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Priapism is an abnormally prolonged erection, painful and irreducible, unrelated to sexual stimulation. Around 25-40% of cases are iatrogenic, especially associated with pharmacological treatments, of which antipsychotics (first and second generation) account for 50%.
The aim is to discuss a clinical case to provide further evidence.
The patient was a 37-year-old man with a diagnosis of schizophrenia who was admitted for clinical decompensation. He had stopped antipsychotic treatment three months earlier due to side effects. He reported previous episodes of priapism associated with Risperidone, Aripiprazole, Olanzapine, and Paliperidone. At admission, he was administered Asenapine 20mg with development of priapism. Treatment was stopped. The urologists performed a lavage of the corpora cavernosa and administered adrenaline. In the absence of effectiveness, surgical intervention was successfully performed. Given the psychopathological improvement, he was discharged without antipsychotic treatment and close follow-up.
He presented a new admission one month later. Amisulpride was prescribed up to 800mg/day with good evolution and no adverse effects.
Antipsychotic-induced priapism appears to be related to the blockade of alpha-1 adrenergic receptors in the corpora cavernosa. There is a positive correlation between the affinity for the receptor and the propensity to cause priapism. The dose and duration of the medication do not appear to be correlated. Other risk factors are a history of previous episodes, restarting medication after noncompliance, use of concomitant substances or medications that cause priapism. Our choice of amisulpride was based on the fact that it has no affinity for alpha-1 adrenergic receptors.
Cases of psychosis are being reported in people infected by the SARS-CoV-2 virus. The relationship between psychosis and corticosteroids treatment is well known. However, there are relatively limited data so far correlating psychosis and SARS-CoV-2.
To describe a case of manic psychosis in a 55-year-old woman treated with corticosteroids for COVID-19 infection. Discuss the etiopathogenic factors involved in psychosis in patients infected by COVID-19.
We present the case of a 55-year-old woman, without previous psychiatric history, who was admitted to psychiatry due to a psychotic episode with maniac symptoms. Three weeks earlier, the patient had been admitted to Internal Medicine for bilateral SArs-CoV2 pneumonia, under treatment with high doses of corticosteroids. The patient presents a verbose and salty speech, euphoric mood with hyperergia, subjective increase of capacities, insomnia and delusional ideation with mystical-spiritual content with delusional interpretations and auditory hallucinations. The patient comes from Ukraine and she has been living in Spain for 20 years. She works as a household assistant. The patient relates various psychosocial stressors throughout her life.
Complementary diagnostic tests were without alterations. Low-dose antipsychotic treatment is prescribed, with a rapid recovery within a week. Finally, the patient showed complete insight of the episode and was discharged from the hospital being asymptomatic.
It would be interesting to publish the reported cases of psychosis and infection by COVID-19 as well as to investigate the etiopathogenic factors that may be contributing to the development of psychosis in patients infected by the virus.
Since the declaration of the COVID-19 pandemic, several studies have demonstrated its considerable psychological impact. The isolation and social distancing, the increased fear of being infected or infecting others and the insecurity generated by the economic impact, could contribute to an increase in the incidence of mental health issues, such as psychotic disorders.
The aim is to discuss four clinical cases in order to provide further evidence on this matter.
We report on three females and one male with no personal psychiatric history who were admitted to a tertiary hospital during the first three months after the declaration of the pandemic. The average age was 44,25 ± 14,97 years.
All patients met the International Statistical Classification of Diseases (ICD-10) criteria for acute and transient psychotic disorder. All of the episodes were triggered by the stress generated from the COVID-19. Complementary tests were unremarkable. They all tested negative for SARS-CoV-2. Rapid discharge with favorable response to relatively low doses of antipsychotics was possible with a mean length of stay of 7,25 ± 2,86 days. In two of the cases the delirious content was predominantly marked by the coronavirus itself.
It has been suggested that the intense psychosocial stress associated with a new life-threatening disease and national lockdown restrictions could be triggers for new-onset psychotic disorders. Some authors have reported cases similar to ours, which means that we could be experiencing and increase in the incidence of psychotic disorders due to the exceptional circumstances we are living around the world.
The role of cannabis on cognitive impairment in first-episode psychosis (FEP) is becoming more important, with multiple investigations on this regard, with heterogeneous results due to different methodologies.
To evaluate the cognitive profile in patients who suffer a FEP, analyzing the potential effect of cannabis.
We present the preliminar results of a cross-sectional case-control study about the effect of cannabis on cognition, in patients suffering a FEP. We recruited a total of 41 FEP during the last two years. We investigated the theorical differences between those who were cannabis users (FEP-Cannabis+)(n=28) and not cannabis users (FEP-Cannabis-)(n=13). We included a control group with healthy subjects who were cannabis users (Healthy-Cannabis+)(n=24).Sociodemographic and clinical questionnaire was completed. The Screening Scale to evaluate Cognitive Impairment in Psychiatry(SCIP-S) and the Cannabis Abuse Screening Test (CAST) were used. The consumption pattern was also evaluated.
In this study, cognitive impairment was found in FEP-Cannabis+,when compared with Healthy-Cannabis+.The most affected areas were immediate verbal learning (I-VL), delayed verbal learning (D-VL), processing speed (PS), and total score (TS). Significant differences were also observed in the cognitive profile of patients suffering FEP depending on their use of cannabis. FEP-Cannabis+) showed lower scores in PS, I-VL and TS.
Although several prognostic factors have been identified in FEP, to date there are no reliable markers for predicting the possible evolution of high-risk mental states to a FEP. More investigations are necessary in order to elucidate the role of cannabis in the cognitive impairment.
One of the usual indications for Electroconvulsive Therapy (ECT) is Paranoid Schizophrenia (PS), being performed usually in cases resistant to antipsychotics.
To present a clinical case of a patient with antipsychotic-resistant PS, including Clozapine, who received ECT.
We present the case of a 47-year-old patient with an 8-years diagnosis of PS. He presented visual, auditory, and kinesthetic hallucinations, delusions, and thought insertion and diffusion phenomena that impeded concentration. He had received treatment with different antipsychotics (including Clozapine), without achieving remission of symptoms. He also presented significant adverse effects such as hypersalivation and extrapyramidal symptoms. Due to the poor response and the adverse effects that limited the dose increase, it was decided to start ECT.
The patient received a total of 9 sessions, presenting a significant reduction in symptoms since the 5th session (disappearance of the sensory-perceptual alterations and thought disturbances). As side effects, the patient presented amnesia of the moments prior to applying the therapy, which subsequently resolved. The patient continued to present concentration difficulties, although after ECT he denied the presence of thought insertion or diffusion phenomena to which he previously attributed the cause of these difficulties.
Although less responsive than in other indications, ECT combined with antipsychotic drugs has been proven to be more effective than monotherapy (regardless of whether it’s Clozapine or another). This lower response could be due to the use of ECT in the most resistant cases, since it has been demostrated that in more acute cases a faster improvement occurs when the two treatments are combined.
Chronic insomnia (ChI) is a common condition in Primary Care (PC). Regardless that it's often related to psychiatric morbidity it appears to be a strong predictor of future depression and a disabling disorder by itself. The aim of this study was to measure and compare clinical and psychiatric characteristics of both patients with primary ChI and secondary ChI.
A random sample of 225 subjects older than 18 years old, from 3 PC Centres of the area of Madrid (Spain) was interviewed using the Oviedo Sleep Questionnaire, a semi-structured interview for sleep disorders. The subjects completed the Patient Health Questionnaire. Data about medical conditions, drug treatments, days of work lost (last year) and use of health care services (last 3 months), were also collected. Psychiatric and clinical characteristics between groups (primary vs secondary ChI) were compared.
78 patients fulfilled criteria for ChI and 53 (67.9 %) of them were suffering from any psychiatric disorder (including subtreshold conditions). Patients with primary ChI compared to secondary insomnia patients had no significant differences in age, gender, use of health care resources and days of work lost. However, patients with secondary ChI compared to primary ChI had more somatic and depressive symptoms (U-Mann-Witney test; p=0.002 and p<0.001, respectively).
There is an important group of patients among PC attendees suffering primary ChI. Patients suffering primary ChI are comparable to patients with psychiatric disorders and insomnia in terms of days of work lost and use of health care resources.
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