Mental Disorders: Posttraumatic Stress Disorder.

Posttraumatic stress disorder (PTSD) has a lifetime incidence of approximately 6.1% in the US population. However, studies of patients receiving regular primary care have shown a higher point prevalence, ranging from 11.1% to 24.5%. Multiple factors have been implicated in the etiology of PTSD, including genes, epigenetic regulation, neuroendocrine factors, inflammatory markers, autonomic risk and resilience, and sleep disturbances. There are many risk factors for PTSD, including exposure to trauma at a younger age, a high number of adverse childhood experiences, and a previous diagnosis of a mental disorder. Military personnel, police officers, and first responders who experience repeated or extreme exposure to traumatic events are at increased risk of PTSD. The National Institute for Health and Care Excellence (NICE) recommends that clinicians in the primary care setting consider screening for PTSD in patients with unexplained physical symptoms that may be associated with PTSD. Multiple evidence-based screening tools are available. If the patient is willing, psychotherapy is the treatment of choice, followed by combined psychotherapy and pharmacotherapy. PTSD is associated with many significant comorbidities and mortality.

Restless legs syndrome following the use of ziprasidone: a case report.

Restless legs syndrome (RLS) is a common sleep-related movement disorder characterised by an uncomfortable urge to move the legs that occurs during periods of inactivity. Although there have been many case reports on antipsychotic-induced RLS, ziprasidone has never been reported as a cause of RLS. We present a case of a female patient with schizophrenia who presented with symptoms of RLS following the administration of high doses of ziprasidone added to quetiapine and valproate. The patient's symptoms of RLS occurred following the administration and titration of ziprasidone to 160 mg, and were relieved upon reducing the dose to 120 mg/day. Other potential causative medications and differential diagnoses that could have caused similar symptoms were excluded. Clinicians should be aware of the potential for ziprasidone-induced RLS. Dopamine and serotonin interaction could be the mechanism underlying ziprasidone-induced RLS.

Massive atropine eye drop ingestion treated with high-dose physostigmine to avoid intubation.

CASE: A 34-year-old male presented after ingesting 150 mg of atropine. He had altered mental status, sinus tachycardia, dry mucosa, flushed skin, and hyperthermia. Sequential doses of physostigmine, totaling 14 mg, were successful in reversing antimuscarinic toxicity and prevented the need to perform airway control with endotracheal intubation. At completion of treatment, heart rate and mental status had improved, and intubation was never performed. DISCUSSION: Atropine causes anticholinergic toxicity; physostigmine reverses this by inhibiting acetylcholinesterase. Atropine eye drop ingestions are rare. The 14 mg of physostigmine administered is much higher than typical dosing. It is likely the physostigmine prevented intubation. Atropine eye drops can be dangerous, and physostigmine should be considered in treatment.