Antibiomania: A Case Report of a Manic Episode Potentially Induced by the Interaction of Clarithromycin and Amoxicillin during H. Pylori Eradication Therapy.

Antibiomanic episodes, or as the DSM-5 refers to them, drug-induced manic episodes, pose a clinical challenge that is still poorly understood. There is insufficient information on the most common clinical presentation, patient profile, or underlying aetiopathogenic mechanisms. We present the clinical case of a 67-year-old woman who, after starting treatment (clarithromycin and amoxicillin) for the eradication of Helicobacter pylori, bacteria presented with a brief manic episode, which resolved after withdrawal of both drugs and with antipsychotic treatment. The possible interaction of both drugs, as GABA antagonists, in the generation of such episodes is discussed, and the clinical importance of such episodes in psychiatric emergency departments and liaison and interconsultation psychiatry, is highlighted.

Antibiomania: A Case Report of a Manic Episode Potentially Induced by the Interaction of Clarithromycin and Amoxicillin during H. Pylori Eradication Therapy

Antibiomanic episodes, or as the DSM-5 refers to them, drug-induced manic episodes, pose a clinical challenge that is still poorly understood. There is insufficient information on the most common clinical presentation, patient profile, or underlying aetiopathogenic mechanisms. We present the clinical case of a 67-year-old woman who, after starting treatment (clarithromycin and amoxicillin) for the eradication of Helicobacter pylori, bacteria presented with a brief manic episode, which resolved after withdrawal of both drugs and with antipsychotic treatment. The possible interaction of both drugs, as GABA antagonists, in the generation of such episodes is discussed, and the clinical importance of such episodes in psychiatric emergency departments and liaison and interconsultation psychiatry, is highlighted. (AU)

Spanish media coverage of youth mental health issues during the COVID-19 pandemic.

BACKGROUND: The media portrayal of mental health is relevant in shaping the population's attitudes towards mental disorders. However, there is little information about the representation of young mental health issues in the Spanish-language press, especially in the context of the COVID-19 pandemic. The general objective of this study was to analyse the tone and content of Spanish newspaper articles about mental disorders in youth during the COVID-19 pandemic. METHODS: We collected media articles from the 10 most read news sources over a 6 month period (January-June 2021). These articles were coded for content using a standardised codebook, followed by an inductive thematic analysis. A total of 205 news items were evaluated. RESULTS: Results showed that the majority of the news items had an overall positive tone (68.3%), only 5.4% were stigmatising and only 7.3% were related to violence. However, few articles offered help seeking information (6%), adolescents were rarely quoted (14%) and children were never quoted. Substantial differences are described in terms of age, gender and disorder. The thematic analysis led to three emergent themes: (i) violence and victimisation; (ii) the COVID-19 pandemic; and (iii) technology and social media. CONCLUSIONS: The percentage of news in the Spanish media that refer to young people's mental health in a stigmatising way or in a way associated with violence is very low. Furthermore, the COVID-19 pandemic may have promoted more positive discussion about youth mental health. However, major challenges remain to be addressed, as patients are seldom quoted, very few articles offer help-seeking information, and a narrative of victimisation without appropriate discussion of resilience regularly occurs.

Spanish mental health residents' perspectives about residency education on the genetics of psychiatric disorders: A cross-sectional survey.

Despite compelling evidence that some patients with a psychiatric diagnosis could benefit from genetic assessment, genetic testing for psychiatric patients is underutilized. Few studies have reported psychiatric genetics training for mental health specialists, and such research is especially lacking in Spain. We aimed to gather the opinions of Spanish mental health residents, including resident intern nurses (RINs), doctors (RIDs) and psychologists (RIPs). A short survey was prepared by an expert team and distributed to all mental health residency centers in Spain during the first semester of 2021. Of the 2028 residents, 18% responded. Participants were mainly females (71%), in their first year of residency (37%) and within the 27-31-year age range. While participants received little theoretical (13.4%) and practical (4.6%) training on average, RIDs had the most affirmative responses. Notably, RINs and RIDs were interested in genetics during residency (>40%) and strongly believed (85.0%) that genetics training using both theoretical and practical methodologies should be incorporated into residency training. However, RIPs were less interested (20%), and only 60% believed that genetics training should be incorporated. Spanish mental health residents, although interested in genetics in psychiatry, receive little training on this topic. They strongly believe that genetics training using theoretical and practical methodologies should be incorporated.

Análisis crítico de un antimicrobiano sub-óptimo, de frecuente sobre-utilización e inadecuada dosificación: vancomicina / Critical review of a suboptimal antibiotic, frequently overused and inappropriately dosed: vancomycin

Resumen Introducción: Vancomicina, terapia estándar para enterococos y estafilococos resistentes a β-lactámicos tradicionales (Staphylococcus aureus [SARM] y Staphylococcus coagulasa negativa), tiene extenso uso empírico en infecciones nosocomiales. Farmacológicamente débil, de estrecho margen terapéutico y farmacocinética poco predecible, es un fármaco sub-estándar según criterios contemporáneos. Tiene excesivo uso, por sobrediagnóstico de infecciones bacterianas y, en infecciones genuinas, por sobre-estimación etiológica de patógenos β-lactámico-resistentes. Últimamente han surgido nuevas amenazas a su efectividad: peores desenlaces en infecciones por SARM con CIM en rango alto de sensibilidad y resistencia de enterococos. Hay frecuente administración inadecuada en: dosis e intervalos, ausencia de dosis de carga inicial, falta de monitoreo con concentraciones plasmáticas, inadecuada dosificación en presencia de insuficiencia renal o diálisis e, importantemente, mantención de uso en ausencia de clara documentación de su necesidad. Nuevos fármacos anti-estafilocócicos no han permitido un reemplazo generalizado de vancomicina por lo que ésta mantiene un importante rol en la medicina contemporánea. Conclusiones: Una comprensión de las fortalezas y debilidades del fármaco, así como de la cambiante epidemiología y propiedades microbiológicas de los patógenos relevantes, al igual que un uso prudente y selectivo, permitirán optimizar su uso y mantener su rol terapéutico en la medicina actual y futura.

Background: Vancomycin, standard parenteral therapy for Gram positive cocci resistant to traditional beta-lactam antibiotics (Staphylococcus aureus and coagulase negative staphylococci [CNS]) and Enterococcus spp, frequent agents of nosocomial infections, is extensively used empirically in that setting. However, its pharmacological weakness, narrow therapeutic margin and poorly predictable pharmacokinetics, make it a suboptimal drug according to contemporary criteria. Vancomycin is over utilized due to both, overestimation of bacterial infections and, in genuine cases, overestimation of the etiological role of these resistant cocci, either nosocomially or community acquired. New threats narrow further its therapeutic role: poorer outcomes in infections with higher vancomycin MIC and resistance by enterococci. It is frequently given at inappropriate dosage and intervals, failing to: give loading dose when recommended, measure blood levels, adjust dosing to changing renal function and continued use when not necessary. Newer anti staphylococcal drugs haven't replaced completely the role of vancomycin, which maintains its usefulness in contemporary medicine. Conclusion: Understanding the strengths and weaknesses of vancomycin, current epidemiology and microbiology of infections for which it may be indicated, as well as the proper administration and monitoring, together with a prudent and selective indication will allow to preserve its present and future utility in the changing medical scenario.

[Critical review of a suboptimal antibiotic, frequently overused and inappropriately dosed: Vancomycin]. / Análisis crítico de un antimicrobiano sub-óptimo, de frecuente sobre-utilización e inadecuada dosificación: Vancomicina.

BACKGROUND: Vancomycin, standard parenteral therapy for Gram positive cocci resistant to traditional beta-lactam antibiotics (Staphylococcus aureus and coagulase negative staphylococci [CNS]) and Enterococcus spp, frequent agents of nosocomial infections, is extensively used empirically in that setting. However, its pharmacological weakness, narrow therapeutic margin and poorly predictable pharmacokinetics, make it a suboptimal drug according to contemporary criteria. Vancomycin is over utilized due to both, overestimation of bacterial infections and, in genuine cases, overestimation of the etiological role of these resistant cocci, either nosocomially or community acquired. New threats narrow further its therapeutic role: poorer outcomes in infections with higher vancomycin MIC and resistance by enterococci. It is frequently given at inappropriate dosage and intervals, failing to: give loading dose when recommended, measure blood levels, adjust dosing to changing renal function and continued use when not necessary. Newer anti staphylococcal drugs haven't replaced completely the role of vancomycin, which maintains its usefulness in contemporary medicine. CONCLUSION: Understanding the strengths and weaknesses of vancomycin, current epidemiology and microbiology of infections for which it may be indicated, as well as the proper administration and monitoring, together with a prudent and selective indication will allow to preserve its present and future utility in the changing medical scenario.