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Possible Antipsychotic Effect of Fluvoxamine
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I am responding to the article by Dr. Stephen Stahl entitled “Antipsychotic treatment of psychotic major depression: potential role of the s receptor” (CNS Spectr. 2005;10(4):319-323).1
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3/15/2006
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Ziprasidone and Hypomania
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In a recent article, Crane described the successful use of ziprasidone as an augmenting agent in treating anxiety disorders.
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3/25/2006
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Serious Adverse Events and the Modafinil Augmentation Study
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Questions regarding the completed suicide and the case of leukopenia/neutropenia in the February 2006 article by Thase and colleagues, “Modafinil Augmentation of SSRI Therapy in Patients with Major Depressive Disorder and Excessive Sleepiness and Fatigue: A 12-Week Open-Label, Extension Study.”
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4/28/2006
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Dietary-Free Glutamate: Implications for Research on Fear-Overconsolidation and PTSD
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The focus on glutamate neurotransmission presented in the October 2005 CNS Spectrums was a turning point in the conceptualization of overconsolidational fear disorders, such as posttraumatic stress disorder (PTSD). We would like to draw attention to a potential confounding factor that can be controlled in future studies.
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5/26/2006
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Applications of Virtual Reality Technology in the Measurement of Spatial Memory in Patients with Mood Disorders
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It appears that a limited number of researchers have considered using virtual reality (VR) for clinical assessment and research purposes. This is likely to change as immersive VR shows promise for increasing ecological validity in assessment and providing a much richer set of behavioural data.
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6/14/2006
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Effectiveness of Lidocaine Patch 5% in Patients With or Without Allodynia
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I would like to clarify one issue regarding the use of the lidocaine patch 5%. Freeman states that the lidocaine patch 5% “is most effective in patients with allodynia.” Although the original studies conducted included only patients with allodynia, more recent clinical data suggests the lidocaine patch 5% is equally effective in patients without allodynia.
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12/7/2006
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Prevalence Underestimated in Problematic Internet Use Study
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Aboujaoude and colleagues’ telephone survey measuring the self-report of “problematic Internet use” is a useful start in determining the prevalence of this compulsive behavior in the United States. However, the results surely underestimate the extent of the problem.
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12/27/2006
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Sensory Phenomena, “Just-Right” and “Not Just-Right” Experiences in OCD Patients: Looking for a Consensus
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Several studies have addressed the subjective experiences that might precede or accompany repetitive behaviors, such as tics and/or compulsions, in obsessive-compulsive disorder and Tourette’s syndrome patients.
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1/25/2007
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Medication Management with Panic Disorder in the Exercise State: Some Prescribing Guidelines
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The question of whether exercise has an acute antipanic activity versus inducing panic symptoms is not without controversy. A literature search revealed no data regarding the utility of serotonin reuptake inhbitors regarding possible modulating effects during exercise. Here is a case presentation that discusses the benefits of medication in panic disorder regarding the ability to tolerate higher intensities of exercise.
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2/21/2007
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Behavior and Substance Addictions: Is the World Ready
for a New Category in the DSM-V?
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We read with interest the letter to the editor by Block that identifies some interesting points of discussion in the context of the article by Aboujaoude and colleagues. Block describes the distinction between various terms such as “problematic Internet use," “compulsive computer use” and “computer addiction” rather meticulously and, to conclude, uses the phrase “potential disorder." Our objection is to the use of the phrase “potential disorder.”
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3/21/2007
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A Case of Long-Term Maintenance ECT in a 78-Year-Old with Depression and Possible Parkinson’s Disease
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Electroconvulsive therapy (ECT) is a well-established treatment modality in psychiatry. However, much concern has been raised about the possible cognitive effects of long-term ECT. ECT is an efficacious treatment option for major depression, especially with melancholic features, cases that are medication resistant or are acutely suicidal, and those with associated psychotic features. There is also sufficient data1 to suggest that ECT helps in movement disorders, especially Parkinson’s disease.
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4/23/2007
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Sertraline and Hyperpigmentation: A Case Report
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Sertraline is a selective serotonin reuptake inhibitor (SSRI) that affects the serotnin neurotransmitter. Reported side effects of SSRIs are mostly mild and the most frequent are headache, vomiting, insomnia, and tremor. Reported skin reactions to SSRIs are mainly rash. There are some reports of hyperpigmentation with flouvoxamine and paroxetine.
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5/21/2007
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Ziprasidone-Associated Mania in a Case of Obsessive-Compulsive Disorder
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Mr. B is a 64-year-old male, treated for over 30 years for GAD with obsessive features, later more accurately defined as OCD per DSM-IV criteria. His obsessions of contamination and time-consuming cleaning rituals had been resistant to trials of several medications, including all available selective serotonin reuptake inhibitors, clomipramine up to 75 mg/day and venlafaxine up to 150 mg/day, as well as cognitive-behavioral therapy.
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7/26/2007
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Abnormal Motor Movements Associated with Combining Psychostimulants and Atypical Antipsychotics in Children
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There has been increasing debate about the use of psychostimulants combined with antipsychotics for treatment of attention-deficit/hyperactivity disorder and comorbid aggression. Many clinicians have observed significant problems with dystonia. The following case series suggests more investigation should be completed before use of this combination of medications should be considered.
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8/27/2007
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A Seven-Year Follow-Up of an Extremely Refractory Bipolar I Patient
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We report the 7-year follow-up of a 40-year-old married woman previously reported as an extremely refractory depressed patient who was repeatedly hospitalized in our department and treated with a variety of aggressive but unsuccessful treatment trials (including combinations) lasting at least 4 months each.
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9/18/2007
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Gamma Hydroxy Butyric Acid and Sodium Oxybate Used to Treat Posttraumatic Stress Disorder
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In contrast to stimulants, which increase norepinephrine and dopamine activity, and modafinil, which likely increases histamine activity to improve alertness, gamma hydroxy butyric acid (GHB), and likely sodium oxybate’s, mechanism of action may include the induction of deep, more restorative sleep through GABA-B receptor agonism. Allopragnanolone and allotetrahydrodeoxycorticosterone are neurosteroids that are enhanced after GHB dosing, and these allosteric modulators increase GABA-A receptor activity lending to hypnotic effects as well.
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10/26/2007
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Chronic Psychotic Disorder Due to Steroid-Responsive Encephalopathy Associated with Hashimoto’s Thyroiditis
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Hashimoto’s thyroiditis is a common cause of thyroid disorder worldwide. This thyroiditis often progresses to hypothyroidism. Psychiatric disorders, especially depression, are commonly described in these patients even after correction of hypothyroidism. Herein we report on a case of a steroid responsive encephalopathy associated with Hashimoto’s thyroiditis misdiagnosed as a primary chronic psychotic disorder.
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11/2/2007
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Treatment of Pica Behavior with Olanzapine
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Pica behavior, the ingestion of items not generally recognized as food, is a diverse syndrome with multiple possible etiologies. Explanations of its pathogenesis include seeking trace mineral supplementation, psychosis, and purposeful self-injury. Associated conditions include iron-deficiency anemia, pregnancy, malnutrition, and chronic renal insufficiency. Pica behavior shares features similar to bulimia, trichophagia, and obsessive-compulsive disorder.
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12/26/2007
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Therapeutic Possibility of “Semax” for Depression
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Along with emerging evidences regarding the role of neurotropic/growth factors in the development of major depression, I attempt to suggest the therapeutic possibility of a revolutionary neuropeptide, “Semax” functioning as neuroregulator, neuromodulator and neuroprotector, in relation with the treatment of major depression.
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12/26/2007
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Anti-suicidal and Self-harm Properties of Lithium Carbonate
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Rosenberg and Salzman’s comprehensive review about novel uses for lithium and anticonvulsants omitted mention of the prevention effects of lithium carbonate on suicide and self-harm behaviors in patients with mood disorders. These effects have been well described in other reviews.
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1/25/2008
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rTMS in Headache Prophylaxis: When Case Reports Hide Our Ignorance
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O’Reardon and colleagues recently showed that daily sessions of high frequency repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) in patients with headache and major depressive disorder can induce relief of depressive symptoms and headache pain. Although these interesting case reports point toward rTMS as a potential therapeutic tool in headache, they mainly highlight a need for clarification.
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2/19/2008
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Self-Mutilation: A Symptom of Psychiatric Disorder or a Nosological Entity with its Own Characteristics?
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Self-mutilation behaviors (SMBs) are becoming increasingly more frequent, especially among youths, causing considerable suffering. In a similar manner with obsessive-compulsive disorder patients with SMB report previous intolerable affects followed by short-lived emotional relief after they hurt themselves, despite ashamed feelings and attempts to hide the injuries. Conversely, sometimes the same patients describe self-mutilation as an irresistible urge when under a stressful situation, hinting impulsive traits.
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3/26/2008
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Differential Diagnosis Between the Early Onset of Schizophrenia and Bipolar Disorder: Potential Role of Neuroimaging
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4/9/2008
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Pravastatin as a Therapeutic Agent for Atypical Antipsychotic-Induced Metabolic Syndrome in Patients with Schizophrenia
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Patients with serious mental disorders experience excess morbidity and mortality, including an increased prevalence of metabolic syndromes. It has been demonstrated that 19% to 63% of schizophrenic patients, 42.4% of patients with schizo-affective disorder, 24.6% to 50% of bipolar patients and 12% to 36% of the patients with recurrent depression have been reported to suffer metabolic syndrome, where atypical antipsychotics are widely prescribed for those patients.
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4/21/2008
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Clinical Experiences and Clinical Trials
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The title of the November “In Session” with Stephen R. Marder, MD, (“Newer Antipsychotics and the Difference between Clinical Experiences and Clinical Trials”) implies that the results of clinical trials may be equivalent to or perhaps even more doubtful than clinical experience in evaluating antipsychotics.
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5/21/2008
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Letter to the Editor
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5/21/2008
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Back to Briquet and Charcot
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In March 1996, a 51-year-old man was urgently admitted to the hospital due to left-sided neurologic symptoms. The patient experienced clumsiness and muscle weakness in the left upper and lower limbs. The patient had been well earlier, but during the preceding year his left eye had been examined by an ophthalmologist because of feeling of pressure and ache, but no significant findings emerged. Two weeks earlier, the patient had experienced nausea and feeling of pressure on the forehead.
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6/19/2008
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Obessive-Compulsive Disorder After Streptococcal Infection in
a Frontal Lobe-Resected Patient
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We report the case of a patient who needed neurosurgery for controlling epilepsy and later developed obsessive-compulsive symptoms after a streptococcal infection. We hypothesize that the onset of these symptoms may have been triggered by a previous lesion of the blood-brain barrier, caused by a neurosurgery.
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7/24/2008
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QTc Prolongation Associated with Ziprasidone Overdose
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In general, atypical antipsychotics have a similar efficacy to the conventional agents in the treatment of the positive symptoms of schizophrenia. However, unlike the conventional agents, they are efficacious at treating the negative symptoms of schizophrenia. As a class, atypical antipsychotics have gained increased acceptance by clinicians due to their perceived superiority to conventional agents in the area of side effects. Nevertheless, it is important to recognize that all antipsychotics have been associated with serious side effects (eg, movement disorders, metabolic syndrome, and cardiovascular symptoms).
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8/1/2008
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Acute Transverse Myelitis and Guillain–Barre Overlap Syndrome Following Influenza Infection
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A female, 34 years of age, was admitted to the hospital with a 5-day history of burning pain bilaterally in the legs, urinary retention, and leg weakness. Neurologic examination revealed abolished Achilles reflexes. She had been recovering from influenza, which she acquired ~4 weeks before admission. Four days before admission she noted some tingling in her left pinky finger that spread and traveled up her hand to the mid-forearm along the lateral aspect of the arm.
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8/20/2008
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Abdominal Tics During Atomoxetine Treatment in a Child With ADHD: Evaluation and Differential Diagnosis
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Atomoxetine is a selective norepinephrine reuptake inhibitor purported to be a safe alternative for children with attention-deficit/hyperactivity disorder and comorbid tics. However, multiple reports suggest that atomoxetine may precipitate and exacerbate tics. We present a child in which abdominal tics were associated with atomoxetine treatment.
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8/26/2008
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About Lamotrigine and Its Hepatic Effects
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Lamotrigine is a promising agent for bipolar disorders and research on use in other psychiatric disorders are still carried on. It is generally well tolerated but its hepatic effects still appear to be unclear.
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9/16/2008
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Can Antidepressants Act as Potential Pro-neoplastic Agents in Patients with Neurotrophic Factor-Related Cancers?
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The prevalence of major depressive disorder is estimated to be 40% in patients with cancer, and this is a 2- to 4-times higher frequency than that in the general population. Long-term, adequate antidepressant treatment is thought to be the most effective way to treat cancer-related depression, and the response rate has been reported as high as 80%.
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9/30/2008
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Diagnostic Dilemmas Associated with Bipolar Disorder After Traumatic Brain Injury
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12/1/2008
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Treatment of FG Syndrome After Discontinuation of ECT
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The patient is a 24-year-old man with a history of FG syndrome (FGS) hospitalized for acute psychosis and agitation. He was given a diagnosis of FGS due to the presence of the following clinical features: an imperforate anus, borderline intellectual functioning, and agenesis of his corpus callosum at birth. He stayed in our psychiatric hospital for 8 weeks and was treated with electroconvulsive treatment (ECT) which he had received for the previous 3 years.
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12/29/2008
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A Response to "Brain Lesions Manifesting as Psychiatric Disorders: Six Cases" by Bunevicius et al, November 2008
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12/30/2008
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The Leukoencephalomalacia and Porencephalia Changes in the Brain and the Potential Usefulness of Olanzapine Treatment
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Encephalomalacia is developed by softening or loss of brain tissue following cerebral infarction, cerebral ischemia, infection, craniocerebral trauma, or other injury. Although the significance of encephalomalacia in the development of psychotic symptoms has not been found till today, volume reduction in white and gray matters has been proposed to be strongly associated with the development of psychotic symptoms2 We report on the case of a patient who developed a psychotic episode possibly associated with multiple leukoencephalomalacia and porencephalia changes in the brain cortex who was eventually responded well to olanzapine.
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1/21/2009
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Computerized Neuropsychological Assessments: Pros and Cons
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3/2/2009
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Selective Benefit of Donepezil on Oral Naming in Alzheimer’s Disease in Men Compared to Women
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Donepezil is a widely prescribed treatment for patients with probable Alzheimer’s disease. Although it is accepted that donepezil can slow the decline of cognitive functioning in various stages of Alzheimer’s disease, sex differences affecting its efficacy are often omitted from a prescribing rationale.
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4/6/2009
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Statins May Act Through Increasing Tissue Plasminogen Activator/Plasmin Activity to Lower Risk of Alzheimer’s Disease
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Members of the family of hydroxymethylglutaryl coenzyme A reductase inhibitors, collectively known as statins, are the treatment of choice for the management of hypercholesterolaemia because they are of proven efficacy and established safety. Several epidemiological studies have demonstrated that, in addition to exerting a cholesterol-lowering effect, statins also appear to lower the incidence and prevalence of Alzheimer’s disease.
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4/22/2009
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Varenicline-induced Mixed Mood and Psychotic Episode in a Patient with Schizoaffective Disorder
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Varenicline is an a4ß2 nicotinic cholinergic receptor (nAChR) partial agonist approved for smoking cessation. We present a patient with schizoaffective disorder, bipolar type, who received varenicline and experienced an activated manic episode and psychotic relapse.
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7/13/2009
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A Case of MELAS Presenting as Anorexia Nervosa
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The case presented describes a 24-year-old female with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke (MELAS) who was diagnosed with anorexia nervosa (AN) and treated for the eating disorder for two years before her mitochondrial cytopathy was detected.
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11/4/2009
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Schizophreniform Psychosis at Onset of Adrenoleukodystrophy
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Psychotic symptoms were described at multiple neurological diseases. Their presentation with neurological signs or findings at image modalities, should conduce to a complex process of differential diagnosis. X-linked adrenoleukodystrophy (ALD) shows a wide range of phenotypic variability. The following case report presents a patient with schizophreniform psychosis at adult onset of ALD.
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12/4/2009
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Clarification Regarding Generic Substitution for Psychotropic Drugs
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Please be advised that there is an error in the article, “Generic Substitutions for Psychotropic Drugs,” which appeared in the September 2009 Supplement to CNS Spectrums, Volume 14, Number 9. In several places in the article, statements indicate that a generic formulation is available for escitalopram, and provides a generic availability date of 2006. These statements are incorrect.
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12/4/2009
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Zinc Sulfate Could be a Potential Agent for the Treatment of Huntington’s Disease Through Activating Central TrkB Signaling
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Huntington’s disease (HD) is a neurodegenerative genetic disorder manifested by chorea and other hyperkinetic and hypokinetic movement disorders. Currently, there are no effective neuroprotective therapies for HD and symptomatic treatments, which are palliative in nature, remain the cornerstone of medical management.
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2/24/2010
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Bipolar Disorder and Tuberous Sclerosis Complex:
Is It A Mere Coincidence?
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Tuberous sclerosis complex (TSC) is associated with significant psychiatric comorbidity mainly in the form of autistic disorders, hyperkinetic disorders, depression, and anxiety disorders. There are very few reports of bipolar disorder in TSC.
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3/3/2010
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Pulvinar Sign in Wernicke’s Encephalopathy
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We present the case of a 39-year-old woman, who was reported to the German Creutzfeldt-Jakob-Disease (CJD) Surveillance Unit. Her magnetic resonance image (MRI) was suggestive of variant CJD (vCJD), which would have been the first case in Germany.
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3/26/2010
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Stimulants in Bipolar Disorder: Beyond Common Beliefs
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Concerning the common belief that stimulants may trigger a (hypo)manic or mixed episode or destabilize bipolar disorder in the long run, McIntyre argues that the avoidance of stimulants in bipolar disorder is not evidence based, because controlled studies are lacking. Therefore, the author supports the judicious use of stimulants in carefully selected bipolar patients in order to reduce comorbid ADHD symptoms.
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6/22/2010
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Varenicline-induced Psychosis
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Varenicline is a novel therapeutic agent used for smoking cessation. It was launched in Turkey in 2008, 2 years after receiving Food and Drug Administration approval in the United States.
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6/28/2010
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The Tissue Plasminogen Activator/Plasmin System
May Act Through Cleavage of Pro-BDNF to Increase Risk of Substance Abuse
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Substance abuse is a complex trait that is influenced by neurobiological, psychosocial, and environmental factors.
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6/28/2010
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Dimensional psychopathology and vulnerability to
psychosis: envisaging the third generation of prodromal/Ultra High-Risk models
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Early identification of psychosis is one of the fields of contemporary psychiatry where pioneering efforts to promote evidence-based practices is closely coupled with an original, translational-oriented concept development.
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6/28/2010
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Burst Transcranial Magnetic Stimulation for the Treatment of Tinnitus
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We read with interest the report “Theta Burst Stimulation in the Treatment of Incapacitating Tinnitus Accompanied by Severe Depression,” by Soekadar and colleagues. The authors describe the successful use of theta burst transcranial magnetic stimulation (TMS) of the temporoparietal cortex for the treatment of severe tinnitus.
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7/28/2010
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Lamotrigine-Associated Depersonalization
Symptoms
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7/28/2010
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Auditory Hallucinations Associated with Headaches Following Traumatic Brain Injury
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7/28/2010
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Rapid improvement in bipolar II depression induced by low-dose lamotrigine augmentation: Two case reports
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9/2/2010
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A Severe Case of Bupropion Hydrochloride Extended-Release Monotherapy-Associated Visual Hallucinations and Delirium in a Female Patient with Major Depressive Disorder
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9/2/2010
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