The following articles are currently In Press and will be published in the next issue of
Successful Resolution Of Prominent Somatic Delusions Following Bi-temporal Electroconvulsive Therapy In A Patient With Treatment- Resistant Schizoaffective Disorder
Joshua L. Cohen, PhD, My-Hanh Thi Vu, MD, Mirza Adam Beg, BS, Soumya Sivaraman, MD, Badari Birur, MD
Somatic delusions occur in a variety of psychiatric disorders including schizophrenia, major depressive disorder, and bipolar disorder. Somatization is associated with lower quality of life and greater risk for suicide. Treatment of somatic delusions is extremely challenging. Here we report an interesting case of severe somatic delusions in a 48-year-old African-American female with a long history of treatment resistant schizoaffective disorder, with multiple somatic complaints surrounding constipation, pregnancy, jaw pain, body aches, vaginal itch, malodorous urine, and neck pain, despite normal clinical examinations and negative medical work up. Additionally, she endorsed persistent auditory and visual hallucinations. Her symptoms remained resistant to several trials of psychotropic medications, including clozapine. Chart review of past hospitalizations revealed significant improvement with Electroconvulsive Therapy (ECT), so the team decided to perform a course of six bi-temporal ECT treatments administered over two weeks. Stimulation was applied at a current of 800mA for 4.5s, with a pulse width of 1ms and frequency of 60 Hz. This case illustrates the successful use of ECT in treating prominent somatic delusions in a patient with treatment- resistant schizoaffective disorder.
Involuntary Facial Twitching In A Patient With Schizophrenia On Treatment With Long Acting Injectable Olanzapine
Feras Ali Mustafa, Agastya Nayar
We report a case of a 49 year old Caucasian male with chronic schizophrenia and a history of non-compliance with treatment, due to lack of insight, resulting in multiple acute psychotic relapses that required compulsory admissions to hospital during which he was treated orally with olanzapine, risperidone and aripiprazole monotherapies.
Revisiting Lithium: Utility for Behavioral Stabilization in Adolescents and Adults with Autism Spectrum Disorder
Mark Mintz, MD and Emma Hollenberg
To examine the efficacy of lithium as a mood stabilizer for patients with autism spectrum disorder (ASD).
A retrospective chart review was performed that examined the use of both extended and immediate release lithium carbonate in patients with ASD that were treated at a single clinical center (CNNH NeuroHealth). Clinical Global Impression (CGI) scales were used to quantify baseline severity of ASD and mood symptoms as well as improvement after treatment with lithium carbonate.
Our retrospective chart review found that 73.7% (n=14) of patients with ASD and concomitant maladaptive behaviors experienced “improvement” (CGI-I rating ≤ 3) with the addition of lithium to their treatment regimen. Those with comorbid “ADHD” phenotype were most predictive of an efficacious response (p = 0.038, Odds Ratio 12.2).
Lithium carbonate is a viable, efficacious and well tolerated alternative to various neuroleptics and other psychotropic medications for use as a mood stabilizer for patients with ASD.
Serum Concentration of Paliperidone Palmitate Administered Every 3 Weeks
Johan Y. Cohen, Ariane Dumoulin-Charette, Nafaa Meraabi, and Raphaël Poirier
Schizophrenia, a disabling yet relatively common mental illness, is often controlled by antipsychotic drugs. However, long-term treatments are subject to non-adherence and consequent treatment failure. Non-adherence can be reduced by administration of slow-release drugs such as intramuscularly injected (IM) paliperidone palmitate. Considerable inter- and intra-individual variation in serum drug concentration exists, whose effect on clinical efficacy remains unclear. We report two cases of off-label use resulting in serum paliperidone levels greatly exceeding the recommended therapeutic window. A 20- and 31-year-old male were treated with 150 mg IM paliperidone palmitate/21 days. After one and two years, blood drug concentrations were 240 nmol/l and 610 nmol/l, respectively. Neither patient exhibited major adverse effects. Thus paliperidone serum levels greatly in excess of recommended targets can be well tolerated, although we urge caution with off-label use of paliperidone palmitate as it is not always the most appropriate way to achieve the control of schizophrenia.
Delayed-Onset Toxicity In An Adolescent Case Following Attempted Suicide With An Overdose Of Paliperidone Intake
Ferhat Yaylacı, Önder Küçük, and Handan Özek Erkuran
Paliperidone is a relatively novel atypical antipsychotic drug that is currently used to treat schizophrenia in adolescents and adults. The drug was generated by combining the active metabolite of risperidone, 9- hydroxyrisperidone, with osmotic controlled- release oral administration system (OROS) technology. Due to its specific design, the drug has been identified as a different form, albeit an active metabolite of risperidone. Such distinction mainly manifests itself during pharmacokinetic processes, because paliperidone is not affected by CYP2D6 metabolism. On the other hand, this drug is regularly released for a period of 24 hours. Even though it is possible to reach relevant literature on the efficacy and safety of paliperidone use in detail, limited data regarding its toxicity exists. A review of the literature in that sense, has revealed a scarce number of case reports and a retrospective study existing. Bearing in mind the specific form and design of the drug, we have hypothesized its toxicity might cause diverse clinical presentations, in the face of overdose or poisoning. This might in turn, prompt us to switch our usual evaluation and intervention practices. With this case report, we have aimed to discuss delayed onset toxicity with paliperidone overdose in an adolescent case, due to a suicide attempt with excessive intake of the medication.
Identifying Predictors of Primary Adherence to Second Generation Long-Acting Injectable Antipsychotics Following Discharge from an Acute Inpatient Psychiatry Unit
Jenna L. Gilbert, Leigh Anne Nelson, Pharm.D., BCPP, Carrie R. Kriz, MS, Yifei Liu, B.S. Pharm, Ph.D., Courtney A. Iuppa, Pharm.D., BCPP, Lauren A. Diefenderfer, Pharm.D., BCPP, Ellie S.R. Elliott, Pharm.D., BCPP, and Roger W. Sommi, Pharm.D., BCPP, FCCP
Describe primary adherence and medication persistence to second generation long-acting injectable (LAI) antipsychotics following an inpatient psychiatry hospitalization, compare rates of psychiatric-related hospital readmissions and emergency visits within 6 months of discharge between patients who were adherent versus nonadherent, and explore predictors of primary adherence to second generation LAI antipsychotics following hospitalization.