RESUMEN
BACKGROUND: Paliperidone is a second-generation antipsychotic agent that is effective in the treatment of schizophrenia and schizoaffective disorder as well as an adjunct to mood stabilizers and antidepressants for bipolar and depressive disorders. Paliperidone is available in both oral and injection forms. Here we report an unexpected case of cutaneous allergic reaction induced by paliperidone long-acting injection (LAI) following oral tolerance. CASE PRESENTATION: A 55-year-old man with first episode delusional disorder was treated with paliperidone tablets with tolerance. On day seven he received the paliperidone LAI and developed an allergic reaction in minutes including flushing of the face, widespread urticaria with mild airway constriction. The allergic symptoms were relived following the administration of antihistamine within several minutes. CONCLUSION: The allergic reaction that occurred post administration of the paliperidone LAI but not the oral tablets suggest it is likely due to the excipients in the formulation of the LAI rather than paliperidone itself. This case highlights the necessity of monitoring allergic reactions in psychiatric patients when converting from oral to LAI format of paliperidone.
Asunto(s)
Antipsicóticos , Hipersensibilidad , Masculino , Humanos , Persona de Mediana Edad , Palmitato de Paliperidona/efectos adversos , Esquizofrenia Paranoide/inducido químicamente , Esquizofrenia Paranoide/tratamiento farmacológico , Preparaciones de Acción Retardada/efectos adversos , Antipsicóticos/efectos adversos , Hipersensibilidad/tratamiento farmacológicoRESUMEN
BACKGROUND: Adherence to medication regimens is of great importance in psychiatry because drugs sometimes need to be taken for long durations in order to maintain health and function. OBJECTIVE: This study aimed to review influences on adherence to antipsychotic medications, the treatment of choice for the delusional disorder (DD), and to focus on adherence in women with DD. METHODS: This is a non-systematic narrative review of papers published since 2000 using PubMed and Google Scholar, focusing on women with DD and medication adherence. RESULTS: Several factors have been identified as exerting influence on adherence in women with persistent delusional symptoms who are treated with antipsychotics. Personality features, intensity of delusion, perception of adverse effects, and cognitive impairment are patient factors. Clinical time spent with the patient, clarity of communication, and regular drug monitoring are responsibilities of the health provider. Factors that neither patient nor clinician can control are the social determinants of health, such as poverty, easy access to healthcare, and cultural variables. CONCLUSION: There has been little investigation of factors that influence adherence in the target population, e.g., women with DD. Preliminary results of this literature search indicate that solutions from outside the field of DD may apply to this population. Overall, a solid therapeutic alliance appears to be the best hedge against nonadherence.
Asunto(s)
Antipsicóticos , Antipsicóticos/uso terapéutico , Femenino , Humanos , Cumplimiento de la Medicación/psicología , Esquizofrenia Paranoide/inducido químicamente , Esquizofrenia Paranoide/tratamiento farmacológicoAsunto(s)
Trastornos Disruptivos, del Control de Impulso y de la Conducta/inducido químicamente , Agonistas de Dopamina/efectos adversos , Alucinaciones/inducido químicamente , Enfermedad de Parkinson/tratamiento farmacológico , Esquizofrenia Paranoide/inducido químicamente , Conducta Sexual/efectos de los fármacos , Anciano , Humanos , MasculinoAsunto(s)
Aciclovir/análogos & derivados , Deluciones/inducido químicamente , Esquizofrenia Paranoide/inducido químicamente , Valina/análogos & derivados , Aciclovir/efectos adversos , Carcinoma de Células Renales/complicaciones , Deluciones/complicaciones , Femenino , Humanos , Persona de Mediana Edad , Esquizofrenia Paranoide/complicaciones , Valaciclovir , Valina/efectos adversosAsunto(s)
Bebidas/efectos adversos , Cafeína/efectos adversos , Estimulantes del Sistema Nervioso Central/efectos adversos , Psicosis Inducidas por Sustancias/diagnóstico , Esquizofrenia Paranoide/inducido químicamente , Adulto , Afecto/efectos de los fármacos , Antipsicóticos/administración & dosificación , Nivel de Alerta/efectos de los fármacos , Cafeína/administración & dosificación , Estimulantes del Sistema Nervioso Central/administración & dosificación , Progresión de la Enfermedad , Relación Dosis-Respuesta a Droga , Haloperidol/administración & dosificación , Haloperidol/análogos & derivados , Humanos , Inyecciones Intramusculares , Masculino , Psicosis Inducidas por Sustancias/psicología , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/tratamiento farmacológico , Esquizofrenia Paranoide/psicologíaRESUMEN
Impulse control disorders, including pathological gambling, binge eating, compulsive shopping and hypersexual behaviors, have frequently been reported as a side effect of dopaminergic medications for Parkinson's disease (PD). Here we describe a patient with PD who developed an unusual manifestation of impulsive behaviors, including cigarette smoking, associated with an increase in dopamine agonist medication. We postulate this to be related to an overstimulation of mesolimbic dopamine receptors responsible for reward-seeking behaviors. Further research is needed to examine impulsive cigarette smoking in PD.
Asunto(s)
Trastornos Disruptivos, del Control de Impulso y de la Conducta/inducido químicamente , Agonistas de Dopamina/efectos adversos , Enfermedad de Parkinson/tratamiento farmacológico , Fumar , Antiparkinsonianos/efectos adversos , Benzotiazoles/efectos adversos , Humanos , Conducta Impulsiva/inducido químicamente , Indoles/efectos adversos , Masculino , Persona de Mediana Edad , Pramipexol , Esquizofrenia Paranoide/inducido químicamenteRESUMEN
BACKGROUND: Delusional jealousy or Othello syndrome (OS) is a well-described psychiatric disorder with paranoid features reported in both organic and functional psychoses. In organic psychoses, the disorder occurs more frequently among chronic male alcoholics and in demented patients. To date, only 2 anecdotal cases of OS have been reported in Parkinson disease (PD) during dopaminergic treatment. OBJECTIVE: To investigate the presence of OS in PD patients and to study the relationship between dopaminergic treatment, avoiding the possible influence of dementia. METHODS: Five hundred sixty-three PD patients without dementia encountered in our movement disorders practice were included in the study. All patients who developed OS were studied. Relationships between clinical and familial history and dopaminergic therapy and OS were assessed. RESULTS: Six patients with OS were identified. They were all male, with a relatively recent diagnosis of PD characterized by mild-moderate motor deficit. Dopaminergic treatment had been prescribed at low dosages. Neither confusional states (including agitated confusion) nor delirium were associated with OS. The disorder became manifest mainly at time of introduction/increment of antiparkinson treatment. Invariably, OS decreased or receded after reduction/suspension of the antiparkinson drug and prescription of an atypical neuroleptic, usually clozapine or quetiapine. CONCLUSION: We hypothesize that nondemented PD patients affected by OS do not necessarily present with severe motor complications and may well have a biologic predisposition for psychiatric disorders. In our opinion this paranoid delusion is rarely considered in PD.
Asunto(s)
Antiparkinsonianos/efectos adversos , Celos , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/tratamiento farmacológico , Esquizofrenia Paranoide/inducido químicamente , Esquizofrenia Paranoide/complicaciones , Adulto , Antiparkinsonianos/uso terapéutico , Antipsicóticos/uso terapéutico , Clozapina/uso terapéutico , Deluciones/inducido químicamente , Demencia , Dibenzotiazepinas/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Fumarato de Quetiapina , Estudios RetrospectivosRESUMEN
OBJECTIVE: This exploratory study compared the neurocognitive performances of individuals with methamphetamine-induced psychotic disorder (MA psychosis) and paranoid schizophrenia. BACKGROUND: MA psychosis presents very similarly to paranoid schizophrenia and the relationship between the 2 disorders is not well-understood. Neurocognitive functioning is one potential factor for comparison, as deficits are documented in both schizophrenia and methamphetamine dependence. METHOD: Participants were selected through chart review. Neurocognitive test scores for participants with paranoid schizophrenia (n=20) and MA psychosis (n=19) were obtained from hospital records and compared. RESULTS: Results of multivariate analysis of variance found no significant differences between the groups in any neurocognitive domain. CONCLUSIONS: These preliminary findings suggest that similarities between the disorders may extend to neurocognition. Low power and sampling limitations may contribute to the null findings.
Asunto(s)
Trastornos Relacionados con Anfetaminas/diagnóstico , Estimulantes del Sistema Nervioso Central/toxicidad , Trastornos del Conocimiento/inducido químicamente , Metanfetamina/toxicidad , Pruebas Neuropsicológicas , Psicosis Inducidas por Sustancias/diagnóstico , Esquizofrenia Paranoide/diagnóstico , Adulto , Trastornos Relacionados con Anfetaminas/psicología , Trastornos Relacionados con Anfetaminas/rehabilitación , Trastornos del Conocimiento/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Pruebas Neuropsicológicas/estadística & datos numéricos , Psicometría , Psicosis Inducidas por Sustancias/psicología , Reproducibilidad de los Resultados , Esquizofrenia Paranoide/inducido químicamente , Esquizofrenia Paranoide/psicología , Esquizofrenia Paranoide/rehabilitaciónRESUMEN
BACKGROUND: In this report, we present the case of a patient with a relapse of schizophrenia following an episode of depression and increased anxiety after antiobesity treatment with rimonabant, a cannabinoid type 1 receptor antagonist. CASE REPORT: After 4 weeks of treatment the patient developed psychiatric symptoms, i.e. depressed mood and elevated anxiety. Four months after the discontinuation of rimonabant, the patient presented with psychotic symptoms fulfilling ICD-10 criteria of paranoid schizophrenia. Antipsychotic treatment with quetiapine was initialized. A stable recovery took further 4 weeks in which combined treatment with quetiapine and ziprasidone was given. CONCLUSION: The course of the illness suggests that the continuous affective symptoms, which were most likely a side effect of rimonabant, may have triggered the psychosis analogous to the stress-diathesis model of schizophrenia. As a consequence, rimonabant may not be the first choice in obese patients with a history of schizophrenia due to a potentially increased risk of a relapse via an indirect mechanism.
Asunto(s)
Fármacos Antiobesidad/efectos adversos , Obesidad/tratamiento farmacológico , Piperidinas/efectos adversos , Pirazoles/efectos adversos , Esquizofrenia Paranoide/inducido químicamente , Adulto , Enfermedad Crónica , Femenino , Humanos , Recurrencia , RimonabantRESUMEN
Psoriasis may be frequently associated with psychiatric diseases. We present a 44-year-old man undergoing cyclosporine therapy for treatment of generalized plaque psoriasis which exacerbated his symptoms of paranoid schizophrenia, and disappeared a few days after discontinuation of cyclosporine. Replacement therapy with etanercept achieved clinical remission of psoriasis without any psychiatric side effects. Systemic medications, such as cyclosporine and etanercept, induce modifications of the cytokine network. This is pathogenetically significant in both psoriasis and psychiatric disorders. This case report suggests that dermatologists need to become more familiar with the risk-benefit of drug-induced cytokines dysregulation in psoriatic patients with comorbid psychiatric disorders.
Asunto(s)
Ciclosporina/efectos adversos , Inmunosupresores/efectos adversos , Psoriasis/complicaciones , Esquizofrenia Paranoide/inducido químicamente , Adulto , Ciclosporina/uso terapéutico , Etanercept , Humanos , Inmunoglobulina G/uso terapéutico , Inmunosupresores/uso terapéutico , Masculino , Psoriasis/tratamiento farmacológico , Receptores del Factor de Necrosis Tumoral/uso terapéutico , Esquizofrenia Paranoide/complicacionesRESUMEN
We report herein the first case of psychosis after short-term use of the combined oral contraceptive (COC) pill in a young patient with no previous psychiatric history. An 11-year-old girl was placed on the COC pill for treatment of menorrhagia, 5 months after her menarche. She developed an initial encephalopathy, which progressed to psychosis. The estrogenic component of the COC pill is the most likely cause of this psychosis. COC pills should be used with caution in patients with an already high estrogenic state as occurs near menarche.
Asunto(s)
Encefalopatías/inducido químicamente , Anticonceptivos Orales Combinados/administración & dosificación , Anticonceptivos Orales Combinados/efectos adversos , Psicosis Inducidas por Sustancias/etiología , Esquizofrenia Paranoide/inducido químicamente , Encéfalo/patología , Encefalopatías/diagnóstico , Niño , Anticonceptivos Orales Combinados/uso terapéutico , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Imagen por Resonancia Magnética , Menarquia , Menorragia/tratamiento farmacológico , Psicosis Inducidas por Sustancias/psicología , Esquizofrenia Paranoide/psicología , Factores de TiempoRESUMEN
During treatment of chronic hepatitis C patients with interferon and ribavirin, a lot of side effects are described. Twenty-three percent to 44% of patients develop depression. A minority of patients evolve to psychosis. To the best of our knowledge, no cases of psychogenic parasitosis occurring during interferon therapy have been described in the literature. We present a 49-year-old woman who developed a delusional parasitosis during treatment with pegylated interferon alpha-2b weekly and ribavirin. She complained of seeing parasites and the larvae of fleas in her stools. This could not be confirmed by any technical examination. All the complaints disappeared after stopping pegylated interferon alpha-2b and reappeared after restarting it. She had a complete sustained viral response.
Asunto(s)
Antivirales/efectos adversos , Interferón-alfa/efectos adversos , Enfermedades Parasitarias/psicología , Ribavirina/efectos adversos , Esquizofrenia Paranoide/inducido químicamente , Antivirales/uso terapéutico , Femenino , Hepatitis C Crónica/tratamiento farmacológico , Humanos , Interferón alfa-2 , Interferón-alfa/uso terapéutico , Persona de Mediana Edad , Proteínas Recombinantes , Ribavirina/uso terapéutico , Esquizofrenia Paranoide/diagnóstico , Resultado del TratamientoAsunto(s)
Alopurinol/toxicidad , Supresores de la Gota/toxicidad , Gota/tratamiento farmacológico , Psicosis Inducidas por Sustancias/etiología , Esquizofrenia Paranoide/inducido químicamente , Adulto , Alopurinol/uso terapéutico , Antipsicóticos/administración & dosificación , Enfermedad Crónica , Clozapina/administración & dosificación , Quimioterapia Combinada , Femenino , Gota/genética , Supresores de la Gota/uso terapéutico , Alucinaciones/inducido químicamente , Alucinaciones/diagnóstico , Alucinaciones/tratamiento farmacológico , Humanos , Piperazinas/administración & dosificación , Psicosis Inducidas por Sustancias/diagnóstico , Recurrencia , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/tratamiento farmacológico , Tiazoles/administración & dosificaciónAsunto(s)
Fármacos Antiobesidad/efectos adversos , Ciclobutanos/efectos adversos , Esquizofrenia Paranoide/inducido químicamente , Fármacos Antiobesidad/uso terapéutico , Ciclobutanos/uso terapéutico , Delirio/inducido químicamente , Delirio/psicología , Humanos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/tratamiento farmacológico , Recurrencia , Esquizofrenia Paranoide/psicologíaRESUMEN
More and more young people consume cannabis in sometimes high dosage at an age when their brain is not yet fully developed and reacts particularly sensitive to toxic influences. Cannabis can induce and exacerbate psychotic symptoms and it can deteriorate the disease process in schizophrenic patients. First-episode schizophrenic patients with long-term cannabis consumption were significantly younger at disease-onset, mostly male and suffered more often from paranoid schizophrenia (with a better prognosis) than those without cannabis consumption in our investigation. The significance of higher serum neurotrophin levels in cannabis consuming schizophrenics as compared to those without cannabis consumption remains equivocal so far. The cognitive functions of this patient group are at least not worse than in those with schizophrenia alone. Taken together, the effect of cannabis on the brain vulnerable to schizophrenia is not yet completely understood; besides the undoubtedly deleterious effects, there may also be some neuroprotective effects.
Asunto(s)
Abuso de Marihuana/epidemiología , Esquizofrenia/epidemiología , Adolescente , Adulto , Factores de Edad , Encéfalo/efectos de los fármacos , Cannabinoides/efectos adversos , Comorbilidad , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Drogas Ilícitas/efectos adversos , Masculino , Abuso de Marihuana/sangre , Abuso de Marihuana/diagnóstico , Factores de Crecimiento Nervioso/sangre , Psicosis Inducidas por Sustancias/sangre , Psicosis Inducidas por Sustancias/diagnóstico , Psicosis Inducidas por Sustancias/epidemiología , Valores de Referencia , Esquizofrenia/sangre , Esquizofrenia/inducido químicamente , Esquizofrenia/diagnóstico , Esquizofrenia Paranoide/sangre , Esquizofrenia Paranoide/inducido químicamente , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/epidemiología , Factores Sexuales , Trastornos Relacionados con Sustancias/sangre , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/epidemiologíaAsunto(s)
Medicamentos Genéricos/efectos adversos , Loxapina/efectos adversos , Loxapina/uso terapéutico , Esquizofrenia Paranoide/inducido químicamente , Esquizofrenia Paranoide/tratamiento farmacológico , Equivalencia Terapéutica , Enfermedad Aguda , Anciano , Clozapina/efectos adversos , Clozapina/farmacocinética , Clozapina/uso terapéutico , Medicamentos Genéricos/uso terapéutico , Humanos , Loxapina/farmacocinética , Masculino , Errores de Medicación , Esquizofrenia Paranoide/psicología , Resultado del TratamientoRESUMEN
Three patients with probable dementia with Lewy bodies (DLB) experienced worsening delusions and visual hallucinations as a result of memantine therapy. Significant resolution occurred once treatment was discontinued. Caution is required when prescribing memantine to patients with possible DLB.