Antidepressant discontinuation manias: a new bipolar subtype?

Introduction

Antidepressant withdrawal manic states are rare and controversial phenomena. The underlying pathophysiology and the clinical implications have not been thoroughly discussed in the literature.

Objectives

We aimed to review reports of antidepressant discontinuation manic states and to discuss the different hypothetical pathophysiological changes underlying this phenomenon. We also argued in favor of its inclusion in the bipolar spectrum.

Methods

We searched Pubmed using the key words: ‘antidepressant withdrawal’ or ‘antidepressant discontinuation’ plus ‘mania’ or ‘hypomania’ from January 2008 until January 2018.

Results

Twenty-nine cases of antidepressant discontinuation manic states were identified. Hypotheses involve the implication of Catecholamines, Acetylcholine and Serotonin in the pathophysiology of this paradoxical phenomenon. The search for red flags for bipolar disorder in these case reports revealed psychiatric histories in favor of a bipolar spectrum disorder in 12 individuals while five were already known to have bipolar disorder.

Conclusions

Antidepressant discontinuation mania should be considered on the bipolar spectrum.

Disclosure

No significant relationships.

The prevalence of post-traumatic stress disorder in Syrian refugees increased after long-distance migration

Introduction

Refugees are forced migrants but there is a large variation in the distance that refugees cover and there is a knowledge gap on how this may affect refugees’ health and health care needs.

Objectives

Herein, we investigate the association between long-distance migration and post-traumatic stress disorder (PTSD), a serious psychiatric disorder associated with deteriorating mental and somatic health and highly prevalent in refugees.

Methods

Included were 712 adult Syrian refugees and asylum seekers in Lebanon and Denmark arriving no more than 12 months prior to inclusion. The Harvard Trauma Questionnaire was used to assess PTSD and the estimate of association was obtained by multiply imputing missing data and adjusting for confounding by propensity score-weighting with covariates age, sex, socioeconomic status, trauma experience, and WHO-5-score, reporting the bootstrap 95-percentile confidence interval (95% CI). Additionally, a number of sensitivity analysis were carried out.

Results

The prevalence of PTSD was high in both Lebanon (55%) and Denmark (60%) and long-distance migration was associated with a 9 percentage point (95% CI [-1; 19]) increase in the prevalence of PTSD among newly arrived Syrian refugees and asylum-seekers.

Conclusions

In the present study the prevalence of PTSD increased after long-distance migration which may support considering “long-distance migration” in refugee health screenings and in particular when assessing the risk of post-traumatic stress disorder. This is a first step in examining the health effects of migration on refugee health.

Disclosure

No significant relationships.

The prevalence of post-traumatic stress disorder increased in refugees after long-distance migration

Background

Refugees are forced migrants but there is a large variation in the distance that refugees cover. This may importantly affect their health needs. Previous studies suggest an inverse association between long-distance migration and self-rated health in the general population, possibly related to difficulty in acculturation but there is a knowledge gap in the health effects of migration in refugee populations. Here, we estimate the association between long-distance migration and post-traumatic stress disorder (PTSD), a severe mental health disorder associated with deteriorating psychiatric and somatic health and highly prevalent in refugees.

Methods

Included were 712 adult Syrian refugees and asylum seekers in Lebanon and Denmark arriving no more than 12 months prior to inclusion. The Harvard Trauma Questionnaire was used to assess PTSD and the estimate of association was obtained by multiply imputing missing data and adjusting for confounding by propensity score-weighting with covariates age, sex, socioeconomic status, trauma experience, and WHO-5-score, reporting the bootstrap 95-percentile confidence interval (CI). Additionally, a number of sensitivity analysis were carried out.

Results

The prevalence of PTSD was high in both Lebanon (55%) and Denmark (60%). After adjusting for biases the prevalence difference increased from 5 percentage point (95-percentile CI [-5; 15] percentage point) to 9 percentage point (95-percentile CI [-1; 19] percentage point). All sensitivity analysis produced estimates of the same direction and magnitude, except when grossly violating the assumption of multiple imputation which halved the magnitude of the association.

Conclusions

We found that long-distance migration was associated with an increase in the prevalence of PTSD among newly arrived Syrian refugees and asylum-seekers. This is a first step in examining the effects of migration in refugee health.

Key messages

Long-distance migration was positively associated with prevalence of post-traumatic stress disorder in Syrian refugees. This is a first step to investigate the impact of migration in refugee health.

A general population survey on patterns of benzodiazepine use and dependence in Lebanon

OBJECTIVE

In Lebanon, benzodiazepines are often available without medical prescription. We aimed to carry out the first community-based pharmaco-epidemiological study on benzodiazepine consumption in the Middle East Area.

METHOD

The prevalence of past-month benzodiazepine use was assessed in a 1000-subject randomized sample from the Lebanese community, and risk factors were studied in a group of 496 current users.

RESULTS

Benzodiazepine use during the past month was found in 9.6% of subjects. Four variables were significantly associated with use: age higher than 45 years, female sex, cigarette smoking and the existence of a recent life event. Benzodiazepine dependence was found in 50.2% of users.

CONCLUSION

Benzodiazepine use in Lebanon is particularly high, and can be related to well-known factors such as female sex and age, but other potent specific variables, such as war stress or the lack of control on drug access, can be hypothesized.

[Atypical neuroleptics in the child and adolescent]

The FDA approval for clozapine in 1990 under several hematologic surveillance conditions has reactualized the debate on the use of atypical neuroleptics for adults with schizophrenia. The use of conventional neuroleptics in children and adolescents has always been a subject of controversy due to their side effects and the absence of controlled studies. The pharmacological action of clozapine and risperidone is mainly on D2 and 5HT. Since 1992 several studies concerning children and adolescents show the efficiency and the tolerance of the clozapine and risperidone in various disorders, especially in very early onset schizophrenia (VEOS). Controlled trials are necessary to confirm the data obtained in open studies.