3 results
Polydipsia and intermittent hyponatremia
- S. Ramos-Perdigues, M.J. Gordillo, C. Caballero, S. Latorre, S.V. Boned, G. Miriam, P. Torres, M. De Almuedo, M.T. Sanchez, E. Contreras, E. Gomez, E. Sanchez, M. Segura, C. Torres, G. Gemma, M. Tur, A. Fernandez, C. Merino
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. s502
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Introduction
Hyponatraemia occurs in 4% of schizophrenic patients. Dilutional hyponatraemia, due to inappropriate retention of water and excretion of sodium, occurs with different psychotropic medications and could lead to hippocampal dysfunction. This complication is usually asymptomatic but can cause severe problems, as lethargy and confusion, difficult to diagnose in mentally ill patients.
ObjectivesTo describe a case of a patient with psychotropic poli-therapy, admitted three times due to hyponatremia and the pharmacological changes that improved his condition.
AimsTo broadcast the intermittent hyponatraemia and polydipsia (PIP), a not rare condition, suffered by treated schizophrenic patients and discuss its physiopathology and treatment thorough a case report.
MethodsA 56-year schizophrenic male was admitted for presenting disorganized behavior, agitation, auditory hallucinations, disorientation, ataxia, vomits and urinary retention. He was on clomipramine, haloperidol and clotiapine (recently added), quetiapine, fluphenazine and clonazepam. After water restriction his symptoms improved and he was discharged. Twenty-five days later, he was readmitted for presenting the same symptoms and after water restriction, he was discharged. Five days later, he was again admitted and transferred to the psychiatric ward.
ResultsHaloperidol, fluphenazine and clomipramine were replaced by clozapine. These changes lead him to normalize the hypoosmolality and reduce his water-voracity. Endocrinology team did not label this episode of SIADH due to its borderline blood and urine parameters.
ConclusionsHyponatremia is frequent in schizophrenic patients and may have severe consequences. Therefore, a prompt recognition and treatment is warranted.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Clozapine induced diarrhea
- S. Ramos-Perdigues, M.J. Gordillo, C. Caballero, S. Latorre, S.V. Boned, M.T. Sanchez, P. Torres, M. Guisado, E. Contreras, M. De Almuedo, E. Esmeralda, E. Sanchez, M. Segura, A. Fernandez, C. Torres, G. Herrero, M. Tur, C. Merino
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. s502
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- Article
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- You have access Access
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Introduction
Clozapine (CZP) is the only antipsychotic approved for resistant schizophrenia 1. Due to its side effects, CZP is not the first therapeutic option in a psychotic episode. Its anticholinergic effects often cause constipation, however, diarrhea have also been described in literature.
ObjectivesWe describe a patient with two episodes of severe diarrhea after clozapine initiation, which lead to CZP discontinuation.
AimsDiscuss about the differential diagnosis of diarrhea in CZP patients and the needing of a further studies for clarify the more appropriate management in CZP induced diarrhea.
MethodsWe present a case report of a 46 years man diagnosed with schizoaffective disorder who presented two episodes of severe diarrhea with fever, which forced his transfer to internal medicine and UCI after CZP initiation.
ResultsAt the first episode analytical, radiological and histological findings led to Crohn's disease diagnosis, which required budesonide and mesalazine treatment. In the second episode, the digestive team concluded that the episode was due to clozapine toxicity despite the controversial findings (clostridium toxin and Crohn's compatible biopsies)
ConclusionsDiarrhea caused by CZP has been controversial in the literature. However due to the severity of digestive episodes and the paucity of alternative treatments further studies for a better understanding of its physiopathology are warranted.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Cannabinoid hyperemesis syndrome, a treatment discussion
- S. Ramos-perdigues, M.J. Gordillo, C. Caballero, S. Latorre, S.V. Boned, M. Guisado, M. De Almuedo, P. Torres, M.T. Sanchez, E. Contreras, A. Fernandez, G. Esmeralda, E. Sanchez, M. Segura, C. Torres, G. Herrero, M. Tur, C. Merino
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S318
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- Article
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Introduction
Cannabinoid hyperemesis syndrome (CHS), is characterized by recurrent episodes of severe nausea and intractable vomiting, preceded by chronic use of cannabis. A pathognomonic characteristic is compulsive bathing in hot water. The resolution of the problem occurs when cannabis use is stopped. However, patients are often reluctant to discontinue cannabis. Treatment with anti-emetic medication is ineffective. Case series suggested haloperidol as a potential treatment. Other antipsychotics as olanzapine has been used as anti-emetic treatment in chemotherapy.
ObjectivesTo describe three cases of patients with CHS whom showed a successful response to olanzapine, even when, haloperidol had failed.
AimsTo present an alternative treatment for CHS which can offer benefits over haloperidol.
MethodsWe present three cases of patients who suffered from CHS and were admitted to emergency department. All patients were treated with olanzapine after conventional anti-hemetic treatment failure. One patient was also unsuccessfully treated with haloperidol.
ResultsAll three patients showed a good response to olanzapine treatment. Different presentations were effective: velotab and intramuscular. Their nausea, vomits and agitation were ameliorated. They could be discharge after maintained remission of symptoms.
ConclusionsOlanzapine should be considered as an adequate treatment for CHS. Its suitable receptorial profile, its availability in different routes of administration and its side effects profile could offer some benefits over haloperidol.
Disclosure of interestThe authors have not supplied their declaration of competing interest.