Sir: Despite the marked progress in the pharmacologic treatment of obsessive-compulsive disorder (OCD)-especially with high doses of serotonin reuptake inhibitors (SRIs), alone or in combination with low doses of antipsychotics-a substantial proportion of patients fail to respond to it. 1 In such cases, an augmentation tactic with drugs from other chemical classes, including antiepileptic drugs, seems advisable. We report on such a case, in which the adjunction of the newer antiepileptic drug pregabalin led to a patient's marked improvement. Case report. Ms. A, a 35-year-old woman, had suffered from OCD according to DSM-IV criteria 2 since the age of 10, with a severe exacerbation at the age of 30 and a continuous, unremitting course thereafter. During the last 5 years, she had been prescribed in adequate dosages 5 different regimens combining SRIs with antipsychotics, with only minimal and transient improvement. On admission in April 2007, Ms. A was receiving sertraline 400 mg/day, risperidone 2 mg/day, and clobazam 20 mg/day. She scored 35 on the Yale-Brown Obsessive Compulsive Scale (YBOCS), 3 with an overall severity scale score of 4, whereas on the Hamilton Rating Scale for Anxiety (HAM-A), 4 she scored 27. Both sertraline and risperidone were maintained at the previously mentioned dosages, whereas clobazam was discontinued. Pregabalin was added to her regimen instead and titrated up to 600 mg/day within 3 weeks. Dizziness and fatigue were the only transient side effects of pregabalin. During pregabalin treatment, Ms. A's mental and behavioral state improved progressively, and at discharge, 12 weeks later, her scores on the YBOCS and HAM-A had dropped by almost 55% and 40%, respectively. More precisely, her YBOCS score dropped to 16, with an overall severity score of 2 and an overall improvement score of 5, and her HAM-A score dropped to 15. Of note, the patient's level of improvement was wholly preserved at her last outpatient appointment 6 months later.
According to the American Psychiatric Association, the risk for complications related to the electroconvulsive therapy (ECT) treatment of patients with cerebrovascular malformations is small. The literature contains a number of case studies presenting the uneventful treatment of patients with cerebral aneurysms with ECT. However, there is a paucity of cases presenting ECT in the context of a cerebral venous angioma. In this article, we present 2 cases of patients treated with ECT who were found to have documented venous angiomas. This is followed with a brief review of the literature.
The criminalization of people with mental illness is a sad commentary on the United States’ mental health system. Yet, the phenomenon presents the field of psychiatry with an opportunity that is now scarce in civil society: lengths of sentence in terms of weeks to years that allow for in-depth observation and treatment of the inmate with mental illness. A few days in a hospital fails to provide the needed opportunity for a detailed and accurate evaluation. Today, people with mental illness account for more than one million annual arrests and many among these individuals will spend weeks to months in jail before being either transferred to a prison for sentences beyond one year or released back into the community. At its core, psychiatric diagnosis relies on the subjective complaints of the patient and objective signs noted on examination. Considering the chronic and fluctuating course of most psychiatric diagnoses, a thorough assessment also requires a review of past documented behaviors. When someone is hospitalized for a psychiatric condition, the first goal is often observation, followed by diagnosis, and then treatment. Psychiatric hospitals are being greatly constrained in the amount of time available for observation and accurate diagnosis; the correctional setting, as an unintended consequence of mass incarceration, provides an extended opportunity to achieve improved diagnostic accuracy. This chapter reflects on the diagnostic opportunities that a jail or a prison setting affords.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.