Clinical Medicine Insights: Psychiatry最新文献

{"title":"A Case of a Vietnam War Veteran with Early-Onset Huntington’s Disease","authors":"R. Allen, E. Suo, J. Lek, M. Samuel","doi":"10.1177/1179557318774538","DOIUrl":"https://doi.org/10.1177/1179557318774538","url":null,"abstract":"We report on the case of Simon (his pseudonym). We describe the presentation of early-stage late-onset Huntington’s disease (HD) in a man with multiple psychiatric diagnoses. Our clinical problem was ‘To what extent are common psychiatric features masking a further diagnosis?’ Initially unwilling to be tested for HD, he agreed on condition that it assists with his discharge plan.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78670088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive and Negative Suicide Ideation (PANSI) Inventory: Initial Psychometric Properties as a Suicide Risk Screening Tool Among Nigerian University Students","authors":"O. Aloba, Sunday Adefemi, Tolulope Aloba","doi":"10.1177/1179557317751910","DOIUrl":"https://doi.org/10.1177/1179557317751910","url":null,"abstract":"Objective: The objective of this study is to examine the factor structure, validity, reliability, and the screening properties as a suicide risk assessment tool of the 14-item Positive and Negative Suicide Ideation (PANSI) in a nonclinical sample of Nigerian university students. Methods: A total of 514 students completed the PANSI, in addition to the Beck Depression Inventory-II (BDI-II) and the General Health Questionnaire-12 (GHQ-12). Results: Prior to the factor analysis, the sample was randomly divided into two. In one half of the sample (sample 1), exploratory factor analysis of the inventory yielded a 2-factor model (Negative Suicide Ideation [PANSI-NSI] and Positive Ideation [PANSI-PI]), whereas confirmatory factor analysis in the other half (sample 2) produced a 2-factor model with indices of fitness that indicated a satisfactory model fit (c2 = 93.8; df = 67; χ2/degree of freedom = 1.400; P = .017; goodness of fit index = 0.951; Tucker-Lewis index = 0.964; comparative fit index = 0.974; root mean square error of approximation = 0.040). The internal consistencies of the items of the PANSI-PI and PANSI-NSI subscales were 0.75 and 0.79, respectively. The construct validity of the 2 subscales was modestly satisfactory: PANSI-PI had negative correlations with the GHQ-12 (r = −.239, P < .001) and the BDI-II (r = −.190, P < .001), whereas the PANSI-NSI had positive correlations with the GHQ-12 (r = .248, P < .001) and the BDI-II (r = .376, P < .001). In addition, a cutoff total score of 17 on the PANSI-NSI was associated with the best sensitivity (80.0%) and specificity (92.5%) in the identification of those students who endorsed experiencing suicidal ideation (area under the curve = 0.82, 95% confidence interval = 0.58-1.00). Conclusions: The PANSI has exhibited satisfactory psychometric properties as a self-rated suicidal behavior assessment instrument in the evaluation of the positive and negative thoughts associated with suicidal ideation among Nigerian university students.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86519452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on the Pharmacological Treatment of Heroin Addiction","authors":"A. Bond, J. Witton","doi":"10.1177/1179557317737322","DOIUrl":"https://doi.org/10.1177/1179557317737322","url":null,"abstract":"Opioids are very addictive drugs because of their powerful effects on reward and pain pathways in the brain. Opioid addiction is currently a worldwide problem and injecting heroin presents serious health risks including death from overdose. The increase in the nonmedical use of prescription opioids and the increase in overdose deaths are worrying trends in North America. There is therefore an increasing need for access to effective treatments. The 2 major drug treatments, methadone and buprenorphine, have proven efficacy but are not necessarily administered in the most effective doses or under optimum conditions. Alternative approaches such as slow-release oral morphine, tincture of opium, and the use of the opioid antagonist naltrexone to maintain abstinence are used seemingly effectively in some countries but have yet to be fully evaluated in randomized controlled trials. Heroin-assisted treatment has proven to be a valuable and effective treatment when administered in specialized clinics but is only appropriate for those who have failed to improve on optimal methadone or buprenorphine maintenance. Recent innovations and substitution treatment as an alternative to incarceration are described. Drug treatment of opioid addiction is most effective when administered as part of a therapeutic program as demonstrated in the initial methadone evaluations and the more recent trials with heroin-assisted treatment.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78908790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Clinical Case of Clozapine-Induced Fatal Diabetic Ketoacidosis","authors":"E. Romney, Vinay J. Nagaraj, Amie Kafer","doi":"10.4137/CMPsy.S30532","DOIUrl":"https://doi.org/10.4137/CMPsy.S30532","url":null,"abstract":"Introduction Clozapine, a second generation medication, has become the atypical antipsychotic drug of choice for refractory or treatment-resistant schizophrenia. In addition to the high risk of agranulocytosis and seizures, clozapine treatment is increasingly associated with significant metabolic effects, such as hyperglycemia, central weight gain and adiposity, hypertriglyceridemia, and elevated low-density lipoprotein cholesterol. A potentially life-threatening complication of altered metabolism is diabetic ketoacidosis (DKA). This report details a case of fatal DKA in a schizophrenic patient undergoing treatment with clozapine. Case Description An African–American male in his 20s with a medical history significant for schizophrenia was presented to the psychiatric inpatient ward with severe paranoid thoughts and aggressive behavior. After trials of risperidone, olanzapine, and haloperidol—all of which failed to adequately control his psychotic symptoms—clozapine titration was initiated and he showed significant improvement. Weight gain was observed throughout hospitalization, but all blood and urine test results showed no metabolic or hematological abnormalities. The patient was discharged for outpatient treatment on clozapine (125 mg morning and 325 mg evening) along with divalproex sodium and metoprolol. Six days post-discharge, the patient died. A medical autopsy later ruled that the death was due to DKA without any evidence of contributory injuries or natural disease. Results and Conclusion Significant increase in body mass index from 28.7 to 33.5 was observed during hospitalization. The blood glucose level, measured after his death, was found to be 500 mg/dL. Altered metabolism due to clozapine can lead to dyslipidemia-mediated-pancreatic-beta-cell damage, decreased insulin secretion as well as insulin resistance. In DKA, low levels of insulin lead to an increased release of free fatty acids from adipose tissue. Acetyl coenzyme A (CoA), derived from the breakdown of free fatty acids, is metabolized by the Kreb's cycle. In hepatocytes, excess acetyl-CoA is converted into ketone bodies (acetoacetate and β-hydroxybutyrate) and released into circulation. Ketone bodies have a low pKa value and their high serum concentrations lead to DKA. In this patient, DKA was most probably clozapine induced and had fatal consequences. Thus, recognizing potential risk factors, providing patient education, and increasing monitoring of patients on clozapine and other atypical antipsychotics are critical to prevent the life-threatening effects of DKA.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84030694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Serum Analysis before and after Antidepressant Treatment in Major Depression: A Pilot Study","authors":"M. Girard, Karine Vuilliers-Devillers, É. Pinault, B. Bessette, Brigitte Plansont, D. Malauzat","doi":"10.4137/CMPsy.S20765","DOIUrl":"https://doi.org/10.4137/CMPsy.S20765","url":null,"abstract":"We investigated the serum protein profiles of subjects with major depressive disorder (MDD), with (n = 4) and without clinical improvement (n = 4), at the initiation of antidepressant treatment (venlafaxine) (T0) and 4 weeks later (T28), by difference gel electrophoresis in two dimensions (2D-DIGE) and mass spectrometry. The nine proteins displaying differences in composition between the two time points in the group with clinical improvement between T0 and T28 included gelsolin, clusterin, and the activated fragment of complement C3 (C3a). We then analyzed serum samples from MDD subjects receiving different antidepressants between T0 and T28. Subjects were classified into two groups, with (n = 17) or without (n = 14) clinical improvement (>50% decrease in baseline Hamilton Depression Rating Scale score), at T28. Clusterin levels did not differ between groups at either time point. Gelsolin and C3a levels differed between T0 and T28 only in the group presenting clinical improvement. A comparison with serum samples from controls suggested that the levels of these two proteins changed during MDD and were potentially modified after successful antidepressant treatment. Despite the small sample size, the results of this pilot study suggest that several changes in the expression of some serum proteins occur in association with the clinical relevance of the treatment, and indicate changes to general pathways requiring further study.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82261467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary Findings for the Effectiveness of Whole Green Coffee Powder (WGCP) versus Placebo in a Double-blind Withdrawal Design Study with Young Adults on Three Tasks of Executive Function","authors":"M. Manos, Craig A. Sidol, A. Monaco, T. Frazier","doi":"10.4137/CMPsy.S13117","DOIUrl":"https://doi.org/10.4137/CMPsy.S13117","url":null,"abstract":"Objective This study compared relative effects of whole green coffee powder (WGCP) on cognitive functioning in neurotypical adults under three treatment conditions: placebo (A), low-dose 889.9 mg WGCP (B1), and moderate-dose 1334.4 mg WGCP (B2). Method Fourteen adults aged 18–25 years, acted as their own controls in three treatment conditions within a seven-session withdrawal design. Participants completed the Cambridge Neuropsychological Test Automated Battery for attention-deficit/hyperactivity disorder (ADHD) at each session. The Side Effects Behavior Monitoring Scale (SEBMS), used to assess stimulant effects in individuals with ADHD, was a secondary outcome measure to assess adverse events associated with caffeine intake delivered by capsule. Self-report of qualitative effects was collected. Results Results indicated that moderate doses of WGCP significantly improved sustained attention (vs placebo and low dose) and working memory (vs low dose only) but had no effect on response inhibition. Low doses of WGCP showed decreased sustained attention. Fifty percent of subjects reported positive subjective improvement in well-being. No side effects were reported. Conclusion Commercially available WGCP (ie, sold as GoBean®) in moderate doses improved executive functioning for sustained attention and working memory but had no effect on response inhibition. Implications for individuals with attention difficulties are discussed.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89091135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Agomelatine: Its Role in the Management of Major Depressive Disorder","authors":"D. Cardinali, M. F. Vidal, D. Vigo","doi":"10.4137/CMPsy.S7989","DOIUrl":"https://doi.org/10.4137/CMPsy.S7989","url":null,"abstract":"Circadian rhythm abnormalities, as shown by sleep/wake cycle disturbances, constitute one the most prevalent signs of depressive illness; advances or delays in the circadian phase are documented in patients with major depressive disorder (MDD), bipolar disorder, and seasonal affective disorder (SAD). The disturbances in the amplitude and phase of rhythm in melatonin secretion that occur in patients with depression resemble those seen in chronobiological disorders, thus suggesting a link between disturbed melatonin secretion and depressed mood. Based on this, agomelatine, the first MT1/MT2 melatonergic agonist displaying also 5-HT2C serotonergic antagonism, has been introduced as an antidepressant. Agomelatine has been shown to be effective in several animal models of depression and anxiety and it has beneficial effects in patients with MDD, bipolar disorder, or SAD. Among agomelatine's characteristics are a rapid onset of action and a pronounced effectiveness for correcting circadian rhythm abnormalities and improving the sleep/wake cycle. Agomelatine also improves the 3 functional dimensions of depression—emotional, cognitive, and social—thus aiding in the full recovery of patients to a normal life.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83431844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Safety and Tolerability of Open-Label Olanzapine Long-Acting Injection in the Treatment of Schizophrenia: 190-Week Interim Results","authors":"D. McDonnell, S. Andersen, H. Detke, F. Zhao, S. Watson","doi":"10.4137/CMPsy.S6659","DOIUrl":"https://doi.org/10.4137/CMPsy.S6659","url":null,"abstract":"The primary objective of this ongoing study is to examine the long-term safety and tolerability of olanzapine long-acting injection (LAI). Current results are from a 190-week interim analysis. Patients were 18–75 years of age with schizophrenia (N = 909) or schizoaffective disorder (N = 22) previously enrolled in 1 of 3 randomized clinical trials of olanzapine LAI. In this open-label extension study, all patients received flexibly-dosed olanzapine LAI every 2–4 weeks. At time of analysis, rate of study discontinuation was 46.3%. The 18-month discontinuation rate was 34.2%. Adverse events in ≥5% of patients were increased weight, insomnia, anxiety somnolence, headache, and nasopharyngitis. There were 26 occurrences of post-injection delirium/sedation syndrome which all fully resolved within 72 hours. Mean weight change was +1.81 kg, with 32.1% of patients experiencing ≥7% weight gain. Mean Clinical Global Impressions-Severity scores remained stable throughout (2.9 at baseline to 2.8 at endpoint). Pharmacokinetic analyses indicated consistent olanzapine plasma concentrations over time, with no evidence of long-term accumulation. Safety profile was consistent with that of oral olanzapine, with the exception of findings specific to intramuscular injection. During the study period, there were 16 (1.7%) occurrences of treatment-emergent diabetes and 1 occurrence of treatment-emergent diabetic ketoacidosis. Percentages of patients with EPS scale-defined treatment-emergent akathisia, parkinsonism, and dyskinesia were 3.3%, 6.6%, and 3.0%, respectively.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84315041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generalized Anxiety Disorder in Adults: Focus on Pregabalin","authors":"M. Boschen","doi":"10.4137/CMPsy.S5069","DOIUrl":"https://doi.org/10.4137/CMPsy.S5069","url":null,"abstract":"Generalized anxiety disorder (GAD) is a chronic illness which impacts significantly on an individual's functioning and quality of life. Pregabalin is a novel structural analogue of the inhibitory neurotransmitter GABA, acting to reduce calcium ion flow through the α2δ subunit of pre-synaptic voltage-dependent calcium channels. Pregabalin has been used in treatment of GAD in a total of eight published controlled trials. In each trial, pregabalin has demonstrated a superiority over placebo, with response rates of over 40% in all studies, including patients on lower doses. One study has provided preliminary evidence for the efficacy of pregabalin in treatment of GAD in older adults. Pregabalin is generally well tolerated, with the most common adverse events being dizziness and somnolence. Adverse effects are generally mild-to-moderate, and transient. Pregabalin has low abuse potential. Limitations of the current literature are discussed, and directions for future research are proposed.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77288852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective (Post-Marketing) Case Series of Patients Receiving Intramuscular (IM) Olanzapine outside of Product Doses and Indications (Off-Label): Assessing Safety and Tolerability","authors":"Joel Lamoure, A. Rudnick","doi":"10.4137/CMPsy.S6550","DOIUrl":"https://doi.org/10.4137/CMPsy.S6550","url":null,"abstract":"Introduction Intramuscular (IM) olanzapine has been approved for the management of acute agitation/psychosis secondary to schizophrenia, bipolar disorder, and dementia, in a dose not to exceed 10 mg per injection and 30 mg per day. Many other clinical situations exist in which patients are acutely agitated and in whom IM olanzapine might be warranted at recommended or higher doses. We systematically reviewed data on 8 such patients, during 10 inpatient admissions, to assess the overall safety and tolerability of this approach. Methods Using a standardized data recording sheet, we retrospectively collected information on 10 inpatient admissions between 2004 and 2007, in which IM olanzapine was administered outside of product dosing and/or indication guidelines. We present composite data and the details of each case individually. Results Records of eight patients (5 males, 3 females; mean age/age range = 43.9/18–77 years) were reviewed over 10 inpatient admissions, 5 to Psychiatry, 4 to Surgery, and one to Internal Medicine. Indications for admission were mania (2), schizophrenia (1), schizoaffective disorder (2), brain injury (2), sepsis (1), sepsis with respiratory failure (1), and cancer (1). Five patients were intoxicated with or experienced withdrawal from alcohol and/or drugs, likely adding to their agitation. Only one symptomatic episode of orthostatic hypotension occurred, in a patient with comorbid C. difficile colitis, which resolved when antibiotics were initiated and olanzapine discontinued; olanzapine IM was successfully reinstituted 2 days later, without incident. No other significant adverse events or side effects were ascribed to IM olanzapine. Conclusions Intramuscular olanzapine may be safe to use outside of product dosing and indication guidelines. Randomized clinical trials are warranted to study such off-label use further.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"30 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78632179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}