Clozapine use in drug induced psychosis in Parkinson´s disease: a case report and review of literature.

Introduction The occurrence of psychotic symptoms induced by dopaminergic drugs marks a new phase in the course of Parkinson’s disease (PD). The term drug induced psychosis may be used when other significant psychiatric diseases are excluded in patients with no history of psychosis. The prevalence of dopaminomimetic psychosis varies from 5% to 20%. Therefore, knowledge of the psychopharmacological management of this condition is essential. Objectives The purpose of this case report and literature review is to to learn the psychopharmacological management of this not uncommon medical complication. Methods Descriptive case study and review of literature Results We present the case of a 71-year-old man with a medical history of Parkinson’s disease with partial response to treatment with high doses of levodopa and carbidopa. He was brought to the emergency department by his family due to the presence of behavioural alterations at home. The patient reported seeing men in foam trying to harm his family. In a disjointed way in his speech, he links this idea with the delusional belief that he is being watched by electronic devices placed throughout the house. In a variegated manner he links this with a coelotypical type of discourse, however the delusional ideation remains unstructured throughout. With no previous personal or family history of mental health and ruling out underlying organic conditions, a diagnosis of psychosis secondary to pharmacological treatment for Parkinson’s disease is presumed. Considering the risks and benefits, it was decided to maintain the anti-Parkinson’s dose in order to avoid worsening the patient’s motor function. Therefore, after reviewing the literature, the best option was to introduce clozapine at low doses, up to 50 mg at night, with the respective analytical control. After a week’s admission, the patient began to improve psychopathologically, achieving an ad integrum resolution of the psychotic symptoms. Conclusions Despite the availability of other antipsychotic treatments such as quetiapine or the more recent pimavanserin, clozapine remains the treatment of choice for drug-induced psychosis in Parkinson’s disease. Disclosure of Interest None Declared


Introduction:
The occurrence of psychotic symptoms induced by dopaminergic drugs marks a new phase in the course of Parkinson's disease (PD).The term drug induced psychosis may be used when other significant psychiatric diseases are excluded in patients with no history of psychosis.The prevalence of dopaminomimetic psychosis varies from 5% to 20%.Therefore, knowledge of the psychopharmacological management of this condition is essential.Objectives: The purpose of this case report and literature review is to to learn the psychopharmacological management of this not uncommon medical complication.Methods: Descriptive case study and review of literature Results: We present the case of a 71-year-old man with a medical history of Parkinson's disease with partial response to treatment with high doses of levodopa and carbidopa.He was brought to the emergency department by his family due to the presence of behavioural alterations at home.The patient reported seeing men in foam trying to harm his family.In a disjointed way in his speech, he links this idea with the delusional belief that he is being watched by electronic devices placed throughout the house.In a variegated manner he links this with a coelotypical type of discourse, however the delusional ideation remains unstructured throughout.
With no previous personal or family history of mental health and ruling out underlying organic conditions, a diagnosis of psychosis secondary to pharmacological treatment for Parkinson's disease is presumed.Considering the risks and benefits, it was decided to maintain the anti-Parkinson's dose in order to avoid worsening the patient's motor function.Therefore, after reviewing the literature, the best option was to introduce clozapine at low doses, up to 50 mg at night, with the respective analytical control.After a week's admission, the patient began to improve psychopathologically, achieving an ad integrum resolution of the psychotic symptoms.Conclusions: Despite the availability of other antipsychotic treatments such as quetiapine or the more recent pimavanserin, clozapine remains the treatment of choice for drug-induced psychosis in Parkinson's disease.

EPV0910
Challenges in Treating Schizophrenia with LAIs -

Analysis of Own Results
Introduction: Schizophrenia is a multifactorial and multifarious disorder with an unidentified etiology and pathogenesis, various clinical symptoms, unpredictable course and definite social significance.It's social significance manifests in the long inability to work, the decrement of qualification and the burdening of family and social services.Patients find following therapy difficult; they often stop it altogether, which leads to new exacerbations and maintaining a vicious cycle.Objectives: To present an analysis of the results of the treatment of patients with LAIs -Trevicta and Xeplion in General Psychiatry Ward of UMBAL "Dr.Georgi Stranski" -Pleven for the period October 2016 -October 2022.Methods: Our retrospective research includes 17 patients treated in General Psychiatry Ward of UMBAL "Dr.Georgi Stranski"-Pleven.A treatment with LAI's -Trevicta and Xeplion (Paliperidone palmitate) had been initiated in these patients.In consideration of the correct applications of the medication, they are always made by qualified personnel who received training for that purpose in the Ward.For assessment of the patients' condition are used: Positive and Negative Syndrome Scale (PANSS) and Personal Social Performance (PSP).Standard statistic methods are used for processing results.
Results: Our research includes 17 female patients as the Ward's profile is such, with the average age of 38.65 years at the initiation of the treatment with Xeplion.Some were later introduced to Trevicta.Of all who participated in the research, 12 patients continue their treatment with regular applications, 2 have changed their address and by unreliable data still continue their treatment and for the other 3 we have no information of their status of treatment.The average count of admissions in the Ward before the initiation of treatment with LAI's is 3.88 against 0.88 after the initiation.
European Psychiatry S1041