3 results
Analysis of the predictive potential of good clinical response of plasma levels of clozapine in patients with resistant schizophrenia in an area of southern Spain
- L. I. Muñoz-Manchado, F. González-Saiz, J. I. Pérez-Revuelta, N. Laherrán-Cantera, R. J. Pardo-Velasco
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S446
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Resistant schizophrenia is a schizophrenia subtype characterized by a non-ability to respond to an appropriate antipsychotic treatment in dosage and duration by the patients. These patients show a lower prognostic and symptomatology. The unique drug which has shown efficacy for resistant schizophrenia treatment is clozapine, which is effective in suicide and aggressive behaviour prevention too. Whereas clozapine has numerous and serious adverse effects such as agranulocytosis risk. Because of this, and for guaranteeing an accurate diagnosis of resistant schizophrenia, distinguishing this from pseudo-resistance due to a poor tracing of schizophrenia, clozapine’s plasmatic levels monitoring is recommended in Spain by many clinical practise-guidelines.
ObjectivesThis studio has the objective of determining if altered clozapine’s plasmatic levels have predictive potential of therapeutical response and answering what clinical and sociodemographic variables are associated to these anormal plasmatic levels.
MethodsIn this work, a cross-sectional observational study was carried out in which clinical and sociodemographic data obtained by the Mental Health Unit of the Jerez de la Frontera University Hospital were collected within the research project entitled: "Role of social cognition as a factor psychosocial functioning of the schizophrenic patient” (ECOFUN), of all the participating patients (in total the sample was 141 patients, of which 40 are in treatment with clozapine).
ResultsThe sample of patients has a mean age of 44 years and medium-high educational levels. The vast majority are men and do not currently consume substances of abuse, and when this consumption occurs, tobacco and alcohol are the most consumed substances. Their total scores on the PANSS and Markova Barrios scales are generally very disparate, but with average values of 55 and 16. It has been obtained as results that there is no significant statistical correlation between the plasma levels of clozapine and the values of the PANSS scale and its subscales in the patients. On the other hand, patients treated with clozapine would present clinical and sociodemographic characteristics practically identical to those of patients treated with other antipsychotics, especially their values on the PANSS scale. In addition, plasma levels of clozapine are correlated, although not significantly, with an improvement in the positive symptomatology of schizophrenia.
ConclusionsAs a conclusion, unusually higher values of clozapine are correlated significantly with lower values in positive symptomatology in schizophrenia, but plasmatic levels are not correlated significantly with values of PANSS scale.
Disclosure of InterestNone Declared
Review of a sample of episodes of forced medication in an area of southern Spain
- L. I. Muñoz-Manchado, J. M. Mongil-Sanjuan, J. I. Pérez-Revuelta, C. M. Robledo Casal, J. M. Villagrán-Moreno
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1067
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Forced medication is one of the most frequently used coercive measures in acute mental health units. It is a practice that can lead to physical, psychological and psychopathological consequences. Therefore, it is necessary to implement measures to reduce its use. In this sense, it is interesting to study the variables that can be associated with its use, and thus take measures accordingly.
ObjectivesThis study attempts to identify the number of forced medication episodes between July 2017 and December 2018 treated in the catchment area of the Mental Health Service at Jerez Hospital. As a secondary objective, it pursues to identify the factors that conducted to the use of forced medication with the intention of being able to reduce the use of these measures.
MethodsA descriptive and retrospective study has been developed reviewing the total number of episodes of forced medication. Patients admitted and discharged from hospital between July 2017 and December 2018 treated in the Mental Health Service at Jerez Hospital. Data were extracted from medical records.
ResultsThe total number of episodes of forced medication identified was 330. In these episodes, the average age was 41 years, with a predominance of 74% of the male gender. The most used route in the episodes was intramuscular (94.8%), in addition, more than 50% needed the association of two drugs, the most used were haloperidol and olanzapine. The 32.7% of the episodes also required the use of mechanical restraint and 44.2% required the presence of security service.
Image:
ConclusionsWe present the descriptive analysis of a further study currently been conducted in hour hospital which means to stablish predictive factors for the use of forced medication. We therefore intend to create patient profile, as well as new measures specifically directed to these factors with which to diminish the use of forced medication.
Disclosure of InterestNone Declared
What do we know about lithium associated hypercalcemia?
- N. Laherrán Cantera, R. Palacios - Garrán, A. Sanchez-Guerra Alonso, C. Gutiérrez Santaló, L. I. Muñoz-Manchado
-
- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S577
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Introduction
Lithium associated with hypercalcemia may mimic a psychiatric condition and be confused for a relapse of bipolar disorder. The etiology seems to be due to a reduced sensitivity of the parathyroid cells to calcium, altering the parathyroid hormone (PTH) response. Lithium as an essential monovalent cation has some structural similarity to calcium (Ca) and can interact with protein receptors. This leads to changes in the inhibitory configuration of PTH and increased serum calcium concentrations, rising the threshold necessary to suppress hormone secretion.
Lithium-induced hyperparathyroidism (HIL) is the main cause of hypercalcemia in these patients.
ObjectivesBased on a clinical case of lithium-associated hypercalcemia in a patient with bipolar disorder, review the existing literature and state the needs for periodic monitoring protocols.
MethodsCase report and bibliographical review.
ResultsA 38-year-old woman, diagnosed with bipolar affective disorder at the age of 18, has been treated with lithium during which she developed secondary tubulointerstitial nephropathy as an adverse effect. Recently, she requested medical evaluation for constitutional syndrome associated with deterioration of general condition with loss of strength and difficulty in walking. Analytically, mild hypercalcemia was detected, and the study was extended to include Ca and PTH.
Chronic lithium therapy often develops mild hypercalcemia (approximately 10 to 20 percent of patients taking lithium), most likely due to increased secretion of PTH. Lithium can also unmask previously unrecognized mild hyperparathyroidism in patients with adenomas within a few years of starting therapy or induce parathyroid hyperplasia with a chronic use.
The hypercalcemia usually, but not always, subsides when the lithium is stopped. Normalization of serum calcium is more likely to occur one to four weeks post-lithium withdrawal in patients with a relatively short duration of lithium use. It is less likely in patients receiving lithium for more than 10 years.
Regarding the case to be presented, a review of the literature is carried out and the need to propose periodic calcium monitoring protocols is exposed.
ConclusionsRecommendations include determination of serum calcium every 6 months, urinary calcium and creatinine every 12 months, and bone mineral density monitoring every 1 to 3 years. Regular analytical monitoring including total calcium, PTH and vitamin D, would identify patients with a tendency to hypercalcemia so that appropriate measures could be taken. So as chronic treatment with lithium can develop mild hypercalcemia, I consider it necessary to develop periodic monitoring protocols for this adverse effect.
Disclosure of InterestNone Declared