Add-on Aripiprazole for Atypical Antipsychotic-induced, Clinically Significant Hyperprolactinemia.

BACKGROUND: Antipsychotic treatment-induced hyperprolactinemia is a highly distressing and disabling side effect for patients. The use of add-on aripiprazole has been identified as a possible treatment strategy in this situation. However, data on prolactin changes with add-on aripiprazole in a real-world naturalistic clinical setting from India are sparse. MATERIALS AND METHODS: The retrospective chart review was conducted at the specialty metabolic clinic at the National Institute of Mental Health and Neurosciences, Bengaluru, India. Sixteen patients (female: male = 13:3) who were on a stable dose of antipsychotic medications, complaining of either sexual dysfunction or menstrual irregularities, were prescribed add-on aripiprazole. The serum prolactin values were obtained before the initiation of aripiprazole and during the follow-up. RESULTS: Patients were on treatment with risperidone, amisulpride, and olanzapine and had a prolactin level of 87.1 ± 60.7 ng/ml. Add-on aripiprazole treatment was given with a mean dose of 13.8 ± 7.4 mg/day. Patients had a significant reduction in prolactin level (35.6 ± 29.1 ng/ml) following treatment with aripiprazole (P = 0.004). CONCLUSIONS: Add-on aripiprazole could be a clinically useful strategy in patients who develop antipsychotic-induced hyperprolactinemia.

Hazards of antihistamine dependence in psychiatric patients: a case report.

Excessive use of over-the-counter (OTC) medications has been a growing public health problem. We present the case of a patient with avoidant personality disorder, social phobia, and dull normal intelligence, with dependence to pheniramine maleate. His anxiety symptoms, initially unresponsive to conventional treatment, reduced only after stopping pheniramine during inpatient care. This case emphasizes the need for awareness and regular monitoring of the use of OTC medications in vulnerable patient populations.

Auditory Neuropathy Spectrum Disorder Masquerading as Social Anxiety.

The authors report a case of a 47-year-old man who presented with treatment-resistant anxiety disorder. Behavioral observation raised clinical suspicion of auditory neuropathy spectrum disorder. The presence of auditory neuropathy spectrum disorder was confirmed on audiological investigations. The patient was experiencing extreme symptoms of anxiety, which initially masked the underlying diagnosis of auditory neuropathy spectrum disorder. Challenges in diagnosis and treatment of auditory neuropathy spectrum disorder are discussed.

Metacognitive training for delusion in treatment-resistant schizophrenia.

Metacognitive training for patients with schizophrenia (MCT) is a novel form of psychotherapy that aims to promote insight into the relationship between metacognitive deficits and psychotic symptoms, especially delusions. MCT has been found to be effective in reducing the delusional conviction and other positive symptoms in patients with schizophrenia. However, we are not aware of any research in which MCT has been used specifically to manage treatment-resistant schizophrenia patients. We report the case of a patient with treatment-resistant schizophrenia who responded to MCT. Her persecutory and referential delusions improved with a course of twelve sessions of therapy. Further, the improvement in delusions had a positive impact on her psychosocial functioning. A follow-up after two months of therapy revealed sustained improvement.

Vitamin B12 levels and psychiatric symptomatology: a case series.

Cobalamin (Vitamin B12) has been implicated in the pathogenesis of various neuropsychiatric disorders. A review of 19 patients (14 vegetarians) with demonstrable vitamin B12 deficiency showed varied psychiatric symptomatology, with the majority not having significant hematological or neurological manifestations.

Piracetam treatment in patients with cognitive impairment.

Piracetam is a cognitive-enhancing agent that is used for the treatment of cognitive impairments of various etiologies. Little is known about its side effect profile, especially in those with psychiatric illness. We herewith present two cases with cognitive impairment who had contrasting responses to piracetam. One of them with organic amnestic syndrome had significant improvement, whereas the other who had an organic personality change as well as a family history of mental illness had significant worsening of behavioral problems after piracetam was introduced. This report highlights the need for caution in the use of piracetam, especially in those with past or family history of psychiatric illness.

Late-onset clozapine-induced agranulocytosis in a patient with comorbid multiple sclerosis.

The risk of clozapine-induced agranulocytosis is highest in the initial 6 months after onset of treatment. There have been very few reports of neutropenia and agranulocytosis after this period. We report a unique case of delayed clozapine-induced agranulocytosis in a patient with preexisting multiple sclerosis (MS) which was treated with granulocyte colony-stimulating factor. Both MS and clozapine-induced agranulocytosis have an underlying autoimmune immune mechanism. This case highlights the need for frequent blood count monitoring on clozapine even after the initial 6 months of starting treatment especially in patients with a past history of drop in white blood cell counts as well as with a comorbid autoimmune disorder.

Obsessive compulsive disorder masquerading as psychosis.

Obsessive compulsive disorder (OCD) is commonly regarded as a disorder with good insight. However, it has now been recognized that insight varies in these patients. Pathological beliefs seem to lie on a continuum of insight, with full insight at one end and delusion at the other. This can indeed pose a considerable challenge, especially in a scenario where the phenomenon is difficult to discern. We report a case of OCD, which was initially diagnosed as psychosis.

Hyperthyroidism presenting as mixed affective state: a case report.

Thyroid disorders have long been associated with psychiatric illness, commonly mood disorders. In bipolar disorder, hypothyroidism is quite a common abnormality. Little is known about the association of thyroid disorders and mixed affective states. We present a case of hyperthyroidism presenting as a mixed affective state and the successful resolution of psychiatric symptoms with antithyroid medication along with a mood-stabilizing agent.