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Tempia Valenta S, Campanile G, Albert U, Marcolini F, Faedi G, De Ronchi D, Atti AR. Beyond the surface: Understanding obsessive symptoms and body perceptions, from shape concerns to fear of blushing. Compr Psychiatry 2024; 132:152481. [PMID: 38552348 DOI: 10.1016/j.comppsych.2024.152481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/16/2024] [Accepted: 03/25/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Recent reclassifications have expanded the understanding of Obsessive-Compulsive Disorders (OCDs), now incorporated into a broader category known as Obsessive-Compulsive Disorder and Related Disorders (OCRDs). This study sought to assess obsessive-compulsive symptoms and body uneasiness among outpatients seeking treatment for Eating Disorders (ED). Additionally, we aimed to explore associations and potential mediation effects between obsessive-compulsive symptoms and body uneasiness. This investigation extended beyond concerns related solely to body shape and weight, encompassing fears associated with specific body components (such as facial features, abdominal region, and limbs) or functions (including sweating, blushing, emitting noises, and releasing odors). METHODS Psychometric assessments included the Obsessive-Compulsive Inventory-Revised (OCI-R) and the Body Uneasiness Test (BUT). Statistical analyses involved bivariate correlations, linear regression, and mediation analysis to explore the associations and potential mediation effects between obsessive-compulsive symptoms and different manifestations of body uneasiness. RESULTS The sample (N = 210) demonstrated substantial obsessive-compulsive symptoms and notable body discomfort. OCI-R scores positively correlated with various dimensions of body dissatisfaction, including shape, weight, and specific body components or functions. Linear regression revealed significant associations between OCI-R scores and overall body uneasiness (BUT-A) as well as concerns about body components or functions (BUTB). Mediation analysis indicated that BUT-A mediated the relationship between obsessive-compulsive symptoms and BUTB. CONCLUSION This study offers new insights into the comprehensive landscape of OCRDs. It specifically emphasizes the association between obsessive-compulsive symptoms and body uneasiness, embracing not only concerns about body shape and weight but also extending to body components and functions.
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Affiliation(s)
- S Tempia Valenta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - G Campanile
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - U Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - F Marcolini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - G Faedi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - D De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - A R Atti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Orsolini L, Bellagamba S, Volpe U. Lurasidone as add-on to fluoxetine in obsessive-compulsive disorder with comorbid restrictive anorexia: a case report. Int Clin Psychopharmacol 2024; 39:211-214. [PMID: 37556307 DOI: 10.1097/yic.0000000000000502] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a pervasive disabling disorder that may overlap with other psychiatric conditions, including anorexia nervosa. Recent guidelines recommend low doses of second-generation antipsychotics as add-on therapy to selective serotonin reuptake inhibitors (SSRIs) for those patients presenting OCD who display residual symptomatology. Here we report a clinical case of a 45-years-old woman affected by severe OCD in comorbidity with anorexia nervosa, restrictive type (AN-r), treated with fluoxetine (titrated up to 40 mg/day) in augmentation with low doses of lurasidone (37 mg/day). At baseline and during a 6 months-follow-up we administered Clinical Global Impression-Severity, Symptom Checklist-90 items, Y-BOCS-II (Yale-Brown Obsessive Compulsive Scale) and EDI-3 (Eating Disorder Inventory). After 1 month of augmentation treatment, a clinically significant response was observed on obsessive symptoms at Y-BOCS-II (≥35% Y-BOCS reduction) and eating symptomatology at EDI-3. Full remission was reported after 3 months (Y-BOCS scoring ≤14) ( P < 0.01). Further longitudinal and real-world effectiveness studies should be implemented to confirm these novel results, to investigate the potential of lurasidone as add-on strategy to SSRI in poor responder OCD patients, including treatment-resistant-OCD (tr-OCD), as well as in improving eating disorder symptomatology, whereas there is comorbidity with AN-r.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
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3
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Stanley M, Poupore N, Knisely K, Miller A, Imeh-Nathaniel A, Roley LT, Imeh-Nathaniel S, Goodwin R, Nathaniel TI. Differences in pharmacologic and demographic factors in male and female patients with vascular dementia, Alzheimer's disease, and mixed vascular dementia. FRONTIERS IN DEMENTIA 2023; 2:1137856. [PMID: 39081989 PMCID: PMC11285705 DOI: 10.3389/frdem.2023.1137856] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/15/2023] [Indexed: 08/02/2024]
Abstract
Background Increasing evidence suggests that demographic and pharmacologic factors may play a significant role in the epidemiology of dementia. Sex differences in prevalence also depend on dementia subtypes, such as Alzheimer's dementia (AD), vascular dementia (VaD), and mixed vascular-Alzheimer's dementia (MVAD). Therefore, studies are needed to investigate sex-specific differences, and identify potential therapeutic targets for both sexes. Methods Data was collected from the Prisma Health-Upstate Alzheimer's registry from 2016 to 2021 for 6,039 VaD patients, 9,290 AD patients, and 412 MVAD patients. A logistic regression was used to determine demographic and pharmacological factors associated with gender differences in patients with VaD, AD, and MVAD. Results In patients with VaD, African Americans (OR = 1.454, 95% CI, 1.257-1.682, p < 0.001) with increasing age (OR = 1.023, 95% CI, 1.017-1.029, p < 0.001), treated with aripiprazole (OR = 4.395, 95% CI, 2.880-6.707, p < 0.001), were associated with females, whereas patients treated with galantamine (OR = 0.228, 95% CI, 0.116-0.449, p < 0.001), memantine (OR = 0.662, 95% CI, 0.590-0.744, p < 0.001), with a history of tobacco (OR = 0.312, 95% CI, 0.278-0.349, p < 0.001), and ETOH (OR = 0.520, 95% CI, 0.452-0.598, p < 0.001) were associated with males. Among AD patients, African Americans (OR = 1.747, 95% CI, 1.486-2.053, p < 0.001), and Hispanics (OR = 3.668, 95% CI, 1.198-11.231, P = 0.023) treated with buspirone (OR = 1.541, 95% CI, 1.265-1.878, p < 0.001), and citalopram (OR = 1.790, 95% CI, 1.527-2.099, p < 0.001), were associated with females, whereas patients treated with memantine (OR = 0.882, 95% CI, 0.799-0.974, p = 0.013), and with a history of tobacco (OR = 0.247, 95% CI, 0.224-0.273, p < 0.001), and ETOH (OR = 0.627, 95% CI, 0.547-0.718, p < 0.001) were associated with male AD patients. In patients with MVAD, rivastigmine (OR = 3.293, 95% CI, 1.131-9.585, p = 0.029), memantine (OR = 2.816, 95% CI, 1.534-5.168, p < 0.001), and risperidone (OR = 10.515, 95% CI, 3.409-32.437, p < 0.001), were associated with females while patients with an increased length of stay (OR = 0.910, 95% CI, 0.828-1.000, p = 0.049), with a history of tobacco (OR = 0.148, 95% CI, 0.086-0.254, p < 0.001) and ETOH use (OR = 0.229, 95% CI, 0.110-0.477, p < 0.001) were more likely to be associated with males. Conclusions Our study revealed gender differences and similarities in the demographic and pharmacological factors of VaD, AD, and MVAD. Prospective studies are needed to determine the role of demographic and pharmacological factors in reducing sex-based disparities among VaD, AD, and MVAD patients.
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Affiliation(s)
- Madison Stanley
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Nicolas Poupore
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Krista Knisely
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Alyssa Miller
- Department of Biology, North Greenville University, Tigerville, SC, United States
| | | | | | | | - Rich Goodwin
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Thomas I. Nathaniel
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
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4
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Lin N, Bacala L, Martin S, Bratiotis C, Muroff J. Hoarding Disorder: The Current Evidence in Conceptualization, Intervention, and Evaluation. Psychiatr Clin North Am 2023; 46:181-196. [PMID: 36740352 DOI: 10.1016/j.psc.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hoarding disorder is characterized by difficulty parting with possessions due to strong urges to save the items, leading to the excessive accumulation of items. High clutter levels result in varied personal, social, and legal consequences. Specialized treatments, including individual, virtual, and group cognitive and behavioral therapies, community-based interventions, and peer support approaches have shown preliminary effectiveness. Animal, attachment, and neurobiological models are expanding our understanding of the etiological bases of the disorder. Specialized populations such as children, older adults, and involuntary patients are highlighted as requiring special consideration for intervention and risk mitigation. Directions for future research are identified.
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Affiliation(s)
- Nancy Lin
- University of British Columbia, School of Social Work, Jack Bell Building, 2080 West Mall, Vancouver, British Columbia V6T 1Z2, Canada
| | - Lindsay Bacala
- University of Manitoba, Faculty of Social Work, 521 Tier Building, 173 Dafoe Road West, Winnipeg, Manitoba R3J 2N2, Canada
| | - Spenser Martin
- Canadian Mental Health Association, 930 Portage Avenue, Winnipeg, Manitoba R3G 0P8, Canada
| | - Christiana Bratiotis
- University of British Columbia, School of Social Work, Jack Bell Building, 2080 West Mall, Vancouver, British Columbia V6T 1Z2, Canada
| | - Jordana Muroff
- Boston University, School of Social Work, 264 Bay State Road, Boston, MA 02215, USA.
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Suhas S, Malo PK, Kumar V, Issac TG, Chithra NK, Bhaskarapillai B, Reddy YCJ, Rao NP. Treatment strategies for serotonin reuptake inhibitor-resistant obsessive-compulsive disorder: A network meta-analysis of randomised controlled trials. World J Biol Psychiatry 2023; 24:162-177. [PMID: 35615998 DOI: 10.1080/15622975.2022.2082525] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Treatment-resistant obsessive-compulsive disorder is a chronic debilitating illness. We conducted a network meta-analysis [NMA] to compare the efficacy of all interventions in SRI-resistant OCD from published Randomised controlled trials [RCT]. METHODS We performed an NMA of RCTs in SRI resistant OCD from all modalities of treatments; pharmacological, psychological, neuromodulation, neurosurgery including deep brain stimulation. The design-by-treatment interaction inconsistency model within the frequentist framework was adopted with a change in Yale-Brown Obsessive-Compulsive Scale score as the primary outcome. We conducted sensitivity analyses excluding studies examining neurosurgical interventions, deep brain stimulation, studies in the paediatric population, and studies from a single geographical region. We also conducted analyses of interventions categorised into treatment groups. RESULTS 55 RCTs examining 19 treatments or placebo involving 2011 participants were included in the NMA. Ondansetron [Standardised mean difference -2.01 (95% CI: -3.19, -0.83)], deep TMS [- 1.95 (-3.25, -0.65)], therapist administered Cognitive Behavioural Therapy [CBT-TA] [-1.46 (-2.93, 0.01)] and aripiprazole [-1.36 (-2.56, -0.17)] were ranked as the best four treatments on using the Surface Under the Cumulative Ranking [SUCRA] percentage values (85.4%, 83.2%, 80.3%, 67.9% respectively). While all four interventions had large effect sizes, CBT[TA] narrowly missed statistical significance in our analysis. In sensitivity analyses, deep TMS was ranked as the best treatment strategy for SRI-resistant OCD. The small number of subjects in individual studies, higher confidence interval limits, and wider prediction interval for most agents warrant a cautious interpretation. CONCLUSIONS Considering the principal analysis and sensitivity analyses together, deep TMS, ondansetron, CBT[TA], and aripiprazole may be considered a first-line intervention for SRI-resistant OCD in adults. OTHER This work was not funded. The NMA has been registered with PROSPERO, [Registration number: CRD42020173589].
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Affiliation(s)
- Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Palash Kumar Malo
- Department of Biostatistics, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Vijay Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Thomas Gregor Issac
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Nellai K Chithra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Binukumar Bhaskarapillai
- Department of Biostatistics, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Naren P Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
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Cariprazine-Associated Obsessive-Compulsive Symptoms in a Patient With Bipolar Disorder: Potential Mechanisms of D3 Receptors. J Clin Psychopharmacol 2023; 43:79-80. [PMID: 36584259 DOI: 10.1097/jcp.0000000000001645] [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: 12/31/2022]
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7
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Effects of repetitive transcranial magnetic stimulation (rTMS) in patients with body dysmorphic disorder (BDD). Brain Stimul 2022; 15:1495-1497. [PMID: 36402377 DOI: 10.1016/j.brs.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/02/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
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Abstract
ABSTRACT Body-focused repetitive behavior (BFRB) is a significantly underrecognized phenomenon that can cause physical complications and marked mental distress. Understanding the condition and offering patients pharmacologic as well as psychotherapeutic support may effectively reduce adverse health outcomes. This article reviews BFRBs, which can present clinically in multiple settings.
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Affiliation(s)
- Deanna Bridge Najera
- Deanna Bridge Najera practices in the ED at MedStar Montgomery Medical Center in Olney, Md.; in the Reproductive Health Clinic at the Carroll County Health Department in Westminster, Md.; and in psychiatric medical management at True North Wellness Services in Hanover, Pa. The author has disclosed no potential conflicts of interest, financial or otherwise
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Stein DJ, Craske MG, Rothbaum BO, Chamberlain SR, Fineberg NA, Choi KW, de Jonge P, Baldwin DS, Maj M. The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management. World Psychiatry 2021; 20:336-356. [PMID: 34505377 PMCID: PMC8429350 DOI: 10.1002/wps.20919] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The clinical construct of "anxiety neurosis" was broad and poorly defined, so that the delineation of specific anxiety disorders in the DSM-III was an important advance. However, anxiety and related disorders are not only frequently comorbid, but each is also quite heterogeneous; thus diagnostic manuals provide only a first step towards formulating a management plan, and the development of additional decision support tools for the treatment of anxiety conditions is needed. This paper aims to describe systematically important domains that are relevant to the personalization of management of anxiety and related disorders in adults. For each domain, we summarize the available research evidence and review the relevant assessment instruments, paying special attention to their suitability for use in routine clinical practice. We emphasize areas where the available evidence allows the clinician to personalize the management of anxiety conditions, and we point out key unmet needs. Overall, the evidence suggests that we are becoming able to move from simply recommending that anxiety and related disorders be treated with selective serotonin reuptake inhibitors, cognitive-behavioral therapy, or their combination, to a more complex approach which emphasizes that the clinician has a broadening array of management modalities available, and that the treatment of anxiety and related disorders can already be personalized in a number of important respects.
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Affiliation(s)
- Dan J Stein
- South African Medical Research Council Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, (UCLA), Los Angeles, CA, USA
| | | | - Samuel R Chamberlain
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, and Southern Health NHS Foundation Trust, Southampton, UK
| | - Naomi A Fineberg
- School of Life and Medical Sciences, University of Hertfordshire, and Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
- University of Cambridge Clinical Medical School, Cambridge, UK
| | - Karmel W Choi
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Peter de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, and Southern Health NHS Foundation Trust, Southampton, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Bratiotis C, Muroff J, Lin NXY. Hoarding Disorder: Development in Conceptualization, Intervention, and Evaluation. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:392-404. [PMID: 35747296 PMCID: PMC9063579 DOI: 10.1176/appi.focus.20210016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Hoarding disorder is characterized by difficulty parting with possessions because of strong urges to save the items. Difficulty discarding often includes items others consider to be of little value and results in accumulation of a large number of possessions that clutter the home. Cognitive-behavioral therapy (CBT) with exposure and response prevention and selective serotonin reuptake inhibitor medications traditionally used to treat obsessive-compulsive disorder are generally not efficacious for people with hoarding problems. A specialized CBT approach for hoarding has shown progress in reaching treatment goals and has been modified to be delivered in group, peer-facilitated, and virtual models. Research on hoarding remains in the early phases of development. Animal, attachment, and genetic models are expanding. Special populations, such as children, older adults, and people who do not voluntarily seek treatment need special consideration for intervention. Community-based efforts aimed at reducing public health and safety consequences of severe hoarding are needed.
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Affiliation(s)
- Christiana Bratiotis
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
| | - Jordana Muroff
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
| | - Nancy X Y Lin
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
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11
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Kazemi F, Vosough I, Sepahi S, Mohajeri SA. Effect of crocin versus fluoxetine in treatment of mild to moderate obsessive-compulsive disorder: A double blind randomized clinical trial. Hum Psychopharmacol 2021; 36:e2780. [PMID: 33599345 DOI: 10.1002/hup.2780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a common disabling disorder. Crocin, the active component of the saffron plant (Crocus Sativus L.) has various pharmacological activities. The present study compared the efficacy and safety of crocin and fluoxetine in treatment of mild to moderate OCD. METHODS & MATERIALS Fifty patients with OCD, aged 18 to 60 years, were randomized to receive either crocin (15 mg) or fluoxetine (20 mg) capsules for 8 weeks. Eligible participants received one capsule/day in the first month, which followed by two capsules daily in the second month. The patients were evaluated using Yale-Brown Obsessive-compulsive scale (Y-BOCS) and Hamilton Anxiety Rating scale (HARS). RESULTS The mean Y-BOCS score in both groups decreased significantly during 2 months (p-value = 0.0001). Also, HARS score in the crocin group was changed from 17.16 to 13.04 whereas, in the fluoxetine group was decreased from 18.28 to 12.34. The results indicated no difference between the two groups in Y-BOCS and HARS score changes after 2-month trial (p-value >0.5). Also, fewer adverse effects were reported in the crocin group compared to the fluoxetine group. CONCLUSION According to our study, it seems that crocin is effective in treatment of patients with mild to moderate OCD with possibly fewer adverse effects compared to fluoxetine.
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Affiliation(s)
- Fatemeh Kazemi
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Iraj Vosough
- Department of Psychiatry, Ibn-e-Sina Psychiatric Hospital, Mashhad, Iran
| | - Samaneh Sepahi
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ahmad Mohajeri
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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Castle D, Beilharz F, Phillips KA, Brakoulias V, Drummond LM, Hollander E, Ioannidis K, Pallanti S, Chamberlain SR, Rossell SL, Veale D, Wilhelm S, Van Ameringen M, Dell’Osso B, Menchon JM, Fineberg NA. Body dysmorphic disorder: a treatment synthesis and consensus on behalf of the International College of Obsessive-Compulsive Spectrum Disorders and the Obsessive Compulsive and Related Disorders Network of the European College of Neuropsychopharmacology. Int Clin Psychopharmacol 2021; 36:61-75. [PMID: 33230025 PMCID: PMC7846290 DOI: 10.1097/yic.0000000000000342] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Abstract
Body dysmorphic disorder (BDD) is characterized by a preoccupation with a perceived appearance flaw or flaws that are not observable to others. BDD is associated with distress and impairment of functioning. Psychiatric comorbidities, including depression, social anxiety, and obsessive-compulsive disorder are common and impact treatment. Treatment should encompass psychoeducation, particularly addressing the dangers associated with cosmetic procedures, and may require high doses of selective serotonin reuptake inhibitors* (SSRI*) and protracted periods to establish full benefit. If there is an inadequate response to SSRIs, various adjunctive medications can be employed including atypical antipsychotics*, anxiolytics*, and the anticonvulsant levetiracetam*. However, large-scale randomized controlled trials are lacking and BDD is not an approved indication for these medications. Oxytocin* may have a potential role in treating BDD, but this requires further exploration. Cognitive-behavioural therapy has good evidence for efficacy for BDD, and on-line and telephone-assisted forms of therapy are showing promise. CBT for BDD should be customized to address such issues as mirror use, perturbations of gaze, and misinterpretation of others' emotions, as well as overvalued ideas about how others view the individual.
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Affiliation(s)
- David Castle
- Department of Psychiatry, University of Melbourne and St Vincent’s Hospital
| | | | - Katharine A. Phillips
- New York-Presbyterian Hospital and Professor of Psychiatry, Weill Cornell Medical College, New York, New York, USA
| | - Vlasios Brakoulias
- School of Medicine, Western Sydney University and Western Sydney Local Health District, Sydney, Australia
| | - Lynne M. Drummond
- National Services for OCD/BDD, SW London and St George’s NHS Trust, London, UK
| | - Eric Hollander
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Konstantinos Ioannidis
- Department of Psychiatry, University of Cambridge, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Stefano Pallanti
- Albert Einstein College of Medicine, Bronx, New York, USA
- Istituto di Neuroscienze University of Florence, Florence, Italy
| | - Samuel R. Chamberlain
- Department of Psychiatry, University of Southampton
- Southern Health NHS Foundation Trust, Southampton
- Department of Psychiatry, University of Cambridge
- Department of Psychiatry, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Susan L. Rossell
- Centre for Mental Health, Swinburne University and St Vincent’s Hospital, Melbourne, Australia
| | - David Veale
- Department of Psychology, King’s College London and the South London and Maudsley NHS Foundation Trust, London, UK
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Bernardo Dell’Osso
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Jose M. Menchon
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, University of Barcelona, Cibersam, Barcelona, Spain
| | - Naomi A. Fineberg
- Department of Clinical and Pharmaceutical Sciences, University of Hertfordshire and Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
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Torales J, Ruiz Díaz N, Ventriglio A, Castaldelli-Maia JM, Barrios I, García O, Navarro R, González-Urbieta I, O'Higgins M, Jafferany M. Hair-pulling disorder (Trichotillomania): Etiopathogenesis, diagnosis and treatment in a nutshell. Dermatol Ther 2020; 34:e13466. [PMID: 33015928 DOI: 10.1111/dth.14366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022]
Abstract
Hair-pulling disorder (Trichotillomania) is a disabling mental disorder. Patient's behavior is characterized by the recurrent pulling of own hair with hair loss and a marked dysfunction in various areas of daily life. Trichotillomania is a relatively common disorder with pediatric onset, often associated with significant morbidity, comorbidity, and functional decline. Surprisingly, children or adolescents have been little studied in the research studies on the pathophysiology and psychopathology of trichotillomania. Furthermore, more evidences regarding the effective and evidence-based pharmacological interventions for the treatment of this condition are encouraged. This narrative review will report on the etiopathogenesis and clinical manifestations of trichotillomania including criteria for diagnosis and treatment issues of this complex mental disorder.
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Affiliation(s)
- Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Noelia Ruiz Díaz
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Medical School, Fundação do ABC, Santo André, SP, Brazil.,Department of Psychiatry, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Iván Barrios
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Oscar García
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Rodrigo Navarro
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Israel González-Urbieta
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Marcelo O'Higgins
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Mohammad Jafferany
- Department of Psychiatry, Central Michigan University, Mount Pleasant, Michigan, USA
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14
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Torales J, Melgarejo O, González I, García O, Barrios I, Jafferany M. Psychopharmacology in dermatology: Treatment of primary psychiatric conditions in dermatology. Dermatol Ther 2020; 33:e13557. [DOI: 10.1111/dth.13557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Julio Torales
- Department of Psychiatry National University of Asunción San Lorenzo Paraguay
| | - Osvaldo Melgarejo
- Department of Psychiatry National University of Asunción San Lorenzo Paraguay
| | - Israel González
- Department of Psychiatry National University of Asunción San Lorenzo Paraguay
| | - Oscar García
- Department of Psychiatry National University of Asunción San Lorenzo Paraguay
| | - Iván Barrios
- Department of Psychiatry National University of Asunción San Lorenzo Paraguay
| | - Mohammad Jafferany
- Department of Psychiatry Central Michigan University Mount Pleasant Michigan USA
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15
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Yeager V, Bogoyas M, Goubran B, Gonzalez L, Ferrer GF. Olanzapine as an Adjunct in the Management of Refractory Psychogenic Excoriation With Comorbid Schizophrenia: A Case Report. Cureus 2020; 12:e8772. [PMID: 32742822 PMCID: PMC7384453 DOI: 10.7759/cureus.8772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Neurotic or psychogenic excoriation (PE) is one of the most commonly diagnosed skin disorders associated with a primary psychiatric condition. PE is characterized by excessive picking and scratching of normal-appearing skin, and is often comorbid or is an inherent manifestation of affective disturbance and psychosis itself in schizophrenia. Evidence in the literature has demonstrated the therapeutic efficacy of selective serotonin reuptake inhibitors (SSRI) in treating PE. Other pharmacological treatments that have shown therapeutic benefits in case reports include doxepin, clomipramine, naltrexone, pimozide, and olanzapine. However, using adjunct therapeutic methods or augmentation in the treatment of neurogenic excoriation in the setting of schizophrenia is still not well explored. In this study, we discuss the case of a 59-year-old medically complex paraplegic male with schizophrenia comorbid with severe refractory PE. The patient had poor adherence to psychopharmacological treatment. Consequently, the patient was repeatedly hospitalized due to acute exacerbations of schizophrenic episodes and self-mutilation due to PE. After several failed treatment approaches, olanzapine 10 mg PO BID was added as an adjunct therapy to the Haldol® Decanoate (Janssen Pharmaceutica, Beerse, Belgium) at a dosage of 100 mg/month intramuscularly to control the acute PE symptoms. This treatment modality proved successful in this case, and the patient has been free from PE relapse for over one year of close follow-up. Olanzapine along with Haldol Decanoate long-acting injectable (LAI), might, therefore, be a useful adjunct therapeutic modality for patients with refractory PE with a comorbid diagnosis of schizophrenia and warrants further research.
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Affiliation(s)
| | | | - Bishoy Goubran
- Division of Clinical and Translational Research, Larkin Community Hospital, Miami, USA
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16
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Skurya J, Jafferany M, Everett GJ. Habit reversal therapy in the management of body focused repetitive behavior disorders. Dermatol Ther 2020; 33:e13811. [PMID: 32542916 DOI: 10.1111/dth.13811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 11/28/2022]
Abstract
Body-focused repetitive behavior disorders are a group of disorders characterized by repetitive actions that include skin picking, hair pulling, nail biting, and other compulsions. These disorders can range from a common habit to a pathological disorder, that negatively impacts the psychiatric health and social well-being of an individual. Diagnosis can be made clinically, and monitored using different scales and assessments. Various treatments have been tried with differing successes. There are currently no first line curative medications for these disorders, but cognitive behavioral therapy has seen the most success in treatment. Specifically habit reversal therapy has shown the most promise in reducing the repetitive behaviors and symptoms seen in these disorders. Habit reversal therapy has also seen success through augmentation with additional therapies such as mindfulness, or treatment with a selective serotonin reuptake inhibitor in a patient with comorbid obsessive compulsive disorder. This paper aims to explore the efficacy of different treatment modalities specifically the effectiveness and approach of habit reversal therapy.
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17
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Palermo S, Marazziti D, Baroni S, Barberi FM, Mucci F. The Relationships Between Obsessive-Compulsive Disorder and Psychosis: An Unresolved Issue. CLINICAL NEUROPSYCHIATRY 2020; 17:149-157. [PMID: 34908986 PMCID: PMC8662710 DOI: 10.36131/cnfioritieditore20200302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the present paper was to review and comment on available literature on the complex relationships between obsessive-compulsive disorder OCD and psychotic disorders, with a focus on diagnostic issues, as well as clinical and prognostic implications. METHOD The databases of PubMed, Scopus, Embase, PsycINFO and Google Scholar were accessed in order to research and collect articles published in English language only, according to the PRISMA guidelines. Free text terms and MeSH headings were combined as it follows: " Obsessive-compulsive disorder" OR "Obsessive-Compulsive Symptoms" AND "Schizophrenic Disorders" OR "Schizophrenic Symptoms" AND "Antipsychotic Treatment" OR "Second-Generation Antipsychotics "SGAs". RESULTS The relationships between obsessive-compulsive disorder (OCD) and schizophrenia spectrum disorders, intended as diagnostic categories, as well as the overlap between obsessive-compulsive and psychotic symptoms, represent an interesting example of how "neurosis" and "psychosis" actually stand along a longitudinal and transversal continuum, much more frequently than it was supposed in the past. It also poses a challenge for clinicians, since treating some symptoms of one disorder may trigger or worsen the other one. CONCLUSIONS The question of the symptom overlapping between OCD and psychoses remains unresolved, if considered within the stringent categorization of the available diagnostic systems, but even all the attempts to explain the heterogeneity of the clinical pictures, according to other theoretical constructs, result inconclusive. The controversial role of antipsychotics, especially of SGAs in the treatment of these complex patients is another problem to be clarified in future and more focused studies.
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Affiliation(s)
- Stefania Palermo
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy,Unicamillus University of Rome, Italy
| | - Stefano Baroni
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Filippo Maria Barberi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Federico Mucci
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy,Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Italy,Corresponding author Dr. Federico Mucci Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Italy E-mail:
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18
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A Case of Comorbid PTSD and Posttraumatic OCD Treated with Sertraline-Aripiprazole Augmentation. Case Rep Psychiatry 2020; 2020:2616492. [PMID: 32047692 PMCID: PMC7007739 DOI: 10.1155/2020/2616492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 11/25/2022] Open
Abstract
Several studies report on traumatic history in Obsessive Compulsive Disorder (OCD) and comorbidity between Posttraumatic Stress Disorder (PTSD) and OCD. First-line pharmacological treatments for both OCD and PTSD are primarily based on antidepressants, including Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Noradrenaline Reuptake Inhibitors (SNRI) such as Venlafaxine for PTSD. Second-Generation Antipsychotic (SGA) augmentation has shown good outcomes for nonresponsive OCD cases. However, evidence on the use of SGA in PTSD is more limited. In the present paper, we report on comorbid OCD-PTSD successfully treated with aripiprazole augmentation of sertraline. Shared psychopathological and pharmacological aspects of the disorders are discussed.
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Piacentino D, Pasquini M, Cappelletti S, Chetoni C, Sani G, Kotzalidis GD. Pharmacotherapy for Hoarding Disorder: How did the Picture Change since its Excision from OCD? Curr Neuropharmacol 2020; 17:808-815. [PMID: 30678629 PMCID: PMC7059160 DOI: 10.2174/1570159x17666190124153048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/21/2018] [Accepted: 01/17/2019] [Indexed: 01/10/2023] Open
Abstract
This brief review deals with the various issues that contributed to the creation of the new Diagnostic and Statistical Manual condition of hoarding disorder (HD) and attempts at reviewing its pharmacotherapy. It appears that after the newly founded diagnosis appeared in the literature as an autonomous entity, distinct from obsessive-compulsive disorder, drug trials are not being conducted and the disorder is left in the hands of psychotherapists, who on their part, report fair results in some core dimensions of HD. The few trials on HD specifically regard the serotonin-noradrenaline reuptake inhibitor venlafaxine, and, possibly due to the suggestion of a common biological background of HD with attention-deficit/hyperactivity disorder, the psychostimulant methylphenidate and the noradrenaline reuptake inhibitor atomoxetine. For all these drugs, positive results have been reported, but the evidence level of these studies is low, due to small samples and non-blind designs. Regretfully, there are currently no future studies aiming at seriously testing drugs in HD.
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Affiliation(s)
- Daria Piacentino
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy.,Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism (NIAAA) Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse (NIDA) Intramural Research Program, National Institutes of Health, Bethesda, MD, United States
| | - Massimo Pasquini
- Department of Neurosciences, School of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Simone Cappelletti
- Anatomical, Histological, Forensic Medicine, and Orthopedic Sciences (SAIMLAL) Department, Sapienza University, Rome, Italy
| | - Chiara Chetoni
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Gabriele Sani
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Georgios D Kotzalidis
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy
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Kayser RR, Snorrason I, Haney M, Lee FS, Simpson HB. The Endocannabinoid System: A New Treatment Target for Obsessive Compulsive Disorder? Cannabis Cannabinoid Res 2019; 4:77-87. [PMID: 32656342 DOI: 10.1089/can.2018.0049] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: Obsessive-compulsive disorder (OCD) is a disabling illness that is associated with significant functional impairment. Although evidence-based pharmacotherapies exist, currently available medications are ineffective in some patients and may cause intolerable side effects in others. There is an urgent need for new treatments. Discussion: A growing body of basic and clinical research has showed that the endocannabinoid system (ECS) plays a role in anxiety, fear, and repetitive behaviors. At the same time, some patients with OCD who smoke cannabis anecdotally report that it relieves their symptoms and mitigates anxiety, and several case reports describe patients whose OCD symptoms improved after they were treated with cannabinoids. Taken together, these findings suggest that the ECS could be a potential target for novel medications for OCD. In this study, we review evidence from both animal and human studies that suggests that the ECS may play a role in OCD and related disorders. We also describe findings from studies in which cannabinoid drugs were shown to impact symptoms of these conditions. Conclusions: An emerging body of evidence suggests that the ECS plays a role in OCD symptoms and may be a target for the development of novel medications. Further exploration of this topic through well-designed human trials is warranted.
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Affiliation(s)
- Reilly R Kayser
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Ivar Snorrason
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Margaret Haney
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Francis S Lee
- Department of Psychiatry, Weill Cornell Medical College, New York, New York
| | - H Blair Simpson
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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21
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Dong N, Nezgovorova V, Hong K, Hollander E. Pharmacotherapy in body dysmorphic disorder: relapse prevention and novel treatments. Expert Opin Pharmacother 2019; 20:1211-1219. [DOI: 10.1080/14656566.2019.1610385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Nancy Dong
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Vera Nezgovorova
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Kevin Hong
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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Itoh Y, Sagawa R, Kinoshita H, Tamba S, Yamamoto K, Yamada Y, Matsuzawa Y. Small-intestinal necrosis due to non-occlusive mesenteric ischemia with diabetic ketoacidosis after quetiapine treatment. Diabetol Int 2018; 10:225-230. [PMID: 31275790 DOI: 10.1007/s13340-018-0386-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 11/23/2018] [Indexed: 11/26/2022]
Abstract
We report a 66-year-old male who developed diabetic ketoacidosis (DKA) and necrosis of the small intestine due to non-occlusive mesenteric ischemia (NOMI), 3 months after starting quetiapine treatment. He was transferred to our hospital and diagnosed as diabetic for the first time, associated with DKA. Despite improvement in DKA, abdominal pain worsened gradually 10 h after hospitalization. Computed tomography (CT) revealed bowel emphysema, and gas out of the gut wall, in the mesenteric veins and the intrahepatic portal vein, suggesting intestinal necrosis. He survived because of resection of necrotic small-intestinal tissue and he finally required no diabetes treatment. Mesenteric arteries were patent with good palpitation without occlusion or thrombosis, and pathological findings showed ischemic enteritis, which is consistent with NOMI. DKA is a rare but serious side effect of second-generation antipsychotic medications (SGAMs) such as quetiapine, which can result in NOMI: a life-threatening complication. We must keep in mind that the plasma glucose concentration may increase in patients taking SGAMs, or that NOMI may occur concurrently if DKA develops.
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Affiliation(s)
- Yoshito Itoh
- 1Departments of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, 530-0005 Japan
| | - Ryo Sagawa
- 2General Medicine, Sumitomo Hospital, Osaka, Japan
| | | | - Sachiko Tamba
- 1Departments of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, 530-0005 Japan
| | - Koji Yamamoto
- 1Departments of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, 530-0005 Japan
- 2General Medicine, Sumitomo Hospital, Osaka, Japan
| | - Yuya Yamada
- 1Departments of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, 530-0005 Japan
| | - Yuji Matsuzawa
- 1Departments of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, 530-0005 Japan
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