RESUMO
Early life adversities like parental loss during childhood, physical abuse, sexual abuse and emotional harassment may have deleterious consequences in an individual’s life, which can manifest under the form of various externalizing or internalizing behaviors. This case study aimed to highlight the impact of unusual early life adversities in a young woman’s mental health and related management issues. Methods: We reported a case of a young lady presenting with anxiety, low mood, disturbed sleep and appetite for more than six months. She also had episodes of dissociative stupor following any stressful event for approximately 13 years. She was hospitalized, evaluated clinically as well as by psychometric assessment. Relevant pharmacological and psychological interventions were performed. Results: She was diagnosed with Major depressive disorder with dissociative disorder and borderline personality disorder. The patient had multiple stressors during childhood like - loss of parents, emotional & physical abuse, which had an impact on her mental wellbeing. Conclusion: Early life adversities are detrimental to the mental health of an individual. The clinical outcome depended upon on the nature of trauma to the mental well-being, mode of intervention done and available psychosocial supports. ASEAN Journal of Psychiatry, Vol. 17 (2): July – December 2016: XX XX.
RESUMO
Erythromycin, the prototypical macrolide, has been widely used since 1950s in the management of infections. It is often combined with other drug therapies, thus creating a potential for pharmacokinetic interactions. It can both inhibit drug metabolism in the liver by complex formation and inactivation of microsomal drug oxidizing enzymes, and also by interfering with microorganisms of the enteric flora through its antibiotic effects. Methodology: Using MEDLINE search [1975-April 2002] all available clinical studies, review articles, and case reports were reviewed to provide an unbiased account of drug interactions with erythromycin. A number of reports and controlled studies have incriminated erythromycin as a potential source of clinically severe drug interactions. For example torsades de pointes associated with QT prolongation occurred with terfenadine, astemizole, and cisapride. Cases of rhabdomyolysis have been reported on concomitant use of statins. Symptomatic hypotension occurred with calcium channel blockers or sildenafil. Excessive sedation occurred from concurrent use of benzodiazepines, buspirone and zopiclone. Ataxia occurred with carbamazepine and valproate, and ergotism with ergotamine. Serotonin syndrome was reported with the use of sertraline and psychosis with bromocriptine. Interactions with cyclosporine, tacrolimus, theophylline, and warfarin are also clinically important. These interactions are due to decreased clearance of these drugs. Increase in digoxin concentration was mainly due to increase in bioavailability. Erythromycin should, therefore, be not administered with some of these drugs or their dosage schedule readjusted. Conclusions: In most cases, the extent of drug interaction varies widely among individuals; this is likely dependent on interindividual differences in CYP3A4 tissue content, preexisting medical conditions and possibly, age. Interactions may occur under single dose conditions or only at steady state. The pharmacodynamic consequences may or may not closely follow pharmacokinetic changes. Drug interactions may be most important when patients are stabilized on the affected drug and erythromycin is then administered