Dimitry Francois

Aspiration Pneumonia Due to Clozapine-Induced Sialorrhea.

Introduction Clozapine is a second-generation antipsychotic, which use is limited to treatment-resistant cases of schizophrenia. Sialorrhea, a well-known side effect of clozapine, occurs in 31–54% of patients receiving clozapine therapy (1). Patients may complain of both daytime and nighttime drooling (the “wet pillow” sign). Here, we report the case of a young man who developed aspiration pneumonia due to clozapineinduced sialorrhea.

A case of late-life onset mania during Varenicline assisted smoking cessation

Ayalon L, Goldfracht M, Bech P. 2010. ‘Do you think you suffer from depression?’ Reevaluating the use of a single item question for the screening of depression in older primary care patients. Int J Geriatr Psychiatry 25: 497–502. Chen P, Ganguli M, Mulsant BH, DeKosky ST. 1999. The temporal relationship between depressive symptoms and dementia: a community-based prospective study. Arch Gen Psychiatry 56: 261–266. Ownby RL, Crocco E, Acevedo A, et al. 2006. Depression and risk for Alzheimer disease: systematic review, meta-analysis, and metaregression analysis. Arch Gen Psychiatry 63: 530–538. Raji MA, Reyes-Ortiz CA, Kuo YF, et al. 2007. Depressive symptoms and cognitive change in older Mexican Americans. J Geriatr Psychiatry Neurol 20: 145–152. Sierksma ASR, van den Hove DLA, Steinbusch HWM, Prickaerts J. 2010. Major depression, cognitive dysfunction and Alzheimer’s disease: Is there a link? Eur J Pharmacol 626: 72–82.

A Case of Arnold–Chiari Malformation Associated With Dementia

To the Editor: Arnold–Chiari malformation is a congenital brain anomaly that was first described by the Austrian pathologist Hans Chiari in the late 19th century. It is categorized into three types based on the degree of herniation. Type I malformation is characterized by downward displacement of the cerebellar tonsils through the foramen magnum; while in type II the cerebellar vermis and possibly the fourth ventricle and pons are involved. Type III malformation is the most severe and rarest form and consists of an encephalomeningocele that contains the brainstem and cerebellum. The malformation is known to produce variable clinical signs and symptoms of cerebellar, cervical and brainstem dysfunction. There is a paucity of literature pertaining to the neuropsychiatric illnesses associated with Arnold– Chiari malformation. To our knowledge, the only neuropsychiatric disorder reported in humans, in association with Arnold-Chiari malformation is anxiety. We now summarize a case of 53-year-old woman with Arnold–Chiari type I malformation who presented with dementia.

Antidepressant-Induced Sexual Side Effects: Incidence, Assessment, Clinical Implications, and Management

Antidepressant medications can cause numerous types of sexual dysfunction. It is important to screen for and treat antidepressant-induced sexual dysfunction, which is often under-reported and may exacerbate mood symptoms and negatively affect relationships and medication adherence. Management strategies include watchful waiting, reducing the antidepressant dose, adding a different type of antidepressant or a medication for erectile dysfunction, switching to another antidepressant, drug holidays, and timing of sexual relations with respect to antidepressant dose. [Psychiatr Ann. 2017;47(3):154-160.] Sexual dysfunction (SD) is a problem among patients with depression, affecting almost one-half of people with untreated depression.1 Whereas 26% of nondepressed people report some sexual dysfunction, this number increases to 45% in people with untreated depression, and to 63% in medically treated patients with depression.2 In addition to high levels of baseline SD in patients with depression, many antidepressant medications independently cause SD in any or all phases of the sexual response cycle, including libido, arousal, orgasm, and ejaculation.1 TYPES OF ANTIDEPRESSANTINDUCED SEXUAL SIDE EFFECTS Antidepressants can cause a variety of types of sexual dysfunction. In a hallmark study by Montejo-Gonzalez et al.,3 decreased libido was seen in Dimitry Francois, MD, FAPA, is an Assistant Professor of Psychiatry; the Associate Director, Psychiatry Clerkship; and the Site Director, Psychiatry Clerkship (Westchester), Weill Cornell Medicine. Ariana Mireille Levin, BS, is a secondyear Medical Student, Weill Cornell Medicine. Eric J. Kutscher, BA, is a second-year Medical Student, Weill Cornell Medicine. Babatunde Asemota, MBBS, is an Assistant Professor of Clinical Psychiatry, Weill Cornell Medicine; and an Assistant Attending Psychiatrist, New York– Presbyterian Hospital Westchester Division. Address correspondence to Dimitry Francois, MD, FAPA, Weill Cornell Medicine, New York–Presbyterian/Westchester, 21 Bloomingdale Road, White Plains, NY 10605; email: dif9013@med.cornell.edu. Disclosure: The authors have no relevant financial relationships to disclose. doi: 10.3928/00485713-20170201-01

Catatonia and Positive Serum Antibodies against N-Type Calcium Channel

Catatonia occurs in a range of psychiatric, neurologic, medical, and toxic conditions. Several neurobiological abnormalities predispose individuals to catatonia. Here we present a case of a 57-year-old man with a major depressive disorder with psychotic features and catatonia, whose evaluation was notable for positive serum antibodies against N-type calcium channel, without evidence for malignancy.

Alcoholism and Catatonia: An Underappreciated Relationship

Catatonia is a complex neuropsychiatric syndrome that has been described in medical literature since the 16th century. Lifethreatening complications involving every organ system can ensue, signaling high levels of associated morbidity and mortality. To this day, little is known about the etiology of catatonia. Catatonia occurs most frequently in patients with affective disorders and schizophrenia, and is more common in medical or neurologic conditions

Late-onset folie à deux in monozygotic twins

Less than 500 cases of folie à deux have been reported worldwide making it a relatively rare psychiatric disorder (Lazarus, 1986). Lasègue and Falret initially defined the syndrome as a psychiatric disturbance that could be transferred from one individual to another under the following circumstances: if the individual that first exhibited the delusions (the “inducer”) was more intelligent and dominant than the secondary individual (the “induced”), if both patients were closely associated in social isolation, and if the delusions were non-bizarre and referred to shared anxieties or experiences (Arnone et al., 2006). The accepted treatment for this condition was separation of the inducer and the induced (Lazarus, 1986). In the DSM-5, shared psychotic disorder is noted as a sub-category in the section on other specified schizophrenic spectrum and other psychotic disorders rather than as a separate diagnostic entity in itself (Parker, 2014). Folie à deux is most often seen in first-degree relatives, which supports the conjecture that genetic vulnerability is a necessity rather than simply an association. Even when folie à deux is seen in unrelated individuals there is significant family psychiatric history in affected individuals (Kendler et al., 1986; Lazarus, 1985). On the other hand, the recorded resolution of symptoms upon separation from the dominant individual proves that environmental factors have significant influence on the pathogenesis and course of the disease (Lazarus, 1985). Our case of folie à deux in monozygotic twins aims to provide additional insight into the dynamics between nature and nurture.

Guidelines for Antipsychotic-Induced Hyperprolactinemia

Treatment with antipsychotic medication can be associated with hyperprolactinemia, which may be asymptomatic or associated with a wide variety of side effects. Determining a baseline prolactin level before beginning antipsychotic therapy can assist the clinician in determining whether or not a patient’s elevated level is due to medication-induced hyperprolactinemia. If other causes of hyperprolactinemic can be ruled out, then careful consideration must be given to the risks and benefits of maintaining the patient on the therapeutic antipsychotic regimen. It is suggested that prolactin levels in patients taking antipsychotics should be monitored, but there is no consensus regarding frequency. Management of antipsychoticinduced hyperprolactinemia should be conducted on a case-by-case basis. [Psychiatr Ann. 2015;45(5):266-272.] Treatment with antipsychotic medication may be correlated with a rise in prolactin level due to hypothalamic dopamine blockade. Hyperprolactinemia associated with antipsychotic use can be asymptomatic or associated with a number of adverse effects. Irregular menses, male gynecomastia, osteoporosis, sexual dysfunction, and infertility in both genders are among the potential risks, necessitating that psychiatrists monitor and manage deleterious effects in patients being treated with antipsychotics. This article includes a discussion of evidence for baseline prolactin screening, suggested work-up in the event that hyperprolactinemia is detected, and possible courses of action. Brigitta E. Miyamoto is a third-year Medical Student, Weill Cornell Medical College. Martha Galecki, MD, is a second-year Resident in Psychiatry, Weill Cornell Medical College. Dimitry Francois, MD, is an Assistant Professor of Psychiatry, Weill Cornell Medical College. Address correspondence to Dimitry Francois, MD, 21 Bloomingdale Road, White Plains, NY 10605; email: dif9013@

The Efficacy of Pharmacotherapy for Borderline Personality Disorder: A Review of the Available Randomized Controlled Trials

Although there are no medications approved by the US Food and Drug Administration for the treatment of borderline personality disorder (BPD), polypharmacy is commonly encountered in individuals with BPD. This review summarizes the results of randomized controlled trials on the efficacy of pharmacologic agents in BPD. Pharmacotherapy in BPD is an adjunctive treatment aimed at stabilizing symptoms and behavior in a crisis situation, and it should be avoided whenever possible. Further studies are needed, including large, randomized controlled trials with long-term follow up, to examine the efficacy of psychiatric medications in patients with BPD. [Psychiatr Ann. 2015;45(8):431-437.] Dimitry Francois, MD, is an Assistant Professor of Psychiatry, Weill Cornell Medical College; an Associate Director, Psychiatry Clerkship, New York-Presbyterian Hospital; and the Site Director, Psychiatry Clerkship, New York-Presbyterian Hospital/Westchester. Steven D. Roth, MD, JD, is an Associate Professor of Clinical Psychiatry, Weill Cornell Medical College; the Acute Division Director and the Unit Chief, Personality Disorders Unit, New YorkPresbyterian Hospital/Westchester Division. Daisy Klingman, MD, is an Assistant Professor of Psychiatry, Weill Cornell Medical College; and an Attending Psychiatrist, Personality Disorders Unit, New York-Presbyterian Hospital/Westchester Division. Address correspondence to Dimitry Francois, MD, 21 Bloomingdale Road, White Plains, NY 10605; email: dif9013@med.cornell.edu. Disclosure: The authors have no relevant financial relationships to disclose. doi: 10.3928/00485713-20150803-09

Cetirizine-associated delusions and depression in an 18-year-old woman.

IntroductionCetirizine is a second-generation H1 histamine receptor antagonist that is commonly used for symptomatic relief of hay fever and other allergies and can be combined with pseudoephedrine hydrochloride, a decongestant. The most common adverse effects include headache, nausea, nasopharyngitis, vomiting, and coughing. ObjectiveTo report on an adolescent 18-year-old woman who developed delusional thinking and depression after starting treatment with cetirizine. Case ReportWe report on an adolescent 18-year-old woman who developed delusional thinking and depression after starting treatment with cetirizine. Once cetirizine was discontinued, the patient returned to her clinical baseline. ConclusionsPhysicians need to be aware of the potential psychiatric adverse effects associated with cetirizine.