Secondary mania associated with enterococcal meningitis in an elderly patient.

Primary mania is associated with bipolar disorder, whereas secondary mania may result from many etiologies, including metabolic, pharmacological and neurological causes. Strong evidence has shown that, in older adults, new onset mania is more likely associated with an underlying cause, suggesting that late-onset mania is often secondary [Bipolar Disord. 2004;6(5):343-67]. Cryptococcal meningitis has been reported to induce secondary mania [Gen Hosp Psychiatry. 2005;27(4):301-3]. Here, we present a 75-year-old female patient who developed mania as a symptom of enterococcal meningitis. To our knowledge, this is the first report describing secondary mania in a case of enterococcal meningitis.

Multiple intracerebral hemorrhages in an elderly patient after adding quetiapine to a stable warfarin regimen.

The efficacy of antipsychotics in patients with dementia exhibiting psychiatric symptoms has been overshadowed by safety concerns in recent years. Evidence suggests that the long-term use of antipsychotics in older adults is associated with a greater risk of cerebrovascular adverse events than accrues with short-term use (less than 30 days) [J Clin Psychiatry. 2010;71(6):689-98]. Here, we present an elderly male patient with dementia who developed multiple intracerebral hemorrhages (ICHs) 3 days after the addition of quetiapine to his stable warfarin regimen. To our knowledge, this is the second case of possible interaction between quetiapine and warfarin. We suggest mechanisms that may account for the patient's clinical presentation and highlight that combining treatment with quetiapine and warfarin may cause serious complications in patients with risk factors for ICH.

Delayed-onset diurnal bruxism, psychic akinesia and depression after carbon monoxide poisoning: a case report.

Diagnosing the delayed neuropsychological sequelae of carbon monoxide (CO) poisoning is a clinical challenge because of its varied presentations. Pallidal lesions, the most common site of involvement in CO poisoning [Clin Radiol. 2000;55(4):273-80] can cause psychic akinesia [Mov Disord. 2001;16(5):810-4; J Neurol Neurosurg Psychiatry 1984;47(4):377-85]. We present a patient with diurnal bruxism, psychic akinesia and depression that were delayed manifestations of CO poisoning.

Comparison of the efficacy and impact on cognition of glycopyrrolate and biperiden for clozapine-induced sialorrhea in schizophrenic patients: a randomized, double-blind, crossover study.

BACKGROUND: Clozapine-induced sialorrhea (CIS) is a subjective distressing adverse effect and occurs in 31%-57% of schizophrenic patients receiving clozapine therapy. Current pharmacotherapy on CIS has focused on anticholinergic agents, even though they may impair cognitive function. Previous case reports have suggested the benefit of glycopyrrolate or biperiden in treating this condition, but no randomized controlled trial has provided evidence. The objective of our study was to evaluate the efficacy and impact on cognition of glycopyrrolate and biperiden treatments for schizophrenic patients suffering from CIS. METHODS: Patients who satisfied the inclusion criteria entered a 12-week, randomized, double-blind, crossover, fixed-dose trial. The study consisted of two 4-week crossover phases, which were separated by a 4-week washout period. Sialorrhea and global cognitive function were assessed by using a Drooling Rating Scale (DRS) and the Mini Mental State Examination (MMSE), respectively. RESULTS: Throughout the study, patients treated with glycopyrrolate or biperiden had significantly reduced DRS scores. Moreover, the DRS scores were significantly lower with glycopyrrolate treatment than with biperiden. In other respects, there were no significant differences in MMSE scores in patients treated with glycopyrrolate. However, we found a significant reduction in MMSE scores in patients treated with biperiden. CONCLUSION: We provide evidence, for the first time, of the efficacy of glycopyrrolate and biperiden in the treatment of CIS. Furthermore, glycopyrrolate displays less impact on cognitive function. Consequently, glycopyrrolate can become a valid option for treating CIS. Observations from our study serve as a springboard for additional large-scale prospective trials.

Arsenic-induced Mre11 phosphorylation is cell cycle-dependent and defective in NBS cells.

Cancer-prone diseases ataxia-telangiectasia (AT), Nijmegen breakage syndrome (NBS) and ataxia-telangiectasia-like disorder (ATLD) are defective in the repair of DNA double-stranded break (DSB). On the other hand, arsenic (As) has been reported to cause DSB and to be involved in the occurrence of skin, lung and bladder cancers. To dissect the repair mechanism of As-induced DSB, wild type, AT and NBS cells were treated with sodium arsenite to study the complex formation and post-translational modification of Rad50/NBS1/Mre11 repair proteins. Our results showed that Mre11 went through cell cycle-dependent phosphorylation upon sodium arsenite treatment and this post-translational modification required NBS1 but not ATM. Defective As-induced Mre11 phosphorylation was rescued by reconstitution with full length NBS1 in NBS cells. Although As-induced Mre11 phosphorylation was not required for Rad50/NBS1/Mre11 complex formation, it might be required for the formation of Rad50/NBS1/Mre11 nuclear foci upon DNA damage.