Selective Serotonin Reuptake Inhibitor-Induced Hyponatremia: Clinical Implications and Therapeutic Alternatives.

BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed among the general population. Despite their benign side effect profile, these drugs can cause significant adverse effects in elderly patients, including severe hyponatremia. We report 1 case of SSRI-induced hyponatremia and review therapeutic alternatives. CASE: We present an 81-year-old male patient treated with sertraline and furosemide who presented with a recent-onset symptomatic hyponatremia. Low sodium levels persisted for more than 1 week after furosemide had been discontinued. Sertraline was then replaced with a nonserotonergic antidepressant (bupropion), leading to a full recovery. CONCLUSIONS: Although SSRIs are the first treatment option for elderly depressed patients, they should be prescribed cautiously in this population because of the risk of potentially severe adverse effects such as hyponatremia. Particularly vulnerable patients could benefit from being prescribed nonserotonergic antidepressants from the start.

A systematic review of the frequency and severity of manic symptoms reported in studies that compare phenomenology across children, adolescents and adults with bipolar disorders.

BACKGROUND: In the last two decades, there has been a significant increase in the diagnosis of Bipolar Disorder (BD) in children. The notion of prepubertal onsets of BD is not without controversy, with researchers debating whether paediatric cases have a distinct symptom profile or follow a different illness trajectory from other forms of BD. The latter issue is difficult to address without long-term prospective follow-up studies. However, in the interim, it is useful to consider the phenomenology observed in groups of cases with different ages of onset and particularly to compare manic symptoms in children diagnosed with BD compared to cases presenting with BD in adolescence and adulthood. This review systematically explores the phenomenology of manic or hypomanic episodes in groups defined by age at onset of BD (children, adolescents and adults; or combined age groups e.g. children and adolescents versus adults). METHODS: Literature reviews of PubMed and Scopus were conducted to identify publications which directly compared the frequency or severity of manic symptoms in individuals with BD presenting with a first episode of mania in childhood, adolescence or adulthood. RESULTS: Of 304 studies identified, 55 texts warranted detailed review, but only nine studies met eligibility criteria for inclusion. Comparison of manic symptoms across age groups suggested that irritability is a key feature of BD with an onset in childhood, activity is the most prominent in adolescent-onset BD and pressure of speech is more characteristic of adult-onset BD. However, none of the eligible studies made a direct comparison of phenomenology in children versus adults. Assessment procedures varied in quality and undermined the reliability of cross-study comparisons. Other limitations were: the scarcity of comparative studies, the geographic bias (most studies originated in the USA), the failure to fully consider the impact of psychiatric comorbidities on recorded symptoms and methodological heterogeneity. CONCLUSIONS: Despite frequent discussion of similarities and differences in phenomenology of mania presenting in different age groups, systematic research is lacking and studies are still required to reliably establish whether the frequency and severity of manic symptoms varies. Such information has implications for clinical practice and the classification of mental disorders.

Should definitions for mental disorders include explicit theoretical elements?

In this article we argue that mental disorders have come to be defined according to a descriptive theory of meaning. In other words, mental disorders are defined according to superficial descriptive criteria that count as necessary and sufficient criteria for the inclusion of a particular instance under its corresponding class. These descriptive criteria are allegedly theory independent, leading to the assumption that psychiatric symptoms are directly identified in an object-like fashion. Against this view, we hold that a descriptive theory of meaning is unable to offer a proper account of the meaning of mental disorders both due to its own internal limitations and to the specific nature of psychiatric phenomena. Due to the hermeneutic structure of psychiatric practice, we argue that the identification and description of mental symptoms and disorders unavoidably depends on (frequently unacknowledged) theoretical assumptions. Since there is no global consensus regarding these theoretical commitments, and due to the fact that these significantly affect the final picture we hold with respect to each mental disorder, we believe that these commitments should be explicitly stated both in diagnostic argumentation and in theoretical discussions in order to maximise self- and mutual understanding.

The problem of psychopathology and phenomenology. What is viable and not viable in phenomenological psychiatry.

The epistemological underpinnings of psychiatric theory and practice have always been unstable. This reflects the essential contradiction existing between the task (the description and individuation of speech and behavior as psychopathological symptoms) and tools (semiotics). As a result of this contradiction, the history of psychiatry is one of permanent crisis in which there are moments of temporary stability as approaches that aim at organizing this mismatch between tasks and tools gain prevalence. However, these approaches can only offer a false sense of unity, consistency and progress. In this sense, a narrow perspective on a particular period may lead us to believe that psychiatry is just another medical specialty with its own specific theoretical framework like others. However, any such perspective overlooks the coexistence of different schools, disagreements, contradictions, global alternatives, etc. For a certain period of time, phenomenology was assumed to be as the solution for psychiatry’s internal contradiction. As we see it, phenomenology was only partially understood. Despite the great influence it exerted upon psychiatry worldwide, it finally fell into disuse as a mere empiricism. Husserl’s phenomenology was more thoroughly understood and better assimilated by other psychiatrists, and its influence has persisted to the present day. If we view phenomenology in its proper (Husserlian) sense, it is possible to understand psychopathology as a means of creating intelligibility and clarifying the uniqueness of psychiatry. On the other hand, if phenomenology is understood as a representational theory, it will eventually lead to an unavoidable relapse into psychologism, which has been the main path of psychiatry until now.

El problema psicopatológico y la fenomenología. Lo vivo y lo muerto en la psiquiatría fenomenológica / The problem of psychopathology and phenomenology. What is viable and not viable in phenomenological psychiatry

La psiquiatría es un saber y una práctica epistemológicamente inestable desde siempre. Esta inestabilidad se asienta en la contradicción esencial que desde sus comienzos, al configurar la positividad de su referente, se establece entre tareas (descripción e individuación de expresión y conducta) y herramientas (semiología). Por ello la historia de la psiquiatría muestra una permanente crisis, estabilizada por formas transitoriamente hegemónicas de organizar ese desajuste entre tareas y herramientas, que, sin embargo, permite ofrecer la falsa percepción de unidad, consistencia y progreso. Si se escotomiza la mirada sobre su curso puede parecer que se trata de una especialidad médica entre otras atendiendo a los ciclos hegemónicos de equilibrio, obviando las distintas corrientes, disensiones, contradicciones, alternativas globales etc. La fenomenología fue durante un tiempo la ocasión para estabilizar esa contradicción. Pero se trataba de una acepción de fenomenología parcial que a pesar de tener gran influencia se abolió en un empirismo. Hay otra acepción de la fenomenología que comprende la filosofía de Husserl más atinadamente y que no ha dejado de tener influencia hasta el presente. En la permanente necesidad de salvar esa contradicción esencial vio y ve la psiquiatría en la fenomenología la posibilidad de enfrentarse a ella de otro modo. Dependiendo de cómo se asuma, permite la posibilidad de contribuir a entender la psicopatología como forma de crear inteligibilidad, definiendo así la peculiaridad de la psiquiatría, o entendiéndose como una teoría representacional, seguir mostrando las limitaciones que le impiden escapar del psicologismo y recaer en el reduccionismo como ha sido el camino seguido en psiquiatría de forma preferente hasta la actualidad (AU)

The epistemological underpinnings of psychiatric theory and practice have always been unstable. This reflects the essential contradiction existing between the task (the description and individuation of speech and behavior as psychopathological symptoms) and tools (semiotics). As a result of this contradiction, the history of psychiatry is one of permanent crisis in which there are moments of temporary stability as approaches that aim at organizing this mismatch between tasks and tools gain prevalence. However, these approaches can only offer a false sense of unity, consistency and progress. In this sense, a narrow perspective on a particular period may lead us to believe that psychiatry is just another medical specialty with its own specific theoretical framework like others. However, any such perspective overlooks the coexistence of different schools, disagreements, contradictions, global alternatives, etc. For acertain period of time, phenomenology was assumed to be as the solution for psychiatry’s internal contradiction. As wesee it, phenomenology was only partially understood. Despite the great influence it exerted upon psychiatry worldwide, it finally fell into disuse as a mere empiricism. Husserl’s phenomenology was more thoroughly understood and better assimilated by other psychiatrists, and its influence has persisted to the present day. If we view phenomenology in its proper (Husserlian) sense, it is possible to understand psychopathology as a means of creating intelligibility and clarifying the uniqueness of psychiatry. On the other hand, if phenomenology is understood as a representational theory, it will eventually lead to an unavoidable relapse into psychologism, which has been the main path of psychiatry until now (AU)