Successful use of electroconvulsive therapy in a patient with anorexia nervosa and severe acute-onset obsessive-compulsive disorder.

Anorexia nervosa (AN) is a complex condition that is often accompanied by several serious comorbidities that may require a variety of treatment modalities throughout the course of the illness. Obsessive-compulsive disorder (OCD), which is common in patients with AN, may occasionally cause serious interruptions to the daily functioning of the patient. We report on a 24-year-old male patient with chronic AN. During the beginning of his illness, he had a major depressive episode that was followed by AN onset. Throughout his illness, he also experienced chronic moderate depressive symptoms and later developed severe OCD. He experienced complete remission from the OCD and an improved mood after undergoing a course of bilateral electroconvulsive therapy (ECT). His OCD symptoms did not recur during the first year of follow-up. ECT may prove to be a fast and effective treatment strategy for severe and disabling acute-onset OCD that occurs during the course of comorbid AN. The case described herein shows how a comorbid psychiatric disorder in a patient suffering from chronic AN may disrupt the daily functioning of the patient if it is not urgently treated.

Increased incidence of autoimmune thyroiditis in patients with antipsychotic-induced hyperprolactinemia.

Prolactin (PRL) elevation in patients with prolactin-secreting pituitary tumors has been linked to increased prevalence of thyroid autoantibodies. However, the effects of antipsychotic drug-induced hyperprolactinemia (HPRL) on development of thyroid autoimmunity and also of other autoimmune phenomena have not been previously studied. To examine whether serum PRL levels were associated with the prevalence of thyroid autoantibodies in patients with schizophrenia receiving long-term antipsychotic treatment, we determined serum PRL, thyrotropin, free thyroxine levels, and the presence of antithyroid peroxidase and antithyroglobulin antibodies in 75 consecutive, clinically stable schizophrenic outpatients who had been on stable doses of antipsychotics for at least 3 months, and had no history of overt thyroid disease. We found that the prevalence of hyperprolactinemia was significantly higher in patients positive for thyroid autoantibodies, when compared with patients negative for them (p=0.045). Serum levels of prolactin were also significantly higher in patients with positivity for thyroid autoantibodies (p=0.039). In separate analyses for genders, a trend-level relationship was observed in females between increased levels of prolactin and the presence of thyroid autoantibodies (p=0.060). Our findings suggest that through the associated HPRL, long-term antipsychotic treatment can induce thyroid autoimmunity. Future research is required to investigate, whether other autoimmune processes might be triggered by antipsychotic drug-induced HPRL, and to what extent the immune alterations reported in patients with schizophrenia are related with this phenomenon.

Use of Lithium in Severe Acute Manic Episodes: Retrospective Prescription Practice From a Tertiary Inpatient Unit.

OBJECTIVE: A retrospective chart review was performed to investigate the common preferences of clinicians for the pharmacological treatment of acute manic episodes, with particular regard to lithium use, and to assess the adherence of clinical practice to established guidelines. METHODS: Cases of manic episodes in patients admitted to Bakirköy Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital were retrospectively reviewed. Length of stay, medication data, serum levels, and adverse effects were evaluated for patients who received lithium therapy (N=98). RESULTS: On the first day of lithium treatment, 81 patients received 900 to 1200 mg of lithium. In total, 44 patients were discharged with the same dose as that given on the first day of treatment. With the exception of 1 patient, the dose was increased by 300 to 600 mg in the remaining patients within the first 10 days on the basis of serum drug concentrations. The mean serum concentrations of lithium in the first week were 0.67±0.17 mEq/L in patients with no dose increase, and 0.51±0.15 mEq/L in patients who did receive a dose increase. In total, 94 patients received at least 1 antipsychotic medication in addition to lithium. CONCLUSIONS: Clinicians attempted to maintain serum lithium levels above 0.60 mEq/L at the time of acute treatment initiation, consistent with established guidelines. Clinical practice in large inpatient settings may force clinicians to use lithium in combination with antipsychotics for the treatment of acute mania; the delayed action of lithium and the need for rapid stabilization may drive these practices.