Chathurie Suraweera

Simvastatin-induced cognitive dysfunction: two case reports

BackgroundSimvastatin is commonly prescribed for hypercholesterolemia to reduce vascular risk in patients. Some of these patients have dementia with cognitive defects of several domains. Although protective effects seem to be present, there is emerging evidence that statins cause cognitive impairment.The role of cholesterol in cognitive function is complex. This is reflected in the effects that statins show on cognition functions. The reduction in cholesterol levels seen with statins is effective in improving learning and memory in some patients. However, there is emerging evidence that statins may worsen cognitive function. Similarly, there are major concerns over whether statins alleviate or worsen cognitive problems. The correlation between cholesterol levels and cognitive function is still controversial, mainly due to a lack of robust evidence.Case presentationWe report the cases of two Asian patients who developed cognitive deficits after starting simvastatin. A 32-year-old man and a 54-year-old woman developed different but clear cognitive deficits that reversed after stopping simvastatin.ConclusionsThe possibility of new-onset cognitive dysfunction and the deterioration of existing cognitive deficits should be considered when prescribing simvastatin to patients.

Antipsychotic-associated weight gain: management strategies and impact on treatment adherence

Antipsychotic-induced weight gain is a major management problem for clinicians. It has been shown that weight gain and obesity lead to increased cardiovascular and cerebrovascular morbidity and mortality, reduced quality of life and poor drug compliance. This narrative review discusses the propensity of various antipsychotics to cause weight gain, the pharmacologic and nonpharmacologic interventions available to counteract this effect and its impact on adherence. Most antipsychotics cause weight gain. The risk appears to be highest with olanzapine and clozapine. Weight increases rapidly in the initial period after starting antipsychotics. Patients continue to gain weight in the long term. Children appear to be particularly vulnerable to antipsychotic-induced weight gain. Tailoring antipsychotics according to the needs of the individual and close monitoring of weight and other metabolic parameters are the best preventive strategies at the outset. Switching to an agent with lesser tendency to cause weight gain is an option, but carries the risk of relapse of the illness. Nonpharmacologic interventions of dietary counseling, exercise programs and cognitive and behavioral strategies appear to be equally effective in individual and group therapy formats. Both nonpharmacologic prevention and intervention strategies have shown modest effects on weight. Multiple compounds have been investigated as add-on medications to cause weight loss. Metformin has the best evidence in this respect. Burden of side effects needs to be considered when prescribing weight loss medications. There is no strong evidence to recommend routine prescription of add-on medication for weight reduction. Heterogeneity of study methodologies and other confounders such as lifestyle, genetic and illness factors make interpretation of data difficult.

Use of lithium in clozapine-induced neutropenia: a case report

BackgroundThe literature describing the long-term use of lithium carbonate to reinstate reduced levels of white blood cell counts in patients treated with clozapine is scarce. We describe a case of successful recommencement of clozapine on a patient who developed risk level of neutropenia which was corrected by lithium carbonate. He was followed up for a period of one year.Case presentationWe report a 40-year-old Sri Lankan male who developed neutropenia and low white blood cell counts following commencement of clozapine. We were successful in restarting clozapine after the addition of lithium carbonate to increase the cell counts. Clozapine was increased to 700 mg a day with 500 mg of lithium carbonate. The patient remains stable after one year with no further episodes of neutropenia.ConclusionLithium carbonate can successfully be used to treat clozapine-induced neutropenia.

Metformin for treatment of antipsychotic-induced weight gain in a South Asian population with schizophrenia or schizoaffective disorder: A double blind, randomized, placebo controlled study

Background: Antipsychotic-induced weight gain causes serious health problems. We investigated the efficacy and safety of metformin in treating antipsychotic-induced weight gain in South Asian patients. Methods: Sixty six adult patients with schizophrenia or schizoaffective disorder treated, with atypical antipsychotics, and who had increased by more than 10% their pre treatment body weight, were randomly assigned to receive metformin or placebo in a double-blind study. Patients received usual treatment and metformin 500mg or placebo twice daily for 24 weeks. The primary outcome measure was change in body weight from baseline to week 24. Linear mixed models were used in the analysis. Results: Mean change in body weight in the metformin group was −1.56 kg (95% CI=−3.06 to −0.05) and 1.0kg (95% CI=0.03−1.97) in the placebo group. Between-group difference was 2.56 kg. At 24 weeks the between-group difference showed significant time-by-treatment interaction (F=3.23, p=0.004). Between-group difference in BMI showed significant time-by-treatment interaction (F=3.41 p=0.03). There was no significant difference in waist–hip ratio or fasting blood sugar. Conclusions: Metformin is effective in reducing weight in South Asian patients with schizophrenia or schizoaffective disorder who had increased their body by more than 10% after treatment with atypical antipsychotics.

Phagophobia: a case report

BackgroundPhagophobia is a rare disorder and the literature is sparse. There is no specific treatment described for this life threatening condition.Case presentationThe patient is a 25-year-old Sri Lankan female with recurrent difficulty in swallowing. Following her initial episode which lasted one year, she presented to us with inability to swallow for one week. She was dependent on liquids and semisolids. The medical team confidently excluded an organic cause. She had difficulty swallowing solids with behaviours like swallowing with the aid of water and swallowing small boluses. She had difficulty eating in front of a crowd as well. She was preoccupied with misconceptions related to food and gastrointestinal disorders like gastritis. The symptom was soon becoming a maladaptive coping mechanism as it occurred when she was under stress and had difficulty solving a problem. The patient was managed with graded exposure and cognitive techniques.ConclusionThe possibility of a psychological cause for dysphagia should be borne in mind although the occurrence is rare. Although no definitive treatment methods for phagophobia are described, cognitive behavioural techniques can successfully be used in the treatment.

Are Urinay Tract Infections Associated with Acute Episodes of Schizophrenia

Objectives To establish any association between urinary tract infections and acute episodes of schizophrenia Methods A Case control study conducted in University Psychiatry unit, National Hospital of Sri Lanka (NHSL), Colombo, Sri Lanka. Thirty four cases with acute episode of schizophrenia and 30 normal controls matched for age and gender were selected. Cases were patients who met the International Classification of Disease (ICD- 10) criteria to diagnose schizophrenia who attended the inward and outpatient care of the unit. Urine full report (UFR) and urine culture were performed in all cases and controls to detect and confirm urinary tract infections (UTI). Data was analyzed using SPSS software. Results Number of cases was 34 and controls were 30. Mean age of cases was 34.8 years while in controls it was 34.1 years. In cases 18 (52.9%) were males and in controls, 16 (53,3%) were males. Among patients who had acute episodes of schizophrenia 5 (14.7%) became positive for UFR and from controls 2 (6.6%) became positive. (Odds ratio=2.4). Urine culture was positive in 1 case and 1 control each. (Odds ratio=0.88). Conclusions Patients with acute schizophrenia are more likely to have positive urine full report than normal healthy controls. But they are not more likely to experience urinary tract infections than the normal healthy controls during their acute episode of schizophrenia.

The Common Side Effects of Long Term Treatment with Clozapine and Their Impact: a Sri Lankan Experience

Objectives To analyse the side effects experienced by patients who are on clozapine for a period of more than one year and to analyse the impact of the side effects. Methods A descriptive cross sectional study carried out in University Psychiatry unit, National Hospital of Sri Lanka, Colombo. All patients attending the clozapine clinic within one month and who are on clozapine for a period of more than one year and who are in remission were selected. Interviewer administered questionnaire was used to assess the presence of side effects and their impact. Data was analyzed using SPSS software. Results Sample was 63. Mean age was 34.9 years (range 18-60). Mean duration of usage of clozapine is 7.0 years (range 1-20). Fifty seven (71.4%) had hyper-salivation and constipation and 12 (19.0%) had nocturnal enuresis. Majority of patients who had hyper-salivation (86.6%) and nocturnal enuresis (100%) were not receiving any medical intervention. Fifteen (23.8%) reported the side effects have caused distress for them and 19% (n=12) revealed they have affected their activities of daily living. Conclusions Most common long term side effects were hyper-salivation and constipation. Majority of patients with hyper-salivation were not receiving medical intervention. Majority of patients did not report that the side effects affect their activities of daily living or they cause personal distress.

EPA-0130 - Analysis of the behaviour and psychopathology in patients with mania

Introduction Mania is a syndrome characterized by elevation of mood, increased activity and self important ideas. Inflated self-esteem may develop into grandiose delusions and suspiciousness into delusions of persecution. Grandiose delusions can be classified into three types. They are delusions of grandiose ability, grandiose identity and religious delusions. Studies on the content of the grandiose delusions and other psychopathology in patients with mania in Sri Lanka is scarce. Aims To analyze the behavior and psychopathology in patients with mania Methods Descriptive cross sectional study. All patients admitted to University Psychiatry Unit, National Hospital of Sri Lanka (NHSL) who met ICD 10 criteria of first episode mania and Bipolar Affective Disorder, current episode manic, within a period of three months were selected. Interviewer administered questionnaire and clinical records were used. Results Sample was 36. Twenty two (61.1%) had manic episode with psychotic symptoms. Thirteen (36.1%) had destructive behaviour. Thirty three (91.6%) did not show sexual disinhibition. Eighteen (50%) had grandiose delusions. Of the grandiose delusions 10 (55.5%) were of grandiose ability, 6 (33.3%) were of grandiose identity and 2 (11.1%) were of the religious subtype. Five (50%) who had delusion of grandiose ability believed they had healing power. Eleven (30.5%) had persecutory delusions and seven (19.4%) had delusions of reference. Five (13.8%) had auditory hallucinations. Conclusions Grandiose delusions were the commonest type of delusion but almost one third had persecutory delusions. Most common subtype of grandiose delusion was grandiose ability. Most common content of grandiose ability was healing power.