Malignant Syndrome and Serotonin Syndrome in a General Hospital Setting: Clinical Features, Frequency and Prognosis.

Objective The differences in the frequency and clinical features of malignant syndrome (MS) and serotonin syndrome (SS) in same population have only rarely been reported. To report the frequency and clinical features of MS and SS in a general hospital setting. Methods The clinical and laboratory features of patients with MS and those with SS, who were consecutively admitted to Chiba Rosai Hospital, during the past 4.5 years were reviewed. Results Of the 2005 patients admitted, MS was observed in 16 patients (0.8%) and SS in 2 (0.1%). In the 16 patients with MS, the underlying disorder included depression (n = 5), and dementia or parkinsonism (n = 11). The underlying etiology of the 2 patients with SS was depression. In 5 patients, MS was difficult to distinguish from SS because of overlapping symptoms and signs and/or treatments with both neuroleptic and serotoninergic drugs. Of the 16 patients with MS, 1 died, 1 remained wheelchair-bound, 4 were able to walk with assistance, and 10 regained their ability to ambulate independently. The 2 patients with SS recovered after cyproheptadine therapy and were discharged on foot. Conclusion MS occurs more frequently than SS in the general hospital setting. Underlying aetiologies in patients with MS were more common due to dementia or parkinsonism than in patients with psychiatric disorders. The differential diagnosis of MS and SS is often difficult and the diagnostic sensitivities largely differ for each of the diagnostic criteria. As a result, the establishment of new diagnostic criteria that specifically focus on distinguishing MS from SS is therefore required.

Avances en el tratamiento farmacológico del trastorno obsesivo-compulsivo / Advances in the pharmacological treatment of obsessive-compulsive disorder

Los antidepresivos serotoninérgicos, la farmacoterapia de primera lnea para el trastorno obsesivo-compulsivo (TOC), producen una respuesta cl¡nica favorable en 40-60% de los pacientes. Los medicamentos con eficacia en el tratamiento del TOC, seg£n los diversos mecanismos de acción, son: 1) sustancias que influyen sobre laserotonina: antidepresivos serotonin‚rgicos (inhibidores selectivos de la recaptación de serotonina y clomipramina), bloqueadores de los receptores 5-HT3 (ondansetrón y granisetr¢n) y antagonistas 5-HT1A (pindolol); 2) antipsicóticos: aripiprazol, risperidona y haloperidol; 3) anticonvulsivantes / estabilizadores del  nimo: lamotrigina; 4) farmacos relacionados con la función glutamatórgica: memantina, N-acetilciste¡na y ketamina; 5) anti-inflamatorios: celecoxib; 6) opi ceos: morfina; 7) farmacos que aumentan la funci¢n colinérgica; y 8) anti-andrógenos. Es de esperarse queen el futuro crezca el repertorio de alternativas farmacológicas para el tratamiento de esta entidad cl¡nica.

Serotoninergic antidepressants, the first line of pharmacotherapy for obsessive-compulsive disorder (OCD), induce afavorable clinical response in 40-60% of patients. Drugs that have shown efficacy for OCD treatment, on the basis of different mechanisms of action, are: 1) substance that work on serotonin: serotoninergic antidepressants (selective serotonin reuptake inhibitors and clomipramine), 5-HT3 receptor blockers (ondansetron and granisetron), and 5-HT1A antagonists (pindolol); 2) antipsychotic drugs: aripiprazole, risperidone and haloperidol; 3) anticonvulsant drugs / mood stabilizers: lamotrigine; 4) glutamatergic function-related drugs: memantine, N-acetylcysteine and ketamine; 5) anti-inflammatory drugs: celecoxib; 6) opioid drugs: morphine; 7) drugs that increase cholinergic function; 8) anti-androgen drugs. The repertoire of pharmacological alternatives for the treatment of OCD is expected to grow in the future.