The Relationship of Insight with Psychopathology and Neuropsychological Functioning in Patients with Schizophrenia

OBJECTIVE

The aim of this study was to investigate the relationship of the different dimensions of insight with clinical variables, symptom severity, and cognitive functions in patients with schizophrenia.

METHOD

In this cross-sectional descriptive study,  66  out  patients that applied to the Karadeniz Technical University, Psychiatry Clinic and were diagnosed with schizophrenia according to DSM-IV were evaluated. The patients were evaluated with Structured Clinical Interview for DSM (SCID-I), the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS), and the Schedule for Assessing the Three Components of Insight (SAI). Wisconsin Card Sorting Test, Verbal Fluency Test, Trail Making Test A and B and Rey Auditory Verbal Learning Test were applied to assess the cognitive function of each patient.

RESULTS

The insight levels of the patients that were evaluated with SAI were found to be correlated with PANSS positive, negative, and general psychopathology symptom severity as well as Verbal Fluency Test and Trail Making Test A and B scores. In the multiple linear regression analysis, PANSS positive, Verbal Fluency Test and Trail Making Test A scores were determined the contributors of SAI total score.

CONCLUSIONS

The relationship between insight and clinical symptoms may change depending on the course of the disease and severity of symptoms. These findings emphasize the importance of frontal executive function in the relationship between insight and cognitive functions.

Sexual Dysfunction and Childhood Trauma In Female Patients With Fibromyalgia

BACKGROUND

Fibromyalgia (FM) is a rheumatological diseases characterized by diffuse pain and stiffness accompanied with fatigue, insomnia and headache. Physical and psychological factors were implicated in sexuality of patients with FM. There are few studies investigating the effect of childhood trauma on sexuality of patients with FM. The aim of this study is to investigate effect of childhood trauma on sexuality of FM.

METHODS

Thirty-six patients with FM and 29 healthy females were included in this study. The patients with FM and healthy controls were assesed in terms of sociodemographic and clinical variables, sexual function and childhood traumas.

RESULTS

The healthy controls had significantly longer duration of marriage with higher rate of marriage by arrangement. Communication subscale score was significantly higher in patients with FM. General and emotional trauma scores were significantly higher in patients with FM. There was no correlation between the scores of GRSSS, CTQ and FIQ.

CONCLUSION

The type of marriage and duration of marriage were important sociodemographic variables concerning sexuality in FM. This study indicated that childhood trauma was not a related factor in sexuality of FM.

The effects of edaravone in ketamine-induced model of mania in rats

Bipolar disorder is a chronic disease characterized by recurring episodes of mania and depression that can lead to disability. This study investigates the protective effects of edaravone (3-methyl-1-phenyl-2-pyrazolin-5-one), a drug with well-known antioxidant properties, in a model of mania induced by ketamine in rats. Locomotor activity was assessed in the open-field test. Superoxide dismutase (SOD), catalase (CAT) and thiobarbituric acid reactive substances (TBARS) levels were measured in order to evaluate oxidative damage in the rat hippocampus and prefrontal cortex. Increased locomotor activity (hyperlocomotion) was observed at the open-field test with ketamine treatment (25 mg/kg, i.p., 8 days). Edaravone (18 mg/kg) treatment did not prevent hyperlocomotion in the mania model induced with ketamine in rats, but lithium chloride (47.5 mg/kg, i.p., positive control) did prevent hyperlocomotion. Edaravone and lithium chloride treatments were found to reduce the increase in SOD and CAT activity following ketamine administration in a non-significant manner but caused no change in TBARS levels.

[Adverse Effects of Medication and Quality of Life in Patients Receiving Second Generation Antipsychotics: A Comparison of Long Acting Injectable and Oral Therapies]

OBJECTIVE

Maintenance treatment with antipsychotic drugs for patients with schizophrenia is highly effective in decreasing the recurrence rate of the disease. In the current study, we aimed to compare long-acting second generation antipsychotic drug injections and oral forms of second generation antipsychotic drugs in terms of their adverse effects on quality of life.

METHOD

Forty-one patients receiving second generation antipsychotic drugs and 139 patients diagnosed with schizophrenia or schizoaffective disorder were treated with oral second generation antipsychotic drugs and enrolled in the study. All patients were evaluated with Positive and Negative Symptoms Scale (PANNS), extrapyramidal symptom rating scale (ESRS) and UKU, and Quality of Life Enjoyment and Satisfaction questionnaire (Q-LES-Q).

RESULTS

The impact of adverse effects of oral second generation antipsychotic drugs on the daily performance of patients with schizophrenia or schizoaffective disorder was found to be significantly higher than that of the long acting injection antipsychotic drugs. The quality of life of patients receiving long acting second generation antipsychotic drug injection was significantly higher when compared with that of the patients treated with oral second generation antipsychotic drugs.

CONCLUSION

The results of this study showed that the long-acting second generation antipsychotic injection treatment was superior to second generation oral forms of antipsychotic drugs in terms of adverse effects and measures of quality of life. Further studies with specific design and the supplementation of larger samples are needed.

[Current Clinical Variables in Schizophrenia Cases with Suicide Attempt History]

OBJECTIVE

High suicide risk was shown to be related with depression and low quality of life in studies investigating clinical variables related to suicidal behavior. The aim of this study was to investigate the effects of a suicide attempt on clinical presentation by comparing sociodemographic variables, clinical signs, symptoms of depression, quality of life, social functionality, and reported adverse drug reactions in schizophrenic patients with and without suicide.

METHOD

Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale (CDS), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Social Functioning Scale (SFS), and Udvalg for Kliniske Undersøgelser Side Effect Rating Scale (UKU) were administered to 115 patients with schizophrenia.

RESULTS

44.3% of patients had at least one suicide attempt. Among sociodemographic variables, a family history of suicide, smoking, and total duration of disease were significantly higher in patients with suicide history than without. Scores of CDS and UKU subscores were significantly higher, and quality of life and social occupation in social functionality were significantly lower in patients with a history of suicide. In correlation analysis, CSD was negatively correlated with Q-LES-Q and independency/performance subscore of SFI, and positively correlated with UKU-Neurological subscore.

DISCUSSION

In line with this data, suicidal behavior may be suggested to affect clinical presentation and course characteristic of schizophrenic patients. Additional treatments towards factors that may impact on the clinical course and social support programs might be suggested for these patients.

[The Relationship of Interleukin-18 and Interleukin-6 Levels with Cognitive Functions in Bipolar Disorder]

OBJECTIVE

Impairment in immune functions is proposed as a key factor in the cognitive decline in bipolar disorder (BD) however there is scarcity of research on the impact of inflammation on cognitive functions. Our aim is to compare IL-18 and IL-6 levels in BD patients and controls and to study the relationship between IL-18 and IL-6 levels and cognitive impairment METHOD: Thirty-six euthymic BD-I patients and 38 age, sex and educational level matched healthy controls were enrolled in the study. All participants were evaluated with neurocognitive tests. The plasma IL-6 and IL-18 levels of both groups were measured with ELISA kits.

RESULTS

There was no statistically significant difference between IL-6 and IL-18 levels of patient and healthy control groups. In the patient group, IL-18 level was positively correlated with completed categories score wheras there was a negative correlation with perseverative response and perseverative errors. Moreover IL-18 level was positively correlated with immediate recall, delayed recall and learning scores while there was a negative correlation with stroop interference scores. No correlation was found between IL-6 level and neuropsychological test scores in the patient group.

CONCLUSION

This is the first study that investigates the relation of IL-18 with cognitive functions. Possible detrimental or protective effects of IL-18 in BD is not yet clear, however the positive association of IL-18 level and neuropsychological test scores might indicate a neuroprotective role of IL-18 in the euthymic period of BD which is the closest state to physiological condition.

Antipsychotic prescribing patterns in outpatients with severe mental illness

Introduction

Prescribing more than one antipsychotic at the same time is becoming common in the treatment of patients with severe mental illness (SMI), although most guidelines recommend monotherapy.

Objectives

The aim of this study was to examine the prevalence of antipsychotic polypharmacy and to compare the practices of polypharmacy and monotheraphy in terms of the rationale and compatibility of the treatment.

Methods

This study included 235 patients with SMI between 18 and 65 years of age who were followed at KTU Psychiatry Department Schizophrenia-Bipolar Disorder outpatient clinic between January 2007 and December 2014. The sociodemographic and clinical data were evaluated by a chart review form which was prepared by the researcher and designed according to American Psychiatric Association treatment algorithm and National Associated Mental Health Program Directors polypharmacy classification.

Results

138 patients (58.7%) were diagnosed with schizophrenia, 75 patients (31.9%) were diagnosed with bipolar disorder and 22 patients (9.4%) were diagnosed with schizoaffective disorder. 62 patients (26.4%) were receiving antipsychotic polypharmacy. Combinations of two second-generation antipsychotics were most common. Anticholinergic drug use was significantly more common in patients on antipsychotic polypharmacy. Reported adverse events were more common in patients on polypharmacy but did not reach the level of statistical significance. Patients on antipsychotic polypharmacy were more likely to be diagnosed with schizophrenia. Polypharmacy patients were also more likely to receive clozapine and amisulpride whereas monotherapy patients were more likely to receive olanzapine.

Conclusion

Our results confirm previous reports that indicate patients with SMI are most likely to receive antipsychotic polypharmacy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Validity and Reliability of the Turkish Version of Needs Based Biopsychosocial Distress Instrument for Cancer Patients (CANDI)

Background

Needs based biopsychosocial distress instrument for cancer patients (CANDI) is a scale based on needs arising due to the effects of cancer.

Objectives

The aim of this research was to determine the reliability and validity of the CANDI scale in the Turkish language.

Patients and Methods

The study was performed with the participation of 172 cancer patients aged 18 and over. Factor analysis (principal components analysis) was used to assess construct validity. Criterion validities were tested by computing Spearman correlation between CANDI and hospital anxiety depression scale (HADS), and brief symptom inventory (BSI) (convergent validity) and quality of life scales (FACT-G) (divergent validity). Test-retest reliabilities and internal consistencies were measured with intraclass correlation (ICC) and Cronbach-α.

Results

A three-factor solution (emotional, physical and social) was found with factor analysis. Internal reliability (α = 0.94) and test-retest reliability (ICC = 0.87) were significantly high. Correlations between CANDI and HADS (rs = 0.67), and BSI (rs = 0.69) and FACT-G (rs = -0.76) were moderate and significant in the expected direction.

Conclusions

CANDI is a valid and reliable scale in cancer patients with a three-factor structure (emotional, physical and social) in the Turkish language.

Trazodone induced galactorrhea: a case report

Trazodone is a heterocyclic antidepressant that exerts its effect via the inhibition of selective serotonin reuptake and the antagonism of 5-HT2A and 5-HT2C receptors. Antidepressant-induced galactorrhea and increases in prolactin levels have rarely been reported. Trazodone can potentiate the serotonergic activity of citalopram. To our knowledge, no cases of galactorrhea associated with use of trazodone have been reported to date. This report describes a unique case of the development of galactorrhea following the addition of trazodone (100 mg/day, 2 weeks) to the treatment of a patient who was receiving citalopram (40 mg/day, 6 weeks) therapy for a diagnosis of depressive disorder, which improved upon the discontinuation of trazodone.

[The Prevalence of Night Eating Syndrome among Outpatient Overweight or Obese Individuals with Serious Mental Illness]

OBJECTIVE

This study aimed to determine the prevalence of Night Eating Syndrome (NES) among overweight or obese patients with serious mental illness and its relationship with insomnia and quality of life.

METHODS

This study included 158 overweight or obese patients diagnosed with schizophrenia, schizoaffective disorder, and bipolar disorder (according to DSM-IV criteria) that were not in the active disease period. A clinical interview and Night Eating Questionnaire (NEQ) were used to assess the prevalence of NES among those in the study group. Body mass index (BMI), sleep quality, and quality of life measures were also evaluated for each patient.

RESULTS

Twelve patients (7.6%) were diagnosed with NES via clinical interview while 26 (16.5%) were diagnosed by having ≥25 points in the NEQ. There were no statistically significant differences between the NES and non-NES groups with respect to age, gender, education and body mass index. However, quality of life scores were lower while the severity of insomnia scores were higher in patients with NES.

CONCLUSION

The prevalence of NES is higher among overweight or obese patients with serious mental illness when compared to prevalence data in a general population, as demonstrated by previously published studies. Night eating behavior may be related to insomnia and poor quality of life measures. The recognition of NES among patients with severe mental disease is essential to promote prevention of obesity and insomnia as related to night eating behavior.

A comparison of euthymic bipolar patients with unaffected first-degree relatives and healthy controls in terms of neuropsychological functions

OBJECTIVE

Cognitive dysfunction in bipolar disorder (BD) is well established in the literature. The neurocognitive deficits have been considered to be endophenotypic markers of BD, and studies have examined whether neurocognitive deficits exist in first-degree relatives of individuals with BD I. We hypothesized that performance in tests of neurocognitive function would be impaired in euthymic BD I patients and their unaffected first-degree relatives compared to that of healthy controls.

METHODS

We compared the performance of bipolar patients, their first-degree relatives, and healthy controls in a battery of neurocognitive tests to reveal possible endophenotypes of BD. A diagnostic interview and neuropsychological test battery were administered to 30 BD I patients, 55 of their unaffected first-degree relatives and 32 healthy controls.

RESULTS

The patients and their first-degree relatives were significantly impaired in executive function assessed using the Wisconsin Card Sorting Test (WCST) and Trail Making Test-B (TMT-B) relative to the controls (WCST; perseverative errors: p < 0.0005, categories completed: p = 0.002, TMT-B; p = 0.002). There were no significant differences between the groups in terms of attention, psychomotor speed, verbal memory, or learning.

CONCLUSION

Our study suggests that the deficits in executive function may be endophenotypic markers of genetic vulnerability to BD I.

The effects of sertraline on blood lipids, glucose, insulin and HBA1C levels: A prospective clinical trial on depressive patients

BACKGROUND

In this study, we aimed to investigate the possible effects of sertraline on blood glucose and lipid levels as risk factors for cardiovascular disease in depressive patients.

METHODS

Eight male and twelve female depressive patients, diagnosed according to DSM-IV criteria, were included in this study. The subjects aged 19-50 years, did not smoke, and had normal body mass index (BMI), homeostasis model assessment-estimated insulin resistance (HOMA-IR) values, blood pressure, blood glucose, insulin and lipid levels. Sertraline therapy (50 mg/day) was started. Patients with diabetes mellitus, heart disease, pregnancy, and those taking other drugs were excluded from the study. Blood glucose, insulin, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), and triglyceride values were measured in patients before, and at the 4(th), 8(th) and 12(th) weeks after treatment with sertraline. Moreover, HbA1C levels were measured at the beginning and at the end of the treatment (at 12(th) weeks).

RESULTS

There were no significant differences in physical examination (blood pressure, BMI, body weight, height, waist circumference) and laboratory findings (glucose, HDL-C, LDL-C, HOMA-IR and HbA1C levels) at the 12(th) week after of treatment with sertraline compared to pretreatment values. However, insulin levels at the 4(th), 8(th) and 12(th) weeks significantly increased compared with pretreatment values. Likewise, triglyceride levels at the 8(th) and 12(th) weeks significantly increased compared with pretreatment values.

CONCLUSIONS

Sertraline-treated patients have to be followed up for blood insulin and triglyceride levels. In addition, their treatment plan needs to be adjusted as necessary to prevent possible metabolic changes.

The relationship between traumatic childhood experiences and proclivities towards substance abuse, self-esteem and coping strategies

OBJECTIVE

The aim of this study was to compare people with substance use disorder with healthy controls in terms of childhood abuse, proclivity towards substance abuse, coping skills and self-esteem as well as the correlation between experiences of abuse in childhood and these variables.

METHOD

The study group included 41 subjects diagnosed with substance use disorder, who had been sentenced under the respective laws as a result of crimes relating to substance use and possession, and the control group. A sociodemographic Data Form, SCID-I, Childhood Trauma Questionnaire, COPE, Substance Abuse Proclivity Scale and Rosenberg Self-Esteem Scale were applied to all participants.

RESULTS

Childhood trauma history was observed to be more common in the study group than in the control group. When the childhood trauma questionnaire was evaluated, the scores for physical abuse were found to be significantly higher in the study group. COPE subscale scores for mental disengagement, focusing on problems and expressing emotions, active coping, coping through religion and emotional social support usage were significantly lower in the study group. The study group's results on the Substance Abuse Proclivity Scale were found to be higher than those of the control group. On the Rosenberg Self Respect Scale, the study group's scores were higher while the control group was more likely to have high self respect.

CONCLUSION

People with substance use disorder are more likely to have a childhood history of physical abuse, higher proclivity towards substance abuse and lower self esteem. The level of abuse increases the level of emotion-based coping while decreasing levels of problem-based coping. There is support for the view that that traumatic childhood experiences are one of the psychosocial risk factors related to, although not specific to substance use.

Do the obsessive-compulsive symptoms have an effect in schizophrenia?

OBJECTIVE

Schizophrenia presents with different symptom domains and functionality during its course. Obsessive-compulsive (OC) symptoms in schizophrenia have many themes to be clarified. Our aim was to compare schizophrenia patients with and without OC symptoms in terms of symptom domains, cognitive functions, and quality of life.

METHOD

Sixty-two patients who met schizophrenia diagnosis were assessed with Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition consecutively over a period of 12 months in the setting of an outpatient clinic at medical university hospital. Yale-Brown Obsessive-Compulsive Scale, Scale for the Assessment of Negative Symptoms, Scale for the Assessment of Positive Symptoms, and neuropsychologic tests were used. Quality of life was assessed with Quality of Life Scale for Patients with Schizophrenia.

RESULTS

Obsessive-compulsive symptoms along with schizophrenia were present in a considerable number in our sample (35.5%). Level of psychotic symptoms was more severe and quality of life was lower in schizophrenia patients with OC symptoms. A positive correlation was found between obsessions and delusions. Moreover, there was a positive correlation between compulsions and total Scale for the Assessment of Positive Symptoms score and bizarre behaviors subscore. There was no difference between the 2 groups regarding neurocognitive functions. The level of quality of life of schizophrenic patients with OC symptoms was lower. Besides, no correlation was found between OC symptoms and neurocognition and quality of life.

CONCLUSIONS

The findings of this study indicate that schizophrenia patients with OC symptoms had severe psychotic symptoms with a distinctive clinical picture including good neurocognition but poor functioning.

[The life threatening adverse effects of psychotropic drugs: a case report]

Neuroleptic malignant syndrome (NMS) is a rare idiosyncratic reaction to antipsychotic drugs that is potentially fatal. Characteristic features of NMS are hyperthermia, muscular rigidity, severe autonomic dysregulation and disturbed consciousness. Signs and symptoms of serotonin syndrome (SS) can be grouped into four inclusive categories that are almost identical to those of NMS. Clinically, NMS and SS share many features, suggesting different spectrums of a similar disorder. To make a distinction between the two is often difficult because of a large clinical overlap. We present a case of a 42-year-old male with a history of schizophrenia that developed signs and symptoms inconsistent with either NMS or SS after intramuscular administration of 2 typical antipsychotics along with 1 dose of a selective serotonin reuptake inhibitor (SSRI). The patient abruptly developed the clinical features in just 24 h. The patient presented with altered mental status and increased levels of creatinine phosphokinase. Twelve days of intensive care unit treatment was chiefly supportive and included bromocriptine. The final outcome was positive with complete disappearance of the symptoms. The treatment for both NMS and SS is similar. The therapeutic interventions primarily consist of removing the suspected agent and providing supportive care. We present this case to highlight some controversial issues concerning the life threatening adverse effects of psychotropic drugs, which illustrate the spectrum concept.

[Incidence of postpartum depression in Trabzon province and risk factors at gestation]

OBJECTIVE

Risk of depression increases in some periods of the women's life and postpartum period is one of these periods. Women in the risk group should be followed-up both prenatally and postnatally. The aim of this study is to investigate the incidence and risk factors of postpartum depression in Trabzon province.

METHOD

Among all pregnants in the third trimester of gestation attending to six primary health care centers belonging to Trabzon province and the Hospital of Obstetrics and Pediatrics were informed about the study and of these 316 person who accepted to attend the study were applied Sociodemographic Questionnary, General Health Inventory, Beck Anxiety Inventory, Beck Depression Inventory. Of these 192 women (75%) were reached at the first visit. At sixth-eighth weeks of postpartum, above mentioned inventories, excluding Sociodemographic Questionnary but additionally Edinburgh Postnatal Depression Scale, were applied to 152 of these women (79%). All tests were re-applied to 132 (68.7%) women at their sixth month after delivery.

RESULTS

Incidence of DSD according to Edinburgh Postnatal Depression Scale was found 28.1% in Trabzon province. Reported depression after previous pregnancies, scores equal or above five in General Health Inventory in pregnancy and high scores in Beck Anxiety Inventory were determined as predictors of postpartum depression in the study population.

CONCLUSION

As being the first follow up study of investigating the incidence of postpartum depression by a scale prepared to used this area, these findings are important to guide the further studies in connected with matter.

Psychiatric morbidity, quality of life, and disability in mesial temporal lobe epilepsy patients before and after anterior temporal lobectomy

Considerable interest has been focused on the psychiatric complications of medically refractory temporal lobe epilepsy (TLE) before and after epilepsy surgery. The aim of the present study was to evaluate the psychiatric status, quality of life, and level of disability in medically refractory mesial temporal lobe epilepsy (MTLE) patients, a homogenous subgroup of patients with TLE, before and after anterior temporal lobectomy (ATL). The study population consisted of 22 patients with medically refractory MTLE who were candidates for ATL. Patients were examined before surgery as well as in the third and sixth months of the postoperative period. Psychiatric diagnosis was determined by using SCID-I. To rate the severity of psychiatric disorders, BPRS, HDRS, and HARS were employed on each visit. WHO-DAS-II and WHOQOL-BREF were used to determine the level of disability and quality of life. Preoperatively, six patients had a psychiatric diagnosis. Three months after surgery, six of the patients had psychiatric diagnoses. Five of these six patients had not been previously diagnosed. There was no significant difference between preoperative and postoperative follow-up evaluations in terms of HDRS, HARS, and BPRS ratings. With respect to the total scores and domains of WHO-DAS-II, the change in pre- and postoperative evaluations was statistically significant only for the social life attendance domain. There was no significant difference in the mean scores on the WHOQOL-BREF domains or on the first question about general evaluation of quality of life. For the second question on the level of satisfaction with health, the difference between the three ratings was statistically significant. Preoperative and postoperative rates of psychiatric disorders in our sample were low. While social phobia was frequently seen preoperatively, the postoperative period was spearheaded by major depressive disorder. The decrease in disability in attendance to social life and improvement in the quality of health were in concordance with the literature, indicating the positive results of surgical treatment of epilepsy on quality of life. This study suggests that surgical intervention might be one of the causes of postoperative psychiatric disorders in patients with MTLE.

Reexamination of the characteristics of the deficit schizophrenia patients

The aim of this study was to reexamine and compare the characteristics of the deficit and nondeficit schizophrenic patients. This cross-sectional study consisted of 62 in- and out-patients, 18-65 years of age, diagnosed with schizophrenia according to DSM-IV. The sociodemographic variables, premorbid adjustment, clinical course and general functioning level in the past five years were evaluated by utilizing the appropriate sections of Comprehensive Assessment of Symptoms and History (CASH). In addition, GAF, the Schedule for the Deficit Syndrome (SDS), Positive and Negative Syndrome Scale (PANSS), Montgomery Asberg Depression Scale (MADRS), the Neurological Evaluation Scale (NES) and the Simpson Angus Extrapyramidal Side Effects (EPS) Rating Scale, Trail A and B, Verbal Fluency, Stroop, Block Design and Finger Tapper tests were administered. Using the SDS, 19 patients (30.6 %) were categorized as deficit; 43 (69.4 %) were categorized as nondeficit. The deficit patients were worse on the Functioning During Past Five Years score of CASH. The PANSS and MADRS mean scores were not significantly different between the two groups, except a higher level of negative symptoms observed in the deficit group. NES scores were also significantly higher in the deficit group. However, sociodemographic and other clinical variables, neurocognitive measures and EPS symptoms did not show any significant difference between the two groups. Our findings suggest that the deficit schizophrenia is a distinct subgroup comprised of patients who have more negative symptoms, neurological impairment and poor functioning which may have a common underlying pathology.

Biliary pseudolithiasis in childhood: a case report

Cholelithiasis is uncommon in childhood and usually associated with any predisposing factors such as congenital abnormalities of biliary tract, hemolytic diseases, TPN administration and diseases of terminal ileum. Recent studies demonstrated ceftriaxone inducing reversible precipitations in gallbladder that mimic cholelithiasis. This complication is termed "biliary pseudolithiasis" or "reversible cholelithiasis". In this paper we describe a patient who developed biliary pseudolithiasis after six days of ceftriaxone therapy which completely resolved eleven days after the end of the treatment, and discuss the indication for cholecystectomy.