A Case Report of Serotonin Syndrome in a Patient on Selective Serotonin Reuptake Inhibitor (SSRI) Monotherapy.

INTRODUCTION: Paroxetine is a selective serotonin reuptake inhibitor (SSRI) with several indications, one of which is for depression. We present a case of probable paroxetine-induced serotonin syndrome. CASE SUMMARY: A 21-year-old female with a history of generalized anxiety disorder and major depression presented with increased depressive symptoms over several months while taking fluoxetine 20 mg daily. Fluoxetine was discontinued without taper and replaced with paroxetine 10 mg daily, along with hydroxyzine 50 mg twice daily as needed for anxiety. Within a week of starting the paroxetine, the patient reported increased anxiety, insomnia, and constant shaking. The paroxetine continued to be uptitrated over a 3-week period to a dose 30 mg due to unremitting depressive symptoms. One month later, the patient presented with tachycardia, generalized body aches, extreme fatigue, weakness, uncontrollable twitching, tremor, and hyperreflexia. A widespread burning sensation accompanied by random hot flashes without diaphoresis was also noted. Serotonin syndrome was diagnosed using the Hunters criteria. Paroxetine was discontinued, and the patient's physical symptoms resolved within a week. DISCUSSION: To date, only 5 cases of serotonin syndrome have been reported in patients receiving SSRI monotherapy at recommended therapeutic doses.

Current approaches to the assessment and management of anger and aggression in youth: a review.

BACKGROUND: Anger and its expression represent a major public health problem for children and adolescents today. Prevalence reports show that anger-related problems such as oppositional behavior, verbal and physical aggression, and violence are some of the more common reasons children are referred for mental health services. METHODS: An extensive review of the literature was conducted using the following online search engines: Cochrane, MEDLINE, PsychINFO, and PubMed. Published and unpublished articles that met the following criteria were included in the review: (a) experimental or quasi-experimental research designs; (b) nonpharmacologic, therapy-based interventions; and (c) study participants between 5 and 17 years of age. RESULTS: Cognitive-behavioral and skills-based approaches are the most widely studied and empirically validated treatments for anger and aggression in youth. Commonly used therapeutic techniques include affective education, relaxation training, cognitive restructuring, problem-solving skills, social skills training, and conflict resolution. These techniques, tailored to the individual child's and/or family's needs, can foster the development of more adaptive and prosocial behavior.