ABSTRACT
Bipolar disorder occurs in the elderly ages and is frequently associated to a brain injury -cerebrovascular disease. Its diagnosis is based on the finding of an ischemic injury in specific regions of the brain. The case of a 63-year-old male with cardiovascular risk factors, who was admitted due to maniform picture during a two-year long bipolar affective syndrome is presented. The neuroimaging tests showed lacunar infarction in the right thalamus and diffuse foci of ischemia in subcortical white matter having right predominance. Due to the refractoriness to psychodrugs of an endogenomorphic depressive episode, electroconvulsive therapy was prescribed, with normalization of motor component, although without mood stabilization. The therapeutic strategies and the evolution of this form of bipolarity are discussed.
Subject(s)
Bipolar Disorder/etiology , Brain Infarction/complications , Thalamus/blood supply , Humans , Male , Middle Aged , Time FactorsABSTRACT
El trastorno bipolar se presenta en edades avanzadas frecuentemente asociado a una lesión cerebral enfermedad cerebrovascular, y su diagnóstico se fundamenta en el hallazgo de un daño isquémico en regiones específicas del cerebro. Se presenta un varón de 63 años, con factores de riesgo cardiovascular, que ingresa por cuadro maniforme en el curso de un síndrome afectivo bipolar de 2 años de evolución. Las pruebas de neuroimagen mostraron infarto lacunar en tálamo derecho y focos difusos de isquemia en sustancia blanca subcortical de predominio derecho. La refractariedad a psicofármacos de un episodio depresivo endógenomorfo indicó terapia electroconvulsiva, con normalización del componente motor, aunque sin eutimización. Se discuten las estrategias terapéuticas y la evolución de esta forma de bipolaridad (AU)
Bipolar disorder occurs in the elderly ages and is frequently associated to a brain injury cerebrovascular disease. Its diagnosis is based on the finding of an ischemic injury in specific regions of the brain. The case of a 63-year-old male with cardiovascular risk factors, who was admitted due to mani form picture during a two-year long bipolar affective syndrome is presented. The neuroimaging tests showed lacunar infarction in the right thalamus and diffuse foci of ischemia in subcortical white matter having right predominance. Due to the refractoriness to psycho drugs of an endogenomorphic depressive episode, electroconvulsive therapy was prescribed, with normalization of motor component, although without mood stabilization. The therapeutic strategies and the evolution of this form of bipolarity are discussed (AU)
Subject(s)
Humans , Male , Middle Aged , Bipolar Disorder , Bipolar Disorder/diagnosis , Bipolar Disorder/epidemiology , Bipolar Disorder/etiology , Bipolar Disorder/therapy , Cerebrovascular Trauma , Thalamic Diseases , Electroconvulsive Therapy , Electroconvulsive Therapy/methods , Tomography, Emission-Computed, Single-PhotonSubject(s)
Haloperidol/blood , Haloperidol/therapeutic use , Schizophrenia/blood , Schizophrenia/drug therapy , Chronic Disease , Drug Administration Schedule , Haloperidol/administration & dosage , Humans , Psychiatric Status Rating Scales , Schizophrenia/diagnosis , Schizophrenic Psychology , Treatment OutcomeABSTRACT
Twenty-two schizophrenic inpatients were treated for 3 weeks with three randomly fixed oral doses of haloperidol (10, 20, or 30 mg). Analysis of the results by a nonlinear regression model revealed a curvilinear relationship between haloperidol levels in plasma and clinical response, as assessed on the Brief Psychiatric Rating Scale (pseudo-R2 = 0.85, F = 17.7, p < 0.001, correlation between coefficients ranged from 0.99 to -0.52). This curve defines roughly three drug level ranges (low, < 5.5 ng/ml; optimal, 5.5 to 14.4 ng/ml; and high or toxic, > 14.4 ng/ml), which are significant for clinical practice. Patients with high levels improve to a lesser extent or even worsen in negative symptoms, showing a nonstatistically significant trend to present more extrapyramidal symptoms. Our data thus support the existence of a therapeutic window for haloperidol. Schizophrenic patients with acute exacerbation and drug levels in this range would have a greater probability of global clinical improvement.
Subject(s)
Haloperidol/administration & dosage , Schizophrenia/drug therapy , Schizophrenic Psychology , Adult , Dose-Response Relationship, Drug , Dyskinesia, Drug-Induced/blood , Dyskinesia, Drug-Induced/diagnosis , Female , Haloperidol/adverse effects , Haloperidol/pharmacokinetics , Humans , Male , Psychiatric Status Rating Scales , Schizophrenia/blood , Schizophrenia, Paranoid/blood , Schizophrenia, Paranoid/drug therapy , Schizophrenia, Paranoid/psychologyABSTRACT
1. Clinical response to treatment with haloperidol was studied in 20 schizophrenic inpatients with acute exacerbation (DSM-IIIR). 2. Patients were assigned to fixed doses of haloperidol (10, 20 or 30 mg/day) for three weeks. Clinical assessment was made using scales SAPS, SANS, BPRS and Simpson-Angus Scale for rating of extrapyramidal side effects. 3. Sixteen patients showed forty per cent or more decrease in positive symptoms assessed by SAPS, being considered the group of responders. Six out of the twenty patients showed improvement in negative symptoms assessed by SANS (improvement above 30%). 4. Clinical predictors of response were only identified for SAPS. The group of responders showed higher basal scores in total scale and formal thought disorder. 5. Negative symptoms responsive to treatment were affective flattening and alogia. Improvement in negative symptoms was independent from that in positive ones. 6. Socio-demographic predictors of clinical response were not found. No differences in clinical response were found in relation to the dose administered. 7. The results of our study suggest that negative symptomatology improves in a scheduled treatment with haloperidol. Assessment of negative symptoms may be useful in the evaluation of treatment of acute schizophrenia.
