve weeks,but need to further prove the effect of naikan cognitive therapy.