Recurrent Heat-Related Illnesses During Antipsychotic Treatment

2005 ◽  
Vol 39 (11) ◽  
pp. 1940-1942 ◽  
Author(s):  
Jeffrey SS Kwok ◽  
Thomas YK Chan
Keyword(s):  
Clinical Diagnosis ◽  
Heat Stroke ◽  
Antipsychotic Treatment ◽  
Anticholinergic Drugs ◽  
Case Summary ◽  
Car Park ◽  
History Of ◽  
Heat Elimination ◽  
Zuclopenthixol Decanoate ◽  
First Admission

OBJECTIVE To report a case of recurrent heat-related illnesses associated with the use of benzhexol, chlorpromazine, and zuclopenthixol decanoate. CASE SUMMARY During the summer of 2004, a 48-year-old man with a history of diabetes mellitus and schizophrenia was twice admitted to the hospital because of heat-related illnesses. On both occasions, he had been working under the sun in an open car park. His medications included benzhexol 2 mg twice daily, chlorpromazine 650 mg at bedtime, and zuclopenthixol decanoate intramuscular injection 600 mg every 4 weeks. In the first admission, the clinical diagnosis was heat stroke. He was discharged home on day 14, with precautionary advice against heat stroke. In the second admission, the clinical diagnosis was heat exhaustion. He was discharged home on day 4 and reminded of the precautions against heat stroke. An objective causality assessment revealed that the adverse event was possibly drug related in the first admission and probably drug related in the second admission. DISCUSSION Several drugs can impair thermoregulation during exercise or under conditions of environmental heat stress. Anticholinergic drugs or drugs with anticholinergic effects can inhibit sweating and reduce heat elimination. Neuroleptics (antipsychotics), such as phenothiazines, have combined anticholinergic and central thermoregulatory effects. The set point of the temperature regulation center can be elevated by the antidopaminergic effect of antipsychotics, such as phenothiazines and thioxanthenes. CONCLUSIONS Certain drugs may induce or worsen heat-related illnesses. During a heat wave, special attention should be given to those most at risk, and the importance of preventive measures should be emphasized.

Pseudo-Parkinson Disease Secondary to Ritonavir–Buspirone Interaction

2003 ◽  
Vol 37 (2) ◽  
pp. 202-205 ◽  
Author(s):  
Patrick G Clay ◽  
Molly M Adams
Keyword(s):  
Drug Interaction ◽  
Inhibitory Effect ◽  
Hiv Positive ◽  
High Dose ◽  
Resting Tremor ◽  
Case Summary ◽  
History Of ◽  
Drug Drug Interaction ◽  
To Receive

OBJECTIVE: To report a case of Parkinson-like symptoms appearing in a patient after introduction of ritonavir to buspirone therapy. CASE SUMMARY: A 54-year-old HIV-positive white man presented to the clinic with a 2-week history of ataxia, shuffling gait, cogwheel rigidity, resting tremor, and sad affect with masked features. This patient had been receiving high-dose buspirone (40 mg every morning and 30 mg every evening) for 2 years prior to the introduction of ritonavir/indinavir combination therapy (400 mg/400 mg twice daily) 6 weeks prior to initiation of the above symptoms. Buspirone was decreased to 15 mg 3 times daily, ritonavir/indinavir was discontinued, and amprenavir 1200 mg twice daily was added. The patient's symptoms began to subside after 1 week, with complete resolution after about 2 weeks. The patient continued to receive buspirone for an additional 12 months without recurrence of symptoms. DISCUSSION: This is the first reported interaction of buspirone and antiretrovirals. Buspirone, extensively metabolized by CYP3A4, was likely at supratherapeutic levels due to the inhibitory effect of ritonavir and, secondarily, indinavir. The Parkinson-like symptoms developed rapidly and severely, impacted this patient's quality of life, and necessitated significant clinic expenditures to identify this drug–drug interaction. CONCLUSIONS: This case demonstrates a severe drug–drug interaction between buspirone and ritonavir and further demonstrates the need for awareness of the metabolic profile for all agents an HIV-infected patient is receiving.

scholarly journals Locked twins—remote from term: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Abraham Fessehaye ◽  
Ferid A. Abubeker ◽  
Mekdes Daba
Keyword(s):  
Gestational Age ◽  
Twin Pregnancy ◽  
Caesarian Section ◽  
Obstetric Complication ◽  
Second Stage ◽  
Case Summary ◽  
History Of ◽  
Twin Pregnancies ◽  
Abdominal Delivery ◽  
First Stage Of Labor

Abstract Background Locked twins is a rare and hazardous obstetric complication, which occurs in approximately 1:100 twin pregnancies. One of the known etiologic factors for locked twins is size of the twins. We report a case of chin-to-chin locked twins that occurred at gestational age of 30 weeks pus 6 days. Case summary A 27 years-old primigravida Oromo mother presented with a history of pushing down pain and passage of liquor of 6 hours duration at gestational age of 30 weeks plus 6 days. With a diagnosis of twin pregnancy (first twin non-vertex), abdominal delivery was decided in latent first stage of labor but mother refused caesarian delivery and she was allowed to labor with the hope of achieving a vaginal delivery. In second stage, interlocking twin was encountered and a low vertical cesarean section was done to effect delivery of twins without the need to decapitate the first twin. Conclusion Locked twin is a rare obstetric complication. Whenever it is encountered, successful delivery can be achieved without the need to have decapitation of the first twin during caesarian section.

Effect of Marriage on Pre-existing Psychoses: A Convenient or Futile Solution for Severe Mental Disorders?

2020 ◽  
Vol 2 (3-4) ◽  
pp. 273-276
Author(s):  
Prakash B. Behere ◽  
Aniruddh P. Behere ◽  
Debolina Chowdhury ◽  
Amit B. Nagdive ◽  
Richa Yadav
Keyword(s):  
Mental Disorders ◽  
Age Of Onset ◽  
Social Stigma ◽  
Positive Family History ◽  
Mental Illnesses ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Contractual Relationship ◽  
History Of ◽  
Paranoid Type

Marriage can be defined as the state of being united as spouses in a consensual and contractual relationship recognized by law. The general population generally believes marriage to be a solution to mental illnesses. It can be agreed that mental disorders and marital issues have some relation. Parents of patients with psychoses expect that marriage is the solution to the illness and often approach doctors and seek validation about the success of the marriage of their mentally ill child, which is a guarantee no doctor can give in even normal circumstances. Evidence on sexual functioning in patients of psychosis is limited and needs further understanding. Studies show about 60%–70% women of the schizophrenia spectrum and illness to experience sexual difficulties. Based on available information, sexual dysfunction in population with psychosis can be attributed to a variety of psychosocial factors, ranging from the psychotic symptoms in itself to social stigma and institutionalization and also due to the antipsychotic treatment. Despite the decline in sexual activity and quality of life in general, it is very rarely addressed by both the treating doctor and by the patient themselves hence creating a lacuna in the patient’s care and availability of information regarding the illness’ pathophysiology. Patients become noncompliant with medications due to this undesirable effect and hence it requires to be given more attention during treatment. It was also found that paranoid type of schizophrenia patient had lower chances of separation than patients with other types of schizophrenia. The risk of relapse in cases with later age of onset of the disease, lower education, a positive family history of psychosis or a lower income increased more than other populations.

Ceftriaxone-Induced Acute Pancreatitis

1993 ◽  
Vol 27 (1) ◽  
pp. 36-37 ◽  
Author(s):  
Anthony E. Zimmermann ◽  
Brian G. Katona ◽  
Joginder S. Jodhka ◽  
Richard B. Williams
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Signs And Symptoms ◽  
Etiologic Agent ◽  
Antibiotic Regimen ◽  
Intravenous Injections ◽  
Case Summary ◽  
Catheter Sepsis ◽  
History Of

OBJECTIVE: To report a case of probable ceftriaxone-induced acute pancreatitis. CASE SUMMARY: A patient with a history of short-bowel syndrome on home total parenteral nutrition developed fever, chills, and right flank pain. She was diagnosed with gram-negative catheter sepsis and prescribed antibiotic therapy to be administered for four weeks. After completion of the first week of therapy, the antibiotic regimen was changed to intravenous injections of ceftriaxone to be given daily at home. Prior to discharge the patient developed acute abdominal pain, leukocytosis, jaundice, and markedly elevated lipase and amylase concentrations consistent with acute pancreatitis. The patient's condition improved upon discontinuation of the ceftriaxone and the remainder of her stay was uneventful. DISCUSSION: There is only one other case report in the literature of probable ceftriaxone-induced pancreatitis. Multiple other medications have been implicated in causing acute pancreatitis. The exact mechanism of this uncommon adverse effect of ceftriaxone is unknown. CONCLUSIONS: There was a temporal relationship between the development of this patient's signs and symptoms and the administration of ceftriaxone. We could not identify any other factors that may have been responsible for the development of her acute pancreatitis. Ceftriaxone should be considered as a possible etiologic agent in patients who present with acute abdominal pain and elevated lipase and amylase concentrations.

scholarly journals Dynamic chronic rectal obstruction causing a severe colonic dilatation in a cat

2017 ◽  
Vol 3 (2) ◽  
pp. 205511691772522
Author(s):  
Sofia García-Pertierra ◽  
Esteban Gonzàlez-Gasch ◽  
Carmen Catalá Puyol ◽  
Jose María Closa Boixeda
Keyword(s):  
Dynamic Compression ◽  
Dynamic Nature ◽  
Referral Centre ◽  
Canal Stenosis ◽  
Case Summary ◽  
Abdominal Radiographs ◽  
History Of ◽  
Colonic Distension ◽  
The Right ◽  
Rectal Obstruction

Case summary A 5-year-old male neutered domestic shorthair cat was presented to our referral centre with a 13 month history of chronic tenesmus due to malunion of the right caudal iliac body. Constipation and pelvic canal stenosis were initially addressed by the referring veterinarian with a right femoral head and neck excision and a right acetabulectomy without observable clinical improvement. At admission, abdominal radiographs revealed severe colonic distension and a narrowed pelvic canal caused by the right proximal femur. Rectal examination and colonography revealed a dynamic compression of the rectum, which worsened with femoral abduction and improved with femoral adduction. A right hindlimb amputation was performed to relieve the obstruction. The cat defaecated 2 days postoperatively and was discharged uneventfully. Neither faecal tenesmus nor dyschaezia were observed over the following 10 months. Relevance and novel information The dynamic nature of the rectal obstruction most likely prevented the development of an irreversible colonic dilatation leading to a megacolon. This is the first report describing a chronic dynamic rectal compression, which was successfully managed with a right hindlimb amputation without the need for subtotal colectomy.

scholarly journals Clinical diagnosis of Plasmodium falciparum among children with history of fever, Sindh, Pakistan

2002 ◽  
Vol 6 (3) ◽  
pp. 233-235 ◽  
Author(s):  
Siroos Hozhabri ◽  
Stephen P. Luby ◽  
Mohammad H. Rahbar ◽  
Saeed Akhtar
Keyword(s):  
Plasmodium Falciparum ◽  
Clinical Diagnosis ◽  
History Of

scholarly journals Multiple scrotal epidermoid cysts: a case of cosmetic infertility

2019 ◽  
Vol 6 (8) ◽  
pp. 3026
Author(s):  
Vinayak Rengan ◽  
Vinodh Duraisami ◽  
Chetna Ravindra ◽  
Karthik Muralidharan
Keyword(s):  
Clinical Diagnosis ◽  
Postoperative Period ◽  
Primary Closure ◽  
Scrotal Skin ◽  
Asian Countries ◽  
Sexual Relations ◽  
Medical Assistance ◽  
Epidermoid Cysts ◽  
History Of

A 48 years old man presented to the surgical OPD with a history of multiple painless swellings on his scrotum for 20 years. He had avoided all sexual relations with his wife due to potential embarrassment. A clinical diagnosis of scrotal epidermoid cysts was made. Both testes were normal on ultrasound. Upon surgery, the scrotal skin was thoroughly excised, and primary closure of skin was done. Postoperative period was uneventful. The patient engaged in intercourse with his partner two weeks after surgery. The man and his partner were referred to the psychiatry unit for appropriate counselling. Scrotal epidermoid cysts cause significant psychological handicap. In Asian countries, the taboo of seeking medical assistance for genital conditions still exists. The treatment of scrotal epidermoid cysts requires a team of surgeons, psychologists, and psychiatrists.

“A CLINICAL STUDY ON ABERRATIONS OF NORMAL DEVELOPMENT AND INVOLUTION OF BREAST AND ITS MANAGEMENT IN UPPER ASSAM”

2021 ◽  
pp. 7-11
Author(s):  
Dipasmita Sarma ◽  
Bijoyananda Das ◽  
Sorbeswar Bhuyan
Keyword(s):  
Clinical Diagnosis ◽  
Positive Family History ◽  
Correlation Study ◽  
Monthly Interval ◽  
Histopathological Diagnosis ◽  
Evening Primrose ◽  
Breast Cyst ◽  
Phyllodes Tumour ◽  
Menstrual History ◽  
History Of

ANDI of breast is a common phenomenon. They are more common than breast malignancy. In this study an attempt was made to study the spectrum of diseases that come under ANDI of breast, their clinical presentation, treatment and also to nd out the clinical and cytohistological correlation. Study group includes 152 cases of Upper Assam who attended the Surgery OPD of AMCH during the study period and also all the patients who were admitted in the department of surgery under the clinical diagnosis of ANDI of breast. Conrmation of diagnosis was made on the basis of history, clinical examination, pathological and radiological investigations. Pathological investigations include FNAC and HPE. Radiological investigations include Ultrasonography and mammography. The following observations were made in the present study: Ÿ The commonest disease encountered was broadenoma of breast (14.47%) followed by mastalgia (23.68%) brocystic disease (14.47%) breast cyst (9.87%). The less common are duct ectasia, scleroding adenosus and phyllodes tumour, 9.87% each. Ÿ Majority are present in the second, third and fourth decades of life. All broadenoma, brocystic disease and phyllodes tumour are present in the third decade. Youngest patient was of 11 years and oldest was of 47 years. mean age of presentation was 27.45 years and the standard deviation was 7.13. Ÿ 86.84% had regular menstrual history and 13.16% had irregular menstrual history. Majority were nulliparous (46.05%). The highest parity was 4. Ÿ 94.08% did not give history of OCP use and 98.68% did not give history of lactation. Ÿ The commonest presentation was pain in the breast (76.32%) followed by lump (71.05%). Ÿ Majority cases presented to the hospital within 3-6 months of their onset of symptoms. The minimum duration of symptom was 1 month and the maximum was 12 months. Ÿ Right breast was involved more commonly 961.84%) than the left (38.16%). Ÿ Upper outer quadrant was involved most commonly involved (34.21%) and the least commonly involved was the central quadrant (1.32%). Ÿ The majority of the breast lumps (85.05%) had size less than 5cm in their greatest dimension. 14.95% had size more than 5cm. Ÿ 63.82% of the lumps had rm consistency whereas 6.58% had soft consistency. There was no positive family history in majority of the patients (89.47%). Ÿ The correlation between clinical diagnosis and histopathological diagnosis had the following ndings: For broadenoma the sensitivity of FNAC is 84.9% and HPE is 86.54% .Both have positive predictive value of 100%.For breast cyst the sensitivity of FNAC is 93.3%.For phyllodes tumour the sensitivity of FNAC is 85.7% and HPE is 75%.. Ÿ In the management, 41.45% cases underwent excision followed by aspioration of cyst in 7.89%, microdochectomy in 7.24%, wide local excision in 3.29% and simple mastectomy in 1.97%. Among conservative treatment 14.47%b were given evening primrose oil, 12.50% were given topical analgesic and breast support and danazol was given in 5.26%. The cases were followed up at three monthly interval for a period of one year and there was no recurrence during this period.

Clinical diagnosis of LGI1 antibody encephalitis in an 83-year-old woman

2021 ◽  
Vol 14 (1) ◽  
pp. e237398
Author(s):  
Jonathan E Attwood ◽  
Saniya Naseer ◽  
Sophia Michael ◽  
Josie Riley
Keyword(s):  
Cognitive Impairment ◽  
Clinical Diagnosis ◽  
Memory Impairment ◽  
Short Term Memory ◽  
Autoimmune Encephalitis ◽  
Short Term ◽  
Term Memory ◽  
Blood Tests ◽  
Abnormal Movements ◽  
History Of

An 83-year-old woman was referred to hospital with a 2-week history of short-lived episodic unpleasant sensations in her head and running down her body. This was accompanied by new short-term memory impairment and arm spasms. Initial investigations including blood tests and brain imaging did not reveal the diagnosis. The patient developed an increasing frequency of abnormal movements of her face and arm. These were clinically recognised as faciobrachial dystonic seizures (FBDS). FBDS are pathognomonic of an autoimmune encephalitis caused by an antibody directed against leucine-rich glioma-inactivated 1 (LGI1). The clinical diagnosis resulted in treatment with immunotherapy, leading to cessation of seizures and rapid cognitive recovery. Later, the predicted serology was confirmed. This reversible and under-recognised cause of cognitive impairment, typically affecting elderly patients, can be diagnosed clinically to enable early and effective treatment.

scholarly journals Interaction of Cannabis Use Disorder and Striatal Connectivity in Antipsychotic Treatment Response

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Melanie Blair Thies ◽  
Pamela DeRosse ◽  
Deepak K Sarpal ◽  
Miklos Argyelan ◽  
Christina L Fales ◽  
...  
Keyword(s):  
Treatment Response ◽  
Reward Processing ◽  
Cannabis Use ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Cannabis Use Disorder ◽  
Schizophrenia Spectrum Disorders ◽  
Double Blind ◽  
History Of ◽  
The Relationship

Abstract Antipsychotic (AP) medications are the mainstay for the treatment of schizophrenia spectrum disorders (SSD), but their efficacy is unpredictable and widely variable. Substantial efforts have been made to identify prognostic biomarkers that can be used to guide optimal prescription strategies for individual patients. Striatal regions involved in salience and reward processing are disrupted as a result of both SSD and cannabis use, and research demonstrates that striatal circuitry may be integral to response to AP drugs. In the present study, we used functional magnetic resonance imaging (fMRI) to investigate the relationship between a history of cannabis use disorder (CUD) and a striatal connectivity index (SCI), a previously developed neural biomarker for AP treatment response in SSD. Patients were part of a 12-week randomized, double-blind controlled treatment study of AP drugs. A sample of 48 first-episode SSD patients with no more than 2 weeks of lifetime exposure to AP medications, underwent a resting-state fMRI scan pretreatment. Treatment response was defined a priori as a binary (response/nonresponse) variable, and a SCI was calculated in each patient. We examined whether there was an interaction between lifetime CUD history and the SCI in relation to treatment response. We found that CUD history moderated the relationship between SCI and treatment response, such that it had little predictive value in SSD patients with a CUD history. In sum, our findings highlight that biomarker development can be critically impacted by patient behaviors that influence neurobiology, such as a history of CUD.

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