ABSTRACT
Major depressive disorder during pregnancy can be detrimental to the fetus and patient. Treatments can include electroconvulsive therapy (ECT) for severe cases. The use of ketamine in ECT can provide symptomatic relief as well as induce anesthesia. Here, we describe the case of a 35-year-old gravid woman with a long-standing history of major depressive disorder who presented with treatment-resistant depression with suicidal ideation after an alteration in her antidepressant medication. After psychiatric evaluation, she was deemed to be a good candidate for ECT augmented with ketamine for symptomatic relief. This was complicated by an positive but asymptomatic COVID-19 status. Despite these factors, the patient experienced significant relief after an eight-treatment course of ECT, with a reduction of her PHQ-9 score from 22/27 to 4/27 points.
ABSTRACT
Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia and an elevated level of serum parathyroid hormone. PHPT leads to hypercalcemia and presents with renal, skeletal, and neuropsychiatric symptoms. Neuropsychiatric manifestations of PHPT such as psychotic, depressive, and anxiety disorders are rare. Delirium may also be present in patients with PHPT. Parathyroidectomy is the treatment of choice for patients with physically symptomatic PHPT, but it remains unclear if parathyroidectomy is indicated for its psychiatric manifestations. It is unclear if parathyroidectomy should be performed as a treatment for medication-refractory psychiatric symptoms or deferred until psychiatric symptoms have been better controlled. We present two cases of hyperparathyroidism (HPT)-associated hypercalcemia-one with lithium-associated HPT-in which psychiatric manifestations resolved with parathyroidectomy.
ABSTRACT
A 24-year-old man with a past medical history of behavioral disturbances and spastic tetraplegia secondary to traumatic brain injury presented to the psychiatry consult service with acute exacerbation of agitation and aggression. The patient's behavioral disturbances were previously reduced with 1500 mg daily of valproic acid (VPA). Prior to admission, VPA was discontinued due to elevated serum ammonia levels of 96 µmol/L and clinical findings consistent with valproate-induced hyperammonemic encephalopathy (VIHE), such as lethargy, confusion, frank delirium, and ataxia. Current guidelines for treating VIHE suggest either a complete discontinuation of the drug or a drug rechallenge with the addition of levocarnitine or carglumic acid supplementation. In this case, VPA was rechallenged without supplementation to decrease the risk of noncompliance. The patient received a lower dose of VPA with subsequent up-titration. His ammonia level decreased to an acceptable level. This case report discusses the challenges of managing VIHE in patients requiring VPA and discusses opportunities for further research in preventing VIHE.
Subject(s)
Anesthesia/methods , Electroconvulsive Therapy/methods , Intubation, Intratracheal , Neuromuscular Nondepolarizing Agents , Rocuronium , Sugammadex , Adult , Depressive Disorder, Major/therapy , Humans , Male , Obesity/complications , Sleep Apnea, Obstructive/complications , Treatment OutcomeABSTRACT
An 81-year-old woman with known schizophrenia presented to the psychiatric consult service with an acute exacerbation of tactile and visual hallucinations and paranoid delusions. This case report examines an atypical progression of illness, including the patient's unusually high functional status and maintenance of activities of daily living well into her disease course despite persistent positive symptoms, highlighting potential benefits of early pharmacological treatment and lifestyle choices.
Subject(s)
Catatonia/diagnostic imaging , Diagnosis, Differential , Encephalitis/diagnostic imaging , Positron-Emission Tomography , Anticonvulsants , Catatonia/therapy , Depressive Disorder, Major/drug therapy , Electroconvulsive Therapy/methods , Humans , Lorazepam/therapeutic use , Male , Middle AgedABSTRACT
PURPOSE: We present a case of a patient who developed seizures shortly after initiating treatment with levofloxacin and to discuss the potential drug-drug interactions related to the inhibition of cytochrome P450 (CYP) 1A2 in this case, as well as in other cases, of levofloxacin-induced seizures. METHODS: Several biomedical databases were searched including MEDLINE, Cochrane and Ovid. The main search terms utilized were case report and levofloxacin. The search was limited to studies published in English. RESULTS: Six cases of levofloxacin-induced seizures have been reported in the literature. Drug-drug interactions related to the inhibition of CYP1A2 by levofloxacin are likely involved in the clinical outcome of these cases. CONCLUSIONS: Clinicians are exhorted to pay close attention when initiating levofloxacin therapy in patients taking medications with epileptogenic properties that are CYP1A2 substrates.
Subject(s)
Anti-Bacterial Agents/adverse effects , Bacteremia/microbiology , Klebsiella Infections/diagnosis , Levofloxacin , Ofloxacin/adverse effects , Seizures/chemically induced , Adrenergic alpha-Antagonists/adverse effects , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Bacteremia/diagnosis , Cytochrome P-450 CYP1A2/drug effects , Cytochrome P-450 CYP1A2/metabolism , Dopamine Antagonists/adverse effects , Drug Administration Schedule , Drug Synergism , Female , Humans , Klebsiella Infections/drug therapy , Male , Metoclopramide/adverse effects , Mianserin/adverse effects , Mianserin/analogs & derivatives , Middle Aged , Mirtazapine , Ofloxacin/administration & dosage , Phosphodiesterase Inhibitors/adverse effects , Theophylline/adverse effectsSubject(s)
Affective Disorders, Psychotic/drug therapy , Antipsychotic Agents/adverse effects , Dopamine Antagonists/adverse effects , Neuroleptic Malignant Syndrome/etiology , Piperazines/adverse effects , Serotonin Antagonists/adverse effects , Thiazoles/adverse effects , Female , Humans , Middle Aged , Neuroleptic Malignant Syndrome/therapyABSTRACT
Se realizó un estudio retrospectivo sobre la terapia electroconvulsiva en un grupo de 99 mujeres con una media de edad de 47 años (oscilando entre 17 y 82 años) que fueron tratadas en una Unidad de hospitalización para mujeres de un hospital psiquiátrico durante el periodo 1993-1996. La muestra estaba formada por 39 pacientes con un diagnóstico de trastorno afectivo, en la mayoría de los casos depresión, y 60 pacientes con un diagnóstico de trastorno esquizoafectivo o esquizofrenia. El número total de electroconvulsiones aplicado fue de 663, con una media de 6,7 por paciente. La TEC se aplicó bilateralmente utilizando el dispositivo Thymatron. Se empleó un método de administración de estímulo adecuado a la edad. Se evaluaron los registros del electroencefalograma respecto a la duración de la crisis y se estableció su correlación con las medicaciones empleadas simultáneamente. Los resultados demostraron que la administración de neurolépticos guardaba correlación positiva con la duración de la crisis (p = 0,05). La utilización de antidepresivos y las benzodiacepinas no guardaba correlación con la duración de la crisis, no obstante las benzodiacepinas se utilizaron sólo en dosis pequeñas en nuestra muestra. En el análisis específico de los medicamentos, después de la corrección de Bonferroni se vio que ninguna medicación simple ni tratamiento combinado usado en nuestra muestra guardó correlación significativa con la duración de la crisis (amitriptilina, dibencepina, mianserina, levomepromacina, clorpromacina, haloperidol, zuclopentixol, perfenacina, tratamiento combinado levomepromacina-perfenacina, levomepromacina-amitriptilina, levomepromacina-haloperidol). (AU)
