Aversive agents: Think twice. A case report on disulfiram-induced mania.

We present a case of disulfiram-induced mania in a patient with both alcohol use disorder (AUD) and psychostimulant use disorder (PUD), without a history of psychosis or mania. This acute presentation may be linked to the increased dopamine levels caused by disulfiram metabolism. Our patient developed manic symptoms 10 days after starting disulfiram, prescribed to treat the AUD. It should be noted that the symptoms resolved rapidly after disulfiram cessation during hospitalization. Disulfiram use is an effective treatment for alcohol dependence. However, there are safety concerns associated with it and it requires close monitoring, particularly in patients with a history of mania, psychosis, or psychostimulant use.

Psychiatric Admissions in a Large Hospital in Madrid during COVID-19 Lockdown: Was There a Change in Patient Profile?

COVID-19 led to a reorganization of health care in Madrid. The objective of this study is to describe the sociodemographic and clinical profile of psychiatric patients admitted to Gregorio Marañón Hospital during lockdown.

Perception and use of informal coercion in outpatient treatment: a focus group study with mental health professionals of Latin culture / Percepción y uso de la coerción informal en el tratamiento ambulatorio: estudio de un grupo focal con profesionales de la salud mental en países de cultura latina

Abstract Introduction. In addition to compulsion (involuntary hospitalization, seclusion, restraint, etc.), there are broader forms of coercion (persuasion, interpersonal pressure, inducement or threat), called informal or covert coercion, all of which try to improve patients adherence to treatment. Objective. To analyse the use of covert coercion in mental health outpatients and the mental health professionals´ views on this practice comparing four countries (Spain, Italy, Mexico and Chile). Methods. We conducted a qualitative research using four focus groups in each country with mental health professionals working in mental health centres and based on a thematic analysis approach. Sample. The total sample was made up of 98 professionals (31 psychiatrists, 25 clinical psychologists, 28 nurses, eight social workers and six other professionals). Results. The use of informal coercion was recognized in clinical practice, but its intensity was related to professionals´ characteristics and to factors related to diagnosis, clinical course, perceived risk, insight, therapeutic relationship and organizational issues in the delivery of services. Its use was justified by effectiveness in improving adherence and, generally, in seeking benefits for the patient, but sometimes in a paternalistic way. Discussion and conclusion. Our results match those described in the literature in terms of: 1. sociodemographic and clinical profile; 2. the reason that leads to its use (adherence); 3. ethical justification (search for patient´s benefit, trying not to impair his freedom); hence, the most intense forms (threat) were misperceived. Our professionals acknowledged the use of covert coercion in their clinical practice, justifying it on ethical and clinical grounds.

Resumen Introducción. Además de la coerción formal (hospitalización involuntaria, contención, etc.), en salud mental existen otras formas de coerción (persuasión, presión interpersonal, inducción o amenaza), denominada informal o encubierta, que pretenden mejorar la adherencia. Objetivo. Conocer el uso de la coerción informal en el tratamiento ambulatorio de enfermos mentales y la percepción que de ella tienen los profesionales de salud mental de cuatro países (España, Italia, México y Chile). Método. Utilizamos una investigación cualitativa con cuatro grupos focales por país, compuestos por profesionales que trabajaban en centros de salud mental, con un enfoque basado en el análisis temático. La muestra fue de 98 profesionales (31 psiquiatras, 25 psicólogos clínicos, 28 enfermeros, ocho trabajadores sociales y otras seis profesiones). Resultados. Se reconoció el uso de la coerción informal en la práctica clínica. Su intensidad dependió de características del profesional y factores relacionados con el diagnóstico, clínica, evolución de la enfermedad, peligrosidad del paciente, conciencia de enfermedad, relación terapéutica y aspectos organizativos asistenciales. Su uso se justificó por la eficacia y la búsqueda de beneficios para el paciente, a veces de forma paternalista. Discusión y conclusión. Nuestros resultados coincidieron en cuanto al perfil sociodemográfico y clínico con lo descrito en la bibliografía. También lo hicieron en cuanto al motivo que lleva a su uso (la adherencia) y su justificación ética (la búsqueda del beneficio del paciente menoscabando su libertad lo menos posible), de ahí que las formas más intensas (amenaza) fueron mal percibidas. Nuestros profesionales reconocieron el ejercicio de la coerción encubierta en su práctica habitual, justificándola clínica y éticamente.

Cognitive deterioration after venlafaxine overdose.

BACKGROUND: Venlafaxine is an antidepressant whose adverse event profile is similar to that of the SSRIs (selective serotonin reuptake inhibitors). Serious complications due to venlafaxine overdose have been described. These generally have been resolved with supportive measures alone. However, although patients usually recover even after massive intake of the drug, death may occur in rare cases. OBJECTIVE: This article reports a case of dementia after an overdose of venlafaxine. CASE REPORT: We present a case of severe cognitive deterioration in a 48-year-old woman after venlafaxine overdose in a suicide attempt. She became comatose after the overdose. On recovery from the coma, she suffered irreversible motor and cognitive alterations and seizures. Several factors could justify the possible association of these side effects with venlafaxine overdose: time relationship, severe focal deficit and other neurological signs, symptomatic fluctuation, relationship of serotonin networks with the cognitive functions and deficits related to the network damage, and the potential capacity of venlafaxine to damage the central nervous system. However, other alternatives, especially factors that could implicate a hypoxic encephalopathy as the origin of the dementia, cannot be entirely ruled out. CONCLUSION: Venlafaxine seems to have special toxicity vis-à-vis the SSRIs, and this case adds to the literature supporting this. Cognitive function should be monitored after an overdose with venlafaxine.