Archives for: May 2005

05/20/05

Mood destabilization with antidepressants in bipolar disorder

Permalink 10:08:02 pm, Categories: Antidepressants  

Risk factors for mood destabilization with antidepressants in bipolar disorder include the following:

  • Genetic risk factors
  • Early age at illness onset
  • Comorbid substance abuse/dependence
  • History of rapid cycling
  • Multiple antidepressant trials
  • History of antidepressant-induced manias

Assessing for these risk factors before antidepressants are used in bipolar patients may help to reduce the risk for adverse consequences.

Ref: - Goldberg, J.F. (2003) When do antidepressants worsen the course of bipolar disorder? Journal of Psychiatric Practice, 9, 181-194.

05/09/05

Screening patients on atypical antipsychotics for type 2 diabetes

Permalink 09:13:16 pm, Categories: Antipsychotics  

Concern about type 2 diabetes has lead to baseline screening and ongoing monitoring recommendations for people prescribed second generation antipsychotics. Consensus development conference of American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists and North American Association for the Study of Obesity recommended checking plasma glucose before and three months after initiation of a second-generation antipsychotic, followed by annual checks. A glucose level greater than 300 mg/dl or less than 60 mg/dl as well as symptoms of hyperglycemia or hypoglycemia should lead to an immediate referral. Symptoms of diabetic ketoacidosis, such as rapid onset of polyuria, polydipsia, weight loss, nausea, vomiting, dehydration, rapid respiration, clouding of sensorium, or coma, constitute an acute emergency (Cimpean, et al., 2005).

Ref: -

American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes (2004). Diabetes Care, 27, 2, 596-601.

Cimpean, D., Torrey, W.C., Green, A.I. (2005) Schizophrenia and co-occurring general medical illness. Psychiatric Annals, 35, 1, 71-81.

05/03/05

Reducing olanzapine-induced daytime somnolence

Permalink 09:37:04 am, Categories: Antipsychotics  

Taking the olanzapine tablet on an empty stomach about an hour bedtime may increase the nighttime sedation and reduce the daytime somnolence (Schatzberg et al., 2003).

Ref:- Schatzberg, A.F., Cole, J.O. & DeBattista, C. (2003) Manual of Clinical Psychopharmacology. Washington, DC: American Psychiatric Press.

05/01/05

Clinical features of clozapine-induced neuroleptic malignant syndrome

Permalink 10:20:31 am, Categories: Antipsychotics  

Neuroleptic malignant syndrome associated with clozapine may be atypical and tend not to be characterized by rigidity, fevers, and elevation of creatine phosphokinase that are seen with standard antipsychotic drugs. Rather, the presentation in clozapine-treated patients may include delirium, autonomic instability, and milder extrapyramidal symptoms (Hasan and Buckley, 1998; Karagianis et al., 1999).

Ref:-

Hasan, S. & Buckley, P. (1998) Novel antipsychotics and the neuroleptic malignant syndrome: a review and critique. American Journal of Psychiatry, 155, 1113-1116.

Karagianis, J.L., Philips, L.C., Hogan, K.P., et al. (1999) Clozapine-associated neuroleptic syndrome: two new cases and a review of the literature. Annals of Pharmacotherapy, 33, 623-630.

Screening schizophrenia patients for hyperlipidemia

Permalink 10:19:01 am, Categories: Antipsychotics  

People with schizophrenia are at high risk for heart disease, and a lipid profile should be checked at least once every two years when LDL is normal and every six months when LDL is greater than 130 mg/dl (Marder et al., 2004). A recent consensus conference sponsored by the American Diabetes Association and the American Psychiatric Association recommended that all patients with schizophrenia should have baseline screening for family and personal history of dyslipidemia, undergo a fasting lipid profile, and be referred for treatment if found to be hyperlipidemic. A fasting lipid profile also should be obtained three months after starting an antipsychotic, at five year intervals if normal, and more often if clinically indicated.

Ref: -

American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes (2004). Diabetes Care, 27, 2, 596-601.

Marder, S.R., Essock, S.M., Miller, A.L. et al. (2004) Physical health monitoring of patients with schizophrenia. American Journal of Psychiatry, 161, 8, 1334-1349.

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Psychopharmacology Tips

This blog on Clinical Psychopharmacology is maintained by Dr. Shahul Ameen, M.D., Psychiatrist, St. John's Hospital, Kattappana, Idukki, Kerala, India.

Psychopharmacology Tips is a part of PsyPlexus, a portal for mental health professionals.

This blog is only for educational purpose of psychiatrists and other physicians. The information published in this blog is not intended for use as a substitute for consultation to a licensed health professional. Patients and consumers who visit Psychopharmacology Tips should carefully review the information gathered from the site with a professional healthcare provider.

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