Panorama general de la terapia electroconvulsiva: indicaciones y funcionamiento

"The electroconvulsive therapy (ECT) constitutes one of the many treatment modalities available for management of psychiatric illnesses like depression, mania, schizophrenia, and catatonic states. It is even considered the single most effective and fastest treatment modality for patients with conditions like antidepressant-resistant depression, recurring suicidal ideations, acute psychoses, and potentially fatal conditions like malignant neuroleptic syndrome. ECT is a brain-stimulation therapy in which the therapeutic goal can be achieved through generating an electrical stimulus with enough intensity to produce a controlled seizure, achieving a positive and favorable neurobiological and neurochemical response.This article focuses on the use of ECT in treating the various neuropsychiatric conditions, its athophysiological principles, the employed technique, its main complications and overall a description of its use, its efficiency and safety, as to the experience of its employment in our institution. This comprises one of the few articles in Mexico with this kind of content that we deem fundamental as part of the general knowledge for healthcare professionals. Keywords: Electroconvulsive therapy, neuropsychiatry, mental health.

Pharmacodynamic gene polymorphism and adverse drug reactionsthen applying antipsychotic drugs

Application of antipsychotic drugs of both the first and subsequent generations quite often causes adverse side effects, which can reduce the compliance to the treatment of patients, reducing their quality of life. One of the most serious NLRs that occur during the period of application of antipsychotic disorders in patients are extrapyramidal disorders (acute dystonia, dyskinesia), malignant neuroleptic syndrome and tardive dyskinesia. During the year of therapy with the use of antipsychotic drugs of the first generation, signs of late dyskinesia appear in 3 to 5% of patients, and in elderly patients this figure is 5 times higher. The achievement of recent years in medicine is the application of the pharmacogenetic approach for predicting the patient’s individual response to taking the drug. Recent advances in medicine is the practice of pharmacogenetic approach to predict the patient’s individual response to receiving the drug. The pharmacogenetic approach to the prescription of medicines is based on the study of the effect of polymorphism of genes encoding the synthesis of isoenzymes of biotransformation and transport of xenobiotics, as well as the synthesis of elements responsible for the pharmacodynamic component. In this article, we will attempt to describe the main adverse side effects arising from the use of antipsychotic drugs, as well as consider pharmacogenetic aspects of their appearance, to summarize the relevant information currently available. arisingfrom the use of antipsychotic drugs, as well as consider pharmacogenetic aspects of their appearance, to summarize the relevant information currently available.

Mild Hypothermia in a Child with Low-Dose Risperidone

Risperidone is a widely used, second-generation antipsychotic approved for treating schizophrenia as well as for treating aggression in children and adolescents with mental retardation. The substance has a well-established risk profile including alterations of body temperature. Apart from hyperthermia with and without full-blown malignant neuroleptic syndrome, low body temperatures (hypothermia) have also been reported anecdotally, usually appearing in the context of comedication. Here, we report a case of hypothermia associated with a low-dose risperidone monotherapy in a child.

Hyperthermia and neuroleptic malignant syndrome-Case report

Neuroleptic malignant syndrome (NMS) is a rare, but life-threatening, idiosyncratic reaction to neuroleptic medications that is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction. NMS often occurs shortly after the initiation of neuroleptic treatment, or after dose increases. Malignant hyperthermia (MH) or malignant hyperpyrexia is a rare life-threatening condition that is usually triggered by exposure to certain drugs. The 46-years-old female patient was diagnosed schizophrenia at the age of 22. Currently, she is hospitalized due to psychotic decompensation. The patient was admitted with following daily dose therapy of: haloperidol 15 mg, biperiden 4 mg and diazepam 15 mg. During this hospitalization she developes muscle rigidity, tremor, hyperthermia, and laboratory results showed increase of enzimes CPK and LDH, so we started treatment of suspected malignant neuroleptic syndrome. After a treatment and recovery with complete withdrawal of all presented symptoms, our patient developed a malignant hypertermia that was resistant to all applicated medications. Our dilemma is whether presented symptoms of malignant hyperthermia are related to malignant neuroleptic syndrome or not?Disclosure of interestThe authors have not supplied their declaration of competing interest.

Adverse drug reactions of systemic antihistamines in children in the Netherlands

BackgroundAntihistamines are used for the treatment of allergic rhinitis, allergic conjunctivitis, chronic spontaneous urticaria and atopic eczema.ObjectiveTo study the reports of adverse drug reactions (ADRs) in children using antihistamines to provide prescribers with an overview of the possible toxicity.DesignWe studied ADRs in children reported to the Netherlands Pharmacovigilance Centre Lareb in the years 1991–2014, assessed the Naranjo score and, when possible, computed the reporting OR.ResultsSerious ADRs included one death (malignant neuroleptic syndrome), cardiac arrhythmia (one case) and convulsions (three cases). Skin eruptions, headache and somnolence were the most frequently reported ADRs. Aggression and agitation were also reported.ConclusionsToxicity can occur with second-generation antihistamines. The main toxicity relates to skin eruptions and central nervous system problems.

Pharmacogenetics and Antipsychotic Treatment Response/ Фармакогенетски Тестирања И Одговор Кон Третман Со Антипсихотоци

Antipsychotic drugs are widely used in the treatment of schizophrenia and psychotic disorder. The lack of antipsychotic response and treatment-induced side-effects, such as neuroleptic syndrome, polydipsia, metabolic syndrome, weight gain, extrapyramidal symptoms, tardive dyskinesia or prolactin increase, are the two main reasons for non-compliance and increased morbidity in schizophrenic patients. During the past decades intensive research has been done in order to determine the influence of genetic variations on antipsychotics dosage, treatment efficacy and safety. The present work reviews the molecular basis of treatment response of schizophrenia. It highlights the most important findings about the impact of functional polymorphisms in genes coding the CYP450 metabolizing enzymes, ABCB1 transporter gene, dopaminergic and serotonergic drug targets (DRD2, DRD3, DRD4, 5-HT1, 5HT-2A, 5HT-2C, 5HT6) as well as genes responsible for metabolism of neurotransmitters and G signalling pathways (5-HTTLPR, BDNF, COMT, RGS4) and points their role as potential biomarkers in everyday clinical practice. Pharmacogenetic testing has predictive power in the selection of antipsychotic drugs and doses tailored according to the patient’s genetic profile. In this perception pharmacogenetics could help in the improvement of treatment response by using different medicinal approaches that would avoid potential adverse effects, reduce stabilization time and will advance the prognosis of schizophrenic patients.

Lorazepam provocation test in purported schizophrenia with lack of treatment response

Some patients with severe mental disorders are refractory to psychotherapeutic or psychopharmacological interventions. We present a patient who at the age of 19 developed several schizophrenia - suspect symptoms. Soon inexplicable general seizures where observed. He was treated with antipsychotics, but had two bouts of malignant neuroleptic syndrome. Electroconvulsive therapy (ECT) gave some symptom relief and he continued on maintenance ECT for years with weekly intervals. Interruption of this treatment pattern rapidly increased symptom load. After seven years a lorazepam provocation test was performed as he had a new relapse after 3 weeks without ECT. In the ensuing hours his aggressiveness and nonsense speaking rapidly diminished. Kahlbaums observation of seizures as part of a catatonia was not understood in this case. The publication of the new DSM-V diagnosis of catatonia may hopefully reduce the probability of treating a patient for schizophrenia for years without access to a more targeted medication and ECT plan.