ABSTRACT
OBJECTIVE: The enzyme system cytochrome P450 plays a central role in the metabolism of drugs in the human body. The enzyme CYP2D6 is important for the metabolism of psychoactive agents. Genetic changes in the CYP2D6 gene can lead to reduced or absent activity. METHODS: We report on a 37-year-old female patient who was given risperidone to treat an acute delusional disorder. Despite receiving a very low dose, the patient suffered from an intoxication. We inferred that an excessively raised plasma level of risperidone may result from a pharmacologically relevant disorder of metabolism. RESULTS: The molecular genetic investigation revealed a compound heterozygous mutation in the CYP2D6 gene and thus documented a genetic predisposition as a "poor [non]metabolizer". CONCLUSIONS: In intoxications with psychoactive agents, the presence of an enzyme defect in the P450 system should be considered as an additional possible cause.
Subject(s)
Antipsychotic Agents/pharmacokinetics , Antipsychotic Agents/toxicity , Cytochrome P-450 CYP2D6/genetics , Delusions/drug therapy , Psychotic Disorders/drug therapy , Risperidone/pharmacokinetics , Risperidone/toxicity , Adult , Antipsychotic Agents/therapeutic use , Chromosomes, Human, Pair 22/genetics , Cyclohexanols/pharmacokinetics , Cyclohexanols/therapeutic use , DNA Mutational Analysis , Delusions/blood , Delusions/genetics , Dose-Response Relationship, Drug , Drug Monitoring , Drug Therapy, Combination , Exons/genetics , Female , Genetic Carrier Screening , Humans , Inactivation, Metabolic/genetics , Introns/genetics , Metabolic Clearance Rate , Psychotic Disorders/blood , Psychotic Disorders/genetics , Risperidone/therapeutic use , Selective Serotonin Reuptake Inhibitors/adverse effects , Selective Serotonin Reuptake Inhibitors/therapeutic use , Venlafaxine HydrochlorideABSTRACT
BACKGROUND: Postictal psychosis is an important complication inpatients with epilepsy. METHOD: We report a male patient with pre-existing epilepsy who developed acute psychosis with delusions and acoustic hallucinations, two days after a prolonged complex-partial seizure. Upon treatment with diazepam and haloperidol, the psychosis subsided within three days. RESULT: The optimation of antiepileptic drugs is the main point to prevent seizures and postictal psychotic episodes in epilepsy. CONCLUSION: This case shows that close collaboration between neurologists and psychiatrists on epilepsy associated psychoses is decisive for an optimal success of therapy.
Subject(s)
Epilepsy, Complex Partial/complications , Epilepsy/complications , Hallucinations/etiology , Psychotic Disorders/etiology , Acute Disease , Adult , Anticonvulsants/therapeutic use , Cooperative Behavior , Delusions/drug therapy , Delusions/etiology , Diazepam/therapeutic use , Hallucinations/drug therapy , Haloperidol/therapeutic use , Hospitalization , Humans , Interprofessional Relations , Male , Neurology/methods , Psychiatry/methods , Psychotic Disorders/drug therapy , Schizophrenia, Paranoid/drug therapy , Schizophrenia, Paranoid/etiology , Treatment OutcomeABSTRACT
Care of a person with mental illness involves multiple burdens, possibly leading to burnout. This study compares partners of persons with schizophrenia and depression with nursing staff based on dimensions of burnout. Nursing staff and partners of patients with schizophrenia or depression were consecutively recruited from psychiatric hospitals and interviewed with the Maslach Burnout Inventory. No significant differences were found in the three dimensions of burnout (emotional exhaustion, depersonalization, and personal accomplishment) for the two groups of caregivers. About one fourth of the respondents in both groups showed a high degree of burnout. Professional and nonprofessional caregivers face a similar degree of burden and need support to perform their caretaking tasks.
Subject(s)
Caregivers/psychology , Depressive Disorder/nursing , Schizophrenia/nursing , Spouses/psychology , Stress, Psychological/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Burnout, Professional/etiology , Burnout, Professional/psychology , Female , Germany , Humans , Male , Middle Aged , Multivariate Analysis , Regression Analysis , Risk , Stress, Psychological/psychologyABSTRACT
Hashimoto encephalopathy is a chronic relapsing steroid responsive encephalopathy characterized by antibodies against thyroid components. Etiology is still unknown. Confusion, seizures and coma are frequent reported symptoms. We present a 65-year old patient with acute onset of partial seizures and cognitive impairment. Hashimoto encephalopathy was assumed with diagnosis of Hashimoto thyroiditis and clinical syndrome. Symptoms resolved with thyroid treatment alone. Hashimoto encephalopathy should be considered in patients with unexplained encephalopathy, even when thyroid function seems to be normal.
Subject(s)
Brain Diseases/diagnosis , Carbamazepine/analogs & derivatives , Dementia, Vascular/etiology , Epilepsies, Partial/etiology , Epilepsy, Tonic-Clonic/etiology , Thyroiditis, Autoimmune/diagnosis , Aged , Anticonvulsants/therapeutic use , Brain Diseases/drug therapy , Carbamazepine/therapeutic use , Dementia, Vascular/diagnosis , Dementia, Vascular/drug therapy , Diagnosis, Differential , Drug Therapy, Combination , Epilepsies, Partial/diagnosis , Epilepsies, Partial/drug therapy , Epilepsy, Tonic-Clonic/diagnosis , Epilepsy, Tonic-Clonic/drug therapy , Glucocorticoids/therapeutic use , Humans , Male , Neuropsychological Tests , Oxcarbazepine , Thyroxine/therapeutic useABSTRACT
The frequency of neuroleptic malignant syndrome (NMS) after clozapine or olanzapine is low and often of non-serious nature. A 49 year-old female patient developed NMS 12 days after olanzapine re-exposure. Olanzapine was stopped, the patient was transferred to an ICU and received a course of nine uni- and bilateral ECT treatments. This led to remission. 14 months earlier the patient had presented with a first severe NMS episode after haloperidol depot injection and 4 days after starting oral clozapine. Following the first NMS episode olanzapine (20 mg per day) was administered for 11 months without adverse effects.
Subject(s)
Antipsychotic Agents/adverse effects , Haloperidol/analogs & derivatives , Neuroleptic Malignant Syndrome/etiology , Pirenzepine/analogs & derivatives , Pirenzepine/adverse effects , Psychotic Disorders/drug therapy , Antipsychotic Agents/therapeutic use , Benzodiazepines , Critical Care , Electroconvulsive Therapy , Female , Haloperidol/adverse effects , Haloperidol/therapeutic use , Humans , Middle Aged , Neuroleptic Malignant Syndrome/diagnosis , Neuroleptic Malignant Syndrome/therapy , Olanzapine , Pirenzepine/therapeutic use , RecurrenceABSTRACT
We report a case of 35-year old female patient with recurrent depressive disorder and Cushing's syndrome. MRI of the brain revealed a microadenoma of the pituitary gland. After neurosurgery the serum levels of cortisol went back to normal and the clinical and mental state of the patient improved rapidly. Depressive episodes require additional diagnostics to exclude somatic etiology.