Dhanya Raveendranathan

Beneficial effects of add-on raloxifene in schizophrenia

The role of estrogens in schizophrenia has been proposed from the observation of schizophrenia occurring later and with symptom severity being lesser in women. Utility of estrogens in treatment of psychoses, though seen to be useful, comes with inherent risks of neoplasias, given its agonistic action on breast and endometrium. This risk can be overcome with use of selective estrogen receptor modulators, like raloxifene. Raloxifene has been used in schizophrenia, with improvement in symptoms and cognitive functions. We report the use of raloxifene as an adjunctive treatment, with risperidone, in treatment-resistant form of schizophrenia. The patient, a 29-year-old woman, over a 7-month follow-up period, showed significant improvement in socio-occupational functioning, with reduction in symptom severity.

Short-term diagnostic stability of acute psychosis: data from a tertiary care psychiatric center in South India.

Context: Studies on acute psychosis in patients from India report good outcome. A small proportion of these patients may suffer relapses or other develop major psychiatric disorders later. Aim: The aim of this study was to examine the diagnostic stability of acute psychosis in patients from India. Materials and Methods: The records of patients who presented with the first episode of acute and transient psychotic disorder (n=57) over 1 year (2004) were analyzed, and the follow-up data at the end of 1 and 2 years were recorded. Results: The mean age of the sample was 30.72 years. The mean duration of illness episode was 18.15±17.10 days. The follow-up data were available for 77.2% (n=44) and 75.4% (n=43) of the sample at the end of first and second years. Relapse was recorded in 47.4 and 54.4% at the end of first and second years, respectively. Conclusion: The diagnosis changed into other disorders such as bipolar disorder, schizophrenia, and unspecified psychosis, while a majority retained the initial diagnosis of acute psychosis. The findings suggest that acute psychosis is a relatively stable condition. A small percentage of these patients may go on to develop schizophrenia or bipolar disorder.

Hyperthyroidism presenting as mixed affective state: a case report.

Thyroid disorders have long been associated with psychiatric illness, commonly mood disorders. In bipolar disorder, hypothyroidism is quite a common abnormality. Little is known about the association of thyroid disorders and mixed affective states. We present a case of hyperthyroidism presenting as a mixed affective state and the successful resolution of psychiatric symptoms with antithyroid medication along with a mood-stabilizing agent.

Late-onset clozapine-induced agranulocytosis in a patient with comorbid multiple sclerosis

The risk of clozapine-induced agranulocytosis is highest in the initial 6 months after onset of treatment. There have been very few reports of neutropenia and agranulocytosis after this period. We report a unique case of delayed clozapine-induced agranulocytosis in a patient with preexisting multiple sclerosis (MS) which was treated with granulocyte colony-stimulating factor. Both MS and clozapine-induced agranulocytosis have an underlying autoimmune immune mechanism. This case highlights the need for frequent blood count monitoring on clozapine even after the initial 6 months of starting treatment especially in patients with a past history of drop in white blood cell counts as well as with a comorbid autoimmune disorder.

Successful use of maintenance electroconvulsive therapy in the treatment of clozapine-associated obsessive-compulsive symptoms in schizophrenia: a case report.

Denovo obsessive-compulsive (OC) symptoms are associated with the use of atypical antipsychotics, clozapine in particular. Treatment of clozapine-associated OC symptoms is challenging and often difficult because continuation of clozapine can result in worsening of OC symptoms, whereas discontinuation may result in worsening of psychosis. We report, for the first time, the use of maintenance electroconvulsive therapy, in clozapine-associated OC symptoms, in a patient with schizophrenia.

Metacognitive training for delusion in treatment-resistant schizophrenia.

Metacognitive training for patients with schizophrenia (MCT) is a novel form of psychotherapy that aims to promote insight into the relationship between metacognitive deficits and psychotic symptoms, especially delusions. MCT has been found to be effective in reducing the delusional conviction and other positive symptoms in patients with schizophrenia. However, we are not aware of any research in which MCT has been used specifically to manage treatment-resistant schizophrenia patients. We report the case of a patient with treatment-resistant schizophrenia who responded to MCT. Her persecutory and referential delusions improved with a course of twelve sessions of therapy. Further, the improvement in delusions had a positive impact on her psychosocial functioning. A follow-up after two months of therapy revealed sustained improvement.

Vitamin B12 Levels and Psychiatric Symptomatology: A Case Series

Cobalamin (Vitamin B₁₂) has been implicated in the pathogenesis of various neuropsychiatric disorders. A review of 19 patients (14 vegetarians) with demonstrable vitamin B₁₂ deficiency showed varied psychiatric symptomatology, with the majority not having significant hematological or neurological manifestations.

Piracetam treatment in patients with cognitive impairment

Piracetam is a cognitive-enhancing agent that is used for the treatment of cognitive impairments of various etiologies. Little is known about its side effect profile, especially in those with psychiatric illness. We herewith present two cases with cognitive impairment who had contrasting responses to piracetam. One of them with organic amnestic syndrome had significant improvement, whereas the other who had an organic personality change as well as a family history of mental illness had significant worsening of behavioral problems after piracetam was introduced. This report highlights the need for caution in the use of piracetam, especially in those with past or family history of psychiatric illness.

Mirtazapine induced akathisia: Understanding a complex mechanism

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Obsessive Compulsive Disorder Masquerading as Psychosis

Obsessive compulsive disorder (OCD) is commonly regarded as a disorder with good insight. However, it has now been recognized that insight varies in these patients. Pathological beliefs seem to lie on a continuum of insight, with full insight at one end and delusion at the other. This can indeed pose a considerable challenge, especially in a scenario where the phenomenon is difficult to discern. We report a case of OCD, which was initially diagnosed as psychosis.