IntroductionDespite drastic increases in antipsychotic prescribing in youth, data are still limited regarding their safety in this vulnerable population, necessitating additional tools for capturing long-term, real world data.MethodsWe present SENTIA (SafEty of NeurolepTics in Infancy and Adolescence; https://SENTIA.es), an online registry created in 2010 to track antipsychotic adverse effects in Spanish youth <18 years old currently taking or initiating with any antipsychotic treatment. SENTIA collects information on sociodemographic, diagnostic and treatment characteristics, past personal medical/psychiatric history, healthy lifestyle habits and treatment adherence. Additionally, efficacy and adverse effect data are recorded including the Children’s Global Assessment Scale; Clinical Global Impressions scale for Severity and Improvement, the Safety Monitoring Uniform Report Form, Simpson-Angus Scale, Abnormal Involuntary Movement Scale, vital signs, blood pressure, and EKG. Finally, fasting blood is drawn for hematology, electrolytes, renal, liver and thyroid function, glucose, insulin, lipid, prolactin and sex hormone levels. Initially, a diagnostic interview and several psychopathology scales were also included. Patients are assessed regularly and followed even beyond stopping antipsychotics.ResultsSince 01/17/2011, 85 youth (11.5 ± 2.9 (range = 4-17) years old, 70.6% male) have been included at one inaugural center. After a mean duration of 17 ± 11 (range = 1-34) months, 78.8% are still actively followed. For feasibility reasons, the diagnostic interview and detailed psychopathology scales were dropped. The remaining data can be entered in <30 minutes. Several additional centers are currently being added to SENTIA.ConclusionsImplementation of a systematic online pharmacovigilance system for antipsychotic adverse effects in youth is feasible and promises to generate important information.
Emergency peripartum hysterectomy (EPH) is usually performed in cases of intractable obstetric hemorrhage unresponsive to conservative treatment. EPH is associated with a high incidence of maternal morbidity and mortality. Most of these women do not have the opportunity to even start breastfeeding. We report a case where breastfeeding was attempted after EPH. The mother spent 6 days in the intensive care unit and suffered several medical and surgical complications. On day 7 she was reunited with her baby. One month later, a diagnosis of post-traumatic stress disorder was made. Breastfeeding became very important, with the patient frequently expressing that this was the most healing aspect in her recovery from the traumatic EPH. At 3 months, five daily feeds were supplemented with formula. Breastfeeding, principally nocturnal, continued 6 months after childbirth, with the baby being weaned at 7 months. Women who undergo EPH need psychological support. The option of breastfeeding should be considered even days or weeks after the surgical intervention as it can be a healing experience for some women who are grieving the loss of their fertility. Professional specialized breastfeeding support should be offered in these cases, and the possibility of reuniting mother and infant even when the mother is in the intensive care unit should be considered.
Background: Serotonin Syndrome (SS) is an adverse drug reaction that drives mental-status changes, autonomic hyperactivity and neuromuscular abnormalities. Neuroleptic Malignant Syndrome (NMS) is an idiopathic reaction to dopamine-antagonist that consists of extra-pyramidal symptoms, autonomic dysfunction, hyperthermia, diaphoresis and fluctuating consciousness. Differential diagnosis is sometimes difficult for their overlapping clinical features. Potentially lethal, both require heightened clinical awareness for prevention, recognition and prompt treatment.
BackgroundMost of the studies about Eating Disorders in adolescents have been typically focused on females, only to conclude that the approach should be similar in males. It has been stimated that 5-10% of patients with Anorexia Nervosa are males. Later age of onset and higher prevalence of premorbid overweight are considered among the main differences with female patients.ObjectivesAnalysis of the anthropometric variables of a sample of males with diagnosis of Restrictive Eating Disorder.MethodsNaturalistic, Descriptive and Retrospective studySample: 22 male adolescentsInclusion criteria: males with Restrictive Eating Disorder diagnosis (according to DSM-IV criteria) admitted to an Eating Disorder ward during 2007 and 2008“ad hoc” questionnaire (15 items)Analysis: PASW statistics 18ResultsAge range: 7-14years (medium age=14,79±2,50years).11 patients (50%) were older than 16 years-oldMedium BMI (Body Mass Index) at the beginning of the admission was 17,79kg/m2.medium weight loss: 13,5±7,02kg/m2 (corresponding to a reduction of 22,24±7,52% of the previous weight)Medium speed of weight loss: 0,92±1,1kg/54BMI at discharge: 18,69 ±3,43 kg/m219/22 patients (86%) had a premorbid history of overweightBinge eating: 8 patients (36,4%)Purgative behaviour: 10 patients (45%)Laxatives use: 4 patients (18%)Intense physical exercise: 21 patients (95,5%)Average duration of current restrictive episode: 13,7 monthsConclusionsIn the studied sample we observed:High prevalence of premobid overweightVery high frequency of compulsive exerciseDrastic weight loss and loss of a very high percentage of the previous weight, in short periods of time, reaching very low BMI.
Introducción: Tras la pandemia por Covid-19, ha aumentado la incidencia del suicidio infanto-juvenil en España y se ha incrementado el uso de los Medios de Comunicación Social (MCS), pudiendo haber contribuido en el aumento de las conductas suicidas. Métodos: Revisión narrativa de estudios publicados en Pubmed sobre conductas suicidas y uso de MCS en menores de edad. Resultados: Los estudios sobre asociación entre suicidio y MCS son contradictorios. La mayoría señalan la existencia de beneficios (mantener la conectividad social y disminuir la soledad) y también riesgos (ansiedad, depresión, adicción y cyberbulling) que pudieron incrementarse, con una posible asociación secundaria de conductas suicidas. La falta de regulación de información sobre el suicidio propicia su contagio (efecto Werther), pero un buen uso de los MCS puede proteger frente a la autolisis (efecto Papageno). Discusión: La relación entre suicidio infanto-juvenil y MCS es compleja y bidireccional. Aunque hay evidencia de que los MCS son un factor de riesgo emergente para la salud mental, el uso de MCS en pandemia pudo ayudar a reducir la sensación de soledad en confinamiento. No se puede descartar su influencia negativa en algunos menores vulnerables, concretamente, en las crisis suicidas. Se debe explorar la relación con los MCS de los menores de riesgo como una dimensión más de vida. Conclusión: El incremento del suicidio en menores tras la pandemia obliga a revisar, entre otros factores, su acceso al mundo digital. Es indispensable establecer investigaciones rigurosas acerca de la posible asociación entre MCS y suicidio infanto-juvenil.
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