History Of Schizophrenia Research Articles

App-based maintenance treatment for alcohol use disorder after acute inpatient treatment: Study protocol for a multicentre randomized controlled trial

BackgroundAlcohol use disorder, a prevalent and disabling mental health problem, is often characterized by a chronic disease course. While effective inpatient and aftercare treatment options exist, the transferal of treatment success into everyday life is challenging and many patients remain without further assistance. App-based interventions with human guidance have great potential to support individuals after inpatient treatment, yet evidence on their efficacy remains scarce. ObjectivesTo develop an app-based intervention with human guidance and evaluate its usability, efficacy, and cost-effectiveness. MethodsIndividuals with alcohol use disorder (DSM-5), aged 18 or higher, without history of schizophrenia, undergoing inpatient alcohol use disorder treatment (N = 356) were recruited in eight medical centres in Bavaria, Germany, between December 2019 and August 2021. Participants were randomized in a 1:1 ratio to either receive access to treatment as usual plus an app-based intervention with human guidance (intervention group) or access to treatment as usual plus app-based intervention after the active study phase (waitlist control/TAU group). Telephone-based assessments are conducted by diagnostic interviewers three and six weeks as well as three and six months after randomization. The primary outcome is the relapse risk during the six months after randomization assessed via the Timeline Follow-Back Interview. Secondary outcomes include intervention usage, uptake of aftercare treatments, AUD-related psychopathology, general psychopathology, and quality of life. DiscussionThis study will provide further insights into the use of app-based interventions with human guidance as maintenance treatment in individuals with AUD. If shown to be efficacious, the intervention may improve AUD treatment by assisting individuals in maintaining inpatient treatment success after returning into their home setting. Due to the ubiquitous use of smartphones, the intervention has the potential to become part of routine AUD care in Germany and countries with similar healthcare systems.

Abstract WMP54: Stroke Secondary Prevention Care In Persons With Schizophrenia

Introduction: Schizophrenia is associated with stroke incidence and case-fatality but the causes of this are not well-understood. We evaluated the association between comorbid schizophrenia and the quality of secondary prevention care after ischemic stroke. Methods: We used linked health administrative data to identify adults discharged alive from acute care hospitals in Ontario, Canada between 2004 and 2017 following an incident ischemic stroke and identified those with a history of schizophrenia using a validated algorithm. Outcomes were screening, treatment among those with the risk factor, control of vascular risk factors, and receipt of outpatient physician services. We used modified Poisson regression to model the relative risk of each indicator outcome among persons with and without schizophrenia who were alive one year after discharge, adjusting for age, sex, income, comorbidity and rural residence. Results: Among 85,046 persons with ischemic stroke, 886 (1.04%) had a diagnosis of schizophrenia. Those with schizophrenia were younger (median age 64 vs 72), more likely to be female (50.1% vs 44.6%), live in the lowest neighbourhood income quintile (41.1% vs 23.0%) and have diabetes (42.8% vs 32.3%). Of those alive 1 year after stroke, those with schizophrenia were less likely to be screened for hyperlipidemia (adjusted relative risk (aRR) 0.89; 95% confidence interval (CI) 0.84 to 0.94) or diabetes (aRR 0.93; 95% CI 0.89 to 0.97), be prescribed antihypertensive agents (aRR 0.96; 95% CI 0.93 to 0.99), or achieve target lipid levels (LDL < 2 mml/L) (aRR 0.87; 95% CI 0.78 to 0.96). There were no differences in prescription of antilipemic (aRR 0.96; 95% CI 0.91 to 1.01) or antiglycemic (aRR 0.95; 95% CI 0.87 to 1.03) agents or in achievement of target HbA1c ≤ 7% (aRR 0.89; 95% CI 0.78 to 1.02). Outpatient stroke specialist care in the 3 months after discharge was less likely among those with schizophrenia (aRR 0.72; 95% CI 0.65 to 0.78) as were visits to primary care physicians (aRR 0.93; 95% CI 0.91 to 0.96). Conclusions: People with schizophrenia and stroke are less likely to receive secondary preventive care across many indicators measured. This information may be useful for targeted interventions to improve post-stroke care in those with schizophrenia.

Patient Journey of Veterans with Schizophrenia: An Analysis of Treatment Patterns, Healthcare Resource Utilization and Costs.

Little is known about the burden of schizophrenia among United States veterans early after diagnosis. This retrospective study describes treatment patterns, healthcare resource utilization (HRU) and healthcare costs among veterans with a recent schizophrenia diagnosis. Adults with a schizophrenia diagnosis recorded between 1 April 2014 and 31 December 2017 and no history of schizophrenia over the preceding 12months were identified from a Veterans Health Administration (VHA) database. Continuous enrollment in the VHA was required for ≥ 12months before and after the index date when the first schizophrenia diagnosis code was identified. Baseline characteristics and follow-up treatment patterns, HRU and costs were examined descriptively. The study population (20,389 patients) had a high baseline mental health comorbidity burden. Despite a schizophrenia diagnosis, 32.1% of patients received no antipsychotic medication during the follow-up period. Among those with ≥ 1 antipsychotic prescription fill, 64.0% received ≥ 1 oral antipsychotic (OAP) therapy and 11.6% received ≥ 1 long-acting injectable (LAI). A delay was observed between diagnosis and treatment for both OAPs (39.0 ± 67.2days) and LAIs (69.4 ± 96.2days). Adherence to therapy (defined as proportion of days covered ≥ 80%) was greater with LAIs (34.5%) vs OAPs (27.3%). Inpatient stays were reported for 33.8% of patients during the 12-month follow-up period, and 5.5% of patients had readmissions. All-cause inpatient stay costs with 12-month follow-up equaled $7999 per patient per year. These data indicate that pharmacotherapy after a recent diagnosis of schizophrenia in the VHA system is suboptimal, and that these patients face a considerable burden in terms of hospitalization, other HRU, and healthcare costs.

Prevalence and clinical implication of adverse childhood experiences and their association with substance use disorder among patients with schizophrenia

BackgroundAdverse childhood experiences (ACEs) and substance use disorder (SUD) are well-known risk factors for psychosis and dramatically affect schizophrenia. In this research, we aimed to measure the prevalence of adverse childhood experiences and substance use disorder in patients with schizophrenia and assess the effect of ACEs on the clinical presentation and overall functioning and the association between them and SUD in patients with schizophrenia. A cross-sectional study included a random sample of 165 schizophrenic patients who were examined by doing drug screen in urine, structured questionnaire to collect Socioeconomic characteristics, history of schizophrenia, structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders-fifth edition, Positive and Negative Syndrome Scale (PANSS), Adverse Childhood Experiences International Questionnaire (ACE-IQ), World Health Organization Disability Assessment Schedule 2.0, compliance rating scale, addiction severity index fifth edition (ASI) for individuals with positive urine drug screen.ResultsOnly 14.4% of the studied patients had no adverse childhood experiences. The prevalence of positive substance abuse screening was 18.2%. There were statistically significant negative correlations between total ACE score and educational level, socioeconomic level, and the onset of schizophrenia. On the other hand, statistically significant positive correlations were found between the total ACE score and PANSS score and ASI score. The first most frequent ACE was significantly associated with female gender, lower education levels, low and middle socioeconomic classes, lifetime substance use, smokers, and positive drug screening. Emotional neglect and contact sexual abuse were significantly associated with positive drug screening. At the same time, Physical abuse was significantly associated with both lifetime substance use and positive drug screening.ConclusionThe current study’s findings indicate that childhood adverse experiences and substance abuse are prevalent problems in patients with schizophrenia. Given that there is an association between both issues, they may affect the symptomatology of the disorder, the prognosis, and the therapeutic plan. It is advised that a greater emphasis on and identification of childhood trauma and drug use disorder may be a necessary step in assessing patients with schizophrenia.

Perceived stress, quality of life, and coping skills among patients with schizophrenia in symptomatic remission

BackgroundSchizophrenia is one of the worst diseases with its ubiquitous challenges due to its unique psychopathology and life events. Patients with schizophrenia use various coping strategies to overcome distress. The aim of the study was to evaluate the association between perceived stress, quality of life, and coping skills in patients with schizophrenia in remission. A total of 48 consecutive patients of schizophrenia, in remission, attending outpatient department of psychiatry at Academic hospital, South India, who satisfied the inclusion and exclusion criteria were recruited for the present study. The participants were assessed on Positive and Negative Symptoms Scale, Ways of Coping Checklist – Revised and Perceived Stress Scale and WHO Quality of Life. Results were analyzed using appropriate statistical package software v 16.0.ResultHighest medial was found in self-controlling and positive reappraisal coping skills. Distancing is associated with high physical domain of quality of life whereas patients with good social support score more in social and physical domain of quality of life.ConclusionPatients with history of schizophrenia even though in remission dwell a stressful life. They often need different kind of social support or cognitive aids. In that view, studying their stress level, ability to cope with it, and quality of life will help us to manage them in better way.

A Case Report of Opisthotonos Associated with Administration of Intramuscular Ketamine.

IntroductionKetamine, a commonly used medication to treat agitation, has known adverse effects such as emergence reactions, vomiting, and laryngospasm. Opisthotonos has not been a commonly reported adverse reaction.Case ReportWe report a case of opisthotonos brought on by administration of ketamine. A 24-year-old male with a history of schizophrenia was brought in by emergency medical services with opisthotonos shortly after treatment with 250 milligrams intramuscular ketamine by paramedics. He had become increasingly paranoid after being off his aripiprazole for a few weeks, and his family had become afraid for his and their safety. Paramedics administered ketamine to control his combative agitation, per protocol. The patient’s extreme neck and back extension rapidly resolved with the administration of midazolam. Further history and workup did not reveal another cause for opisthotonos.ConclusionThis is the first reported case to our knowledge of ketamine-associated opisthotonos in the emergency setting. Emergency care providers should be aware of this potential side effect.

LARGE SADDLE PULMONARY EMBOLISM WITH RIGHT VENTRICULAR DYSFUNCTION IN AN ASYMPTOMATIC PATIENT

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Definition of saddle pulmonary embolism (PE) is a visible thromboembolus straddling the bifurcation of the main pulmonary artery trunk. Saddle pulmonary embolism occurs in 5.2% cases in all patients with pulmonary embolism (1). We report an atypical case of an asymptomatic and hemodynamically stable patient with a saddle PE and right ventricular (RV) strain. CASE PRESENTATION: A 65-year-old man with history of schizophrenia, polysubstance abuse on methadone, hepatic fibrosis, lung nodules reported 1 hour of transient chest pain and SOB two days before ER visit. On admission he did not have any symptoms. He denied risk factors for deep venous thrombosis. All vital signs were normal. Clinical examination revealed attenuated pulmonic component of the second heart sound. Electrocardiogram (EKG) revealed new biphasic t-waves in anterior leads. Labs were significant for troponin ultra 0.43 ng/ml. He was initially admitted to CCU for acute myocardial infarction without ST segment elevation in the settings of elevated troponin and new EKG changes of biphasic T waves in anterior leads. Repeated EKG - right axis deviation. Echocardiogram (ECHO- normal left ventricle, RV function was severely reduced and size severely enlarged, abnormal septal motion during diastole and systole consistent with volume and pressure overload and pulmonary pressure of 43 mmHg. CT pulmonary angiography (CTPA) was positive for saddle PE extending into all 5 lobes of the lungs (figure 1). Venous scan of lower extremities revealed deep venous thrombosis of the right popliteal vein. Treatment for PE was initiated with therapeutic dose of anticoagulation therapy. He remained hemodynamically stable and asymptomatic throughout the course and his hospital stay was uneventful and he was discharged on therapeutic dose Apixaban. DISCUSSION: Risk assessment for acute PE includes classification according to hemodynamic instability with patients presenting with hemodynamic instability being high risk for 30 days mortality and requiring reperfusion treatment (systemic thrombolysis or pulmonary embolectomy). Patient with hemodynamic stability but with RV strain on ECHO or CTPA have intermediate high risk and can be treated with parenteral or oral AC and rescue reperfusion if deterioration happens (2). CONCLUSIONS: Conclusion: Patient with RV strain and large saddle PE can remained hemodynamically stable and can adequately be managed with AC therapy. REFERENCE #1: Musani MH. Asymptomatic saddle pulmonary embolism: case report and literature review. Clin Appl Thromb Hemost. 2011 Aug;17(4):337-9. doi: 10.1177/1076029610363588. Epub 2010 Mar 22. PMID: 20308228. REFERENCE #2: Stavros V. Konstantinides, Guy Meyer, Cecilia Becattini, Héctor Bueno, Geert-Jan Geersing, Veli-Pekka Harjola, Menno V. Huisman, Marc Humbert, Catriona Sian Jennings, David Jiménez, Nils Kucher, Irene Marthe Lang, Mareike Lankeit, Roberto Lorusso, Lucia Mazzolai, Nicolas Meneveau, Fionnuala Ní Áinle, Paolo Prandoni, Piotr Pruszczyk, Marc Righini, Adam Torbicki, Eric Van Belle, José Luis Zamorano, 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS), European Respiratory Journal 2019; DOI: 10.1183/13993003.01647-2019 DISCLOSURES: no disclosure on file for Moses Bachan; no disclosure on file for Zinobia Khan; No relevant relationships by Mirjana Petrovic Elbaz, source=Web Response No relevant relationships by Robert Siegel, source=Web Response No relevant relationships by Swarnalatha Uday sumathy, source=Web Response

Catatonia as a Presenting Symptom of Isolated Neurosarcoidosis in a Woman With Schizophrenia

Abstract: Background Catatonia is a presenting sign for many primary psychiatric disorders but it can also herald medical and neurological conditions. Increasing research has highlighted co-occurrence catatonia and delirium and how this combination warrants a thorough medical workup. Case presentation We present a case of a middle-aged woman with catatonia and delirium secondary to neurosarcoidosis only involving the brain; we document her 30-day hospitalization and intensive medical work-up that eventually revealed isolated neurosarcoidosis. This is the first reported case to our knowledge in the literature of catatonia occurring due to isolated neurosarcoidosis. Conclusion For this patient, albeit with a history of schizophrenia, the presence of delirium pushed the medical team to pursue a comprehensive work up instead of relying on a psychiatric diagnosis as the explanation for her puzzling clinical presentation. This case report supports a paradigm shift for physicians to think of catatonia similar to delirium: A syndrome that results from an underlying condition that must be treated in order to resolve the catatonia.

A-59 Psychosis and Coma in COVID-19: A Case Report

ObjectiveThe objective of this case is to spotlight the potential neurological andneuropsychiatric symptoms associated with COVID-19.MethodA 55-year-old African American male with a history of schizophrenia, bipolar disorder, obesity, tobacco use, and hypertension voluntarily presented to the local hospital with auditoryhallucinations and delusions. During an inpatient stay, the patient developed symptomsconsistent with COVID-19 and subsequently tested positive for the virus. Thirty-nine days after the initial positive COVID-19 test result, he remained in a coma with retained brainstem responses. An EEG demonstrated encephalopathy and MRI showed multiple, well-circumscribed white matter lesions consistent with acute demyelination (Figure 1). After three days of high-dose steroids and over a month in a coma, the patient began following simple commands. Unfortunately, on hospital day 66, the patient developed sudden hypotension and worsening respiratory status.ResultsWhile psychotic episodes in relation to COVID-19 are not widely reported, psychotic episodes are shown in three COVID-19 cases. Other reports have found significant changes in consciousness in COVID-19 patients with delayed awakening from a comatose state. Pre-existing inflammatory responses in those with psychiatric disease may be accelerated by the immune response due to COVID-19.ConclusionMental status changes in those with psychiatric illness who have COVID-19 are worth exploring. It is unclear whether a history of COVID-19 may accelerate a neuropsychiatric process or other central nervous system diseases. Future research may want to examine the possible interrelationship between pre-existing neurological vulnerabilities and COVID-19. The possibility of high-dose steroid treatment for COVID-19 neuroinflammatory complications should be considered.

The Right to Choose

The Right to Choose

Purple urine bag syndrome is a rare manifestation of bacteriuria on bladder catheter: case report

BackgroundPurple urine bag syndrome (PUBS) is a complication of bacterial colonisation of bladder catheters in which urine turns purple in the tubing, as well as in the catheter bag. This rare phenomenon can be very worrisome and stressful for the patients and their families, as well as for the healthcare team taking care of them. Recognising this complication is essential in order to avoid misdiagnosis and erroneous treatment. We report a case of PUBS in a 71-year-old female patient.Case presentationA 71-year-old woman with previous medical history of schizophrenia was admitted to the emergency department for anorexia and suspicion of psychotic decompensation. Acute urine retention and rectal faecal impaction were clinically suspected and confirmed by bladder ultrasound and rectal examination, respectively. The patient underwent bladder catheterisation as well as a rectal enema. The day after her admission, our medical team was approached by the nurse in charge of the patient because of purple urine in her catheter bag and tubing. The diagnosis of PUBS was made with the help of the Oxford urine chart. A dipstick urinalysis revealed alkaline urine (pH = 8), and the urine culture was subsequently positive for Proteus mirabilis, which is sensitive to quinolones, beta-lactams and nitrofurantoin. The bladder catheter was changed. The patient received empiric antibiotic therapy with Levofloxacin 500 mg once daily. After obtaining the antibiogram, the targeted antibiotic therapy was adapted with oral Cefuroxime 500 mg three times a day for a total duration of seven days of antibiotic therapy. There was no recurrence of purple urine.ConclusionPUBS is a rare complication of bacteriuria, which induces a purple colouration of the tubing as well as the catheter bag. It is a simple spot diagnosis, as there is no other known cause of purple urine. This is why we believe that the Oxford urine chart represents a very interesting and easily accessible tool to help clinicians to investigate any abnormal urine colour.

Access to firearms: essential factor for risk management in psychiatry

ObjectiveIncrease awareness of the risk associated with access to firearms in clinical practice.Case reportA 57-year-old man, with a 30 year history of schizophrenia, was reviewed routinely at home. His illness is predominantly characterised by chronic delusions of a grandiose nature. He believes he has been offered various senior employment positions and has acted on these beliefs by presenting at workplaces in business attire. He has no insight into his condition. At review, he described awakening a week earlier in a panic and seizing hold of his legally held shotgun. He planned to shoot out the window as he believed people were breaking in. His wife prevented him from doing so by taking the gun and hiding it. A few days later he found the gun and intended to frighten off potential pursuers by pretending to shoot birds. He was persuaded to surrender the gun and it was taken to the local Garda (Police). A short time later, he presented to Garda Headquarters, over an hour away, seeking the return of his gun. At review, he had limited insight into the potential seriousness of the situation. The team immediately liaised with Gardaí, a HCR- 20 risk assessment was completed and clozapine levels checked.DiscussionWe had not know that our patient owned a shotgun despite very regular contact with him. During a comprehensive psychiatric history we routinely ask about risk of harm to self and others, but rarely ask specifically about access to or ownership of guns. Working on a farm, rural living or having an interest in shooting sports may raise the issue. Suicide, security breaches and homicide are the main risks conferred by firearms in mental illness. Mental illness is not necessarily prohibitive to gun ownership. Applicants for gun certificates in the UK must disclose specific medical conditions, including a psychotic illness, and an automatic medical report is sought. In the Irish Republic it is the responsibility of the applicant to declare any specific physical or mental health condition. Although a medical report may be sought, it is not automatic in all cases. Lack of insight into psychotic illness may potentially influence self-declaration upon application for a certificate.ConclusionAwareness of a persons access to firearms should be part of our routine risk assessment.

Autistic traits in offspring of schizophrenic patients in comparison to those of normal population: a case-control study

BackgroundAutism is not a discreet condition and those families members with autistic propend are more likely to display autistic symptoms with a wide range of severity, even below the threshold for diagnosis of autism spectrum disorders. Even with a parental history of schizophrenia, the likelihood of autistic spectrum disorder was found to be 3-fold greater. The aim of this study is to assess autistic traits among offspring of schizophrenic patients in the age group from 4 to 11 years and compare it in the offspring of normal individuals, and its association with the sociodemographic data. To determine whether schizophrenic parents are a risk factor to autistic traits in their children.ResultsThere was a statistically significant (P < 0.05*) increase in Autism Quotient Child scores of the case group where 47.2% had a score equal or more than the cutoff point (76), while only 17 19.4% of the control group had the same score with odds = 3.71 indicating that children of schizophrenic parents 18 were three times likely to have Autism Quotient-Child score greater than or equal to the cutoff point (76) than 19 children of healthy parents. No statistically significant association (P ≥ 0.05) was found between all 20 sociodemographic characteristics and Autism Quotient-Child scores among the case group except for family 21 income and social class where there was a statistically significant association (P < 0.05) between insufficient income 22 and low social class and higher Autism Quotient-Child score (≥ 76).ConclusionsChildren of schizophrenic parents are at high risk to have autistic traits than children of normal parents.

Management challenges in a schizophrenic patient with multiple brain abscesses: A case report

IntroductionCerebral abscesses are rare, occurring in approximately 0.3–1 per 100 000 patients. Mortality rate still remains as high as 22%. Very few cases of acute psychotic episodes associated with brain abscess have been reported.ObjectivesTo present a case report of a patient with schizofrenia associated with multiple brain abscesses, focusing on clinical features and managing challenges.MethodsPresentation of a clinical case supported by a non-systematic review of literature containing the key-words “brain abscess”, “psychosis” and “schizophrenia”ResultsThis is a case report of a male 44-year-old patient with a known history of schizophrenia since the age of 18 and with multiple brain abscesses diagnosed 2 month ago. He was admitted to our inpatient service after discontinuation of her medication resulting in an acute psychotic episode. Antibiotic therapy with rifampicine, metronidazole, trimethoprim and sulfamethoxazole was started. Also, administration of clozapine was initiated (up to 400mg/day) with partial improvement, so aripiprazole was added (up to 45 mg/day), with insufficient response. We suspected of a drug interaction between rifampicine (known potent broad inducer of drug-metabolizing enzymes) and antipsychotic medication, so we decided to change aripiprazole to amisulpride 1200 mg/day, which CYP-catalyzed metabolism appears to be minor. A significant improvement in positive symptoms and mood was observed. The patient has since had no delusions or hallucinations and is living independently at home.ConclusionsThis clinical case highlights the possible association between brain abscesses and relapses in schizophrenia. It is of utmost importance to be aware for possible drug interactions between antibiotic therapy and antipsychotic medication.DisclosureNo significant relationships.

569 Surrogate Decision Making: Who Has the Ultimate Say in Patient Care?

Abstract Introduction Burn patients may present with an inability to communicate. In these cases, we need to rely on surrogates such as the Medical Power of Attorney (MPoA) or next of kin. A MPoA gives the agent the authority to participate in medical decision and in accordance with their wishes. The agent may consent to, refuse, withdraw, or withhold treatment, including life-sustaining interventions. At times, they may feel unable to participate in decision making without assistance (i.e. family members). The process can become more complicated and decision making can become “muddied” due to others influencing decisions. In our state, the MPoA is the proxy if the patient is unable to participate in decision making; however, there are cases when the patient doesn’t have an MPoA and the next of kin is the surrogate. In these cases, the next of kin would be consulted in the following order: spouse, adult children, parents, and nearest relatives. Some next of kin may not know the patient’s wishes complicating their care. Methods Two cases involving surrogates: #1: 60-year-old man with a history of HIV involved in a MVC and sustained 30% TBSA third and fourth degree burns to the face, torso, and extremities. The severity of his injuries and outcomes were discussed with his wife. She was not certain what her would want and she consulted her family because she did not know what to do; however, she knew that he would not want to live like this. After talking to the family, the kids “over-ruled” her. They wanted aggressive care despite the risks of complications and inability to perform ADLs because of his severe facial and hand burns. Case#2: 40 something year-old man with a history of schizophrenia that sustained 65% TBSA third and fourth degree burns to his face, neck, torso, and extremities due to self-immolation. The patient’s mother was identified, and it was explained to the patient’s mother that if he did survive his injury, he will not be able to perform any of his ADLs due his hand and facial burns. The patient’s mother wanted everything done for her son. Results Both patients were unable to perform ADLs due to their injuries. One patient was discharged for further inpatient care and the other was discharged home because his mother refused further care. The first patient was unable to communicate about his thoughts on his outcome. The other patient was discharged home. He was upset about what he looked like. He also told the staff that he will do his best to finish what he started. Conclusions Complex issues can arise when the patient cannot communicate their wishes and the next of kin plays the role of surrogate. The family may disagree and alter the decision-making process. After seeing this scenario play out and patients not being happy about their outcomes, the policies regarding surrogate decision making should be re-evaluated.

Malignant Catatonia Requiring High Dose Bromocriptine: Case Report

Catatonia can occur in patients diagnosed with schizophrenia and bipolar disorder and malignant catatonia is life threatening. Anti-psychotic medications should be discontinued during acute phase of catatonia. Anti-psychotic discontinuation in catatonia is a challenge in patients maintained on long-acting injectable antipsychotics because of the extended release. Case report: We present a case of malignant catatonia developed in a patient with history of schizophrenia and developmental delay. Symptoms lasted several weeks as he was recently administered long acting injectable antipsychotic medication, requiring high dose Bromocriptine treatment. Patient required several days of bromocriptine treatment. Because of the shorter half-life, frequent and higher dosing of bromocriptine led to resolution of malignant catatonia. Malignant catatonia is a medical emergency and prompt treatment including high dose bromocriptine could lead to resolution of catatonia.

A Seasonal Cause of Encephalitis: Influenza Virus A (H3N1) Infection.

Influenza virus encephalitis should be considered in some specific settings, such as during pandemics or seasonal epidemics.Altered mental status in a patient with a history of mental disease may be easily dismissed as secondary to prior disease or medication.Although rare, extrapulmonary manifestations of influenza virus infection can be serious and fatal.

Rare and Underestimated Association of Pulmonary Embolism and Olanzapine Therapy; Report of Two Cases.

Venous thromboembolic disease (VTD) is a very common and severe pathological condition in which there are many predisposing factors. Olanzapine is a drug frequently used in psychiatric practises; it is thought to increase the risk of VTD. Here, we report two cases, a young man and a woman, with a medical history of schizophrenia treated by olanzapine who developed pulmonary embolism and we did not find any aetiologies of VTD in them. Due to the link between olanzapine and pulmonary embolism, which has been previously described, olanzapine is considered responsible for this problem. Two mechanisms have been reported in the literature in this regard; significant weight gain and lethargy, which are very common side effects of olanzapine. So far, no direct effect of olanzapine on platelet aggregation or coagulation has been found. In patients developing VTD while being treated with olanzapine, discontinuation of olanzapine as a treatment option must be done with an adjustment of antipsychotic treatment and regular monitoring of psychic symptoms. Since the diagnosis of pulmonary embolism is not easy to make in a schizophrenic patient, clinicians should take that in consideration when prescribing these drugs and when facing clinical situations where VTD is suspected.

Investigating the effects of genetic risk of schizophrenia on behavioural traits

To characterise the trait-effects of increased genetic risk for schizophrenia, and highlight potential risk mediators, we test the association between schizophrenia polygenic risk scores (PRSs) and 529 behavioural traits (personality, psychological, lifestyle, nutritional) in the UK Biobank. Our primary analysis is performed on individuals aged 38–71 with no history of schizophrenia or related disorders, allowing us to report the effects of schizophrenia genetic risk in the sub-clinical general population. Higher schizophrenia PRSs were associated with a range of traits, including lower verbal-numerical reasoning (P = 6 × 10–61), higher nervous feelings (P = 1 × 10−46) and higher self-reported risk-taking (P = 3 × 10−38). We follow-up the risk-taking association, hypothesising that the association may be due to a genetic propensity for risk-taking leading to greater migration, urbanicity or drug-taking — reported environmental risk factors for schizophrenia, and all positively associated with risk-taking in these data. Next, to identify potential disorder or medication effects, we compare the PRS–trait associations in the general population to the trait values in 599 medicated and non-medicated individuals diagnosed with schizophrenia in the biobank. This analysis highlights, for example, levels of BMI, physical activity and risk-taking in cases in the opposite directions than expected from the PRS–trait associations in the general population. Our analyses offer simple yet potentially revealing insights into the possible causes of observed trait–disorder associations, which can complement approaches such as Mendelian Randomisation. While we urge caution in causal interpretations in PRS cross-trait studies that are highly powered to detect weak horizontal pleiotropy or population structure, we propose that well-designed polygenic score analyses have the potential to highlight modifiable risk factors that lie on the path between genetic risk and disorder.

Profile of Schizophrenia Aggressiveness with the Risk of Suicide based on the Personality and Social Performance Score

A B S T R A C TIntroduction. The risk of schizophrenia for suicide is 10%, of which 10% -15% ofpeople with schizophrenia die of suicide at 20 years of follow-up. Aggressiveness is afactor to be watched out. Other factors are hallucinations, suicide, early-onset,history of schizophrenia, surveillance, age, gender, education, genetics, affect ofdepression. This study aimed to describe the sociodemographic profile,aggressiveness, hallucinations of suicide in schizophrenic patients. Methods. Thedesign of this study is descriptive research. The number of samples in this study was49 schizophrenic patients at risk of suicide. The risk of aggressiveness is measuredby the Personality and Social Performance Score. Results. Of the 49 patients, it wasfound that the proportion of male patients was 31 people (63.3%) and 18 women(36.7%). Aggressive behaviour based on PSP score was divided into modestaggressiveness of 22 people (44.9%), severe 20 people (40.8%), very severe two people(4.1%). Suicidal hallucinations were also found in 11 patients (22.4%). Conclusion.There are markedly aggressive behaviour and hallucinations of suicide in the majorityof schizophrenic patients.