Cases Of Schizoaffective Disorder Research Articles

From polipharmacy to monotheraphy a case about schizoaffective disorder

The aim of the present poster is to describe an initial complex case of schizoaffective disorder with other clinical adverse conditions (metabolic disorders) in a young adult male, which gradually went into a positive treatment way from polipharmacy to monoteraphy. His psychiatric history started when he was 25-year-old, he was diagnosed of heroine dependence, hypercholesterolemia and hypertrigliceridemia. In 2000 he had a suicide attempt in a context of depressive mood and delusions. He needed a psychiatric hospitalization for the first time in his life and he received anti-psychotics for the first time too. Drug abuse was detected in that hospitalization (cannabis and alcohol). In 2001 was diagnosed of paranoid schizophrenia. In 2007 the diagnosis was modified to schizoaffective disorder and also was detected high blood pressure, Diabetes Mellitus II and overweight. From 2007 to the present he passed from a scheme treatment composed by four or more psychotropic drugs to monotherapy (only one psychotropic drug, an anti-psychotic), he stayed clinically stable and all his metabolic parameters remained equal or improved.Disclosure of interestJanssen-Cilag research study.

Lamotrigine-induced agranulocytosis in a case of schizoaffective disorder

Sir, Lamotrigine is efficacious in the treatment of bipolar disorder including bipolar depression, both as monotherapy and in combination with sodium valproate.[1] Skin rashes, blood dyscrasias such as neutropenia, thrombocytopenia, macrocytic anemia and pancytopenia[12] and agranulocytosis[3] are the side effects reported. We present a case of lamotrigine-induced agranulocytosis which reversed on stopping the drug. Mr. D, a 30-year-old male, known case of schizoaffective disorder currently in depression on treatment from private presented to us with persistent pervasive sadness of mood, loss of interest in previously pleasurable activities, ideas of hopelessness and helplessness, and marked impairment in sleep and appetite. The patient had been experiencing these symptoms since the past 2–3 months in spite of being compliant with his medications. He was on risperidone 6 mg, trihexyphenidyl 6 mg, escitalopram 20 mg, and divalproate 1 gm. As he had minimal improvement with escitalopram, it was gradually tapered along with risperidone and trihexyphenidyl and stopped over 10 days. Lamotrigine 50 mg was added to ongoing valproate. After 2 weeks, the patient reported 20% improvement in symptoms and lamotrigine was increased to 100 mg. The patient then followed after a month with reduction of depressive symptoms but the presence of diarrhea, on and off fever, and generalized weakness present for 15 days. On examination, he was febrile, pulse rate was 110, and blood pressure was 80/60 mm Hg. The patient was admitted and his hematological profile revealed total leukocyte count (TLC)-1100 cells/mm3 with absolute neutrophil count (ANC) - 55 cells/mm3. Hemoglobin, platelets, liver and kidney function tests were normal. A hematology reference was sought, and on examination of his bone marrow aspirate, a reactive marrow was seen. The hematologist made a provisional diagnosis of lamotrigine-induced agranulocytosis, as no other cause was evident. Lamotrigine was discontinued, and the patient was managed conservatively. After 48 h, his TLC increased to 3000 cells/mm3 and ANC to 1000 cells/mm3. Conservative management with antibiotics and parenteral fluids was continued till patient improved. He was subsequently discharged only on divalproate which was increased to 1500 mg. The patient is now following up regularly and is reporting 50% improvement. The most likely cause postulated for lamotrigine-induced hematologic abnormalities is probably a combination of immunoallergic, direct medullary toxicity, and granulopoietic reactions.[4] Psychotropic drugs also increase the risk of leukopenia.[1] Another theory postulates enzymatic inhibition of dihydrofolate reductase by lamotrigine.[2] Either of the above mechanisms could have been the cause for the agranulocytosis in our patient. Hence, it is necessary for the clinician to be aware of the same as patients may be on other concurrent psychotropic medications which may cause leukopenia and aggravate agranulocytosis. Timely stopping of lamotrigine does reverse the effects,[45] which was also seen in our patient. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Mental Health Assessment in Patients Admitted to Iran Psychiatric Hospital with a Diagnosis of Psychosis Due to 2 - 5 Years of Methamphetamine Use

Background: Psychotic disorder due to methamphetamine has a high prevalence with an unknown nature and history. Patients with such disorders are faced with the risk of recurrence of abuse and other psychiatric disorders. Methamphetamine-induced psychotic disorders may continue by independent of methamphetamine abuse, such as primary psychotic disorders (such as schizophrenia). Objectives: This study was performed to evaluate the mental health and frequency of methamphetamine-induced psychosis in patients referred to Iran psychiatric hospital (a university hospital in Tehran, Iran). Patients and Methods: The research was done on patients with methamphetamine-induced psychosis after 2 to 5 years using of methamphetamine (150 person in the Iran Psychiatric Hospital) .The diagnostic interview was done based on a semi-structured interview (SCID). The data was analyzed by Binary Logistic Regression Model. Results: From 150 patients that were followed, 6 of them (4.0%) died during the phone interview-follow up. The mean age of alive patients was 34.9 ± 8.7 years and 12 of them were women (8.0%). At the follow-up interview, 38 patients reclassified as the cases of schizophrenia (25.3%), 17 as the cases of major depressive disorder (11.3%), 7 as the cases of bipolar disorder type I (4.7), two as the cases of schizoaffective disorder (1.3%), and two of them as the cases of delusional disorder (1.3%). A total of 84 cases (56.0%) were diagnosed as recovered cases or as methamphetamine-induced psychotic disorders. Prediction of diagnosis change showed the diagnosis of methamphetamine use disorder (adjusted OR = 3.978, 95% CI: 1.265 - 12.512), previous psychiatric admission (adjusted OR = 6.749; 95% CI: 1.639 - 27.779), and short duration of psychotic episode (adjusted OR = 0.171; 95% CI: 0.056 - 0.520. Conclusions: The results of our study show that methamphetamine-induced psychotic disorders are associated, in many cases, with the mood disorders. It seems that comorbid mood disorders, age of first use, history of previous psychiatric hospitalization, the risk of methamphetamine use disorders, and psychotic episodes are associated longer with the diagnosis towards primary psychotic disorders.

Aripiprazole oral treatment in a sample of patients with dual diagnosis

IntroductionAripiprazole is the firstborn of the new dynasty of antipsychotic called third generation or neuromodulator of dopamine-serotonin system. It has proven to be an effective and well-tolerated antipsychotic. Dual Pathology represents the presence of comorbidity between mental illness and substance use disorders. It is an under-diagnosed problem and it is increasing frequency.ObjectivesThe aim of this study was to determine and describe the clinical profile of the patients admitted to the Dual Pathology Unit (UPD) at The Montalvos Hospital (Part of Salamanca University Teaching Hospital, Spain) treated with oral Aripiprazole.MethodsDescriptive, observational, retrospective study of a sample of patients admitted to the UPD to which oral aripiprazole was prescribed during hospitalization. A number of sociodemographic, clinical, and treatment-related variables are described.ResultsFrom a sample of 25 patients and according to DSM-5 criteria (APA, 2013) main diagnoses were: 14 cases of substance-induced psychotic disorder, 3 cases of schizophrenia; 3 cases of schizoaffective disorder; 2 cases of bipolar disorder; 1 case of schizophreniform disorder; 1 case of borderline personality disorder; 1 case of personality syndrome. The most used drugs before the admittance were cocaine, cannabis and opioids. The average dose of aripiprazole was 9 mg and no side effects or drug interactions were reported.ConclusionsApart from its well known efficacy in treament of psychosis, oral aripiprazole may be a first line treatment for Dual diagnosis patients, specially those with problems of non-compliance, due to high level prolactine side effects.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Messages from hypothesis-driven genotyping: the case of schizoaffective disorder, bipolar type

Messages from hypothesis-driven genotyping: the case of schizoaffective disorder, bipolar type

Brain Lesions Manifesting as Psychiatric Disorders:Eight Cases

Sometimes patients with organic brain lesions in neurologically silent brain areas might present only with psychiatric symptoms, such as depression, anxiety disorders, schizophrenia, anorexia nervosa, or cognitive dysfunction. This study presents eight cases of patients with brain lesions (four cases of meningiomas, one case of intracerebral cysts, one case of anaplastic oligodendroglioma, one case of multiform glioblastoma, and one case of occlusive hydrocephalus) who, for a significant period of time, were diagnosed and treated for psychiatric disorders (three cases of Alzheimer's disease, two cases of schizoaffective disorder, one case of schizophrenia, one case of depression, and one case of organic emotional lability disorder). When neurologic symptoms developed, they underwent neuroimaging studies and organic brain lesions were diagnosed. Further treatment required neurosurgical interventions. These cases show that brain tumors can be neurologically silent for a sufficient period of time and manifest as psychiatric disorders. Therefore, neuroimaging studies are needed when atypical changes in mental status or neurologic symptoms and signs develop.

A Case of Resolution of an Acute Psychotic Episode After High Fever

Fever (pyretotherapy) was used for psychosis during the turn of the 19th century, but pyretotherapy (ie, the treatment of a disorder by inducing fever) fell out of use after the introduction of convulsive methods. Here, we report on a case of schizoaffective disorder and review classical and recent literature on fever and psychosis. The patient developed auditory hallucinations, persecutory delusional ideas, and was terrified soon upon his arrival in a foreign country. After being treated for 12 days with olanzapine and haloperidol, he developed a fever due to urinary infection; his creatine phosphokinase levels were high, prompting the suspension of antipsychotics. Psychotic symptom resolution followed immediately fever abatement. Antipsychotics were reintroduced at lower dosages. He was discharged asymptomatic with a prescription of olanzapine 15 mg/day and haloperidol 3 mg/day. The time course of symptom resolution in this patient suggests that fever had a beneficial role in this case. The associations between body temperature changes and psychotic symptoms need to be further studied.

La récidive dans l'homicide pathologique. Étude descriptive et analytique de douze observations

This descriptive and analytic study concerns 12 men who committed homicide recidivism and were under compulsion admitted to the maximum-security hospital for insane in Cadillac, near Bordeaux, between 1 st January 1990 and 1 st January 2005. These patients murdered 17 victims at their first crimes and 18 during the following homicides. There are 6 cases of schizophrenia (50%) usually of paranoid type, 2 cases of persistent delusional disorder (17%), 2 cases of moderate mental retardation (17%), respectively one case of schizo-affective disorder and of pervasive developmental disorder (8%). Mean age for the first crime is 28,2 years (SD 9,8; range 14–42) and 37,8 years for the second (SD 12; range 23–64). Mean interval between criminal events (2 to 5 homicides by patient) is 8,9 years (SD 8,6; range 0–28). Most of the 35 victims are not family relatives (83%) but the murderer knew them before (74%). One third of homicide recidivism occurs against another patient during hospitalisation (4 cases) or against another prisoner in jail (2 cases). The act of homicide often seems to be impulsive and very violent. The weapon used is frequently the one that just comes to hand at the time. Criminal background and acts of violence linked to murders, especially assault and battery (75%) and attempted murder (50%), are frequent in lifetime. Three patients have committed at least one attempted murder before the first homicide. Clinician and expert knowledge of previous psychiatric, legal and violent criminal history of these patients is essential in prevention of recidivism.

A case of schizoaffective disorder that showed an increased level of acoustic sensitivity induced by carbamazepine

A case of schizoaffective disorder that showed an increased level of acoustic sensitivity induced by carbamazepine