A manic episode in a 64-year-old man: an adverse effect of varenicline

Varenicline is a novel treatment for smoking cessation. However, it has not been well studied in patients with medical and psychiatric comorbidity. We report a case of an acute manic episode in a 64-year-old man with a history of bipolar disorder post stroke, who was started on varenicline. This case demonstrates the importance of monitoring neuropsychiatric adverse drug reactions after the start of varenicline therapy in patients with a current or past history of mental illness.     

Quetiapine in acute mania: a case report (with a six-month follow-up)

Quetiapine is an effective and well-tolerated antipsychotic. To date, experience with quetiapine in bipolar disorders is very limited and information on the use in acute patients is lacking. A patient with a DSMIV diagnosis of acute mania intolerant to lithium and to neuroleptics was treated with quetiapine. The daily dosage of quetiapine was gradually titrated up to 600 mg t.i.d. Quetiapine was effective, as evidenced by rating scale scores of the BPRS, YMRS and CGI, which dropped by 91% and 94% respectively from baseline (devoid of relevant side-effects). Quetiapine seems to be a promising agent for the treatment of manic episodes in bipolar disorders, although controlled trials are needed.     

"The detergent is circulating in my blood": a case report

INTRODUCTION : We report an interesting case of monosymptomatic hypochondriacal psychosis (MHP) which, because of its rarity, tends to be neglected in differential diagnosis. The patient presented with delusions including smelling the odour of detergent and thinking detergent was circulating in his blood. He had many medical and paramedical treatments over 2½ years, and was finally diagnosed with MHP. METHOD : Risperidone was then started, and gradually increased. RESULTS : A significant improvement was observed. However, risperidone was discontinued, because of its hypomanic effects. CONCLUSION : We suggest that risperidone may be an effective alternative treatment in MHP cases, but the hypomanic effects may limit its usefulness. (Int J Psych Clin Pract 2002; 6: 117-119)     

A daughter of a depressed mother: a case report

Stern notes that infants attempt to enliven their depressed mothers. The reconstructed childhood of a patient who was the daughter of a depressed mother is discussed. The treatment of this 31-year-old single woman whose talk was rapid, whose comments were studded with high-powered names, and whose checks bounced is described. The intensity of this patient's attempts to connect with the therapist illustrated her need to enliven the therapist. This adult charmer is reminiscent of the infants that Stern observed in interaction with their depressed mothers.     

Validation of the Hypomania Checklist (HCL-32) in a nonclinical sample of German adolescents

We tested the psychometric properties of the Hypomania Checklist (HCL-32) in a sample of nonclinical adolescents, examined the association with current psychopathology, and tested if “hypomanic” adolescents differ from other participants regarding HCL-scores and psychopathology. A total of 294 students completed the HCL-32 and the SDQ, a screening for psychopathology. In adolescence, the internal structure of hypomania seems to be represented by a triple structure. The first factor “active-elated” is an indicator of symptoms related to energy and activity. The adult factor “irritable-risk taking” is better reflected by two separate factors (“disinhibited/stimulation-seeking” and “irritable-erratic”). These factors were associated with externalizing problems. “Hypomanic” adolescents showed higher HCL total and disinhibited/stimulation-seeking scores and reported more conduct problems than “non-hypomanic” youngsters. The internal structure of the HCL in adolescents mirrors the association of juvenile bipolarity with substance use and symptoms of ADHD and conduct disorder and presents preliminary evidence for its validity.     

Evidence of weekly cyclicity in mood and functional impairment in those with a bipolar disorder

A key characteristic of bipolar disorder is fluctuation in mood symptoms and functional capacity, yet assessment of bipolar symptomatology often relies heavily on interval measurement that is unable to capture the full range of daily symptom variability and severity. The current study provides a detailed analysis of the variability in mood symptoms, functional impairment and medication compliance in a large sample of individuals newly diagnosed with bipolar disorder. Individuals diagnosed with bipolar disorder in the previous 12 months (n=192) rated their mood, functional impairment, medication compliance and symptom triggers daily over 10 consecutive weeks. High mood, low mood and functional impairment were found to vary on a weekly cycle, independently of medication compliance. Low mood and functional impairment were worse on weekdays, particularly Mondays and Tuesdays, whereas mood was most elevated on Saturdays. Work-related stressors were the most common symptom triggers on weekdays, whereas sleep-related problems and positive social events were the most common triggers on weekends. This study provides evidence that individuals newly diagnosed with bipolar disorder experience fluctuations in mood and functioning that vary according to a weekly cycle. This finding has implications for the assessment and treatment of patients, and for future research.     

对抗精神病药不良反应敏感者1例

1病例简介 患者,女,18岁,因“猜疑、耳闻人语4月,加重1周,总病程7年”第2次住院。患者2003年3月起病,表现为猜疑被害,曾在当地医院住院,诊断精神分裂症,予以氯氮平治疗,最高剂量为125mg／d,用药后第4周出现粒细胞下降（白细胞2．7×10^9／L,中性粒细胞1．24×10^9／L）,而自动出院。     

Transient aphasia after right-unilateral ultrabrief electroconvulsive therapy: A case report

A brief period of aphasia is an extremely rare and likely underreported adverse effect of electroconvulsive therapy. Clinical studies that have described this phenomenon are scarce and its prevalence is unknown. We present a unique case of a 35-year old woman, who underwent an outpatient ECT session at our department, followed by a short span of aphasic symptoms, the extent of which were monitored clinically and via the czech version of the Minnesota aphasia screening test.     

Lowering the seizure threshold in electroconvulsive therapy using transcranial magnetic stimulation: A case report

We demonstrate the feasibility of lowering the seizure threshold using a combined approach of electroconvulsive therapy and transcranial magnetic stimulation. High-frequency transcranial magnetic stimulation of the supplementary motor area shortly before each electroconvulsive treatment session resulted in a reduction of the seizure threshold by half in a male patient with a severe psychotic depressive episode of bipolar affective disorder.     

Coprophagia in an elderly man: a case report and review of the literature

OBJECTIVE: Coprophagia or the ingestion of feces has long been associated with psychiatric illness. It is considered to be a variant of pica. This behavior requires an extensive medical and psychiatric differential diagnosis. Medical disorders associated with coprophagia include seizure disorders, cerebral atrophy, and tumors. Psychiatric disorders associated with coprophagia include mental retardation, alcoholism, depression, obsessive compulsive disorder, schizophrenia, fetishes, delirium, and dementia. In animals, coprophagia is associated with boredom, thiamine deficiency, and lesions of the amygdala. METHODS: A case of coprophagia in an elderly man is reported here. A 77-year-old man with mild mental retardation was referred for urgent psychiatric evaluation due to coprophagia. The case is discussed and the literature reviewed. RESULTS: Psychiatric evaluation revealed cognitive dysfunction and depression. Physical examination and laboratory evaluation were noncontributory. He was started on sertraline 25 mg daily with resolution of his coprophagia. Coprophagia has been treated using behavioral interventions, supportive psychotherapy, elemental diets, tricyclic anti-depressants, carbamazepine, haloperidol, and electroconvulsive therapy. CONCLUSIONS: Use of Selective Serotonin Reuptake Inhibitors (SSRIs) may also be an effective treatment for coprophagia, particularly in the setting of depression or anxiety.     

Neurologic symptoms in a depressed woman : A medical-psychiatric case conference

A 48-year-old woman with head and neck pain and upper extremity weakness demonstrated equivocal neurologic findings and otherwise essentially negative laboratory and x-ray evaluations. An interview at a case conference revealed significant depression, severe marital discord, and a poor self-image. The correlation of the onset of her physical symptoms with certain life events suggested that psychologic factors were important contributors to her disorder. Discussed here are an approach to understanding such problem patients and methods of ongoing management.     

Notalgia paresthetica following neuralgic amyotrophy: a case report

Abstract. We report the case of a patient who developed notalgia paresthetica during the recovery from a neuralgic amyotrophy. A 23-year-old woman had a typical neuralgic amyotrophy (severe shoulder pain, followed by a long thoracic nerve palsy); five months after the onset of pain, when scapular winging was improving, she began to feel a burning sensation in a restricted interscapular area, on the same side. Electromyography was consistent with a long thoracic nerve neuropathy, with minor neurogenic changes in deltoid and biceps brachii. Radiography of the spine was unremarkable. The notalgia paresthetica disappeared shortly before the complete recovery of scapular winging. The abnormal activation of shoulder girdle and spine extensor muscles during the time of long thoracic nerve palsy may explain the association between the two disorders.     

Vestibulo-ocular dysfunction induced by cortical damage in man: a case report.

We studied the rare case of a patient presenting with vestibulo-ocular dysfunction and clinical vestibular symptoms after right temporo-parietal cortex infarction. The vestibulo-ocular reflex (VOR) was elicited in the dark, by sinusoidal (0.02; 0.05 and 0.1 Hz) and by step velocity rotation (100 degrees/s2) in clockwise and counterclockwise directions. Horizontal and vertical eye movements were recorded by DC electro-oculography (EOG). When compared to a control group of 8 healthy subjects, this patient presented VOR asymmetry with (1) a significant VOR velocity bias toward the lesioned side revealed as a vestibulo-ocular offset that occurred only under dynamic conditions (2) a significant reduction of the VOR time constant when rotation was directed to the lesioned side. VOR gain was normal. We suggest that the parieto-temporal cortex is implicated in the regulation of vestibulo-ocular symmetry in man. This cortical processing of vestibular integration might involve a multidimensional velocity storage integrator that subserves the maintenance of spatial coordinates along the spatial vertical axis.