IntroductionNMS is an infrequent, life-threatening neurologic emergency usually associated with the use of neuroleptics and some other agents that affect central dopaminergic neurotransmission. Because of its low frequency, heterogeneous nature and clinical variability it might be difficult to diagnose.ObjetivesTo identify risk factors to develop a NMS and to set effective treatments.MethodsLiterature search was performed in PubMed and UpToDate. Report of a case at our center: 69 year old man with psychotic depression which do not improve with optimal doses of SSRIs, Mirtazapine and Benzodiazepines. Olanzapine (10mg) was added and symptoms compatible with a neuroleptic malignant syndrome were appeared. Supportive care was needed because of medical complications. A treatment with bromocriptine, sertraline, lorazepam and dantrolene was begun with little improvement. It was decided to begin ECT.ResultsIt was applied a ECT therapy (12 bifrontotemporal sessions, 380mCu) with a high and effective response. Pshycosis and pshycomotor symptoms disappeared and depression decreased significantly.DiscussionHence a high index of suspicion is needed in the diagnosis of NMS in order to reduce mortality and secuelae. Differential diagnosis must be performed with confusional states due to medical cause, catatonia, serotoninergic syndrome and other neurologic states. As for the treatment, general support meassures and several farmacologic options have been used, though none of them have proved to decrease mortality. ECT remains a good option for improvement of the syndrome as well as the pychiatric condition. No systematic clinical trials evaluating the efficacy of different treatments have been done so far.
Introduction:Schizophrenia is a psychiatric disorder which involves chronic or recurrent psychosis and it is commonly associated with impairment in social and occupational functioning. Antipsychotic medications are a first-line treatment, however, most patients experience disabling impairment even after benefiting from antipsychotics, including positive and negative symptoms, cognitive deficits, poor social functioning and episodes of acute symptomatic relapse.Methods:Systematic literature review in UpToDate and Pubmed.Objectives:To identify the most relevant intervention areas of systematic rehabilitation in schizophrenia.Clinical case:45 years old schizophrenic male who admitted in a Medium Stay Psychiatry Unit with severe behavioural impairment and psychotic symptoms. At least 10 hospitalizations and pronounced disability in basic life skills despite optimal treatment. Poor insight and compliance, frequent relapses, co-morbid substance abuse and difficult family support. Clozapine was added to his treatment with improvement in psychotic symptoms. A multidisciplinary intervention was also done and he was discharged home with important improvement in social skills, better insight and familiar functioningDiscussion:Despite following an adequate antipsychotic treatment, including Clozapine as the main medication in resistant schizophrenia, it is often partially effective with severe impairments in social and occupational functioning. Family-based interventions, cognitive behavioural therapy and social skills training, added to this medication seem to be essential in the systematic treatment of schizoprenia. It includes a multidisciplinary team and a specific length of time but it is based on the patient's status. Despite evidence of their efectiveness, the availability of these interventions varies widely, as does the availability of clinicians to provide them.
Introduction:New psychopharmacology provides a better tolerability profile and drug adherence, which should be accompanied by lower relapse rate, incomings and improvement in psychosocial functioning of patients.Objectives:1. To describe sociodemographic, clinical and psychometric properties of a sample of psychotic patients admitted to the Acute Unit. 2. Assessing the functionality of psychotic patients requiring hospitalization.Methods:Sample:patients admitted to the Psychiatric Hospital Unit of the Hospital San Juan de Alicante (August 1 to 31, 2013), with admission diagnosis of psychotic decompensation (F20). Register of sociodemographic and clinical dates, PANSS, CGI and PSP. Statistical analysis using SPSS.Results:N=19. 94%=male, 84.2%=single, 68.4%=family support.37%=schizophrenia, 52.7%=brief reactive psychosis, 10.5%=schizophreniform disorder. 9.7% first psychotic episodes. 52.6%=toxic consumption. Mean scores:PSP = 50.89, CGI= 4.42, PANSS=89.89. Significant relationship between the support and PSP(35=not, 53=yes, p<0.015). Direct relationship between PANSS and CGI (p< 0.0001, 0.89R).Conclusions:Although toxics, poor adherence or the long course of the disease are associated with unfavorable scores on scales of function and psychopathology, our results donnot meet it. We attribute the negative results to low sample size and heterogeneity of the group of patients included in the study. Maybe factors such as family support, employment and intellectual level have a greater role. We consider it appropriate to continue the study in the future, standardizing clinical groups and expanding the sample size in order to obtain results with greater statistical significance.
IntroductionA psichiatric emergency is a situation where disorders of thought, mood or behavior are so disruptive that require immediate assistance.ObjectivesTo analyze clinical and sociodemographic characteristics, predictors of hospitalization, and poli-attendance in patients attended in a reference area psychiatric emergency service.MethodologyAll assistances from 01.12.2011 to 31.01.12 were recorded in a database. Patient poly-attendance was defined by two or more assistances during the study period. Logistic regression analysis was performed to find out hospitalization and poli-attendance predictors.ResultsN = 219. 50.68% male, 49.32% female; 86.75% between 20-64 years. 45.62% finished primary studies. 80.82% owned social support network. 80.73% unemployed. 71.89% voluntary assistances. 58.97% already tracked by mental health, 24.66% first contact. Reason care: anxiety (24.20%), behavioral disorders (22.57%), suicide (20.55%) and psychosis (12.79%). Final diagnoses: psychosis (24.20%), anxiety (15.48%), depression (10.05%), drugs abuse (9.13%), personality disorders (17.35%), mental retardation (8.22%), social issues (16.89%).26.94% were poly-attendance, assisted by: organic mental disorder (OR= 21,10, IC95%), personality disorders (OR=4,313, IC95%), mental retardation (OR=5,545, IC95%), social issues (OR=2,94, IC95%). 24.20% of the patients hospitalized. Factors associated to risk: age range 15-20 (OR 12.10, IC95%); psychosis (OR = 51.03, IC 95%), depression (OR = 14.61, IC95%), bipolar disorder (OR=20,38, IC 95%).ConclusionsMinor diseases, social issues or stables axis II disorders accomplished most attendances. Hospitalitation was associated with severe mental illness and lower age.Poly-attendance is not associated with axis I patology, but it is with axis II and IV disorders.
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