5 results
Syndrome of inappropiate antidiuretic hormone secretion (SIADH) secondary to sertraline: case report and literature review
- C. Cardenes-Moreno, S. Yelmo-Cruz, I. Perez-Sagaseta, J. J. Tascon-Cervera, J. Dorta-Gonzalez, A. Crisostomo-Siverio, L. Torres-Tejera, M. Paniagua-Gonzalez, S. Canessa, M. R. Cejas-Mendez
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S556
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Currently, in addition to their frequent use in community medicine, the use of antidepressants is a fundamental pillar of pharmacological treatments used in psychiatry. Due to this frequent use, we must be aware of the possible side effects, in particular the SIADH produced in this clinical case by SSRIs. There are already described cases of this association including other antidepressants and many different types of drugs.
ObjectivesTo review the current literature on the management of this pathology when it is secondary to the use of frequently used drugs such as SSRIs.
MethodsWe report the case of a 64-year-old woman hospitalised in the psychiatric department for malnutrition secondary to unspecified eating disorder (ED). During admission, treatment with sertraline was started with ascending doses up to 100mg, subsequently producing slight edema with the following analytical results: plasma Na: 123 mEq/L (135-145), plasma osmolarity: 250 mOsm/kg (275-300), urinary Na: 174 mEq/L (>40), fulfilling diagnostic criteria for SIADH.
Afterwards, we reduced sertraline until discontinuation and started treatment with water restriction and urea (30 grams/24 hours) during admission and after discharge. During admission, we observed disappearance of the edema and partial improvement of the analytical values (Na:131 mEq/L), which were normalised with home treatment of daily urea.
ResultsThe precise prevalence of SIADH from the use of SSRIs is unknown, it is known that patients older than 65 are at higher risk of developing severe hyponatraemia in the first 5 weeks after initiation. Similarly, treatment with water and urea restriction, together with discontinuation of SSRIs, appears to be sufficient.
ConclusionsSSRIs can cause SIADH a reversible but potentially life-threatening pathology, and we need to be aware of this possibility especially in the older population and being able to handle it
Disclosure of InterestNone Declared
Fahr’s Disease: a case report of a patient with neuropsychiatric symptoms
- I. Perez-Sagaseta, S. Yelmo-Cruz, C. Cardenes-Moreno, L. Torres-Tejera, A. Crisostomo-Siverio, J. Dorta-Gonzalez, J. J. Tascon-Cervera, M. Paniagua-Gonzalez, S. Canessa, M. R. Cejas-Mendez
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S769-S770
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Fahr’s disease (FD) is a rare disorder consisting of bilateral and symmetrical calcium deposits in basal ganglia and cerebral cortex. These lesions are associated with neurological and psychiatric symptoms such as a rigid hypokinetic syndrome, mood disorders and memory and concentration abnormalities. It can be idiopathic or secondary to endocrine disorders, infectious diseases or mitochondrial myopathies.
ObjectivesTo highlight the importance of considering organic causes when evaluating patients presenting atypical psychiatric symptoms and claim the role of neuroimaging.
MethodsCase report and non-systematic review of literature: sources obtained from Pubmed database.
ResultsA 69-year-old man, native of Syracuse (Italy), was admitted to the Psychiatry Unit in February 2022 presenting behavioural disturbances and irritability. In July 2021 he presented the same symptoms, being mistakenly diagnosed with Bipolar Disease type I. He has no previous psychiatric history. He started with changes in his personality, short-term memory loss, aggressiveness and disorganized behaviour at the age of 66. At admission he was talkative and hyperfamiliar, presenting delusions of grandiosity, exalted affectivity and insomnia. Neurological examination showed short-term memory problems, signs of frontal disinhibition and abnormal glabellar tap sign. Blood tests, CT brain and MRI were performed to rule out organic underlying causes. Neuro-imaging found bilateral and symmetric calcifications in globus pallidus, thalamus and corpus striatum, in favour of FD. Secondary causes (abnormalities in the PTH, vitamin disorders and infectious diseases such as HIV, brucellosis or neurosyphilis) where discarded, allowing us to conclude it was probably a primary case of FD. Valproate was started as a mood stabilizer and anticonvulsant. Genetic tests were indicated.
ConclusionsFD should be considered as a differential diagnosis in the evaluation of psychiatric symptoms, especially when atypical and/or presented with neurological symptoms. The role of neuro-imaging is essential.
Disclosure of InterestNone Declared
Anorexia nervosa and Wernicke-Korsakoff syndrome: case report an literature review
- S. Yelmo-Cruz, J. J. Tascon-Cervera, I. Perez-Sagaseta, C. Cardenes-Moreno, L. Torres-Tejera, A. Crisostomo-Siverio, E. Diaz-Mesa, J. Dorta-Gonzalez, M. Paniagua-Gonzalez, S. Canessa, A. L. Morera-Fumero, M. R. Cejas-Mendez
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S424
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Wenicke-Korsakoff syndrome (WKS) is a neurological disorder caused by thiamine deficiency. Wernicke Encephalopathy (WE) is the acute phase and the chronic phase is called Korsakoff-syndrome (KS).
ObjectivesTo review the current literature on the management of WKS in a patient with anorexia nervosa.
MethodsWe report the case of a 63-year-old woman admitted to the Psychiatry Unit after weight loss in the last 3 months (from 39 kg to 33,500 kg). She only made one meal a day. By exploration and analysis, neoplastic disease is ruled out (thoraco-abdomino-pelvic CT without pathological findings). She has maintained restrictive intakes for more than 30 years. A long-term anorexia nervosa (AN) is suspected, with a worsening of restrictive behavior in recent months. Upon admission, she has a weight of 33,500 kg and a BMI of 14,10. She has a left palpebral ptosis and an alteration of the anterograde memory as well as affectation of executive functions. Progressive oral diet is started, and due to the suspicion of a WKS, thiamine ev is started for a week and then continued with oral thiamine. Thiamine levels are extracted once the ev treatment has begun, so we do not have previous levels to know if they were decreased. Brain MRI shows bilateral hyperintensities in white matter and at supratentorial level in T2 and FLAIR. After a month and a half of admission, the patient has progressively regained weight, has managed to make adequate intakes and has improvement in memory.
ResultsAn adverse consequence of severe malnutrition in AN due to severe food restriction and purging behavior is thiamine deficiency, and also global cerebral atrophy and concomitant cognitive deficits can be found. Thiamine deficiency occurs in 38% of individuals with AN and is often unrecognized. WKS is caused by thiamine deficiency, and WE is the acute phase of this syndrome (presentation of triad can vary). The chronic phase is KS and consists in amnesia with confabulations. WKS typically develops after malnourishment in alcoholic patients but can be associated in nonalcoholic such as prolonged intravenous feeding, hyperemesis, anorexia nervosa, refeeding after starvation, thyrotoxicosis, malabsorption syndromes; hemodialysis; peritoneal dialysis; AIDS; malignancy. WKS is a clinical diagnosis, and no specific abnormalities have been found in cerebrospinal fluid, brain imaging or electroencephalograms. MRI has a sensitivity of 53%, but high specificity of 93%, and shows an increased signal in T2 and FLAIR sequences, bilaterally symmetrical in the paraventricular regions of the thalamus, the hypothalamus, mamillary bodies, the periaquedutal region, the floor of the fourth ventricle and midline cerebellum.
ConclusionsIf the disorder is suspected, thiamine should be initiated immediately in order to prevent irreversible brain damage, with an estimated mortality rate of about 20%, or to the chronic form of the WE in up to 85% of survivors
Disclosure of InterestNone Declared
Salinity and nitrogen fertilization and nitrogen metabolism in rose plants
- H. LORENZO, J. M. SIVERIO, M. CABALLERO
-
- Journal:
- The Journal of Agricultural Science / Volume 137 / Issue 1 / August 2001
- Published online by Cambridge University Press:
- 24 October 2001, pp. 77-84
-
- Article
- Export citation
-
Rose production is limited by salinity and highly affected by the nitrogen source present in the nutrient solution. The influence of sodium on several aspects of nutrition has been investigated in ‘Lambada' rose plants using different sources of nitrogen in the fertilization treatment. Experiments using a previously defined mono-shoot model plant and a simplified hydroponic culture allowed us to study the effects of salinity v. nitrogen on NPK uptake during the culture period. Mineral concentrations, nitrate reductase (NR) and glutamine synthetase (GS) activities were also analysed. This study showed that rose plants were more sensitive to saline conditions under NH4+ fertilization without detectable effects on growth or in NPK mineral contents in shoots. Parameters affected most were enzymatic activities analysed such as leaf nitrate reductase activity which was reduced under NH4+ nutrition. Leaf glutamine synthetase was also enhanced by saline conditions. The Na/K ratio showed that under NH4+ nutrition, the highest sodium accumulation occurred in roots. Nitrate uptake did not show a clear pattern related to nitrogen source, however, ammonium uptake was affected by salinity when NH4+ was the sole nitrogen source in the nutrient solution. Potassium and phosphate uptake were always lower when NH4+ was present in the nutrient solution.
Influence of additional ammonium supply on some nutritional aspects in hydroponic rose plants
- H. LORENZO, M. C. CID, J. M. SIVERIO, M. CABALLERO
-
- Journal:
- The Journal of Agricultural Science / Volume 134 / Issue 4 / June 2000
- Published online by Cambridge University Press:
- 01 June 2000, pp. 421-425
-
- Article
- Export citation
-
The influence of an additional supply of ammonium to a nitrate containing hydroponic solution on the mineral nutrition of greenhouse rose plants (Rosa hybrida cv. ‘Lambada’) has been investigated. The effect on NPK uptake, mineral contents in roots and leaves as well as nitrate reductase (NR) and glutamine synthetase (GS) activities were examined. The addition of ammonium in a nutrient solution containing nitrate produced a total nitrogen uptake increase during shoot elongation, while in the absence of ammonium, nitrate uptake was lower during shoot elongation. Adding ammonium to the hydroponics solution caused an increase of potassium uptake while ammonium absorption was constant. Phosphate uptake was always higher in combined nitrate plus ammonium treatment, likewise in this treatment the most relevant effect on plant mineral content was the increase of P concentration in the roots. In both treatments with or without NH+4, free nitrate was notably higher in the roots than in leaves, indicating that nitrate reduction in rose plants takes place mainly in the leaves. NR activity in the leaves was higher when ammonium was present, whereas the root GS activity was similar in both treatments. The influence of ammonium on phosphate uptake and the subsequent effects on transport of other ions and enzymatic activities are discussed.