Table of Contents - Academy of Psychosomatic Medicine

Discussion: In these two cases there may have been a
combination of factors, perhaps altered metabolism of the
venlafaxine metabolite, and an interaction with the CNI due
to a p-glycoprotein interaction that boosted the serum metabolite
level resulting in serotonin syndrome. Neither patient
was on another medication that should have interacted with
venlafaxine to cause serotonin syndrome. An interaction
between venlafaxine and tacrolimus may result in serotonin
syndrome via elevated metabolite desmethylvenlafaxine.
References:
1. McAlpine DE, O’Kane DJ, Black JL, Mrazek DA. Cytochrome
P450 2D6 Genotype Variation and Venlafaxine Dosage.
Mayo Clin Proc.2007 Sep; 82(9): 1065-1068.
2. El Ela AA, Hartter S, Schmitt U, Hiemke C, Spahn-Langguth
H, Langguth P. Identification of P-glycoprotein substrates
and inhibitors among psychoactive compounds—
implications for pharmacokinetics of selected substrates. J
Pharm Pharmacol 2004 Aug; 56(8):967-975.
24. Frequency of Psychotropic Prescription in
a Brazilian General Hospital
Presenting Author: Ana Paula Carvalho
Co-Authors: Fernanda Moreira, PhD, Dartiu Silveira, PhD
Purpose: To assess the frequency of psychotropic prescription
in a Brazilian General Hospital, to verify demographics
and hospitalization factors possibly related to prescription,
and to check the requests of consultation-liaison psychiatry
for these patients.
Methods: A cross-sectional descriptive study of psychotropic
prescription frequency in a 258 bed general hospital located
in city of Diadema at São Paulo’s State. Randomly sorted
medical reports of patients that left the hospital in February
2004 were analyzed; including wards of all medical areas
with the exception of Psychiatry Data for this study were collected
using a questionnaire especially developed for this
purpose. After collecting all relevant information, statistics
were performed using the SPSS software.
Results: The frequency of psychotropic prescriptions was
27.4% in the hospital, with the opiates leading the prescriptions
(69.23%) followed by the benzodiazepines (34.61%),
anticonvulsants (22.90%), antidepressants (5.76%), and
antipsychotics (1.92%). The features associated to the use
of these medications were: age, civil status, length of stay
in the hospital, unit where the patient was, treatment type,
existence of previous hospitalization, medical psychiatric
diagnosis reported by unit’s physician, and having being hospitalized
in the intensive care unit. The requests for consultation-liaison
psychiatric were reduced, occurring for only 1.6%
of all patients.
Conclusion: The frequency of psychotropic prescription was
high in the general hospital setting. The diagnosis and the
fact of having being hospitalized in an intensive care unit are
important factors related to the use of this kind of medication.
The consultation-liaison psychiatry service is not being used
adequately, despite its importance for the adequate evalua-
11
tion of hospitalized patients and for the continuous education
of professionals involved in medical care.
25. Clozapine Withdrawal Catatonia and
Neuroleptic Malignant Syndrome: A Case
Report and Literature Review
Presenting Author: Magdalena Spariosu, MD
Co-Author: Stephen Saravay, MD, FAPM
Background: Recent literature suggests that there is an
overlap of symptoms between neuroleptic malignant syndrome
and catatonia. Both have been reported as occurring
in Clozapine withdrawal.
Objective: To increase awareness of negative outcomes in
sudden Clozapine discontinuation.
Method: Literature Review and Case Report of a 44 y.o.
female with Schizoaffective D/O, who after being hospitalized
to ICU for GI bleeding was switched from Clozapine to
Haloperidol.
Results: Three days after Clozapine discontinuation patient
developed change in Mental Status, became mute, rigid, with
waxy flexibility, immobile with a sporadic limb myoclonus and
autonomic instability (fever, elevated white blood count and
elevated serum creatine kinase). Pt was started on Lorazepam
and Diphenhydramine while Haloperidol was discontinued.
Twenty four hours later patient returned to her baseline.
Conclusion: This case and the literature reviewed support
the theory of cholinergic rebound involved with Clozapine
withdrawal, exacerbated by initiation of Haloperidol and by
resolution of symptoms after initiation of an anticholinergic
and discontinuation of Haloperidol.
26. Atypical Antipsychotic-Induced
Hyponatremia: Case Report and Literature
Review
Presenting Author: Magdalena Spariosu, MD
Background: There are very few cases reported discussing
atypical antipsychotic induced hyponatremia. This paper is
talking about a patient who developed hyponatremia secondary
to Risperidone and subsequently to Aripiprazole.
Objective: To increase awareness about atypical antipsychotic
induced hyponatremia.
Method: Case report and literature review
Results: Patient developed hyponatremia shortly after initiation
of Risperidone. Serum Sodium normalised when Risperidone
was discontinued. The second agent started was
Aripiprazole, which caused the same results in this patient
as the Risperidone. After discontinuing Aripiprazole sodium
level normalised. After having normal sodium for several
days, patient was started on Fluphenazine at a very small
dose. Sodium was closely monitored while Fluphenazine
was slowly increased to therapeutic dose.