scholarly journals The use of tetrabenazine for the treatment of drug-induced tardive dyskinesia – report of four cases

2016 ◽  
Vol 16 (4) ◽  
pp. 194-200
Author(s):  
Ewa Szczepocka ◽  
◽  
Radosław Magierski ◽  
Tomasz Sobów ◽  
Adam Wysokiński ◽  
...  
Keyword(s):  
Movement Disorders ◽  
Mental Condition ◽  
Psychotic Symptoms ◽  
Drug Induced ◽  
Symptoms Of Depression ◽  
The Face ◽  
History Of ◽  
Chronic Neuroleptic ◽  
Written Informed Consent

Tardive dyskinesias are defined as a syndrome of involuntary, irregular, hyperkinetic movement disorders, including mixed movement disorders of the face and the mouth as well as choreoathetoid movements of the trunk and limbs. They are a serious and usually irreversible side effect of chronic neuroleptic treatment and affect approximately 15–20% of patients. Treatment attempts using amantadine, levetiracetam, piracetam, clonazepam, propranolol, vitamin B6, vitamin E, ondansetron, botulinum toxin and Ginkgo biloba were made. However, in many cases the treatment efficacy has not been confirmed in long-term studies in larger groups of patients. Tetrabenazine, registered in Poland for the treatment of hyperkinetic motor disorders in the Huntington’s disease, is one of the available therapeutic options. We present the course and the effects of tetrabenazine therapy in four patients with antipsychotic-induced tardive dyskinesias. Based on the experience gained during the research program using tetrabenazine, we believe that the use of this agent should be limited to patients in a stable mental condition, with no current symptoms of depression or active psychotic symptoms. In our opinion, suicidal tendencies or thoughts and a history of neuroleptic malignant syndrome are absolute contraindications. The off-label use of tetrabenazine requires a written informed consent of the patient and careful monitoring of their mental and neurological condition.

scholarly journals Cycles and circulation: a theme in the history of biology and medicine

2021 ◽  
Vol 43 (3) ◽  
Author(s):  
Nick Hopwood ◽  
Staffan Müller-Wille ◽  
Janet Browne ◽  
Christiane Groeben ◽  
Shigehisa Kuriyama ◽  
...  
Keyword(s):  
Natural Philosophy ◽  
Life Cycles ◽  
Modern Times ◽  
Systems Ecology ◽  
The Face ◽  
History Of ◽  
Celestial Bodies ◽  
Reproductive Cycles ◽  
Economics And Biology

AbstractWe invite systematic consideration of the metaphors of cycles and circulation as a long-term theme in the history of the life and environmental sciences and medicine. Ubiquitous in ancient religious and philosophical traditions, especially in representing the seasons and the motions of celestial bodies, circles once symbolized perfection. Over the centuries cyclic images in western medicine, natural philosophy, natural history and eventually biology gained independence from cosmology and theology and came to depend less on strictly circular forms. As potent ‘canonical icons’, cycles also interacted with representations of linear and irreversible change, including arrows, arcs, scales, series and trees, as in theories of the Earth and of evolution. In modern times life cycles and reproductive cycles have often been held to characterize life, in some cases especially female life, while human efforts selectively to foster and disrupt these cycles have harnessed their productivity in medicine and agriculture. But strong cyclic metaphors have continued to link physiology and climatology, medicine and economics, and biology and manufacturing, notably through the relations between land, food and population. From the grand nineteenth-century transformations of matter to systems ecology, the circulation of molecules through organic and inorganic compartments has posed the problem of maintaining identity in the face of flux and highlights the seductive ability of cyclic schemes to imply closure where no original state was in fact restored. More concerted attention to cycles and circulation will enrich analyses of the power of metaphors to naturalize understandings of life and their shaping by practical interests and political imaginations.

scholarly journals Ezetimibe: An Unusual Suspect in Angioedema

2020 ◽  
Vol 2020 ◽  
pp. 1-3 ◽  
Author(s):  
Tiffany Lu ◽  
Tarundeep Grewal
Keyword(s):  
Clinical History ◽  
Prior History ◽  
African American Female ◽  
Drug Induced ◽  
Current Case ◽  
Normal Limits ◽  
Inhibitor Level ◽  
The Face ◽  
History Of ◽  
Esterase Inhibitor

We describe a case of new onset angioedema likely due to Ezetimibe therapy in an elderly patient with a prior history of drug-induced bradykinin reactions who had been on the medication for multiple years. This is the second reported incidence of Ezetimibe-associated angioedema in literature. A 90-year-old African American female presented with angioedema of the face and oral mucosa with associated difficulty speaking developing hours after taking Ezetimibe 10 mg PO. She denied adding any new or unusual foods to her diet. A thorough clinical history determined Ezetimibe was the likely culprit. Ezetimibe was immediately discontinued. The swelling subsided after administration of methylprednisolone 125 mg, epinephrine 1 mg/mL, injection 0.3 mL, diphenhydramine 25 mg, and famotidine 20 mg BID within 48 hours. The patient’s C1 esterase inhibitor level was measured to be within normal limits. Food panel allergy testing showed very low or undetectable IgE levels in all categories. Based on the limited reports in literature and our current case, we conclude that there is a likely association of angioedema with Ezetimibe. The mechanism, however, is unknown since it is not related to bradykinin or mast cell-mediated activation. Clinicians should advise patients taking Ezetimibe to report any swelling of the lips, face, and tongue and to immediately discontinue its use if these signs are present.

Prevalence of Obesity in Patients Receiving Depot Antipsychotics

1988 ◽  
Vol 153 (2) ◽  
pp. 214-217 ◽  
Author(s):  
T. Silverstone ◽  
Glenyss Smith ◽  
Elizabeth Goodall
Keyword(s):  
Antipsychotic Drugs ◽  
Clinical Importance ◽  
Chronic Schizophrenia ◽  
Psychotic Symptoms ◽  
Drug Induced ◽  
London Borough ◽  
Prevalence Of Obesity ◽  
Depot Neuroleptic ◽  
Depot Antipsychotics

Antipsychotic drugs have long been noted to cause pronounced weight gain, and drug-induced obesity can assume major clinical importance in long-term medication in the management of chronic schizophrenia. Obesity is associated with increased morbidity and may reduce compliance, leading to a return of psychotic symptoms. In a survey of 226 patients attending depot neuroleptic clinics in one inner London borough, it was found that the prevalence of clinically relevant obesity was four times that in the general population.

scholarly journals A Case Report of Severe Delirium after Amantadine Withdrawal

2017 ◽  
Vol 9 (1) ◽  
pp. 44-48 ◽  
Author(s):  
Franz Marxreiter ◽  
Jürgen Winkler ◽  
Martin Uhl ◽  
Dominik Madžar
Keyword(s):  
Cognitive Impairment ◽  
Case Report ◽  
Withdrawal Syndrome ◽  
Dopamine Agonists ◽  
Psychotic Symptoms ◽  
Drug Induced ◽  
Comt Inhibitors ◽  
Mao B ◽  
Psychotropic Substance

Amantadine is frequently used in addition to dopaminergic substances like dopamine agonists or L-Dopa in advanced Parkinson disease (PD). However, adverse effects like hallucinations limit its use. PD patients developing severe psychotic symptoms upon treatment with either dopaminergic substances and/or amantadine need to stop intake of any psychotropic substance. Here, we report the case of a 71-year-old PD patient without previously known cognitive impairment. He presented with drug-induced psychotic symptoms due to changes in his therapeutic regimen (increase in COMT inhibitors, newly introduced MAO B inhibitors). Also, amantadine had been part of his long-term medication for more than 2 years. The severity of his psychotic symptoms required a L-Dopa monotherapy. After changing his medication, the patient developed severe delirium that resolved rapidly after i.v. amantadine infusion, suggesting an amantadine withdrawal syndrome. Amantadine withdrawal syndrome is a rare adverse event that may present even in PD patients without cognitive impairment. This case report highlights the need for a gradual withdrawal of amantadine even if acute and severe psychotic symptoms are present. Moreover, this is the first report of a cognitively unimpaired patient developing an amantadine withdrawal syndrome.

scholarly journals The effectiveness of long-term aripiprazole injections to a patient with paranoid schizophrenia: a case report

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Anna Maria Szota ◽  
Aleksander Araszkiewicz
Keyword(s):  
Case Report ◽  
Negative Symptoms ◽  
Social Withdrawal ◽  
Paranoid Schizophrenia ◽  
Psychotic Symptoms ◽  
Suicidal Thoughts ◽  
Duration Of Hospitalization ◽  
History Of ◽  
Long Acting

AbstractParanoid schizophrenia is a chronic, psychotic disorder which can be treated with long-acting injectable (LAI) antipsychotic drugs. There are risperidone (Risperdal Consta®), olanzapine (Zypadhera®), paliperidone (Xepilon®) and aripiprazole (Abilify Maintena®) currently available.The aim of this study was to present a case history of the patient to whom monthly injections of aripiprazole effectively prevented both relapses of psychotic symptoms and hospitalizations.Case report: A 55-year-old male patient with a 13-year history of paranoid schizophrenia has been effectively treated with aripiprazole (LAI) (400mg, every 4 weeks). During the last 8 years of treatment his mental state has been stabilized, without any acute psychotic symptoms and without any anxiety, or violent behaviours. Moreover, there have been no psychotic symptoms, or suicidal thoughts, or tendencies recordered. Therefore, no hospitalization has been required. However, despite the treatment, negative symptoms such as blunted affect, cognitive dysfunction and social withdrawal have been sustained.Discussion: The available articles on aripiprazole (LAI) treatment indicate that it was effective in reducing the positive and negative symptoms of schizophrenia, as well as reducing the frequency and duration of hospitalization. However, the case report of a patient who has not had relapses of psychotic symptoms and suicidal thoughts and has not been hospitalized during 8 years of treatment with aripiprazole (LAI) has not yet been reported.Conclusions: Regular, long-term injections of aripiprazole (LAI) are very effective at preventing positive symptoms of schizophrenia development and preventing both suicidal thoughts and hospitalizations. Therefore, treatment with this drug in everyday practice should be increased.

scholarly journals Differentiating tardive dyskinesia: a video-based review of antipsychotic-induced movement disorders in clinical practice

CNS Spectrums ◽  
2020 ◽  
pp. 1-10
Author(s):  
Robert A. Hauser ◽  
Jonathan M. Meyer ◽  
Stewart A. Factor ◽  
Cynthia L. Comella ◽  
Caroline M. Tanner ◽  
...  
Keyword(s):  
Tardive Dyskinesia ◽  
Movement Disorders ◽  
Treatment Options ◽  
Mood Stabilizers ◽  
Drug Induced ◽  
Parkinsonian Tremor ◽  
Stabilizing Agents ◽  
Appropriate Treatment ◽  
History Of ◽  
Abnormal Behaviors

Abstract Accurate diagnosis and appropriate treatment of tardive dyskinesia (TD) are imperative, as its symptoms can be highly disruptive to both patients and their caregivers. Misdiagnosis can lead to incorrect interventions with suboptimal or even deleterious results. To aid in the identification and differentiation of TD in the psychiatric practice setting, we review its clinical features and movement phenomenology, as well as those of other antipsychotic-induced movement disorders, with accompanying links to illustrative videos. Exposure to dopamine receptor blocking agents (DRBAs) such as antipsychotics or antiemetics is associated with a spectrum of movement disorders including TD. The differential diagnosis of TD is based on history of DRBA exposure, recent discontinuation or dose reduction of a DRBA, and movement phenomenology. Common diagnostic challenges are the abnormal behaviors and dyskinesias associated with advanced age or chronic mental illness, and other movement disorders associated with DRBA therapy, such as akathisia, parkinsonian tremor, and tremor related to use of mood stabilizing agents (eg, lithium, divalproex). Duration of exposure may help rule out acute drug-induced syndromes such as acute dystonia or acute/subacute akathisia. Another important consideration is the potential for TD to present together with other drug-induced movement disorders (eg, parkinsonism, parkinsonian tremor, and postural tremor from mood stabilizers) in the same patient, which can complicate both diagnosis and management. After documentation of the phenomenology, severity, and distribution of TD movements, treatment options should be reviewed with the patient and caregivers.

Long-term persistence and vicariance within the Australian Monsoonal Tropics: the case of the giant cave and tree geckos (Pseudothecadactylus)

2013 ◽  
Vol 61 (6) ◽  
pp. 462 ◽  
Author(s):  
Paul M. Oliver ◽  
Rebecca J. Laver ◽  
Katie L. Smith ◽  
Aaron M. Bauer
Keyword(s):  
New Caledonia ◽  
Morphological Diversity ◽  
North West ◽  
The North ◽  
Arid Conditions ◽  
The Face ◽  
History Of ◽  
Cape York ◽  
Rag 1

The Australian Monsoonal Tropics (AMT) are one of the largest unbroken areas of savannah woodland in the world. The history of the biota of this region is poorly understood; however, data from fossil deposits indicate that the climate was more mesic in the past, and that biodiversity has been shaped by attenuation and turnover as arid conditions expanded and intensified through the Miocene and Plio-Pleistocene. The giant cave and tree geckos (Pseudothecadactylus) are distributed across three disjunct regions of relatively high rainfall in the AMT (the north-west Kimberley, the ‘Top End’, and Cape York). We present an analysis of the diversity and biogeography of this genus based on mitochondrial (ND2) and nuclear (RAG-1) loci. These data indicate that the three widely allopatric lineages of Pseudothecadactylus diverged around the mid-Miocene, a novel pattern of relatively long-term persistence that has not previously been documented within the AMT. Two Pseudothecadactylus species endemic to sandstone scarps in the west Kimberley Region and ‘Top End’ also include divergent mitochondrial lineages, indicative of deep intraspecific coalescence times within these regions. Pseudothecadactylus is a highly relictual lineage with an extant distribution that has been shaped by a history of attenuation, isolation and persistence in the face of increasingly arid conditions. The low ecological and morphological diversity of Pseudothecadactylus also contrasts with its diverse sister lineage of geckos in New Caledonia, further underlining the relictual nature of standing diversity in the former.

scholarly journals A clinical and epidemiological study of hyperpigmentary disorder of face

2020 ◽  
Vol 6 (2) ◽  
pp. 183
Author(s):  
Dayanand Raikar ◽  
Mohammed Waseem Javed ◽  
Anant Arunrao Takalkar
Keyword(s):  
Clinical Feature ◽  
Age Group ◽  
Drug Induced ◽  
Cross Sectional ◽  
Dermatology Department ◽  
Pigmentary Disorders ◽  
Skin Cancers ◽  
The Face ◽  
History Of ◽  
Study Population

<p class="abstract"><strong>Background:</strong> Facial pigmentary disorders are a group of heterogenous entities, sharing a common clinical feature of altered pigmentation of the face and thus easily visible cosmetic disfigurement. Although the increased melanin provides protection from harmful effects of UV radiation, including photodamage and skin cancers, it also makes darkly pigmented skin more vulnerable to post-inflammatory dyspigmentation. The importance of these disorders is growing, as they form the major percentage of dermatology consultations. The objective of the study was to assess the clinical profile of patients with facial hyperpigmentation.</p><p class="abstract"><strong>Methods:</strong> The present cross-sectional hospital based observational study was conducted at Dermatology Department of during the period of June 2017 to December 2017 including patients with diagnosis of facial hyperpigmentation. Data analysed with SPSS 24 version.<strong></strong></p><p class="abstract"><strong>Results:</strong> 29% were from 21 to 30 years age group followed by 25% from 31 to 40 years age group. Mean age of the study population was 28.4±11.8 years. 76% were female patients. Commonly observed facial hyperpigmentation type was melasma in our study i.e. 46%. It is followed by post inflammatory hyperpigmentation (PIH) in 16% and ephilides in 8%. Rehl's melanosis and drug induced melanosis was seen in 7% each of the patients. Ephilides, Rehl's melanosis and drug induced was seen in 7% each of the patients. Family history of pigmentaory disorder was found in melasma, PIH and ephilides in our study.</p><p class="abstract"><strong>Conclusions:</strong> Commonly reported age group was 20-40 with female preponderance. Commonly observed facial hyperpigmentation type was melasma (46%), PIH (16%) and ephilides (8%).</p>

scholarly journals Drug-Induced Tardive Dyskinesia

2021 ◽  
Vol 8 (9) ◽  
pp. 413-422
Author(s):  
Marianto Marianto ◽  
Hartono Kosim ◽  
I Made Wedastra
Keyword(s):  
Tardive Dyskinesia ◽  
Movement Disorder ◽  
Movement Disorders ◽  
Drug Induced ◽  
Comprehensive Management ◽  
Delay In Treatment

Drug-induced movement disorders could be classified into acute, subacute, and chronic based on the time of occurrence. Tardive dyskinesia (TD) is one of the most frequent long-term drug-induced movement disorders. Delay in treatment often caused TD to be irreversible. In this review, we will discuss TD in-depth to enhance clinician knowledge regarding the diagnosis, prevention, and comprehensive management of patients with TD. Keywords: tardive dyskinesia, movement, disorder, antipsychotic.

Politics, Independence, and Retirees

2018 ◽  
Author(s):  
Peter Conti-Brown
Keyword(s):  
Interest Rates ◽  
Central Banks ◽  
Central Banking ◽  
Time Inconsistency ◽  
Short Term ◽  
2016 Election ◽  
Low Interest Rates ◽  
The Face ◽  
History Of

Until recently, it was widely believed that central banks must protect people from their own worst instincts: the populace demands easy money and low interest rates, and a politically sensitive representative class will give it to them. Central banks have the responsibility of resolving this time inconsistency problem by protecting the long-term value of the currency even against the short term demands of politics. Yet the financial crisis of 2008 and the 2016 election have changed this narrative. This chapter explores how this new political economy of central banking, in the face of long-term low interest rates, changes the posture of central banks against the rest of the polity. It discusses some history of political pressures against central banks in other climates and makes predictions about how the ‘new normal’ of lower interest rates will challenge the Fed’s ability to stay above the political fray, despite its best intentions.

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