The effect of aripiprazole and quinagolide, a dopamine agonist, in a patient with symptomatic pituitary prolactinoma and chronic psychosis.

BACKGROUND: Highly potent dopamine D(2) receptor antagonistic antipsychotics may induce hyperprolactinemia. Conversely, drugs for the treatment of prolactinoma may activate dopamine D2 receptors, which can induce or aggravate psychosis. Aripiprazole, as a partial D(2) receptor agonist, may be the drug of choice in patients suffering from both psychosis and prolactinoma. OBJECTIVE: We evaluated the effects of aripiprazole on the size of a cystic macroadenoma by magnetic resonance imaging and on prolactin levels in a patient suffering from psychosis and prolactinoma. METHOD: This is a case report of a 53-year-old female patient with a chronic psychotic disorder and moderate mental retardation who had developed a prolactinoma that was resected but still had residual adenoma and hyperprolactinemia. Antipsychotic medication was switched from risperidone to aripiprazole before a dopamine agonist was initiated. RESULTS: After change in treatment, there were reductions in serum prolactin levels, tumor size and visual field defects. We observed no psychotic decompensation. CONCLUSION: The combination of aripiprazole and quinagolide could be considered as an effective treatment in patients suffering from both psychosis and a prolactinoma.

Medical weblogs: advocacy for positive cyber role models.

BACKGROUND: The development of empathy and of medical professionalism is important in medical education. Research has shown a decline in empathy during medical study. An important factor that may contribute to this decline is the lack of positive role models. Students identify positive and negative role models in the clinical ward and in classrooms. Positive clinical role models, showing good professionalism, will foster the student's professional growth. CONTEXT: Students base both knowledge and opinions on information they find on the internet, such as 'medical weblogs'. These weblogs may be regarded as a new aspect of the 'informal curriculum', even though they might be written by 'negative role models'. In our experience, students frequently require debriefing of the undifferentiated, frequently disrespectful, grotesque or unprofessional approaches they encounter in general, and in this aspect online in particular. INNOVATION: When written by appropriate professionals, medical weblogs can provide a unique opportunity for the medical student to follow the writings of positive role models. Would it be a worthwhile investment if globally distributed medical professionals from different specialties put time and effort into writing weblogs on their daily practice and reflections? These weblogs could be assembled on one international educational website, labelled as 'professionally approved' and made easily accessible. Medical students internationally would have access to the daily practice of medical professionals who are excellent positive role models. They could also be encouraged to discuss issues with them. We hypothesise that witnessing the encounters of these globally distributed doctors, and following their reflections, may add to the growth of empathy and professionalism in students.