Effect of atenolol or metoprolol on waking hour dynamics of the QT interval in myocardial infarction

In subjects with a recent acute myocardial infarction, the hour immediately following awakening is associated with an abrupt exaggeration of heart rate-dependent changes and variability of the QT interval. Beta blockers were observed to blunt these waking hour changes.

The influence of espresso coffee on neurocognitive function in HIV-infected patients

The aim of our study was to evaluate the impact of coffee intake on cognitive function in persons living with HIV (PLWH). 130 PLWH with CD4 > 200 cells/mm(3), undetectable viral load, treated with HAART were included. A structured interview was applied and relevant clinical and laboratory data were assessed, including coffee intake. For neuropsychological assessment, the HIV Neurobehavioral Research Center Battery was chosen. Univariate nonparametric statistics and multivariate regression model were used. A significant association between espresso coffee use and a better cognitive function was verified in five of the eight psychometric measurements. In the multivariate analysis, after variable adjustment, linear regression analysis showed that coffee intake was a positive predictor for attention/working memory, executive functions and Global Deficit Score. Although the mechanisms behind the influence of caffeine on cognitive functioning are controversial, regular espresso coffee intake may have favourable effects on cognitive deterioration caused by HIV.

Cryptococcus: isolamento ambiental e caracterização bioquímica

O gênero Cryptococcus caracteriza-se por ser uma levedura responsável por infecção sistêmica, causada pelas espécies Cryptococcus neoformans e Cryptococcus gattii. O fungo é encontrado em substratos de origem animal e vegetal, e a infecção ocorre com a inalação de basidiósporos ou leveduras desidratadas infectantes presentes no ambiente. O presente trabalho teve por objetivo pesquisar a existência de microfocos de Cryptococcussp.em amostras ambientais da cidade de Araçatuba, São Paulo, com a finalidade de minimizar os riscos de contaminação do homem e dos animais, buscando o conhecimento da ecoepidemiologia do Cryptococcus. Foram colhidas 50 amostras oriundas de ocos e troncos de árvores (Cassiasp., Ficussp., Caesalpinea peltophorides) de 10 locais representativos do perímetro urbano, as quais foram encaminhadas ao Laboratório de Bacteriologia e Micologia da Faculdade de Medicina Veterinária de Araçatuba-Unesp, onde foram processadas e semeadas em placas de Petri contendo ágar semente de Níger e Sabouraud dextrose com clorafenicol e incubadas à temperatura de 30ºC, por um período não inferior a cinco dias. Posteriormente, foram submetidas às provas bioquímicas: produção de urease, termotolerância a 37ºC e quimiotipagem em ágar CGB (L-canavanina-glicina-azul de bromotimol). A análise dos resultados revelaram que 17 (34%) dos cultivos foram positivos para o gênero Cryptococcus, sendo nove (18%) para Cryptococcus gattiie oito (16%) para Cryptococcus neoformans. Outras leveduras correlacionadas, como Rhodotorula sp. e Candida sp., também foram isoladas. Conclui-se que os basidiósporos de Cryptococcusencontram-se dispersos na natureza, constituindo microfocos ambientais, não vinculados necessariamente a um único hospedeiro.

Aquisição de imunidade passiva em cabritos alimentados com colostro de cabras com e sem mastite

O objetivo deste trabalho foi avaliar a transferência de imunidade passiva de cabras, que pariram com mastite, para seus respectivos cabritos. Os animais foram distribuídos em dois grupos, a saber: grupo 1 (GI), constituído por cabritos, filhos de cabras sem isolamento microbiológico em ambas as glândulas mamárias, e grupo 2 (GII), composto por cabritos, filhos de cabras com resultado positivo à lactocultura, em pelo menos uma das glândulas mamárias. Foram coletadas amostras de colostro e sangue à parição, bem como às 24 e às 48 horas após o parto/nascimento. O diagnóstico e o monitoramento da mastite nos animais foram realizados por meio do California Mastitis Test (CMT), contagem de células somáticas e isolamento microbiológico. A proteína total foi mensurada pelo método do biureto, e as concentrações de imunoglobulina A (IgA), imunoglobulina G (IgG), transferrina, albumina e haptoglobina por meio da eletrofoerese em gel de poliacrilamida contendo dodecil sulfato de sódio (SDS-PAGE). Os agentes mais isolados na cultura microbiológica foram os Staphylococcus coagulase negativa. Não houve diferença significativa (P<0,05) entre os valores médios de imunoglobulina G (IgG) nos cabritos provenientes de cabras com mastite quando comparados aos recém-nascidos oriundos de cabras livres de infecções intramamárias. Da mesma forma, a atividade de gamaglutamiltransferase (GGT) não mostrou diferença entre os grupos em todos os momentos avaliados. A ingestão de colostro decorrente de cabras com mastite não causou falha na transferência de imunidade passiva nos respectivos conceptos.

HIV/AIDS “worried well”–When the “virus” leads to a significant illness, even in its absence

Introduction

Management of HIV/AIDS “worried well” people is among the most complex and challenging psychiatric problems in HIV care.

Objectives

To provide an overview of HIV/AIDS “worried well”.

Methods

Literature review based on PubMed/Medline, using the keywords “HIV” and “worried well”.

Results

The HIV/AIDS “worried well” are those individuals who are intensely worried about being infected with HIV, despite overwhelming evidence to the contrary. Indeed, they will rapidly return with the renewed conviction that the physician has “got it wrong” or “missed something”. So, they tend to over-utilize health care services. Seven HIV/AIDS “worried well” sub-groups have been identified: those with past sex or drug use history; those with relationship problems; the partners/spouse of those at risk; couples in individual or family life transitions; past history of psychological problems; misunderstanding of health education material; and pseudo and factitious AIDS. These patients have several striking consistencies in their presenting phenomenology and background features and usually have psychiatric problems associated. The authors will analyze all these aspects. Currently there are no guidelines to deal with this clinical condition, however cognitive-behavioral therapy along with selective serotonin reuptake inhibitors has been an effective approach. It is also important to ensure follow-up discussion to these patients, especially where unresolved life issues may cause future vulnerability in absence of intervention.

Conclusions

Patients may express their concerns about HIV infection by several ways, directly or indirectly, and psychiatrists need to be aware of this reality, which causes much suffering as well as severe monetary loss.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Psychosis Induced by Interferon-α–A Limitation of Treatment

Introduction

Psychosis is an uncommon but serious complication of treatment with interferon-α, a cytokine frequently used to treat several infectious and malignant diseases.

Objectives

To provide an overview of interferon-α-induced psychosis.

Methods

Literature review based on PubMed/MEDLINE, using the keywords “interferon-α” and “psychosis”.

Results

Psychotic symptoms usually emerge between 6 to 46 weeks and on average 3 months after the start of interferon-α treatment, occurring most frequently in the form of persecutory, guilt or grandeur delusions and auditory hallucinations. Often they are accompanied by mood symptoms, anxiety, attention disturbances and insomnia. Many factors are known to increase the risk of psychiatric effects as a whole associated with interferon-α. Pathogenesis of interferon-induced psychosis remains unclear, however several theories have been discussed, namely the overlap influence of biological vulnerability and the cytokine's action on the brain. Dopaminergic, opioid, serotoninergic and glutaminergic pathways as well as hypothalamic-pituitary-adrenal axis hypersensitivity are some of the hypotheses raised about the underlying cause of that susceptibility. Psychosis management usually includes stopping interferon-α and introducing antipsychotics with minimal antidopaminergic effects and at the lowest possible dose, due to the increased risk of extrapyramidal reactions in these patients.

Conclusion

The decision to use interferon-based treatments in psychiatric patients should be highly individualized. Early recognition and adequate treatment of interferon-induced psychosis might prevent subsequent emergence of serious debilitating symptoms. Thus, it is very important that medical and psychiatric treatment teams work closely together and are familiar with this important subject.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Anxiety Among Hiv-Infected Patients – When Anxiety Is A Disorder and not Simply A Natural Reaction to a Life-Threatening IIIness

Introduction

HIV infection is a chronic disease characterized by a great deal of uncertainty and unpredictability, being anxiety disorders a frequent psychiatric problem.

Objective

To provide an overview of anxiety in HIV-infected patients.

Methods

Literature review based on PubMed/Medline, using the keywords “HIV” and “anxiety disorders”.

Results

HIV-infected individuals can experience symptoms of anxiety across the spectrum of anxiety disorders. Adjustment disorder with anxious mood is the most common diagnosis, followed by generalized anxiety disorder and panic disorder. Some patients present with these disorders prior to notification, others develop them during the course of their illness, mainly at key moments. In HIV-infected patients, anxiety can be a manifestation of side effects of medication; a symptom of an illness associated with HIV disease; or, most commonly, the psychological response to the stressors of the illness. In fact, many issues are responsible for the anxiety experienced by people living with HIV. The authors will analyze them. Besides the distress of anxiety disorders, these lead to a decrease in adherence to antiretroviral treatments, resulting in adverse progression of HIV disease and increased risk of mortality. Importantly, however, appropriate psychiatric intervention can do it over.

Conclusions

Careful diagnosis and treatment of anxiety disorders in the context of HIV disease is even important, given the serious effects if untreated. Thus, anxiety should never be seen simply as a natural reaction to a life-threatening illness.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Aids Mania – Is It A Potential Indicator to Initiate HAART?

Introduction

Mania occurs in higher rates among individuals with HIV/AIDS, especially with the progression of HIV infection, and constitutes an additional risk factor for facilitate the HIV spread.

Objective

To provide an overview of secondary mania in HIV-infected patients.

Methods

Literature review based on PubMed/Medline, using the keywords “HIV”, “AIDS” and “mania”.

Results

Secondary mania or AIDS mania may be due to illicit or prescribed drugs, CNS infection with HIV, medical illness, including opportunistic infections. Of these, HIV neurotoxicity has been proposed to be the most important factor in its pathogenesis. Mania AIDS differs from primary mania with regard to clinical presentation, course, management and prognosis. The authors will analyze them. Besides decrease to treatment adherence, maniac symptoms also predispose to HIV risk behaviors, which may lead to further HIV transmission. Importantly, the occurrence of HIV mania may announce the transition from HIV infection to AIDS perhaps before other clinical signs are evident. Early recognition and treatment of manic symptoms with mood stabilisers, antipsychotics and HAART improve quality of life, protect from further cognitive deterioration and decrease mortality. In these patients, medication side-effects toxicity, drug interactions, and adherence require special attention.

Conclusions

Mania has been associated with HIV/AIDS and in many instances acts as a barrier to achieving best treatment outcomes. Thus, psychiatrists need to be aware of the complexities involved in the emergence of manic episodes in HIV-infected patients in order to deal with them in the most appropriate and effective manner.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Postictal psychosis – A complex challenge

Introduction

Patients with epilepsy have 6–12 times higher risk of suffering from psychosis, with a prevalence of about 7–8%, and the coexistence of these two conditions is associated with increased morbidity and mortality. The psychosis of epilepsy is generally split into two groups: interictal psychoses and postictal psychosis (PIP), and the latter has been estimated to represent 25% of all types. However, many of these episodes remain under-recognized and/or are often misdiagnosed.

Objectives

To provide an overview of PIP.

Methods

Literature review based on PubMed/Medline, using the keywords “epilepsy” and “psychosis”.

Results

PIP has been recognized since the 19th century, when Esquirol described postictal “fury”. Although its etiology and pathogenesis remain poorly understood, several risk factors and etiopathogenic mechanisms have been suggested and analysed. An essential step in PIP management is its accurate and early diagnosis. Generally, before the onset of PIP there is a lucid period of one to six days after the seizure(s). PIP frequently has a polymorphic presentation, tends to be affect-laden and symptoms often fluctuate. It is of limited duration and frequently responds very rapidly to low doses of benzodiazepines and antipsychotics. However, the propensity of the antipsychotics to provoke seizures and the risk of pharmacokinetic interaction with anti-epileptics are important considerations. Recurrence rates range 25% to 50%.

Conclusions

Given the negative impact of PIP in morbidity and mortality among these patients, it is crucial that neurologists and psychiatrists are able to adequately recognize and treat this clinical condition.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Depression Among HIV-Infected Patients–A Reality that Must Not be Forgotten

Introduction

HIV-infection is a very stigmatized, chronic disease with increased rates of psychiatric disorders, being major depression the most common.

Objective

To review the recent research related to depression in HIV-infected patients.

Methods

Literature review based on PubMed/Medline, using the keywords “HIV” and “depression”.

Results

HIV-infected patients have a chance 2-7 times higher of developing major depression, around the time of diagnosis or during the course of their illness. However, only fewer than 50% of the cases are recognized clinically. Several factors contribute to its under-recognition and under-treatment, such as the overlap between the neurovegetative symptoms of depression, the somatic symptoms of HIV disease, and the effects of comorbid diseases; the mistaken belief that depressive symptoms are expected in this group; the neuropsychiatric side effects associated with some antiretrovirals. Besides, major depression presents important diagnostic challenges due to biological, psychological, and social components associated with the infection. The authors will analyze the clinical presentation.

Depression has been associated with a negative impact on quality of life, poorer HAART adherence, faster HIV disease progression and increased mortality risk. Importantly, however, appropriate psychiatric intervention can do it over. In fact, studies suggest that patients receiving SSRI treatments for depression have rates of adherence and CD4+ T-cell counts similar to non-depressed patients receiving HAART.

Conclusions

The high prevalence of major depression in HIV-positive individuals and its serious consequences if untreated, increase even further the importance of its effective identification and subsequent treatment in this group of patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The role of augmentation treatment with second-generation antipsychotics in major depression disorder–current evidence in the literature

Introduction

Major depressive disorder (MDD) is a chronic mental illness with a considerable lifetime prevalence in adult men and women. Only a third of MDD patients remit following adequate antidepressant treatment, while most suffer from significant core depressive or residual symptoms during their clinical course. Augmentation treatment with second-generation antipsychotics (SGAs) has been one of the suggested approaches to overcome this shortage of efficacy of antidepressant therapy.

Objectives

To review the role of SGAs as an augmentation strategy to antidepressant therapy in MDD.

Methods

A search of the MEDLINE/Pubmed database was conducted for articles from 2010 to 2015, using the MeSH terms “antypsichotics”, “depression” and “treatment”.

Results

There is a general consensus in the literature that antidepressant augmentation treatment with SGAs is more effective than placebo in the management of patients with MDD who failed to respond adequately to antidepressant therapy alone. The majority of studies found no significant differences between the different studied drugs (namely, aripiprazole, quetiapine, olanzapine and risperidone). On the other hand, discontinuation rates due to adverse effects are also higher with SGAs versus placebo. However, it remains unclear if augmentation with SGAs is more effective than other therapeutic strategies, such as combination or switching to other antidepressant or augmentation with other psychotropics.

Conclusions

There is strong evidence that SGAs augmentation is an effective and generally safe therapeutic approach to patients with MDD who respond poorly to antidepressants. Nevertheless, more studies are needed to understand the efficacy of this treatment comparing other therapeutic approaches.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Living with Parkinson disease – the central role of primary care physicians and a multidisciplinary approach

Introduction

Parkinson disease is a frequent neurodegenerative disorder. Presence of psychopathology is well described in this illness, nevertheless the etiology is still unknown.

Methods and aims

The authors present a clinical case of a patient with idiopathic Parkinson disease with depressive symptoms after the decline of his functioning. We aim to emphasize the importance of a multidisciplinary approach and the central role of general physicians in screening these situations.

Results

The patient is a male with 64 years old, reformed with a personal history of hypertension. With 62 years old he started with mild motor complaints that got worse over time, culminating after a year and half on him being almost dependant for most of his daily activities. He also started to express feelings of sadness, despair, and recurrent thoughts of death. He refused to seek out medical help, but was convinced by his wife to consult his general physician that observed the patient and referenced him to Neurology and Psychiatry consultations. He also started sertraline 50 mg/day. He was diagnosed with Parkinson disease and started medication with ropinirole, levodopa and carbidopa with a good response. In Psychiatry consultation the dose of sertraline was increased to 100 mg/day with improvement, and it was provided information on the disease to the patient and family and also supportive psychotherapy.

Conclusions

General physicians have a privileged position on screening patients with psychopathology when other physical conditions or illnesses are present. The fast and correct referencing of these patients can improve the prognosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Aripiprazol and Hypersexuality: when partial is to much

Introduction

A growing number of published cases has showed that hypersexual behavior may arise with treatment with second-generation antipsychotics, including aripiprazole and olanzapine. Aripiprazole is a second-generation antipsychotic commonly used to treat schizophrenia and bipolar disorder. It has a unique pharmacologic profile acting as a partial agonist of the dopamine D2 receptor, as a partial agonist at the 5-HT1A receptor, and as an antagonist at the 5-HT2A receptor. Literature shows that medication with partial dopaminergic agonistic activity can cause compulsive behaviors, such as pathological gambling, compulsive eating, compulsive shopping, and hypersexuality. Although it is difficult to predict who would develop these behaviors, the literature suggests that patients at a higher risk of developing impulsive behaviors include those with a personal or family history of obsessive-compulsive disorder, impulse control disorder, bipolar disorder, impulsive personality, alcoholism, drug abuse, or other addictive behaviors.

Objectives

Here, we present a case of a 32-year-old male who developed hypersexuality symptoms after receiving aripiprazole as treatment for bipolar disorder.

Methods

We have done a literature review using the MeSH terms Aripiprazole and hypersexuality in the “PubMed”.

Results

After switching Aripiprazole to Risperidone the hypersexuality symptoms started to decrease and got almost complete relief after 2 weeks.

Conclusions

This case highlights the rare hypersexuality side effect that can arise in patients receiving aripiprazole for bipolar disorder treatment. Clinicians should be aware of the increased risk of hypersexuality and other impulsive behaviors as they can significantly impair a patient’s daily functioning.

Disclosure

No significant relationships.

Can intramammary infections change immunoglobulins and acute phase proteins of colostrum and transition milk in dairy goats?

ABSTRACT Proteiongram analysis is useful for the early diagnosis of intramammary infections during the period of colostrogenesis. This study aimed to evaluate the profile of total proteins, immunoglobulins, lactoferrin, and gamma-glutamyl transferase (GGT) in the colostrum of dairy goats with intramammary infections. Animals were divided in groups: GI (n=12) of goats without mammary gland infections, and GII (n=8) of goats with mammary gland infections. Intramammary infections were diagnosed using microbiological isolations and somatic cell counts (SCCs). Total protein was evaluated in the samples using SDS-PAGE shortly after parturition, and 24 and 48 hours after that event. Non-aureus Staphylococcus (NAS) were detected in all isolates. At 48 h, GII had high IgG levels and a SCC of 1660.25 × 10³/mL. Levels of total protein were high in this group at 24 and 48 h. Albumin levels were high in goats with mastitis at 24 h. Overall, the IgG, lactoferrin, and albumin levels differed between animals with and without intramammary infections at M0. GGT activity was not influenced by the intramammary infection. The results of this study reinforce the importance of the proteinogram as an auxiliary tool in the diagnosis of mastitis in dairy goats.

Antidepressant withdrawal mania: Two case reports

Introduction

Although rarely reported, antidepressant discontinuation may induce hypomania or mania even in the absence of bipolar disorder [1,2].

Objectives

We report two cases of antidepressant withdrawal induced mania.

Methods

Clinical process consultation and PubMed search were performed in November 2016 using the search keywords antidepressant, mania and discontinuation.

Results

Case report 1: a dysthymic 60 years old woman with 20 years of psychiatric following had been treated with venlafaxine 150 mg/daily the past year. She abruptly stopped taking this drug, developing heightened mood, irritability and racing thoughts five days later. She was admitted at our hospital, initiating then valproate and antipsychotics. Two weeks later, the hypomania clinical state remitted completely.

Case report 2: a 64 years old woman, with a 12-year-old diagnosis of unipolar depression was brought to our emergency service with complaints of disorganized behavior, paranoid delusional ideas, excessive speech, irritable mood and reduced need for sleep, 1 week after abrupt trazodone 150 mg/daily discontinuation. Valproic acid 1000 mg/daily and olanzapine 20 mg/daily were introduced, with gradual improvement of symptoms. Two weeks later she was completely asymptomatic.

Conclusion

Psychiatrists should be aware of the risk of antidepressant withdrawal induced mania. More studies should be conducted about this subject, aiming for the clarification of risk factors and the establishment of clinical criteria for this phenomenon.

Disclosure of interest

The authors have not supplied their declaration of competing interest.