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Valaparla VL, Banerjee P, Elnaeem A, Sharma T, Bhatt S, Memon Z, Shaltoni H, Dabi A, Rodríguez-Fernández JM. Cerebral vasospasm due to Fusarium solani meningitis: A complication from medical tourism. Case report and literature review. J Stroke Cerebrovasc Dis 2024; 33:107432. [PMID: 37966093 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES Medical tourism is expanding globally, with patients seeking cosmetic procedures abroad. To date, little information is known regarding the risks and outcomes of cosmetic tourism, especially potential stroke complications. Here, we present a case of fungal meningitis in the setting of medical tourism leading to ischemic strokes and vasospasm. MATERIAL AND METHODS We describe an immunocompetent 29-year-old female patient who initially presented with intractable headaches and an abnormal cerebrospinal fluid (CSF) profile who was eventually diagnosed with Fusarium solani meningitis as a part of a common source outbreak in Matamoros, Mexico. These patients were part of a cohort who underwent cosmetic procedures requiring spinal anesthesia. This report also highlights the unusual clinical course leading to poor outcomes in such conditions. RESULTS The patient initially presented with headaches, papilledema, elevated opening pressure on the spinal tap, abnormal CSF studies, and eventually developed ischemic strokes and hydrocephalus. CSF showed positive beta D-Glucan with repeated negative CSF fungal cultures. A cerebral angiogram revealed extensive basilar artery vasospasm that led to ischemic strokes. Continued clinical worsening and lack of response to antifungal treatment prompted further imaging that revealed significant non-obstructive hydrocephalus subsequently complicated by spontaneous intracranial hemorrhage. CSF PCR for Fusarium solani species was positive days after her passing. CONCLUSION This novel case highlights fungal meningitis caused by Fusarium solani complicated by bilateral ischemic strokes stemming from basilar artery vasospasm. Complications from medical tourism impact not only individual patients but also the health systems of both countries. Professional and regulatory entities for cosmetic surgeries must highlight and educate patients on the risks and complications of cosmetic surgeries happening abroad. Physicians should be aware of ongoing outbreaks and possible complications of these procedures.
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Affiliation(s)
| | - Pankhuri Banerjee
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Awab Elnaeem
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Tripti Sharma
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Sandeep Bhatt
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Zeeshan Memon
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Hashem Shaltoni
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Alok Dabi
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
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Valaparla VL, Lobaina M, Patel C, Li X, Patel AV. Recurrent cryptogenic strokes in a young female as a novel presentation of Parry Romberg syndrome: a case report and review. Int J Neurosci 2023:1-5. [PMID: 37942652 DOI: 10.1080/00207454.2023.2280890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/29/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Parry Romberg Syndrome (PRS) is a less common genetic condition presenting with progressive hemifacial atrophy involving skin, underlying connective tissue, muscle and facial bone. Neurological manifestations include seizures, headaches, deafness and trigeminal neuralgia refractory to medications, while stroke is a less common presentation. MATERIALS AND METHODS A 43-year-old right-handed female with previous history of Lower Motor Neuron (LMN) type facial palsy, seizure disorder and linear scleroderma, presented to our clinic with recurrent cryptogenic strokes. She developed progressive hemifacial atrophy on the left side and left eye ectropion and was eventually diagnosed with rare Parry Romberg Syndrome. RESULTS Patient underwent extensive work up for stroke to rule out etiologies like hyperlipidemia, diabetes, lupus and vasculitis. Peripheral labs for inflammatory markers and Cerebrospinal fluid (CSF) studies were unremarkable. Brain imaging at different points in time showed progressive atrophy of brain parenchyma, overlying bone, connective tissue and facial muscles on the left side. Central Nervous System (CNS) vessel imaging and diagnostic cerebral angiogram was unremarkable. CONCLUSION This novel case underscores the potential CNS involvement in PRS, which is a rare disease entity. Neurological manifestations are not uncommon, including stroke. Further research is needed to understand the mechanisms of stroke in this rare disease process, that could help develop potential therapeutic targets.
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Affiliation(s)
| | - Milena Lobaina
- Department of Neurology, University of TX Medical Branch, Galveston, Texas, USA
| | - Chilvana Patel
- Department of Neurology, University of TX Medical Branch, Galveston, Texas, USA
| | - Xiangping Li
- Department of Neurology, University of TX Medical Branch, Galveston, Texas, USA
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Li K, Rashid T, Li J, Honnorat N, Nirmala AB, Fadaee E, Wang D, Charisis S, Liu H, Franklin C, Maybrier M, Katragadda H, Abazid L, Ganapathy V, Valaparla VL, Badugu P, Vasquez E, Solano L, Clarke G, Maestre G, Richardson T, Walker J, Fox PT, Bieniek K, Seshadri S, Habes M. Postmortem Brain Imaging in Alzheimer's Disease and Related Dementias: The South Texas Alzheimer's Disease Research Center Repository. J Alzheimers Dis 2023; 96:1267-1283. [PMID: 37955086 PMCID: PMC10693476 DOI: 10.3233/jad-230389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Neuroimaging bears the promise of providing new biomarkers that could refine the diagnosis of dementia. Still, obtaining the pathology data required to validate the relationship between neuroimaging markers and neurological changes is challenging. Existing data repositories are focused on a single pathology, are too small, or do not precisely match neuroimaging and pathology findings. OBJECTIVE The new data repository introduced in this work, the South Texas Alzheimer's Disease research center repository, was designed to address these limitations. Our repository covers a broad diversity of dementias, spans a wide age range, and was specifically designed to draw exact correspondences between neuroimaging and pathology data. METHODS Using four different MRI sequences, we are reaching a sample size that allows for validating multimodal neuroimaging biomarkers and studying comorbid conditions. Our imaging protocol was designed to capture markers of cerebrovascular disease and related lesions. Quantification of these lesions is currently underway with MRI-guided histopathological examination. RESULTS A total of 139 postmortem brains (70 females) with mean age of 77.9 years were collected, with 71 brains fully analyzed. Of these, only 3% showed evidence of AD-only pathology and 76% had high prevalence of multiple pathologies contributing to clinical diagnosis. CONCLUSION This repository has a significant (and increasing) sample size consisting of a wide range of neurodegenerative disorders and employs advanced imaging protocols and MRI-guided histopathological analysis to help disentangle the effects of comorbid disorders to refine diagnosis, prognosis and better understand neurodegenerative disorders.
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Affiliation(s)
- Karl Li
- Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Tanweer Rashid
- Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jinqi Li
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Nicolas Honnorat
- Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Anoop Benet Nirmala
- Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Elyas Fadaee
- Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Di Wang
- Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sokratis Charisis
- Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Hangfan Liu
- Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Crystal Franklin
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Mallory Maybrier
- Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Haritha Katragadda
- Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Leen Abazid
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Vinutha Ganapathy
- Department of Neurology, University of Texas Health Science Center, San Antonio, TX, USA
| | | | - Pradeepthi Badugu
- Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Eliana Vasquez
- Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Leigh Solano
- Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Geoffrey Clarke
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Gladys Maestre
- Department of Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Harlingen, TX, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Tim Richardson
- Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jamie Walker
- Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kevin Bieniek
- Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Pathology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Sudha Seshadri
- Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Mohamad Habes
- Glenn Biggs Institute for Neurodegenerative Disorders, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Mandal T, Bairy LK, Sharma PSVN, Valaparla VL. Impact of gender, depression severity and type of depressive episode on efficacy and safety of escitalopram: an observational study on major depressive disorder patients in southern India. Egypt J Neurol Psychiatry Neurosurg 2021. [DOI: 10.1186/s41983-021-00302-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Antidepressant response is a complex trait influenced by clinical, demographic and genetic factors.
Objectives
To explore the influences of baseline depression severity, gender and type of depressive episode on efficacy and safety of escitalopram (10–20 mg/day) in South Indian patients with major depressive disorder (MDD).
Methods
The study was conducted on 18–65-year-old patients (n = 151) suffering from a first or recurrent episode of MDD with a 17-item Hamilton Depression Rating Scale (HDRS-17) score of ≥ 18 at baseline. Efficacy assessments were done using HDRS-17, Montgomery-Asberg Depression Rating Scale (MADRS), and Clinical Global Impression (CGI) at baseline and weeks 4, 8 and 12. Patients were monitored for adverse drug reactions (ADRs). Clinical outcomes were compared among various groups based on gender, type of depressive episode (first or recurrent episode) and baseline HDRS-17 scores (moderate depression—score between 17 and 23; severe depression—score ≥ 24).
Results
Among the 148 subjects who completed the 12-week study, 43.9% and 42.6% achieved response and remission, respectively. The decline in HDRS-17 and MADRS scores from baseline was significant (p value < 0.05) at all follow-up visits and a similar pattern was seen with CGI. Efficacy outcomes were better in the moderate baseline depression group compared with severe depression. There were no associations of efficacy with gender and type of depressive episode. A total of 247 adverse drug reactions (ADR) were reported and 119 (80.41%) subjects experienced at least one ADR during the study period. No serious ADR was reported. Male patients experienced more ADRs compared with females. The safety profile of escitalopram was similar across various groups based on baseline depression severity and type of depressive episode.
Conclusion
The study revealed that escitalopram is efficacious in south Indian MDD patients with a favourable safety profile. The efficacy was influenced by baseline depression severity whereas more ADRs were reported by male patients.
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Villarreal J, Valaparla VL, Curtis K, Thottempudi N, Elrahi S, Gil Guevara A, Gogia B, Sun R, Masel T, Rai P. Neuromodulation in Intractable Epilepsy Through Responsive Vagal Nerve Stimulation: A Three-Year Retrospective Study at the University of Texas Medical Branch, Galveston. Cureus 2021; 13:e18698. [PMID: 34790456 PMCID: PMC8584105 DOI: 10.7759/cureus.18698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Vagus nerve stimulation (VNS) functions through neuromodulatory mechanisms to provide quality of life improvements to those with drug-resistant epilepsy. Responsive VNS (rVNS) generators are designed to further reduce seizure burden by detecting ictal tachycardia and aborting seizures soon after their onset. Methods: Electronic medical records were accessed from January 2015 to December 2018 to identify patients with epilepsy managed with rVNS generators. Data were collected on seizure burden before and after rVNS implantation. Seizure burden was compared using t-tests, and monthly seizure reductions were gauged with the McHugh scale. Twenty-seven individuals met inclusion criteria; 10 were eliminated due to prior VNS implantation or undocumented seizure frequencies. Results: The average seizure burden prior to rVNS implantation was 24.78 seizures/month. Following generator placement, the mean seizure frequencies at three months, six months, 12 months, and 18 months were 6.81, 16.57, 5.65, and 5.78 seizures/month, respectively. However, despite documented reductions in the average monthly seizure frequency, we found no statistically significant differences in seizure frequency relative to baseline. Conclusion: While many participants showed individual reductions in seizure burden, this study was unable to definitively conclude that rVNS therapy leads to statistically significant reduction in seizure burden.
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Affiliation(s)
- Joseph Villarreal
- Department of Neurology, University of Texas Medical Branch, Galveston, USA
| | | | - Kyra Curtis
- Department of Neurology, University of Texas Medical Branch, Galveston, USA
| | | | - Sama Elrahi
- Department of Neurology, University of Texas Medical Branch, Galveston, USA
| | - Andrea Gil Guevara
- Department of Neurology, University of Texas Medical Branch, Galveston, USA
| | - Bhanu Gogia
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Ruiqing Sun
- Department of Neurology, University of Texas Medical Branch, Galveston, USA
| | - Todd Masel
- Department of Neurology, University of Texas Medical Branch, Galveston, USA
| | - Prashant Rai
- Department of Neurology, University of Texas Medical Branch, Galveston, USA
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Valaparla VL, Nehra R, Mehta UM, Grover S. Social cognitive deficits in schizophrenia and their neurocognitive correlates across the different phases of illness. Asian J Psychiatr 2021; 55:102501. [PMID: 33296864 DOI: 10.1016/j.ajp.2020.102501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/01/2020] [Accepted: 11/19/2020] [Indexed: 11/16/2022]
Abstract
AIM This study aimed to assess the relationship between neurocognition (NC) and social cognition (SC) in patients with schizophrenia during the symptomatic phase and the phase of clinical remission. METHODOLOGY Thirty-two patients were assessed on Color trail test (CTT), Hopkins verbal learning test (HVLT), Controlled oral word association (COWA) test, Wisconsin card sorting test (WCST), Ravens standard progressive matrices (SPM) and Social cognition rating tool in Indian setting (SOCRATIS) during symptomatic and remission phases of illness at least 3 months apart. RESULTS Compared to baseline assessment, even after controlling for PANSS scores except for social perception index all other domains of SC showed significant improvement at the time of remission. Although there was significant improvement in a few subtests of verbal learning, IQ and number of correct responses of COWA, colour trail test, no significant difference was seen in performance on WCST. Although second order theory of mind task had some association with IQ at the baseline assessment, no association was seen between SC and NC in the remission phase. CONCLUSIONS To conclude, present study suggests that impairments in all the domains of SC (except for social perception index) and NC (except for WCST) improve in the remission phase.
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Affiliation(s)
| | - Ritu Nehra
- Department of Psychiatry, PGIMER, Chandigarh, 160012, India
| | | | - Sandeep Grover
- Department of Psychiatry, PGIMER, Chandigarh, 160012, India.
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Valaparla VL, Sahoo S, Padhy SK. Selective mutism in a child with autism spectrum disorder: A case report and an approach to the management in such difficult to treat scenario in children. Asian J Psychiatr 2018; 36:39-41. [PMID: 29960134 DOI: 10.1016/j.ajp.2018.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/21/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
| | - Susanta K Padhy
- Department of Psychiatry, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
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Valaparla VL, Nehra R, Mehta UM, Thirthalli J, Grover S. Social cognition of patients with schizophrenia across the phases of illness - A longitudinal study. Schizophr Res 2017; 190:150-159. [PMID: 28285028 DOI: 10.1016/j.schres.2017.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 02/26/2017] [Accepted: 03/02/2017] [Indexed: 10/20/2022]
Abstract
AIM This longitudinal study aimed to evaluate social cognition of patients with schizophrenia at two points, i.e., during the symptomatic phase and clinical remission phase. Additional aim was to evaluate the relationship of social cognition with psychopathology and functional outcome. METHODOLOGY Fifty-one patients (N=51) were evaluated on Social Cognition Rating Tools in Indian Setting (SOCRATIS), Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), Socio-occupational functioning scale (SOFS) and Indian Disability Evaluation and Assessment Scale (IDEAS) during the symptomatic phase of illness. These patients were followed-up longitudinally for achieving clinical remission. Out of the 51 patients, 32 patients underwent second assessment after a mean duration of 143 (SD 34.9) days, while in clinical remission. Data of 111 healthy controls was used for comparison. RESULTS Social cognitive deficits were present in both the phases of illness. However, when the baseline and follow-up data was compared, it was evident that the severity of social cognition deficits is lower during the clinical remission phase. Higher levels of social cognitive deficits in both phases of illness are associated with higher socio-occupational dysfunction and higher disability. CONCLUSION Present study suggests that impairment in social cognition in patients with schizophrenia is present both in symptomatic and remission phase, with higher level of deficits during the symptomatic phase. Social cognition impairments are associated with poor social and occupational functioning and higher level of disability.
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Affiliation(s)
| | - Ritu Nehra
- Department of Psychiatry, PGIMER, Chandigarh, India
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Abstract
Venlafaxine is a serotonin-norepinephrine reuptake inhibitor used for the management of depression and anxiety disorders. The drug has been rarely reported to be associated with the development of akathisia. A review of the literature revealed only three such case reports. In this report we present the case of a middle-aged female, who developed akathisia while receiving venlafaxine (225 mg/day). The patient was suffering from recurrent depressive disorder and Crohn's disease. She was earlier treated with Cap venlafaxine up to 75 mg/day, but had a relapse of depressive symptoms when an attempt was made to taper off venlafaxine. When she presented to us, her depressive symptoms amounted to severe depression without psychotic symptoms. In view of the past response to venlafaxine, she was restarted on venlafaxine, but did not achieve remission of symptoms with the earlier dose and hence, venlafaxine was increased up to 225 mg/day. Within 48 h of increasing venlafaxine to 225 mg/day, she developed akathisia, which subsided after stopping venlafaxine.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vijaya Lakshmi Valaparla
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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