Neuroleptic Malignant Syndrome with Low-dose Quetiapine After Venlafaxine Withdrawal: A Case Report. / Venlafaksin Kesilmesinin Arkasindan Düsük Dozda Ketiyapin Kullanimi ile Gelisen Gürültülü Nöroleptik Malign Sendrom: Olgu Sunumu.

Neuroleptic Malignant Syndrome (NMS) is an idiosyncratic and potentially life-threatening drug reaction. Although uncommon, NMS cases induced by oral quetiapine have been reported. Most reports have predisposing risk factors such as an organic brain disorder, concomitant use of other antipsychotics or lithium, overdose or rapid titration. NMS with low doses of quetiapine is a much rarer clinical picture. Venlafaxine is commonly associated with withdrawal upon discontinuation sometimes as soon as the next day. In this case report, a 40-year-old man treated with venlafaxine for generalized anxiety disorder with symptoms of full-blown NMS after venlafaxine withdrawal, induced by low-dose quetiapine (50 mg), is presented. In accordance with the previous reports, we speculate that venlafaxine withdrawal was a predisposing factor in our case however we also discussed other possible explanations for NMS. Acknowledging the risk of NMS, even with low doses of quetiapine in patients devoid of known risk factors, is of paramount importance for prompt diagnosis and mitigating morbidity and mortality. To our knowledge, this is the first case of NMS with such a low dose of quetiapine without any other known risk factors or substances. Keywords: Antipsychotics, NMS, Quetiapine, Venlafaxine, Consultation Liaison Psychiatry.

Remission and follow-up of a bipolar depression patient treated with Accelerated Intermittent Theta Burst Stimulation protocol. / Hizlandirilmis Aralikli Teta Patlayici Stimülasyon protokolü ile bipolar depresyonda remisyon ve takip.

No abstract available.

Bidirectionality of LF when the movie makes you sad: Effects of negative emotions on heart rate variability among patients with major depression.

OBJECTIVES: Heart rate variability (HRV) reflects the capacity to adapt to internal and environmental changes. Decreased HRV may indicate inadequate adaptive capacity. This study aims to investigate the relationship between the heart and brain's adaptive abilities, both at rest and when negative emotions are stimulated in depression. SUBJECTS AND METHODS: The study included 30 patients (20 female, 10 male) with major depression (mean age = 29.8 ± 7.8) and 30 healthy controls, all of whom had similar characteristics in terms of age and gender, selected through convenience sampling. The patients were drug-free at the time of the assessment. Holter recordings were obtained while subjects watched videos stimulating anger, fear, sadness, and a neutral video, and at rest, HRV parameters were calculated. To control for interindividual variability and account for paired sampling, linear mixed effects models were employed. RESULTS: Watching the 'sadness video' led to an increase in low frequency band (LF) [LF change (Control vs depression); Difference:-620.80 df:107 t:-2.093 P:0.039] and LF/high frequency band ratio (LF/HF) [LF/HF change (control vs depression group); Difference:-1.718 df:105 t:-2.374 P:0.020] in the depression group. The video led to a decrease in LF and LF/HF in the controls. Although the differences between the conditions and interactions with the group were significant, the effects were independent of depression severity. CONCLUSION: In depression, brain's regulatory effect on the heart differed from controls in the sadness condition, possibly due to increased arousal levels in subjects with depression and their inability to suppress sympathetic activity when a state of sadness is stimulated.

The superiority of ketofol and etomidate against propofol or thiopental anesthesia for ECT.

OBJECTIVES: Most anesthetic drugs used for electroconvulsive therapy (ECT) have dose-dependent anticonvulsive effects, counter-acting seizure induction, lowering seizure quality. However, a consummate drug for ECT anesthesia has not yet been established. Therefore, in this study, we aimed to investigate the effects of etomidate, thiopental, propofol and co-administration of ketamine-propofol (ketofol) on seizure quality and hemodynamic safety. METHODS: Registries of 121 patients (1077 sessions) were retrospectively evaluated. The effects of anesthetics on ECT-related parameters (stimulation charge, central seizure duration, number of failed stimulation trials, mean arterial pressure, and peak heart rate) were analyzed via linear mixed-effects models. RESULTS: Overall, the seizure duration decreased, and the stimulation charge increased in time with continuing sessions within a course of ECT. The decrease in seizure duration and the increase in required stimulation charge was significantly lower with etomidate and ketofol. Additionally, ketofol was significantly related to a lower number of failed stimulation trials compared to propofol. Ketofol and propofol use was associated with a significantly lower postictal mean arterial pressure. CONCLUSION: Ketofol and etomidate were equivalently superior in the rate of decrease in seizure duration and the required elevation in stimulus charge, which would interpret into valuable clinical guidance, especially for "seizure resistant" patients, and their use may potentially lower ECT related cognitive side effects.