Adekola O. Alao

Cybersuicide: Review of the Role of the Internet on Suicide

The internet as a widespread source of communication is already having a significant influence in medicine and psychiatry. Although the internet has great potential in psychiatric education, clinical care, and research, its impact on social issues should not be underestimated. Firstly, the internet as a means of communication may encourage suicidal behavior by depicting ways by which suicide may be committed. Secondly, some internet websites may discourage people with mental illness from seeking psychiatric help, condone suicide, and forbid entry to anyone offering to discourage users from committing suicide. However, the internet could be a resource to help a potentially suicidal person get help, and can be used to identify those at risk for suicide, communicate with them, and potentially prevent suicide. If used appropriately, the internet is a powerful communication tool that can be used to benefit suicidal patients.

Depression and Sickle Cell Disease

Depressive symptoms are very common in patients with a chronic medical illness such as sickle cell disease (SCD). Clinicians may fail to recognize depression in such patients when, as in SCD, the two conditions have many overlapping symptoms. Based on a Medline database search, we review papers addressing the relationship between depression and SCD. Data regarding this relationship are conflicting. We provide recommendations for improving the treatment of patients with SCD and depression.

Aripiprazole in the Treatment of Delirium

Objective: Delirium is a common condition frequently seen in consultation-liaison psychiatry. It is especially common among medically compromised patients, and is an indicator of the severity of the medical illness. In addition, it is associated with a higher morbidity, mortality, and longer hospitalization. Traditionally, haloperidol has been used to treat agitation as it may occur in delirium. However, atypical antipsychotics are being increasingly used to treat delirium. Method: In this article, we will describe two cases of delirium successfully treated with aripiprazole. Results: Both patients had significant improvement in their delirium as measured by the delirium rating scale. Conclusion: Aripiprazole appears to be effective in reducing the symptoms of delirium.

An Unusual Foreign Body Ingestion in a Schizophrenic Patient: Case Report

The topic of foreign body ingestion has received extensive coverage in the areas of surgery, emergency medicine, and pediatrics. A subset of this topic, the intentional ingestion of foreign bodies, however, is much less common, and requires special evaluation and management. Here, we report a case of ingestion of a rolled, metal tuna can lid in a male prison inmate previously diagnosed with depression and paranoid schizophrenia. Following evaluation by the surgical team, the foreign body was removed by laparotomy and the patient was discharged back to the prison without complication. In many cases, ingestions of this type involve a command hallucination ordering the patient to swallow the foreign body. Interestingly, the patient in the present case reported auditory hallucinations commanding him not to swallow the can lid. On further investigation, we found that patient had a proclivity toward this swallowing behavior even prior to his incarceration. Early identification of inmates with this proclivity has important implications for treatment and prevention.

The Use of Clonidine in the Treatment of Nightmares among Patients with Co-Morbid PTSD and Traumatic Brain Injury:

Objective: To describe the successful treatment of PTSD associated nightmares in two patients with PTSD. Case Summaries: The report of the successful use of clonidine to treat PTSD associated nightmares among two Veterans following combat exposure. Discussion: Clonidine, a centrally acting alpha-agonist agent used to treat hypertension, stimulates alpha-adrenoreceptors in the brain stem. This action results in reduced sympathetic outflow from the central nervous system. We hypothesize that this central mechanism of action is why clonidine may be more effective in treating nightmares among patients with PTSD when compared with other agents. Conclusion: Clonidine should be considered as an alternative in the treatment of nightmares among patients with PTSD.

Charles Bonnet syndrome: visual hallucination and multiple sclerosis.

Multiple sclerosis (MS) is a fairly common condition that affects approximately 350,000 people in the United States (1). It is associated with various neuropsychiatric symptoms including cognitive and behavioral symptoms. However, visual hallucinations are rare in multiple sclerosis without the presence of cognitive deficits (2). We are describing the case of a 40-year-old married white female with isolated complex visual hallucinations compatible with the Charles Bonnet syndrome (CBS). The patient was successfully treated with the atypical antipsychotic olanzapine.

Drug Addiction in Sickle Cell Disease: Case Report:

There has been widespread speculation that patients with sickle cell disease (SCD) may become drug dependent if their painful crisis is treated with narcotics. However, there has been no scientific evidence to support this assertion. Paradoxically, individuals suffering from sickle cell disease who are not adequately treated may develop an addiction to narcotics due to self-medication to treat their pain. In this article, we describe a 38-year-old African American woman who became addicted to cocaine due to self-medication of her sickle cell pain with cocaine.

Psychiatric Complications of Malaria: A Case Report

This article reviews the psychiatric complications of malaria. A case of malaria infection is described. The diagnoses, treatment, and neuropsychiatric complications of acute and chronic malaria infection are discussed. The treatment of malaria and its complications are summarized.

Psychiatric Complications of Hydrocephalus

This article explores the association between normal pressure hydrocephalus and psychiatric symptoms, such as depressed mood, delusions, and hallucinations. We are reporting a case of a 30-year-old female with a history of congenital hydrocephalus, is used to illustrate this association. Such patients may benefit from treatment with ventriculoperitoneal or ventriculoatrial shunt procedures.

Valacyclovir-Induced Psychosis and Manic Symptoms in an Adolescent Young Woman With Genital Herpes Simplex

BACKGROUND Genital herpes is a common and painful infection. Its prevalence within the United States is estimated to be 40 million to 60 million people. Three medications, acyclovir, valacyclovir, and famciclovir, have been shown to reduce the duration and severity of the disease. OBJECTIVE The authors report on the first known case of valacyclovir-induced psychosis with symptoms of mania in a young woman with no previous psychiatric history. METHOD The patient presented with irritable mood and grandiose delusions 72 hours after starting valacyclovir for genital herpes. Valacyclovir treatment was stopped, and risperidone was initiated. RESULTS The symptoms continued after stopping the valacyclovir, but improved with risperidone. DISCUSSION There are reports of neuropsychiatric side effects with valacyclovirs structural analogs in elderly patients with renal dysfunction. Clinicians should be aware that valacyclovir may induce psychosis with manic presentation in young, healthy patients without a psychiatric history.