Relapse of Psychosis Status Post Meningioma Resection.

A 53-year-old Caucasian female with a previous psychiatric history of bipolar I disorder and attention deficit hyperactivity disorder presented to the emergency department after endorsing 10-11 months of auditory and visual hallucinations, persecutory delusions, depression, anosmia, weakness of lower extremities, and headache. The patient described her auditory hallucinations as non-commanding voices talking to her about her family, her visual hallucinations as seeing "shadows and shapes," and her paranoid delusions as people coming after her. The patient had sustained a fall a week and a half earlier, requiring eight sutures to her posterior scalp. Her MRI of the brain showed a well-circumscribed 3.5 x 4.7 x 3.2 cm mass in the floor of the anterior cranial fossa. Computer tomography of the brain showed a 4.5 cm mass near the anterior interhemispheric fissure and edema in the right frontal cortex. Meningioma resection resulted in the cessation of hallucinations and delusions for one week. However, the patient was brought back to the emergency department because her auditory hallucinations and delusions returned. This case report demonstrates residual psychosis, even after frontal meningioma resection.

Selective Serotonin Reuptake Inhibitors and Adverse Effects: A Narrative Review.

Depression is the most prevalent psychiatric disorder in the world, affecting 4.4% of the global population. Despite an array of treatment modalities, depressive disorders remain difficult to manage due to many factors. Beginning with the introduction of fluoxetine to the United States in 1988, selective serotonin reuptake inhibitors (SSRIs) quickly became a mainstay of treatment for a variety of psychiatric disorders. The primary mechanism of action of SSRIs is to inhibit presynaptic reuptake of serotonin at the serotonin transporter, subsequently increasing serotonin at the postsynaptic membrane in the serotonergic synapse. The six major SSRIs that are marketed in the USA today, fluoxetine, citalopram, escitalopram, paroxetine, sertraline, and fluvoxamine, are a group of structurally unrelated molecules that share a similar mechanism of action. While their primary mechanism of action is similar, each SSRI has unique pharmacokinetics, pharmacodynamics, and side effect profile. One of the more controversial adverse effects of SSRIs is the black box warning for increased risk of suicidality in children and young adults aged 18-24. There is a lack of understanding of the complexities and interactions between SSRIs in the developing brain of a young person with depression. Adults, who do not have certain risk factors, which could be confounding factors, do not seem to carry this increased risk of suicidality. Ultimately, when prescribing SSRIs to any patient, a risk-benefit analysis must factor in the potential treatment effects, adverse effects, and dangers of the illness to be treated. The aim of this review is to educate clinicians on potential adverse effects of SSRIs.

Viloxazine in the Treatment of Attention Deficit Hyperactivity Disorder.

Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children. Over the past twenty years, research on the disease and its characteristics and treatment options has grown exponentially. The first-line pharmacologic treatment of ADHD is stimulants, which have a response rate of ~70%. With the support of four phase 3 studies involving more than 1,000 pediatric patients 6-17 years old, the FDA has approved the non-stimulant, serotonin-norepinephrine modulating agent (SNMA) viloxazine in an extended-release capsule (viloxazine ER) for treatment of ADHD in children aged 6-17. Viloxazine modulates serotonergic activity as a selective 5-HT22B receptor antagonist and 5-HT2C receptor agonist and moderately inhibits norepinephrine transporter (NET), thus blocking the reuptake of norepinephrine. A phase 2 study by Johnson et al. found that once-daily dosing of viloxazine ER in 200, 300, or 400 mg dosages in children with ADHD for eight weeks resulted in a statistically significant reduction of ADHD-RS-IV total score. A post hoc analysis of data from four phase 3, randomized, placebo-controlled, double-blind, three-arm, clinical trials by Faraone et al. found that early response to viloxazine treatment, defined as a change in ADHD-RS-5 total score at week 2, best predicted the treatment response at week 6 [75% positive predictive power (PPP), 75% sensitivity]. Proper treatment of the symptoms and comorbidities associated with ADHD is crucial in improving a patient's quality of life, cognitive function, and overall therapeutic outcomes. Viloxazine's mechanism of action, clinical effects, and limited side effect profile point toward the drug's relevance in the treatment of ADHD.

The Reemergence of Nitrite as a Beneficial Agent in the Treatment of Ischemic Cardiovascular Diseases.

Nitrite was a therapeutic agent used in the treatment of angina pectoris and hypertension, but was replaced by nitroglycerin. However, nitrite has recently been rediscovered following observations that this anion possesses novel pharmacologic actions such as producing vasodilation, modulating hypoxic vasodilation, and providing cytoprotection in ischemia-reperfusion injury. Moreover, recent observations in animal and human studies have demonstrated that the reduction of nitrite to vasoactive nitric oxide occurs through both enzymatic and non-enzymatic processes. These findings suggest that nitrite may act as a storage form for nitric oxide and provide support for investigating the use of nitrite in the treatment of ischemic disease states including pulmonary hypertension.