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Bou Khalil R, Yazbek JC. Potential importance of supplementation with zinc for autism spectrum disorder. Encephale 2021; 47:514-517. [PMID: 33863509 DOI: 10.1016/j.encep.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 11/29/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022] [Imported: 08/29/2023]
Abstract
Zinc is an essential micronutrient for cellular proliferation and subsequent body and brain development. Zinc deficiency is becoming a major public health issue equally in under-developed and developed countries. The lack of sufficient zinc, whether related to environmental or internal factors, is an important environmental stressor that is eligible to become elucidated as a contributing factor for the pathogenesis of autism spectrum disorder (ASD). The aim of this manuscript is to briefly overview available data regarding the relationship of zinc deficiency with the development of ASD and to relate these data with currently known pathogenetic mechanisms of this disorder namely brain growth disturbances and neuropeptides secretion. Zinc deficiency impacts brain connectivity and growth and alters adequate neurotransmission. In addition, zinc deficiency may indirectly act on the brain by disturbing the immune system and by altering the normal gut-brain connection. Zinc seems to be important for the social effect of neuropeptides. Zinc supplementation in pregnant women and newborn children with the aim of preventing ASD needs further consideration.
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Bou Khalil R. "Emotional Chemobrain": A new concept for chemotherapy adverse drug effect? L'ENCEPHALE 2020; 47:613-615. [PMID: 33190820 DOI: 10.1016/j.encep.2020.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 07/11/2020] [Accepted: 08/08/2020] [Indexed: 11/18/2022] [Imported: 08/29/2023]
Abstract
"Emotional chemobrain" is a new paradigm that relates the occurrence of alterations in the psychological wellbeing of patients to the adverse drug effects of chemotherapy on the neurobiological level. The concept of "emotional chemobrain" is the analogue concept of the classical concept of "chemobrain" but that concerns emotional disturbances related to chemotherapy. Disgust is a negative emotion that might accompany any stressful life event such as having cancer. Increased disgust may lead to the development of mental disorders such as mood and anxiety disorders. Patients with cancer may develop negative emotions such as self-disgust because of their affected autonomy and life style on the one hand and because of chemotherapy's effect on their brain on the other. Self-disgust might be considered as a factor contributing to psychological distress exacerbation in this category of physically ill individuals. In addition to lifestyle modifications and body changes, self-disgust might be exacerbated by chemotherapy in the same way other negative emotions might be exacerbated by this kind of treatment. It might be speculated that the emotional side effects of chemotherapy concern activation modifications in brain regions relevant to emotional elaboration and regulation such as the insular lobe and the amygdala. "Emotional chemobrain" should be considered whenever neuropsychiatric adverse effects of chemotherapy are manifested in patients with cancer. Future studies might be interested in studying the effect of chemotherapy on brain regions that can affect regulation of emotions such as self-disgust.
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Duriez P, Bou Khalil R, Chamoun Y, Maatoug R, Strumila R, Seneque M, Gorwood P, Courtet P, Guillaume S. Brain Stimulation in Eating Disorders: State of the Art and Future Perspectives. J Clin Med 2020; 9:E2358. [PMID: 32717984 PMCID: PMC7465000 DOI: 10.3390/jcm9082358] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] [Imported: 08/29/2023] Open
Abstract
The management of eating disorders (EDs) is still difficult and few treatments are effective. Recently, several studies have described the important contribution of non-invasive brain stimulation (repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and electroconvulsive therapy) and invasive brain stimulation (deep brain stimulation and vagal nerve stimulation) for ED management. This review summarizes the available evidence supporting the use of brain stimulation in ED. All published studies on brain stimulation in ED as well as ongoing trials registered at clinicaltrials.gov were examined. Articles on neuromodulation research and perspective articles were also included. This analysis indicates that brain stimulation in EDs is still in its infancy. Literature data consist mainly of case reports, cases series, open studies, and only a few randomized controlled trials. Consequently, the evidence supporting the use of brain stimulation in EDs remains weak. Finally, this review discusses future directions in this research domain (e.g., sites of modulation, how to enhance neuromodulation efficacy, personalized protocols).
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Disgust and fear: common emotions between eating and phobic disorders. Eat Weight Disord 2020; 25:79-86. [PMID: 29766462 DOI: 10.1007/s40519-018-0512-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 05/01/2018] [Indexed: 10/16/2022] [Imported: 08/29/2023] Open
Abstract
Eating disorders (ED) are prevalent mental illnesses composed mainly of anorexia nervosa, bulimia nervosa and binge eating disorders. Anxiety disorders are another set of mental illnesses, with phobic disorder (PD) being the most prevalent disorder. ED and PD are highly comorbid. The aim of this study is to assess, in 131 individuals attending an outpatient clinic for different health issues, the level of fear related to situations generating avoidance such as in social anxiety and specific phobias according to the fear questionnaire (FQ), the level of disgust according to the disgust scale (DS-R) and the vulnerability towards ED according to the SCOFF scale to demonstrate that high levels of both fear and disgust increase the vulnerability towards ED. The study demonstrated that the level of disgust increased when fear increases (r = 0.377, p < 0.001 for the first part of the FQ; r = 0.225, p = 0.01 for the second part of the FQ). Moreover, individuals with vulnerability towards having an ED presented a higher level of disgust than individuals without this vulnerability (p = 0.009). Furthermore, individuals with vulnerability towards ED have a higher level of anxiety related to PD subtypes (p = 0.008 for agoraphobia; p = 0.001 for injection/blood phobia) as well as to social anxiety (p = 0.01), independently from having a depressive or another anxiety disorder. In the multivariate analysis, a history of psychiatric consultation has been the only significantly different parameter between individuals with or without vulnerability towards ED (p = 0.0439). Accordingly, fear and disgust are negative emotions that seem to be clinically associated which better explains the comorbidity of ED with PD. LEVEL OF EVIDENCE: Level III. Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
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Bou Khalil R, Richa S. Letter to the editor: Are thyroid function abnormalities only related to antipsychotic treatment in patients with severe mental disorders? J Psychiatr Res 2019; 117:148-149. [PMID: 30466962 DOI: 10.1016/j.jpsychires.2018.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 10/21/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022] [Imported: 08/29/2023]
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Insulin-growth-factor-1 (IGF-1): just a few steps behind the evidence in treating schizophrenia and/or autism. CNS Spectr 2019; 24:277-278. [PMID: 30419988 DOI: 10.1017/s1092852918001256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] [Imported: 08/29/2023]
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Bou Khalil R, Richa S. On cognitive debiasing and the judgment of suicide-attackers. Encephale 2018; 44:476-478. [PMID: 29580704 DOI: 10.1016/j.encep.2018.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/22/2017] [Accepted: 01/15/2018] [Indexed: 10/17/2022] [Imported: 08/29/2023]
Abstract
Suicide-attacks are possibly increasing in frequency all over the world. To date, these attacks are not considered as a manifestation of a particular mental illness. However, the process of radicalization of suicide-attackers has to interest the field of mental health. One plausible explanation for the radicalization of individuals is the use of biased cognitive schemes by the indoctrinator. Among these cognitive schemes could figure the causal attribution bias in which the subject cannot distinguish in front of two factors that operate simultaneously, the share of each factor in achieving a certain goal. Another cognitive bias would be the confirmation bias during which the subject would tend to adhere to ideas from his/her own thinking or the thinking of subjects who share some cultural values with him/her and refute any other ideas. Finally, the bias of polarization or splitting could also be incriminated. Through this bias, the subject would either be proud of being a member of a cultural group or ashamed when he/she feels that this group is being attacked and that he/she is unable to rescue it. Approaches to increase the awareness of individuals to the adverse effects of these biased cognitive schemes may theoretically reduce the risk of committing suicide-attacks. However, despite numerous attempts of "deradicalization" involving technological means of communication as well as social "reintegration" centers, all approaches aiming at raising awareness of cognitive biases need to be studied in a scientific manner before they become widespread.
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Bou Khalil R, Guimaraes A. To collapse when there are no other means to cope. Asian J Psychiatr 2018. [PMID: 29529419 DOI: 10.1016/j.ajp.2018.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] [Imported: 08/29/2023]
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Bou Khalil R, Guimaraes A, Richa S. The "Loss of Pride" Syndrome in Yazidi Refugees. Am J Psychiatry 2018; 175:112-113. [PMID: 29385826 DOI: 10.1176/appi.ajp.2017.17070754] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] [Imported: 08/29/2023]
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Bou Khalil R. Are Hypomanic/Manic Episodes "Induced by" or "Associated with" Quetiapine Initiation? DRUG SAFETY - CASE REPORTS 2017; 4:21. [PMID: 29177912 PMCID: PMC5702285 DOI: 10.1007/s40800-017-0063-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] [Imported: 08/29/2023]
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Bou Khalil R. On the Magical Thinking Related to Mental Health in Chad. Am J Psychiatry 2017; 174:427-428. [PMID: 28457164 DOI: 10.1176/appi.ajp.2016.16101159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] [Imported: 08/29/2023]
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Is insulin growth factor-1 the future for treating autism spectrum disorder and/or schizophrenia? Med Hypotheses 2017; 99:23-25. [DOI: 10.1016/j.mehy.2016.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 12/05/2016] [Accepted: 12/10/2016] [Indexed: 12/14/2022] [Imported: 08/29/2023]
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The importance of the hypothalamo-pituitary-adrenal axis as a therapeutic target in anorexia nervosa. Physiol Behav 2016; 171:13-20. [PMID: 28043861 DOI: 10.1016/j.physbeh.2016.12.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/26/2016] [Accepted: 12/27/2016] [Indexed: 12/19/2022] [Imported: 08/29/2023]
Abstract
Anorexia nervosa (AN) is an eating disorder, mainly affecting women, with a lifetime prevalence of about 1%, that can run a chronic course. While an effective pharmacotherapy is lacking, it is hypothesized that the progesterone and type II glucocorticoid receptor antagonist mifepristone (RU486) might be useful, as it is well known that the hypothalamo-pituitary-adrenal axis (HPA) is activated in AN. Even if secondary to the eating disorder, an active HPA axis may contribute to maintaining the neuroendocrine, emotional and behavioral effects observed in AN. More specifically, it is suggested that the HPA axis interacts with limbic structures, including the insular and prefrontal cortices, to uphold the changes in interoceptive and emotional awareness seen in AN. As such, it is proposed that mifepristone (RU486) reverses these effects by acting on these limbic regions. In conclusion, the theoretical efficacy of mifepristone (RU486) in improving symptoms of AN should be tested in randomized clinical trials.
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Hypersalivation as an Adverse Drug Reaction Related to Lithium Carbonate: A Case Report. J Clin Psychopharmacol 2016; 36:739-740. [PMID: 27749501 DOI: 10.1097/jcp.0000000000000586] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] [Imported: 08/29/2023]
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Bou Khalil R, Khoury E, Koussa S. Linking multiple pathogenic pathways in Alzheimer’s disease. World J Psychiatry 2016; 6:208-214. [PMID: 27354962 PMCID: PMC4919259 DOI: 10.5498/wjp.v6.i2.208] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/16/2016] [Accepted: 05/11/2016] [Indexed: 02/05/2023] [Imported: 08/29/2023] Open
Abstract
Alzheimer’s disease (AD) is a chronic neurodegenerative disorder presenting as progressive cognitive decline with dementia that does not, to this day, benefit from any disease-modifying drug. Multiple etiologic pathways have been explored and demonstrate promising solutions. For example, iron ion chelators, such as deferoxamine, are a potential therapeutic solution around which future studies are being directed. Another promising domain is related to thrombin inhibitors. In this minireview, a common pathophysiological pathway is suggested for the pathogenesis of AD to prove that all these mechanisms converge onto the same cascade of neuroinflammatory events. This common pathway is initiated by the presence of vascular risk factors that induce brain tissue hypoxia, which leads to endothelial cell activation. However, the ensuing hypoxia stimulates the production and release of reactive oxygen species and pro-inflammatory proteins. Furthermore, the endothelial activation may become excessive and dysfunctional in predisposed individuals, leading to thrombin activation and iron ion decompartmentalization. The oxidative stress that results from these modifications in the neurovascular unit will eventually lead to neuronal and glial cell death, ultimately leading to the development of AD. Hence, future research in this field should focus on conducting trials with combinations of potentially efficient treatments, such as the combination of intranasal deferoxamine and direct thrombin inhibitors.
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Bou Khalil R, Khoury E, Richa S. Do Fibromyalgia Flares Have a Neurobiological Substrate? PAIN MEDICINE 2016; 17:469-475. [PMID: 26917625 DOI: 10.1093/pm/pnw008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] [Imported: 08/29/2023]
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Bou Khalil R, El Choueifaty D, Richa S. Displaced Iraqi Families in Kurdistan: Strangers in a Strange Land. Am J Psychiatry 2016; 173:16-7. [PMID: 26725342 DOI: 10.1176/appi.ajp.2015.15070990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] [Imported: 08/29/2023]
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Communicating in psychiatry: It's my word against yours. Asian J Psychiatr 2015; 16:65-6. [PMID: 26187238 DOI: 10.1016/j.ajp.2015.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 06/26/2015] [Indexed: 11/22/2022] [Imported: 08/29/2023]
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El-Hachem C, Rohayem J, Bou Khalil R, Richa S, Kesrouani A, Gemayel R, Aouad N, Hatab N, Zaccak E, Yaghi N, Salameh S, Attieh E. Early identification of women at risk of postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS) in a sample of Lebanese women. BMC Psychiatry 2014; 14:242. [PMID: 25193322 PMCID: PMC4172818 DOI: 10.1186/s12888-014-0242-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/18/2014] [Indexed: 12/11/2022] [Imported: 08/29/2023] Open
Abstract
BACKGROUND During the postpartum period, women are vulnerable to depression affecting about 10 to 20% of mothers during the first year after delivery. However, only 50% of women with prominent symptoms are diagnosed with postpartum depression (PPD). The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening instrument for PPD . The main objectives of this study are to assess whether an EPDS score of 9 or more on day 2 (D2) postpartum is predictive of a depressive episode between days 30 and 40 postpartum (D30-40), to determine the risk factors as well as the prevalence of PPD in a sample of Lebanese women and to determine a threshold score of EPDS predictive of PPD. METHODS A sample of 228 women were administered the EPDS on D2. An assessment for PPD was done on D30-40 during a telephone interview. RESULTS On D2, the average score on EPDS was 7.1 (SD = 5.2) and 33.3% of women had an EPDS score ≥ 9. On D30-40 postpartum, the average score was 6.5 (SD = 4.7) and 19 women (12.8%) presented with PPD. A positive correlation was shown between scores on EPDS on D2 and D30-40 (r = 0.5091, p < 0.0001). A stepwise regression shows that an EPDS score ≥9 on D2 (p < 0.001) and a personal history of depression (p = 0.008) are significantly associated with the diagnosis of PPD on D30-40. CONCLUSION The EPDS may be considered as a reliable screening tool on as early as D2 after delivery. Women with EPDS score ≥ 9 and/or a positive personal history of major depressive disorder should benefit from a closer follow-up during the rest of the post-partum period.
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Bou Khalil R. To be or not to let others be: Is it relevant to the mental health field? Aust N Z J Psychiatry 2014; 48:505-6. [PMID: 24711579 DOI: 10.1177/0004867414531151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] [Imported: 08/29/2023]
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Bou Khalil R, Richa S. When affective disorders were considered to emanate from the heart: the Ebers papyrus. Am J Psychiatry 2014; 171:275. [PMID: 24585330 DOI: 10.1176/appi.ajp.2013.13070860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] [Imported: 08/29/2023]
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Adiponectin in eating disorders. Eat Weight Disord 2014; 19:3-10. [PMID: 24374725 DOI: 10.1007/s40519-013-0094-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 12/19/2013] [Indexed: 12/21/2022] [Imported: 08/29/2023] Open
Abstract
PURPOSE To elucidate the possible role of adiponectin, an adipokine secreted by white adipose tissue that plays an important role in the neuromodulation of food intake, in the pathogenesis of eating disorders. METHODS A comprehensive review of the available literature via MedLine is done using the term "adiponectin" in association with one of the following terms: "anorexia nervosa", "bulimia nervosa", "binge eating disorder" or "eating disorders". RESULTS The majority of studies evaluating serum adiponectin levels in patients with eating disorders show that serum adiponectin levels are increased in patients with anorexia nervosa. After refeeding, adiponectin levels tend to rejoin the levels of healthy individuals. Data concerning serum adiponectin levels in patients with bulimia nervosa show that these levels can be equal, higher or lower than those found in healthy controls and lower than those found in anorexia nervosa patients. Binge eating disorder is accompanied with lower serum adiponectin levels than normal. Adiponectin receptor type 1 seems to be more related to the central pathological effect of adiponectin on eating behavior. CONCLUSION The potential role that plays adiponectin in the pathogenesis of eating disorders needs to be elucidated by further studies.
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Potential role of repetitive transcranial magnetic stimulation in obesity. Eat Weight Disord 2014; 19:403-7. [PMID: 24323296 DOI: 10.1007/s40519-013-0088-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022] [Imported: 08/29/2023] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique with mild side effects. Some forms of obesity may arise from eating disorders and recent data suggest that rTMS treatment could have beneficial effects in eating disorders. PURPOSE The purpose of this comprehensive review is to hypothesize that rTMS may play a role in obesity. MATERIALS AND METHODS Articles were selected based on a search on medline using the terms "rTMS", "food craving", "eating disorders", "addiction", and "obesity". They were published between 1995 and 2013. RESULTS Repetitive transcranial magnetic stimulation has been evaluated in the treatment of bulimia nervosa. It appears that it exerts its effect via the reduction of the level of craving for food. Obesity is being recognized as one of the endpoints of food addiction and craving. Besides, rTMS and transcranial direct current stimulation are brain stimulation techniques being used in the treatment of psychoactive substance addiction. CONCLUSIONS Repetitive transcranial magnetic stimulation, through the reduction of food craving may be a potential treatment for a subset of individuals suffering from obesity. Further studies with a higher number of subjects are still needed to confirm the effects of rTMS on obesity.
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Bou Khalil R. Where all and nothing is about mental health: beyond posttraumatic stress disorder for displaced Syrians. Am J Psychiatry 2013; 170:1396-7. [PMID: 24306337 DOI: 10.1176/appi.ajp.2013.13091249] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] [Imported: 08/29/2023]
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Khalil RB, Baddoura C. Quetiapine induced hypomania: a case report and a review of the literature. Curr Drug Saf 2013; 7:250-3. [PMID: 22950378 DOI: 10.2174/157488612803251333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 07/19/2012] [Accepted: 08/01/2012] [Indexed: 11/22/2022] [Imported: 08/29/2023]
Abstract
OBJECTIVES The 5-HT2 antagonistic action of quetiapine may disinhibit the dopaminergic system enhancing dopaminergic activity in the forebrain and influencing the mood state. Our objective is to investigate the possible induction of manic symptoms by quetiapine through a case report and a review of the literature. METHOD We report the case of a 54 year old woman suffering from bipolar depression who developed hypomania seven weeks after the initiation of 300 mg/d of quetiapine. A literature review concerning the induction of hypomania or mania by quetiapine have retrieved the presence of seven similar case reports or series. RESULTS Available literature points toward an early induction of hypomania or mania with low dosage of quetiapine treatment (between 100 and 400 mg/day never exceeding 600 mg/day). Hypomania or mania are possible short term complications that can be present few days to few weeks of treatment initiation. The discontinuation of the drug or the increase of its dose seems to reverse the hypomanic or manic symptoms. Patients described in the literature suffer mostly from schizophrenia. CONCLUSION The atypical antipsychotic drug quetiapine, which have antidepressant properties at low doses via its indirect dopamine enhancing activity due its serotoninergic antagonism, appears to be involved in the induction of rare hypomanic or manic state in patients suffering from bipolar disorders and to have mood stabilizing properties at higher doses when its dopamine antagonist activity becomes more prominent. Its manic/hypomanic induction properties should not prevent its administration to patients suffering from bipolar disorder.
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