Quetiapine-induced cervical dystonia.

OBJECTIVE: Our objective was to report and describe a case of quetiapine-induced dystonia in an older lady with psychosis. Quetiapine is a second-generation antipsychotic and known to be rare in causing extrapyramidal side effects with rates similar to placebo. CONCLUSIONS: There have been few documented cases of quetiapine-induced dystonia. It is important to be vigilant and consider the development of dystonia in patients who may not fit the typical risk profile.

Metabolic monitoring and management among clozapine users.

OBJECTIVE: To assess, among clozapine users, the rates of monitoring, presence and treatment of metabolic syndrome and its components. METHODS: A chart review was conducted of all clozapine users who were followed up in community mental health clinics at two Metro South Health Hospitals over a 1-year period. Metabolic syndrome was diagnosed according to the International Diabetes Federation criteria. RESULTS: We included 251 clozapine users. Only 43.4% (109/251) had data collected for all five metabolic syndrome parameters. Among these people, 45.0% (49/109) met criteria for metabolic syndrome, while 61.2% (30/49) of those with metabolic syndrome were offered appropriate treatments. Correspondence with primary care providers occurred in only 18.7% ( n = 47). Non-pharmacological interventions, such as motivational interviewing and education about healthy lifestyle alternatives, occurred in 49.8% ( n = 125). CONCLUSIONS: There is growing awareness of the importance of metabolic monitoring, however, there remain specific gaps in the collaborative work among mental health services, primary care providers and clozapine users, to ensure appropriate physical health interventions.

Neurosyphilis in a non-HIV patient: more than a psychiatric concern.

Neurosyphilis is a form of tertiary syphilis infection caused by the spirochete bacterium Treponema pallidum. Patients suffering from this illness can present with neurological manifestations such as headaches, seizures, hearing loss, and ataxia. However, the typical presentation of neurosyphilis is the insidious onset of psychiatric symptoms including personality changes. A good history and clinical work-up is essential in the diagnostic process. There has been a recent increase in the incidence of infectious syphilis in Canada (1). However, in other parts of the world including China, infectious syphilis rates have remained high due to limited access to primary care and affordable treatments (2) Here, we present a case of neurosyphilis in a 40 year old Chinese male residing in China who presents with an 18 month history of personality changes as well as neurological and physical manifestations of the infection.