ABSTRACT
OBJECTIVE: To describe a case of aripiprazole-induced problem gambling and impulse-control deficit in a gambling-naïve patient following commencement of low-dose aripiprazole. METHOD: Case report. RESULTS: This case adds to the literature on the dopamine partial agonist aripiprazole causing or exacerbating problem gambling, and extends that literature to low-dose use of aripiprazole in the gambling naïve. CONCLUSIONS: When commencing a patient on aripiprazole the possibility of emergence of problem gambling and other impulse-control deficits should be monitored, even in those with no history of similar behaviours and even on a low dose.
Subject(s)
Antipsychotic Agents/adverse effects , Aripiprazole/adverse effects , Disruptive, Impulse Control, and Conduct Disorders/chemically induced , Dopamine Agonists/adverse effects , Gambling/chemically induced , HumansABSTRACT
OBJECTIVE: We present a case of clozapine-related myocarditis, with a rising C-reactive protein as the only initial evidence supporting the diagnosis. METHOD: An otherwise healthy young male presenting with treatment-resistant schizophrenia was started on clozapine. Monitoring was performed. RESULTS: At day 18 he developed fever, tachycardia and a raised C-reactive protein, while troponin levels and echocardiogram remained normal. CONCLUSIONS: Current protocols monitoring for myocarditis have their limitations and can often only be used to support a presumptive diagnosis of myocarditis. In keeping with the current clozapine monitoring guidelines, we demonstrate that a rise in C-reactive protein levels can be a critical early sign of myocarditis warranting close monitoring and serious consideration for cessation of clozapine.
Subject(s)
Antipsychotic Agents/adverse effects , C-Reactive Protein/metabolism , Clozapine/adverse effects , Early Diagnosis , Myocarditis/chemically induced , Myocarditis/diagnosis , Adult , Humans , Male , Myocarditis/blood , Time Factors , Troponin/bloodSubject(s)
Antipsychotic Agents/adverse effects , Benzodiazepines/adverse effects , Delirium/chemically induced , Depressive Disorder/drug therapy , Psychotic Disorders/drug therapy , Aged , Alzheimer Disease/diagnosis , Anti-Anxiety Agents/administration & dosage , Antipsychotic Agents/administration & dosage , Benzodiazepines/administration & dosage , Delirium/diagnosis , Diagnosis, Differential , Dibenzothiazepines/administration & dosage , Hallucinations/chemically induced , Humans , Male , Olanzapine , Oxazepam/administration & dosage , Quetiapine Fumarate , Tachycardia/chemically inducedSubject(s)
Catatonia/diagnosis , Dementia/drug therapy , Neuroleptic Malignant Syndrome/diagnosis , Aged , Anti-Anxiety Agents/administration & dosage , Antipsychotic Agents/administration & dosage , Benzodiazepines/administration & dosage , Benzodiazepines/adverse effects , Catatonia/drug therapy , Catatonia/psychology , Chlorpromazine/administration & dosage , Chlorpromazine/adverse effects , Cholinesterase Inhibitors/administration & dosage , Cognition Disorders/drug therapy , Cognition Disorders/psychology , Creatine Kinase/blood , Creatine Kinase/drug effects , Dementia/complications , Dementia/psychology , Disease Progression , Donepezil , Female , Humans , Indans/administration & dosage , Lorazepam/administration & dosage , Muscle Rigidity/chemically induced , Neuroleptic Malignant Syndrome/complications , Neuroleptic Malignant Syndrome/psychology , Olanzapine , Piperidines/administration & dosage , Recurrence , Risperidone/administration & dosageABSTRACT
It is known that 9-13% of individuals with a diagnosis of schizophrenia commits suicide. In addition, patients with schizophrenia have approximately a 50% lifetime risk for attempting suicide. The authors review the identified risk factors for suicide in schizophrenia. The most significant risk factors include the age of the patient, male gender, depression, presence of positive symptoms and substance abuse. There is evidence that implicates the serotonin system in the suicide of individuals with schizophrenia. Overactivity of the hypothalamo-pituitary-adrenal axis has also been reported in individuals who went on to attempt suicide. The authors review the molecular biology of suicide in schizophrenia. With regard to prevention of suicide, pharmacological intervention with typical antipsychotics and antidepressants may be helpful. It is suggested that atypical anti-psychotics, in particular clozapine may provide additional benefit in reducing the rate of suicide attempts. The authors emphasise the importance of early treatment of individuals with a diagnosis of schizophrenia, the role of maintenance therapy and the importance of a collaborative approach between in- and outpatient services.
