Paliperidone palmitate-induced enuresis: a case report

Introduction

Schizophrenia is a severe mental illness that requires long-term treatment with antipsychotics and the intramuscular (IM) long-acting injectable (LAI) formulations may enhance treatment adherence. Some antipsychotics have been associated with enuresis, including atypical antipsychotics such as risperidone(6.2%), quetiapine(6.7%), olanzapine (9.6% ) and clozapine (20.7%) [1]. Although oral paliperidone has been related to urinary incontinence, there is only 1 report of urinary incontinence linked to monthly paliperidone palmitate [2]. [1] Harrison-Woolrych, M., Skegg, K., Ashton, J., Herbison, P., Skegg, D.C., 2011. Nocturnal enuresis in patients taking clozapine, risperidone, olanzapine and quetiapine: comparative cohort study. British Journal of Psychiatry 199, 140–144. doi:10.1192/bjp.bp.110.087478 [2] Karslıoǧlu, E.H., Özalp, E., Çayköylü, A., 2016. Paliperidone Palmitate-induced Urinary Incontinence: A Case Report. Clinical Psychopharmacology and Neuroscience 14, 96–100. doi:10.9758/cpn.2016.14.1.96

Objectives

To establish an association between paliperidone palmitate and enuresis.

Methods

Case report and a narrative review of the literature.

Results

The patient was a 25-year-old healthy man when he was diagnosed with schizophrenia. Doctors prescribed paliperidone palmitate (LAI) 200mg monthly and he started to complain of enuresis. He was clearly suffering with this unpleasant and embarrassing adverse effect so the LAI was reduced to 150mg. Enuresis remained, so it was prescribed oxybutynin 20 mg/day and the patient improved.

Conclusions

We reported a case in which enuresis is likely to be associated with high-dose paliperidone LAI (with no clinical evidence of an organic cause). To treat it, the most effective strategy was oxybutynin 20 mg/day. This case is also important to show the impact of this symptom, which is not actively investigated.

Disclosure

No significant relationships.

Tau-dependent suppression of adult neurogenesis in the stressed hippocampus

Stress, a well-known sculptor of brain plasticity, is shown to suppress hippocampal neurogenesis in the adult brain; yet, the underlying cellular mechanisms are poorly investigated. Previous studies have shown that chronic stress triggers hyperphosphorylation and accumulation of the cytoskeletal protein Tau, a process that may impair the cytoskeleton-regulating role(s) of this protein with impact on neuronal function. Here, we analyzed the role of Tau on stress-driven suppression of neurogenesis in the adult dentate gyrus (DG) using animals lacking Tau (Tau-knockout; Tau-KO) and wild-type (WT) littermates. Unlike WTs, Tau-KO animals exposed to chronic stress did not exhibit reduction in DG proliferating cells, neuroblasts and newborn neurons; however, newborn astrocytes were similarly decreased in both Tau-KO and WT mice. In addition, chronic stress reduced phosphoinositide 3-kinase (PI3K)/mammalian target of rapamycin (mTOR)/glycogen synthase kinase-3β (GSK3β)/β-catenin signaling, known to regulate cell survival and proliferation, in the DG of WT, but not Tau-KO, animals. These data establish Tau as a critical regulator of the cellular cascades underlying stress deficits on hippocampal neurogenesis in the adult brain.

Neuropsychiatric Symptoms in Fahr's Syndrome

Objectives and methodology

To review the neuropsychiatric symptoms of Fahr's syndrome.

Results/discussion

Fahr's Syndrome is a rare degenerative neuropsychiatric condition, characterized by bilateral and symmetrical calcifications of the basal ganglia. It can be associated with several metabolic, infectious or genetic conditions. It is clinically manifested by movement disorders, psychosis, cognitive impairment, mood disorders, personality dysfunction or obsessive-compulsive spectrum disturbances. First presentation can be psychiatric in approximately 40% of the cases. Cognitive dysfunction, mood disorders and psychosis are the most common presentations. In the present case, depression, dementia and movement disorders were the main clinical pictures. This report alerts for the significance of neuropsychiatric symptoms within this diagnosis, considering the multisystemic approach of the illness.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Interim storage of spent and disused sealed sources: optimisation of external dose distribution in waste grids using the MCNPX code

Radioactive sealed sources are in use worldwide in different fields of application. When no further use is foreseen for these sources, they become spent or disused sealed sources and are subject to a specific waste management scheme. Portugal does have a Radioactive Waste Interim Storage Facility where spent or disused sealed sources are conditioned in a cement matrix inside concrete drums and following the geometrical disposition of a grid. The gamma dose values around each grid depend on the drum's enclosed activity and radionuclides considered, as well as on the drums distribution in the various layers of the grid. This work proposes a method based on the Monte Carlo simulation using the MCNPX code to estimate the best drum arrangement through the optimisation of dose distribution in a grid. Measured dose rate values at 1 m distance from the surface of the chosen optimised grid were used to validate the corresponding computational grid model.

The effects of peer education on STD and AIDS knowledge among prisoners in Mozambique

The study was designed to evaluate the impact of education on AIDS knowledge among prison inmates in Maputo, Mozambique. A 6-month follow-up study was carried out in 1993 among 300 prisoners. A knowledge, attitudes, and practices questionnaire regarding AIDS and STD was administered to each subject as part of the intake medical examination and after an educational intervention provided by 30 prisoner 'activists'. A large proportion of prisoners had high risk behaviours (65% had 2 or more sexual partners per month and 39% had a history of STD) and low AIDS knowledge at incarceration. Statistically significant increases in knowledge occurred after the intervention. Prisoners with less formal education had a poorer performance on the initial questionnaire (43% vs 69% P < 0.00001) and had a greater improvement after the intervention (41% vs 24%, P < 0.00001). The results demonstrate that educational interventions involving peer health educators contribute positively to the acquisition of knowledge among prisoners.

[Hyperplastic polyp of the colon]

On re-examining 477 polyps of the colon obtained by endoscopic polypectomy, the authors describe a type of polyp with they have called hyperplasiogenous. This polyp is characterised by a proliferation of rectilinear glands, divided at their base, forming a connecting spur; this spur may form a more complex alveolar or tubulo-alveolar structure. The glands have cells with a tall, clear cytoplasm and a small, homogeneous nucleus with no irregularities or metaplasia. Endoscopically, they are small, sessile and either the same colour as the mucous membrane or redder. They are located mainly in the rectum and sigmoid colon. They are more frequently found in men and begin to appear after the age of thirty. They are often associated with tumours of the colon. The authors consider possible that the hyperplasiogenous polyp may represent an initial stage of adenoma.