Biomedical subjects
Publications and source records attributed to Nurgul Ozpoyraz.
We present a patient who developed discontinuation symptoms following abrupt cessation of nefazodone. Three days after the first appearance of the discontinuation symptoms (i.e. 5 days after cessation of the drug), all symptoms resolved spontaneously without a need for intervention. This case report emphasizes the importance of gradual discontinuation of serotonergic drugs to avoid any consequent unpleasant discontinuation symptoms.
OBJECTIVE: To report a case of persistent psychosis that developed during interferon alfa (IFN-alpha) therapy for chronic hepatitis B. CASE SUMMARY: A 26-year-old man who was diagnosed with active chronic hepatitis B began treatment with IFN-alpha. Five months after initiation of therapy, he developed acute psychosis with prominent persecutory delusions and auditory hallucinations. Despite discontinuation of IFN-alpha therapy and addition of antipsychotic drug treatment, only partial recovery from psychosis was observed after 4 months of hospitalization. DISCUSSION: Unlike many previously reported cases, this patient showed only partial recovery from psychosis, despite the discontinuation of IFN therapy. Except for receiving a relatively high dose of IFN-alpha (10 million units 3 times/wk), the patient did not have any previously proposed risk factors for developing psychiatric adverse effects. The Naranjo probability scale indicates a probable relationship between the acute psychosis and IFN therapy. CONCLUSIONS: Despite its rare occurrence, psychosis can emerge during IFN-alpha therapy. This adverse effect may persist for several months, even after appropriate medical management. IFN-alpha should be used with careful monitoring of patients' psychiatric status during all stages of therapy.
The purposes of this study were to evaluate possible effects of lithium on thyroid function, determine the relationship among thyroid function, antibody levels, and demographic/clinical variables, and establish the prevalence of lithium-related goiter, clinical hypothyroidism, and thyroid antibodies. Forty-nine patients who had taken lithium for a minimum of 6 months were enrolled, as were 46 age- and sex-matched controls naïve to lithium use. Blood was drawn to measure levels of total and free T3, T4, thyroid-stimulating hormone (TSH), and antimicrosomal and antithyroglobulin antibodies. Thyroid volume was quantified on ultrasonography. Twenty-nine patients in the study group (59%) and 7 in the control group (15%) had goiter. Free T4 levels were significantly lower in the study group, and TSH levels were higher. Among lithium-treated patients, 12% had clinical hypothyroidism and 2% had subclinical hypothyroidism. Thyroid antibodies were present in 23% of the lithium group and 15% of the control group. No significant relationship was apparent among thyroid antibodies, thyroid volume, and clinical hypothyroidism. Our findings suggested that along with its goitrogenic effects, lithium inhibited thyroid function and led to clinical hypothyroidism. Older age, family history of thyroid disorders, and the presence of thyroid antibodies significantly influenced thyroid function in the present study.
Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed in the treatment of depression and anxiety, as well as obsessive-compulsive, eating, and impulse-control disorders. Paralleling their widespread use has been an increase in adverse-effect reports not noted during short-term efficacy studies. Significant among these adverse effects is SSRI discontinuation syndrome, which follows the interruption of extended treatment or a reduction in drug dosage and entails somatic and psychological symptoms. These self-limiting symptoms resolve on reintroduction of the drug and cannot be explained as a remanifestation of the original disorder. To facilitate proper diagnosis and avoid unnecessary therapeutic or diagnostic interventions, all physicians who prescribe SSRIs should become familiar with these symptoms. The most appropriate approach to therapy for discontinuation syndrome involves educating patients and reassuring them that this is a reversible condition, reinstating the original SSRI, and further slowing the rate of tapering.
The aim of this study was to assess the comorbidity of lifetime and current prevalences of anxiety disorders among 70 patients with bipolar I disorder in remission using structured diagnostic interviews and to examine the association between comorbidity and several demographic and clinical variables. Forty-three (61.4%) bipolar I patients also met DSM-IV criteria for at least one lifetime comorbid anxiety disorder. Obsessive-compulsive disorder (39%) was the most common comorbid lifetime anxiety disorder, followed by simple phobia (26%) and social phobia (20%). First episode and male sex were found to have lower rates of comorbid current anxiety disorders. The presence of anxiety disorders was related to significantly higher scores on both anxiety and general psychopathology scales. The results of the present study support previous findings of a high comorbidity rate of anxiety disorders in bipolar I disorder cases and indicate that the presence of an anxiety disorder leads to more severe psychopathology levels in bipolar I patients.