RESUMEN
This is a report of a series of three cases of trazodone-induced oral lingual dyskinesias. Each case demonstrated a distinct pattern of the development of this dyskinesia after trazodone exposure for several months. All cases showed abrupt cessation of the movement disorder when the drug was discontinued. Two of the three cases had no prior exposure to any dopamine-blocking agents. One of the three had a distant exposure to a dopamine antagonist. Trazodone has a mechanism of action that can account for both the development and treatment of dyskinetic movements. This article will discuss proposed mechanisms for trazodone's action with an emphasis on case reports of dystonic movements being more prevalent in the elderly.
RESUMEN
This is a case report of three cases of trazodone-induced buccal-lingual dyskinesias. Each case demonstrated the distinct pattern of the development of this dyskinesia after trazodone exposure for several months. All cases showed abrupt cessation of the movement disorder when the drug was discontinued. One of the three cases demonstrated a highly unusual presentation of an on/off pattern of buccal dyskinesia directly related to repetitive exposure and termination of the drug trazodone. Two of the three cases had no prior exposure to any dopamine blocking agents. One of the three had a distant exposure to a dopamine antagonist. As opposed to other antidepressants, trazodone has a mechanism of action which can account for both the development and treatment of dyskinetic movements. Its metabolite, M/chlorophenylpiperazine (M-CPP) is a 5HT2C agonist capable of causing abnormal oral-facial movements in rodent models. The presence of oromandibular dyskinetic movements can occur spontaneously with age, with trazodone being a potential predisposing factor. This article will discuss proposed mechanisms for trazodone's action with an emphasis on case reports of dystonic movements.
RESUMEN
Factors associated with posttraumatic growth (PTG) are investigated in mothers who have suffered fetal or infant death. Mothers (N = 66) completed the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996), the Core Beliefs Inventory (CBI; Cann et al., 2010), and answered questions about the severity of their loss, age of fetus or infant, time since loss, social support, finding meaning, and involvement in loss-related behavior. Results indicate a greatly traumatic loss (M = 4.41), a great degree of core belief disruption (M = 3.57), and a moderate level of PTG (M = 2.80). CBI scores are positively correlated with severity of the loss and age of the fetus or infant. PTGI scores are positively related to CBI scores and to social support from family and friends who have suffered similar losses and support groups. PTG and finding meaning are positively correlated with involvement in loss-related activities and supporting others.
RESUMEN
Clozapine is often considered the gold standard for the treatment of schizophrenia. Clinical guidelines suggest a gradual titration over 2 weeks to reduce the risks of adverse events such as seizures, hypotension, agranulocytosis, and myocarditis. The slow titration often delays time to therapeutic response. This raises the question of whether, in some patients, it may be safe to use a more rapid clozapine titration. The following case illustrates the potential risks associated with the use of multiple antipsychotics and rapid clozapine titration. We present the case of a young man with schizophrenia who developed life threatening neuroleptic malignant syndrome (NMS) during rapid clozapine titration and treatment with multiple antipsychotics. We were unable to find another case in the literature of NMS associated with rapid clozapine titration. This case is meant to urge clinicians to carefully evaluate the risks and benefits of rapid clozapine titration, and to encourage researchers to further evaluate the safety of rapid clozapine titration. Rapid clozapine titration has implications for decreasing health care costs associated with prolonged hospitalizations, and decreasing the emotional suffering associated with uncontrolled symptoms of psychosis. Clozapine is considered the most effective antipsychotic available thus efforts should focus on developing strategies that would allow for safest and most efficient use of clozapine to encourage its utilization for treatment resistance schizophrenia.
RESUMEN
BACKGROUND: In the absence of effective treatments for the negative symptom complex of schizophrenia, we explored the effect of 4 consecutive weeks of repetitive transcranial magnetic stimulation (rTMS) exposure (20 sessions) as an add-on treatment to atypical antipsychotics. METHODS: Three groups of 17 schizophrenic subjects each were exposed to 20 treatments of either placebo, 1 Hz (100 pulses per day=2000 total) or 10 Hz (1000 pulses per day=20,000 total) rTMS at 110% motor threshold over the left dorsolateral prefrontal cortex, while being maintained on their atypical antipsychotic. Subjects were evaluated at baseline, weeks 2 and 4, and at 4-week follow-up after the last treatment. RESULTS: The primary outcome measure (change in Scale for Assessment of Negative Symptoms score) showed a statistically significant drop at weeks 2, 4, and 8 for the high frequency (10 Hz) group, but not the 1 Hz or placebo groups. Secondary outcome measures of the Wisconsin Card Sorting Test and SF-36 did not demonstrate any significant change. CONCLUSIONS: rTMS may serve as a relatively noninvasive treatment of the negative and neurocognitive deficits associated with schizophrenia.
