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1.
Gen Hosp Psychiatry ; 35(6): 683.e1-2, 2013.
Article in English | MEDLINE | ID: mdl-23906839

ABSTRACT

Hashimoto's thyroiditis (HT) is an autoimmune thyroiditis that occurs frequently in middle-aged women. To date, there is no formally reported association between acute mania and hypothyroidism due to HT. We report a case of acute mania associated with hypothyroidism resulting from HT. Our patient's mania and hypothyroidism remitted gradually after the treatment with mood stabilizer/antipsychotic drugs and levothyroxine therapy. This case highlights the importance of ascertaining thyroid function and checking antithyroid antibodies in middle-aged female patients with affective symptoms to the hospital for the first time.


Subject(s)
Bipolar Disorder/psychology , Hashimoto Disease/psychology , Hypothyroidism/psychology , Acute Disease , Adult , Antimanic Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Bipolar Disorder/drug therapy , Dibenzothiazepines/therapeutic use , Female , Humans , Hypothyroidism/drug therapy , Quetiapine Fumarate , Thyroxine/therapeutic use , Valproic Acid/therapeutic use
3.
Bipolar Disord ; 15(4): 359-64, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23551803

ABSTRACT

OBJECTIVES: Calcitonin, a neuropeptide, has been shown in preliminary double-blind trials to reduce agitation in patients with acute mania. Given that it has effects similar to those of lithium and anticonvulsants on modulation of second-messenger signaling pathways and stabilization of neuronal membranes, this study examined the efficacy of calcitonin nasal spray in treating acute manic symptoms in patients with treatment-resistant mania using a double-blind, placebo-controlled design. METHODS: A total of 46 hospitalized patients experiencing either a manic or a mixed episode, who were refractory to treatment with adequate doses of either a mood stabilizer or an antipsychotic, or a mood stabilizer/antipsychotic combination, and had a score of ≥16 on the Young Mania Rating Scale (YMRS), were randomized to receive adjunctive nasal calcitonin 200 IU (n = 24) or saline (n = 22) spray for three weeks. The primary efficacy measure was the change in YMRS scores using the last observation carried forward (LOCF) method. RESULTS: The clinical and demographic characteristics were similar between the groups. Patients had a mean YMRS score of 26 in the placebo group and a mean score of 25 in the calcitonin group. There were no significant differences in YMRS scores or percentage responders at three weeks between patients who received calcitonin and those who received placebo. There were also no significant differences in change scores on any other scales. Few patients experienced any adverse events. CONCLUSIONS: This study does not support the use of nasal calcitonin in the treatment of treatment-resistant mania.


Subject(s)
Bipolar Disorder , Calcitonin/administration & dosage , Psychomotor Agitation , Adult , Antimanic Agents/administration & dosage , Bipolar Disorder/complications , Bipolar Disorder/diagnosis , Bipolar Disorder/drug therapy , Bipolar Disorder/psychology , Double-Blind Method , Drug Monitoring , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Nasal Sprays , Psychiatric Status Rating Scales , Psychomotor Agitation/drug therapy , Psychomotor Agitation/etiology , Psychomotor Agitation/psychology , Treatment Outcome
6.
J ECT ; 27(2): 165-7, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21602639

ABSTRACT

Headaches and nausea are the 2 most common adverse effects of electroconvulsive therapy (ECT). These adverse effects have been frequently reported in the postictal period and make it difficult for the patient to continue with the following ECTs. Mirtazapine is an antidepressant with a mechanism that involves activating serotonin (5-HT1) receptors. This mechanism has been hypothesized to be the underlying therapeutic effects for depression and anxiety. In addition, mirtazapine possesses antagonistic effects on the postsynaptic serotonin 5-HT2 and 5-HT3 receptors. The pharmacological actions are hypothesized to be related to its treatment effects of headaches and nausea. Here, we report a case series of patients developing post-ECT headaches and nausea, and the concomitant administration of mirtazapine successfully relieved the ECT-associated adverse effects. This case series suggest that mirtazapine may be an optional treatment for ECT-induced headaches and nausea.


Subject(s)
Antidepressive Agents, Tricyclic/therapeutic use , Electroconvulsive Therapy/adverse effects , Headache/drug therapy , Mental Disorders/therapy , Mianserin/analogs & derivatives , Nausea/drug therapy , Adult , Depressive Disorder, Major/therapy , Female , Headache/etiology , Humans , Mianserin/therapeutic use , Middle Aged , Mirtazapine , Nausea/etiology , Psychotic Disorders/therapy , Retrospective Studies , Schizophrenia/therapy
7.
Arch Psychiatr Nurs ; 25(1): 53-62, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21251602

ABSTRACT

The purpose of this study was to examine the reliability, validity, sensitivity, and specificity of the Chinese Version of the Mood Disorder Questionnaire (MDQ-C). A total of 170 patients were administered the Mini International Neuropsychological Interview and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision as criterion standard by on-site psychiatrists. The Cronbach's alpha, test-retest reliability, and the content validity index of the MDQ-C were .83, .76, and .80, respectively. Factor analysis revealed that two factors, elevated mood overactivity and irritable behavior, explained 40.89% of the variance. On the basis of the sensitivity and specificity results, the optimal cutoff point was 6. The MDQ-C is an effective short and comprehensive tool with robust psychometric properties for diagnosis of bipolar disorders, specifically for patients with bipolar I.


Subject(s)
Asian People/psychology , Bipolar Disorder/diagnosis , Mood Disorders/diagnosis , Psychological Tests , Surveys and Questionnaires , Adult , Bipolar Disorder/ethnology , Case-Control Studies , Factor Analysis, Statistical , Female , Humans , Male , Matched-Pair Analysis , Mood Disorders/ethnology , Psychometrics , Reproducibility of Results , Sensitivity and Specificity , Taiwan
15.
Clin Neuropharmacol ; 31(4): 245-7, 2008.
Article in English | MEDLINE | ID: mdl-18670250

ABSTRACT

Adjunctive use of methylphenidate, a central stimulant, has been considered as a potential therapeutic choice for patients with refractory unipolar depression, geriatric depression, bipolar depression, and depression secondary to a medical illness. We present a case of psychotic unipolar depression in which the patient responded significantly to the adjunctive use of methylphenidate. A 45-year-old woman had melancholic depressive symptoms and mood incongruent psychotic features during her second episode of unipolar depression. She attempted suicide by hanging herself and was forcibly hospitalized. She was initially treated with venlafaxine (262.5 mg/d), olanzapine (20 mg/d), and benzodiazepines. However, she responded unsatisfactorily to the combination treatment. Because her family refused electroconvulsive treatment, we added methylphenidate to her medications for adjunctive use. The dose of methylphenidate was started at a dose of 5 mg/d. It was not until the patient received 30 mg/d of methylphenidate that her persistent psychosis and severe depression were substantially improved. She tolerated her medications well and did not report any side effects. She was discharged in a stable condition 2 weeks after the adjunctive use of methylphenidate. The patient's methylphenidate was gradually tapered and finally discontinued. To date, she remains well and is regularly followed up at our outpatient clinic. Our case suggests that adjunctive use of methylphenidate can be a therapeutic option in treating some patients with psychotic unipolar depression who do not adequately respond to the combination treatment of an antidepressant and an atypical antipsychotic. Further controlled studies are warranted to verify this.


Subject(s)
Central Nervous System Stimulants/therapeutic use , Depressive Disorder/drug therapy , Methylphenidate/therapeutic use , Anti-Anxiety Agents/therapeutic use , Antidepressive Agents, Second-Generation/therapeutic use , Antipsychotic Agents/therapeutic use , Benzodiazepines/therapeutic use , Cyclohexanols/therapeutic use , Depressive Disorder/psychology , Dose-Response Relationship, Drug , Drug Therapy, Combination , Female , Humans , Middle Aged , Olanzapine , Suicide, Attempted , Treatment Outcome , Venlafaxine Hydrochloride
17.
Int Clin Psychopharmacol ; 21(4): 241-3, 2006 Jul.
Article in English | MEDLINE | ID: mdl-16687996

ABSTRACT

Topiramate, a newer anticonvulsant, has a modulating effect on voltage-dependent sodium and calcium ion channels, potentiates GABA neurotransmitters and blocks kainite/AMPA glutamate receptors. We describe the use of topiramate in the treatment of fetishism, a paraphilic sexual disorder. A 23-year-old male had developed sexual fantasies and urges towards women's feet and shoes from childhood onwards. The patient would masturbate with women's shoes, which he had bought or stolen from others. He would feel sexually excited by seeing and/or smelling female feet and shoes. He had received individual psychotherapy because of his unusual sexual expressions, marked distress and interpersonal difficulty. However, the psychotherapy was not effective and his symptoms of fetishism did not abate until he had been treated with topiramate (200 mg per day). He has been on the dose of this medication for more than 6 months and his symptoms of fetishism have since diminished. In addition, he has not experienced any significant side-effect with this medication. Experience with our patient suggests that topiramate may be effective in treating paraphilic sexual disorders. Further controlled studies are required to confirm its efficacy in patients of this type.


Subject(s)
Central Nervous System Agents/therapeutic use , Fetishism, Psychiatric/drug therapy , Fructose/analogs & derivatives , Adult , Anticonvulsants/therapeutic use , Fructose/therapeutic use , Humans , Male , Topiramate
18.
Article in English | MEDLINE | ID: mdl-16581170

ABSTRACT

Delayed carbon monoxide (CO) encephalopathy is a serious complication of acute CO poisoning. We present a case of successful treatment of ziprasidone, a newer atypical antipsychotic, in delayed CO encephalopathy. A 52-year-old depressed woman suffered acute CO intoxication after an attempt of suicide by burning charcoal. She was initially treated with hyperbaric oxygen (HBO) therapy for the acute intoxication. One week later, the patient developed neuropsychiatric symptoms including parkinsonism, tardive dyskinesia (TD), cognitive deterioration, urinary incontinence, gait disturbance, mutism, disorientation to time, place and person, and disorganized as well as disturbing behavior. During her psychiatric hospitalization, the patient had been treated with daily HBO therapy, bromocriptine (2.5 mg/day), the conventional antipsychotic sulpiride (600 mg/day), and atypical antipsychotics such as risperidone (5 mg/day) and quetiapine (400 mg/day). However, her delayed neuropsychiatric sequelae of CO intoxication persisted despite of these treatments. It was until she had been treated with ziprasidone (80 mg/day) for 10 days that her mental condition was improved. With ziprasidone therapy, the patient obtained substantial improvement in her neuropsychiatric symptoms, cognitive function, and daily activities. Our case indicates that ziprasidone can be used effectively in the treatment of delayed CO encephalopathy.


Subject(s)
Antipsychotic Agents/therapeutic use , Brain Diseases/drug therapy , Carbon Monoxide Poisoning/drug therapy , Piperazines/therapeutic use , Thiazoles/therapeutic use , Female , Humans , Middle Aged
19.
Article in English | MEDLINE | ID: mdl-16442685

ABSTRACT

Anticonvulsant hypersensitivity syndrome (AHS) is a rare but life-threatening adverse effect of aromatic anticonvulsants such as phenytoin, phenobarbital and carbamazepine, although there is extensive experience with AHS related to these anticonvulsants. Very few cases of lamotrigine-associated AHS have been reported in bipolar patients and most reported cases were published in non-psychiatric journals. The authors describe here the occurrence of an AHS in a 48-year-old bipolar woman who was treated with lamotrigine, valproic acid and venlafaxine for her depressive symptoms. She developed a high fever, generalized maculopapular rash, pancytopenia, pneumonitis and hepatitis after we added lamotrigine to valproate and venlafaxine. These adverse drug reactions resolved after the discontinuation of lamotrigine and valproate, and the administration of oral antihistamine and corticosteroid. Our case demonstrates that the most important steps in the management of lamotrigine-associated AHS are to recognize the disorder, discontinue the offending anticonvulsants, provide supportive care in an inpatient setting, and treat with antihistamine and steroids when appropriate.


Subject(s)
Anticonvulsants/adverse effects , Drug Hypersensitivity/etiology , Triazines/adverse effects , Anticonvulsants/therapeutic use , Bipolar Disorder/drug therapy , Female , Humans , Lamotrigine , Middle Aged , Triazines/therapeutic use
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