RESUMO
OBJECTIVE: Herpes simplex virus (HSV) infection triggered n-methyl-D-aspartate (NMDA) encephalitis can lead to varied neuropsychiatric manifestations, including movement disorders and manic symptoms. HSV is known to affect the same brain regions as in secondary mania. METHOD: We present a 35-year-old female diagnosed with recurrent depressive disorder (RDD) who developed NMDA encephalitis triggered by HSV infection. RESULT: HSV-triggered NMDA encephalitis led to a manic switch in a woman with RDD on antidepressants, along with the new onset of dyskinetic movements. CONCLUSION: A neurological insult predisposed our patient to the variable effects of antidepressant drugs.
Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato , Transtorno Bipolar , Transtorno Depressivo , Encefalite por Herpes Simples , Feminino , Humanos , Adulto , Simplexvirus , N-Metilaspartato , Encefalite Antirreceptor de N-Metil-D-Aspartato/complicações , Encefalite Antirreceptor de N-Metil-D-Aspartato/diagnóstico , Encefalite Antirreceptor de N-Metil-D-Aspartato/tratamento farmacológico , Autoanticorpos , Transtorno Bipolar/complicações , Transtorno Bipolar/tratamento farmacológico , Encefalite por Herpes Simples/complicações , Encefalite por Herpes Simples/diagnóstico , Encefalite por Herpes Simples/tratamento farmacológico , ManiaRESUMO
BACKGROUND: Although alprazolam is approved only for use in panic disorder and generalized anxiety disorder, it is used for numerous other conditions, not only by psychiatrists but also by medical professionals in general. This commentary critically analyzes the use of alprazolam. METHODS: A narrative review approach was adopted, using relevant articles and textbooks, to compile pertinent literature for the aforementioned topic. RESULTS: Among all its adverse reactions, the most bothersome concern about the use of alprazolam is its potential for abuse and dependence. This can be attributed to certain unique pharmacokinetic and pharmacodynamic properties of this benzodiazepine. Also, the withdrawal triggered by use of alprazolam is challenging to treat. Alternate pharmacological and non-pharmacological strategies for use in anxiety and insomnia are available, which might be safer than alprazolam. Also, policy changes can serve as an answer to curb alprazolam abuse to some extent. Alprazolam might still be a good choice for individuals who do not have a history of abuse of other substances, with adequate psychoeducation and close monitoring of their usage pattern. CONCLUSION: There is a need to reconsider the need for long-term use of benzodiazepines in general, and alprazolam in particular. However, they still might be an appropriate choice in individuals where abuse and dependence are less likely.
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Ansiolíticos , Transtorno de Pânico , Humanos , Alprazolam/efeitos adversos , Benzodiazepinas/efeitos adversos , Transtorno de Pânico/tratamento farmacológico , Transtornos de Ansiedade/tratamento farmacológico , Transtorno da Personalidade Antissocial/induzido quimicamente , Transtorno da Personalidade Antissocial/tratamento farmacológico , Ansiolíticos/efeitos adversosRESUMO
Consultation Liaison Psychiatry (CLP) deals with the interface shared between psychiatry and various other disciplines of medicine. The interface shared by psychiatry and ophthalmology is among the lesser discussed ones in the field of CLP, despite the fact that it holds clinical relevance in the evaluation, management and outcomes of both psychiatric and ophthalmological disorders. This narrative review focusses on the ophthalmological aspects of psychiatric disorders, with respect to their manifestations, assessment, and management. Psychiatric disorders, including schizophrenia, affective disorders, 'functional' disorders, and substance use disorders, have numerous ophthalmic manifestations, which can have clinical implications for the patients. Even the psychotropic drugs given for psychiatric disorders can lead to side effects affecting the eye, but these are among the lesser-discussed side effects. Some psychiatric disorders can be investigated using various ophthalmic functions, the assessments ranging from simple physical examination to the use of instruments like a fundoscope, which can be useful for a psychiatrist in their routine practice. Lastly, eye functions can also be used in the treatment of psychiatric conditions, as is seen in eye movement desensitization and reprocessing. This review reiterates the fact that more attention needs to be given to the field of 'psycho-ophthalmology', which holds great promise in the coming days.
Assuntos
Oftalmopatias , Transtornos Mentais , Oftalmologia , Psiquiatria , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Transtornos Mentais/psicologia , Psiquiatria/métodos , Oftalmopatias/diagnóstico , Oftalmopatias/terapia , Psicotrópicos/efeitos adversos , Encaminhamento e ConsultaRESUMO
OBJECTIVE: To assess presentation of neurosyphilis with a focus on the psychiatric aspects. METHOD: File review of the cases with a positive cerebrospinal fluid venereal disease research laboratory test between 1999 to 2020. RESULTS: Medical records of 143 neurosyphilis patients were analysed. Hallucinations, delusions, and catatonia were the commonest psychiatric symptoms. Brain atrophy was the commonest neuroimaging finding. The number of neurosyphilis patients and the proportion with delirium or catatonia declined during the second decade (2010-2020). CONCLUSION: Atypical presentation of psychiatric symptoms around the fifth decade, with associated neurological symptoms or brain imaging changes, should prompt evaluation for neurosyphilis.
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Catatonia , Neurossífilis , Humanos , Catatonia/complicações , Atenção Terciária à Saúde , Neurossífilis/complicações , Neurossífilis/diagnóstico , Índia/epidemiologia , HospitaisRESUMO
There is a dearth of studies on neuroimaging correlates of Bipolar Disorder (BD) in Multiple Sclerosis (MS). We describe the clinical profile and neuroimaging findings of four cases of MS with BD. Among them, two patients had multiple mood episodes preceding the neurological symptoms, one had concurrent manic and neurological symptoms, and one had multiple depressive episodes and an isolated steroid-induced manic episode. Frontal and temporal lobes, and Periventricular White Matter were involved in all four cases, and hence may be considered biological substrates of BD in MS. Larger studies are needed to validate the utility of these findings.
Assuntos
Transtorno Bipolar , Imageamento por Ressonância Magnética , Esclerose Múltipla , Neuroimagem , Adulto , Humanos , Pessoa de Meia-Idade , Transtorno Bipolar/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Comorbidade , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/complicações , Neuroimagem/métodos , Substância Branca/diagnóstico por imagem , Substância Branca/patologiaRESUMO
The extent of variability in identified risk factors for suicide attempts (SA) in schizophrenia limits their generalization. This study aimed to identify the rates and associated correlates of SA in schizophrenia by reviewing a large cohort (n=500). Nearly one-fourth had a history of SA, which was independently associated with a family history of SA, more inpatient admissions, and better long-term treatment response. These findings highlight the complex interaction between biological factors influencing SA and illness determinants in schizophrenia. Furthermore, they reinforce the need for future research to unravel the association between suicide vulnerability and the pathophysiology of schizophrenia to attenuate morbidity and mortality associated with the same.
Assuntos
Esquizofrenia , Tentativa de Suicídio , Humanos , Esquizofrenia/epidemiologia , Índia/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Masculino , Adulto , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Centros de Atenção Terciária/estatística & dados numéricos , Fatores de Risco , Adulto JovemRESUMO
Bell's mania is the co-occurrence of delirium and mania. We present two cases of Bell's mania in a neurosurgical setting. The first case is of a 52-year-old male who presented with holocranial headache, disorientation, and manic symptoms for five months. He was found to have suprasellar craniopharyngioma. He significantly improved with olanzapine, but re-emergence of mood symptoms was noted after surgery. The second case is of a 42-year-old male who presented with a 15-day history of seizures and disorientation. He was found to have a dural arteriovenous fistula. He developed Bell's mania in the post-procedural period, which improved with olanzapine. Compression of the hypothalamo-pituitary stalk in the first case and vascular and inflammatory changes in the second case could have led to Bell's mania. Atypical age of onset and presence of neurological symptoms in patients presenting with psychiatric symptoms should raise the suspicion of an underlying organicity. Atypical anti-psychotics can be a useful management strategy for Bell's mania.
RESUMO
Ophthalmic disorders have psychiatric aspects associated with them at various levels. Psychological factors have a well-documented role in the causation, aggravation, and maintenance of various ophthalmic conditions, including glaucoma, central serous retinopathy, dry eye disease, and retinitis pigmentosa. Many ophthalmic conditions, including blindness, have psychological manifestations as well, which need to be addressed, in addition to the ophthalmic pathology. There is also significant overlap in the treatment of the two disciplines in many ways. For instance, many ophthalmic drugs have psychiatric side effects. Even ophthalmological surgeries have psychiatric aspects associated with them, which primarily include black patch psychosis and anxiety in the operation theater. This review will be useful for psychiatrists and ophthalmologists, for their clinical practice and research. Future research should focus on this interface to give it its well-deserved attention.