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Non-Convulsive Status Epilepticus as A Complication of Electroconvulsive Therapy: A Case Report
- T. Saltoglu, B. Senol, G. Koc
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S248-S249
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Introduction
Status Epilepticus is defined as a condition that can have long-term outcomes involving neuronal death and injury due to the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms that lead to abnormally prolonged seizures. Electroconvulsive therapy (ECT) is a highly effective treatment option for psychiatric disorders. Although it rarely occurs in the treatment, non-convulsive status epilepticus can be seen as a complication after ECT. Due to its rarity, this complication is not yet well understood, is challenging to diagnose, and information about treatment options is limited.
ObjectivesBy sharing this case report, we aim to emphasize the importance of being careful in terms of the risk of status epilepticus in patients receiving electroconvulsive therapy.
MethodsHere in we present a 29-year-old patient with no previous neurological disease and who had a history of schizophrenia. Electroconvulsive therapy was planned because the patient was resistant to antipsychotic treatment. EEG was planned for the patient who had urinary incontinence during the ninth session of ECT. Generalized slow wave activity and intermittent rhythmic delta activity were observed in the EEG, therefore it was found suspicious for NCSE, and the patient was planned to perform an EEG again by administering diazepam to confirm the diagnosis. After diazepam, the patient whose EEG tracing was clearly improved was admitted to the neurology intensive care unit. He was followed up for 48 hours with continuous 4 mg/hour/day midazolam and continuous bedside EEG in the neurology intensive care unit. Concomitant lamotrigine was started at 100 mg/day. Significant improvement in EEG, sinusoidal alpha, and beta waves with the eye open was observed at the 48th hour, and the patient was transferred back to the psychiatry service. Lamotrigine treatment was increased up to 200 mg/day and clozapine treatment was adjusted to 350 mg/day in the psychiatry service. In the patient whose EEG was requested again before discharge.
ResultsThe diagnosis of NCSE post-ECT can be laborious; the symptoms may not be characteristic and clear, and usually not distinguish from symptoms of confusion, delirium, or psychiatric illness, hence the follow-up psychiatrist should be careful. In suspicious cases, EEG should be taken, especially in patients at risk for seizures. These risky conditions include previous seizure history, and lithium or clozapine use.
ConclusionsThe diagnosis of NCSE after ECT is a demanding condition. Particular attention should be paid to factors that will lower the seizure threshold. In cases with ECT treatment with clozapine, intermittent clozapine blood levels can be quantified and medication interactions and smoking can be considered. When the cases are examined, the common aspect of most of them is that the treatments have good results.
Disclosure of InterestNone Declared
Treatment of tardive dyskinesias with vitamin E: A case series
- B. Senol, F. N. Akarca, R. N. Ekinci, E. Goka
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1004
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Introduction
Tardive dyskinesia is usually persistent, irreversible involuntary movement of the tongue, lips, face, trunk and extremities in patients taking long-term dopaminergic antagonist drugs. Although it is mostly associated with the use of neuroleptics, cases of tardive dyskinesia existed before the discovery of these agents. Patients with schizophrenia and other neuropsychiatric disorders are particularly at risk for tardive dyskinesia because they are exposed to neuroleptics and anticholinergic agents for longer periods than healthy individuals. Free radicals are thought to be probably involved in the pathogenesis of tardive dyskinesia. Vitamin E is a fat-soluble antioxidant, and it is thought to be effective in the treatment of antipsychotic-associated tardive dyskinesia, as it has a cytotoxic free radical-binding effect.
ObjectivesIn this poster presentation, it was aimed to evaluate the clinical results of the treatment of tardive dyskinesia with high-dose vitamin E in four inpatients with serious mental illness and long-term antipsychotic use. In addition, the treatment of tardive dyskinesia will be discussed in the light of current literature data.
MethodsIn the case report, there are three patients with schizophrenia and one with mild mental retardation. They were treated with 1600 IU of vitamin E per day. The patients continued their vitamin E treatment for 90 days. The severity of tardive dyskinesia of the patients was measured by Abnormal Involuntary Movement Scale (AIMS).
ResultsAt the end of the 90 day treatment, the AIMS measurements of the subjects decreased 72,7%, 73,3%, 72,2% and 80% respectively.
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ConclusionsIn our clinic, we observed that patients using long-term typical antipsychotics were prescribed antipsychotics in unindicated situations or in high doses, patients with high risk for tardive dyskinesia were not taken into consideration when planning treatment, and we encountered cases of tardive dyskinesia despite the widespread use of atypical antipsychotic drugs in hospitalized patients. The use of benzodiazepines is restricted especially in elderly individuals due to their side effects and the risk of addiction in long-term use. Although the clinical importance of vitamin E is unknown, it is preferred because it can be used with a low risk of side effects, considering that it can prolong bleeding time. Although the results of a review of tardive dyskinesia treatment do not suggest that vitamin E reliably improves tardive dyskinesia symptoms, our experience shows that patients benefit from vitamin E treatment. In this regard, there is a need for studies that will be conducted with a large sample and compare the effectiveness of vitamin E with the treatments known to be effective in tardive dyskinesia.
Disclosure of InterestNone Declared
Soil quality assessment based on hybrid computational approach with spatial multi-criteria analysis and geographical information system for sustainable tea cultivation
- F. Saygın, Y. Şavşatlı, O. Dengiz, K. Yazıcı, A. Namlı, A. Karataş, N. D. Şenol, M. O. Akça, S. Pacci, B. Karapıçak, A. Ay, S. Demirkaya
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- Journal:
- The Journal of Agricultural Science / Volume 161 / Issue 2 / April 2023
- Published online by Cambridge University Press:
- 16 February 2023, pp. 187-204
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Long-term intensive tea cultivation is suspected of deteriorating soil quality status and degrading land sustainability. This study aimed to determine the soil quality index of soils in a micro-catchment in Rize Province, Turkey, used for long-term intensive tea cultivation, by means of spatial multi-criteria analysis (SMCA) and standard scoring function (SSF) integrated with geographical information system (GIS) and geostatistics, considering bio-physical-chemical properties of a detailed soil dataset. Soil samples (102) were collected from the surface layer (0–20 cm). In the soil quality index for tea-cultivated soils (TSQI), soil indicators were weighted by an analytical hierarchy. Various indicator units were normalized with the SSF. The TSQI model was divided into five main criteria: (i) physical properties, (ii) chemical properties, (iii) fertility, (iv) biological indicators and (v) soil erosion susceptibility parameters. Principal components analysis (PCA) was applied and minimum dataset (MDS) created to determine the most effective indicators. The spatial distribution pattern of the tea total dataset soil quality index (TSQITDS) and tea minimum dataset soil quality index (TSQIMDS) values were statistically similar. TSQITDS low and very low-class areas accounted for 34.1% of the total area, while TSQIMDS low and very low-class areas constituted 33.6%. These areas, especially those with low soil quality properties, were in the northern and north-western parts of the micro-catchment. TSQITDS very high and high-class areas accounted for 56.2% of the total area, while TSQIMDS very high and high-class areas were found in 55.3% of the total area. These areas are located in the south of the micro-catchment.