[Hallucinations. Diagnostic orientation].
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Diagnosis, Differential↗
Biomedical subjects
I Blondiaux
Publications and source records attributed to I Blondiaux.
[Renal and metabolic complications of lithium].
Renal and metabolic adverse effects of lithium therapy are illustrated by the case report of a manic depressive woman aged 78 years, so treated for about 25 years. Long term lithium therapy with plasma lithium level in the therapeutic range impairs renal concentrating ability in 25-50% of the patients (when the total ingested amount reaches 100-200 mol, 700-1400 g). About 10-15% of the patients have overt nephrogenic diabetes insipidus (NDI) with elevated antidiuretic hormone plasma level and unresponsiveness to desmopressin. In rats, lithium treatment down regulates expression of the main water channel, aquaporin 2, in the renal collecting duct. NDI may be complicated by hypernatremic dehydration if the access to water is restricted, whatever the cause. Treatment of NID is best started with nonsteroidal antiinflammatory drugs, being then substituted for amiloride. Prolonged lithium therapy may induce chronic interstitial nephritis. In some patients this may result in mild or moderate non progressive chronic renal insufficiency. Acute lithium intoxication (with supratherapeutic doses) may be complicated by acute renal failure (ARF); even in the absence of ARF hemodialysis is indicated when plasma lithium level reaches 4 mmol/l or more. Other metabolic adverse effects of lithium therapy include: hypercalcemia due to hyperparathyroidism (in 5-10% of the patients); hypothyroidism (often latent); hyperthyroidism. In conclusion, these renal and metabolic adverse effects are generally mild or moderate, allowing the continuation of lithium therapy in most affected patients.
Aged↗
[Discontinuation of neuroleptic treatment in patients with schizophrenia].
Neuroleptic maintenance treatment in schizophrenia is a conflicting issue. There is no reliable criteria to identify patients for which neuroleptic withdrawal can be experienced. However, treatment discontinuation, whose risks can be limited, must be attempted for reasons such as the patient's wellbeing, longterm side-effects prevention and patient-doctor relationship management. Anyway, it can lead to more specific indications for drug maintenance.
Antipsychotic Agents↗
[Adherence to neuroleptic treatment of schizophrenic patients].
Non adherence is a topical problem: about 50% of psychiatric patients do not take their medication as prescribed. Literature's overview is revealing a lack of definition of treatment adherence and the unsatisfactoriness of methods to measure it. Reasons for reluctance to take drugs include complex treatment regimen, drug presentation, duration of treatment and side-effects, most notably akathisia and akinesia. Information exchange with patients and their family about medication is also an important factor. The patient-doctor relationship appears to be a very sensitive aspect of the problem: attempting to view non adherence psychodynamically could lead to improve it.
Antipsychotic Agents↗