Our results suggest the media has an active role promoting stigma, as well as passively broadcasting and thus passing on prejudices.
The psychiatric conditions secondary to substance use (whether legal or illegal drugs) are well characterized and include psychosis, mania, depression and behavior changes. We present a case of metformin-induced psychosis in a 79 years-old patient without any previous psychiatric history. She was brought to emergency room after suicide attempt by hanging. She had a one-month history of altered behavioral and presented paranoid delusional though. Hallucinations were excluded. A detailed clinical evaluation excluded dementia, late-onset chronic psychosis and primary mood disorders with psychotic symptoms and revealed that symptoms initiate few days after the introduction of metformin to treat her diabetes. After Metformin suspension, total remission of psychotic symptoms was obtained in one week and patient return to previous functionality. Psychosis secondary to metformin use is a very rare complication of oral antidiabetic drugs use but the awareness of this condition can lead to an earlier recognition and diagnosis.
IntroductionValproic acid (VA) is an effective mood stabilizer. Although it's usually well tolerated, it may cause hyperammonemia through carnitine deficiency created by its inhibition of mitochondrial enzymes in the urea cycle. Clinical presentation of hyperammonemia usually involves lethargy and somnolence but this diagnosis is often overlooked due to a clinical presentation that may include normal liver enzyme tests and serum VA levels within therapeutic range.ObjectivesTo present case-reports of VA-induced encephalopathy and a review study regarding the theme available in Medline.AimBrief literature review.MethodThree case-reports are presented and literature of this theme shortly reviewed.ResultsThe authors present cases of three adult females with Personality Disorder with lack of impulse control and Bipolar Disorder who have began treatment with VA and presented in the Emergency Department with generalized weakness and confusion. Subsequently, they developed hyperammonemia, despite its therapeutic serum levels and normal liver enzymes. În all cases the patient's mental status and ammonia level returned to baseline following discontinuation of VA.ConclusionsConfusion with VA is a serious, rather frequent but reversible side affect. It has been reported that VA can interfere with the enzyme carbamoylphosphate synthetase, which is responsible for incorporating ammonia into the urea cycle. It can also increase the transport of glutamine across the mitochondrial membrane in the kidney, thereby increasing the production of ammonia causing neurotoxicity. Clinicians should be aware of changes in patient's cognitive and functional capacity, especially in elderly patients and during the first two weeks of treatment.
IntroductionFactitious disorder (FD) is defined by the intentional production or feigning of physical or psychological symptoms with the objective of assuming the patient role. It's frequently difficult to adequately diagnose this disorder when the faked symptoms are those of a psychological or a psychiatric disorder. In these cases, there is often high comorbidity with other mental disorders, thus making it difficult to differentiate between real and factitious symptoms.ObjectivesTo present a case-report of FD with hallucinations and a review study regarding the theme available in Medline.AimBrief literature review.MethodA case report is presented and literature of this theme shortly reviewed.ResultsThe case involves a 23-year-old female, a psychology student, born in destructured family. She had attempted suicide many times since she was 16 years old, one of them with high lethality. One month before her admission to our inpatient clinic in order to allow a clear diagnosis to be made, she began active auditory hallucinations, persecutory delusional ideation with disorganized behavior and consequent social isolation. A suitable dose of atypical antipsychotic drug was administered but Psychotic disorder was ruled out and she was dignosed with FD. After the factitious symptoms that prevented any type of therapeutic approach disappeared, the real symptoms of the patient were those characteristic of a borderline personality disorder.ConclusionsThis case emphasizes the need for the careful observation of these patients in order to establish the diagnosis and to improve a specific management strategy for them.
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