Low risk of viral hepatitis amongst patients with severe mental disorders.

BACKGROUND AND AIMS: Patients with severe mental disorders (SMD) have been classically considered as a particularly high-risk population for bloodborne virus infections. We performed a systematic screening of hepatitis B and C virus among the population with SMD in the area of influence of Hospital Clínic (Barcelona) in order to evaluate the real prevalence of these infections and achieve HCV microelimination in this subpopulation. METHODS: We screened two cohorts for anti-HCV and HBsAg: Cohort A (hospitalized patients with SMD, done systematically) and Cohort B (outpatients, mental health centre-CSMA, done voluntarily). Risk factors and socio-demographic variables were collected. In positive cases, telematic review was activated by Hepatology, calculation of FIB-4 and prescription of direct-acting agents (DAA) in HCV or follow-up in HBV. RESULTS: In Cohort A, 404 patients were screened. 3 HBV patients were detected (0.7%). In all of them, there was a history of drug use. 12 anti-HCV positive patients were detected (3%); 8 of them had a history of drug use. Among the HCV positive, only 2 patients were viraemic (received DAA, both achieving SVR) as most of them (n = 6) had already been cured with DAA. In cohort B, 305 patients were screened, after 542 (64% of the target population) declined to participate. No cases of HCV or HBV were detected. CONCLUSIONS: HCV/HBV prevalence among SMD population with no history of drug use does not seem to be different from the general population. These data may be of interest for defining health policies.

Total serum cholesterol levels and suicide attempts in child and adolescent psychiatric inpatients.

Associations between cholesterol and suicidal behavior in adolescent patients have not been explored in depth. In this study, 66 patients consecutively admitted to a psychiatric inpatient unit following attempted suicide were compared with a control group of 54 patients with no history of suicide attempts. The age range of the sample was from 8 to 18 years old. Cholesterol levels were significantly lower in attempted suicide patients than in controls (p < 0.02), supporting the hypothesis that lower cholesterol levels might be associated with suicidal behavior in patients with similar acute phase of their disorder.

Syndrome of inappropriate secretion of antidiuretic hormone due to citalopram and venlafaxine.

INTRODUCTION: Selective serotonin reuptake inhibitors (SSRIs) and venlafaxine are often used to treat depression in the elderly due to their low incidence of side effects. All five of the SSRIs currently available and venlafaxine have been associated with hyponatremia. CASE REPORT: This article describes the case of an 87-year-old man with depression who presented with hyponatremia after starting treatment with citalopram. After excluding other common causes of hyponatremia, a diagnosis of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) was confirmed. Sodium levels returned to the normal range following discontinuation of citalopram. Subsequently, due to the persistence of depression, treatment with venlafaxine was initiated. Three weeks later, hyponatremia associated with SIADH was once again diagnosed and venlafaxine was discontinued. The hyponatremia resolved in 2 weeks. DISCUSSION: Both SSRIs and venlafaxine have been associated with SIADH in numerous case reports and retrospective studies. Risk factors for developing hyponatremia with these drugs are advanced age and treatment with other medications. To our knowledge, this is the first case report in which SIADH was associated with two different families of antidepressants in the same patient. CONCLUSION: Physicians should be aware of the risk of hyponatremia when prescribing SSRIs and venlafaxine in elderly patients with multiple drug therapies. Sodium levels should be monitored during treatment.