ABSTRACT
Differentiation between psychogenic and organic amnesia is sometimes quite difficult. This paper focuses on the psychogenic and organic components of a complex case of amnesia rooted in remote and prolonged traumatic stress and manifested under circumstances evoking dissociated memories. The Transient Global Amnesia (TGA) of a concentration camp survivor who developed sudden amnesia during a psychiatric intake interview was clearly triggered by the pressure of repressed Holocaust memories. The importance of distinguishing between TGA and dissociative amnesia is emphasized, and the role of psychological upset as a precipitant in TGA is stressed.
Subject(s)
Amnesia/psychology , Holocaust/psychology , Life Change Events , Repression, Psychology , Survivors/psychology , Acute Disease , Affect/physiology , Aged , Amnesia/diagnosis , Amnesia/therapy , Female , HumansABSTRACT
OBJECTIVE: To report cases of manic-like behavior induced by fluvoxamine, a selective serotonin-reuptake inhibitor; to review pertinent literature; and to encourage replication of our findings in larger patient samples. DESIGN: Description of a case series of fluvoxamine-induced, manic-like behavior. PATIENTS: Eight patients with depression or obsessive features who developed manic-like behavior after initiation of fluvoxamine therapy. RESULTS: Manic symptomatology resolved in all eight patients following dosage reduction or withdrawal of fluvoxamine. Four patients still are maintained on low-dose fluvoxamine without recurrent manic symptoms. CONCLUSIONS: Our case series suggests that fluvoxamine may have the ability to induce or unmask manic behavior in depressed patients. Clinicians are alerted to monitor for this "switching" effect, especially in patients previously or currently treated with neuroleptics or lithium, and in those patients exhibiting characteristics of obsessive-compulsive disorder.
Subject(s)
Bipolar Disorder/chemically induced , Depressive Disorder/drug therapy , Fluvoxamine/adverse effects , Adult , Female , Fluvoxamine/administration & dosage , Humans , Male , Middle AgedABSTRACT
A psychiatric clinical pharmacist, acting as a primary clinician under the supervision of the attending psychiatrist, monitored the medication for 14 chronic schizophrenic out-patients over a 10-year period. Successful treatment resulted in a decreased rate of rehospitalization, shorter length of hospital stay, a decrease in total neuroleptic dosage, significantly fewer medication-related side-effects, and improved compliance as compared to the 10-year period prior to entry into the study. Our study suggests that with the expansion of community health services, expanded roles and the use of a clinical pharmacist may contribute significantly to the medication management of chronic schizophrenic out-patients. However, a parallel group study is required to confirm our results.
Subject(s)
Antipsychotic Agents/therapeutic use , Community Pharmacy Services , Drug Monitoring , Schizophrenia/drug therapy , Adult , Ambulatory Care , Chronic Disease , Community Psychiatry , Female , Follow-Up Studies , Humans , MaleABSTRACT
Low-dose bromocriptine administered for antipsychotic drug-induced hyperprolactinemia and galactorrhea precipitated an acute psychotic state in a female patient. Discontinuation of the bromocriptine and increase in antipsychotic dosage resulted in complete remission. We advise caution in the use of bromocriptine especially in patients with a pre-existing psychiatric history and recommend monitoring for changes in mental status when bromocriptine is prescribed.
