EEG abnormalities and two year outcome in first episode psychosis

OBJECTIVE

This study examines the relationship of EEG to 2 year symptomatic outcome, duration of illness and untreated psychosis and gender.

METHOD

A total of 122 patients presenting for treatment of first episode psychosis had their baseline EEG classified by modified Mayo Clinic system criteria as normal, essentially normal or dysrhythmia. Positive and negative symptoms of psychoses were rated on entry and after 2 years of treatment. The socio-demographic variables and duration of illness and of untreated psychosis were also recorded.

RESULTS

Patients with a normal EEG showed significantly more reduction in both positive and negative symptoms of psychoses over 2 years and were more likely to be in 'remission' as compared with the essentially normal or dysrhythmia group. The dysrhythmic group had significantly higher duration of illness than either the normal or essentially normal groups. There were no gender differences in the distribution of EEGs.

CONCLUSION

An abnormal EEG in patients with first episode psychosis is associated with a poorer prognosis and a longer duration of untreated illness.

An interstitial deletion of the long arm of chromosome 21 in a case of a first episode of psychosis

OBJECTIVE

Case of an interstitial deletion of the long arm of chromosome 21 presenting with first episode of psychosis.

METHOD

A case report.

RESULTS

A 16-year-high school student of Somalian origin presented with a first episode of psychosis, mild mental retardation and dysmorphic features. Chromosome analysis revealed an interstitial deletion in the long arm of chromosome 21, described as 46, XX del (21) (q21q22.1).

CONCLUSION

First episode of psychosis occurred in combination with neurobiological vulnerability and a complex genetic inheritance. The occurrence of psychosis in our case may be attributable to genes located within the region 21q21q22.1. The possibility that other loci exist on chromosome 21, which predispose to schizophrenia has to be considered. Identification of susceptibility genes will greatly facilitate investigation of factors that contribute to the disease process and may lead to early intervention and prevention.

Influence of chronic barbiturate administration on sleep apnea after hypersomnia presentation: case study

When sleepiness is excessive, undesirable, inappropriate or unexplained, it often indicates a clinical disorder that is generically termed hypersomnia. One of the leading causes of hypersomnia is sleep apnea. We present the case of a 44-year-old woman with a history of bipolar spectrum disorder and epilepsy who initially showed evidence of hypersomnia. The hypersomnia settled with changes to her medication, but the patient was subsequently found to have severe obstructive sleep apnea. The relation between the patient's medication and sleep apnea is discussed, and the possible respiratory-suppressant effects of chronic barbiturate treatment are considered. The role of other evoking factors within the context of this case and the mechanisms by which drug interactions and psychotropic treatment may worsen, obscure or perpetuate sleep apnea are also examined.

Hypoglycemia associated with high doses of sertraline and sulphonylurea compound in a noninsulin-dependent diabetes mellitus patient

Unlike other selective serotonin reuptake inhibitors (SSRIs), sertraline has linear pharmacokinetics so that increases in dose lead to proportional increases in drug concentration. The half-life of sertraline is about 26 h so that it reaches a steady state in one week, according to the product monograph. Hypoglycemia associated with sertraline and coadministration of oral hypoglycemics belonging to the sulphonylurea derivatives has rarely been reported. A patient with schizoaffective disorder with non-insulin-dependent diabetes mellitus (NIDDM) treated with sertraline, risperidone and glyburide who developed hypoglycemia is presented. The article highlights that inhibition of P450 enzymes can be affected by several different factors. Interactions are possible whenever a patient concomitantly receives two drugs that bind to the same P450 system Greater inhibition was likely induced at doses higher than those recommended. This process was reversed within 10 days of discontinuing the sertraline. Good glycemic control followed discontinuation of psychotropic drugs and the oral hypoglycemic agent. Knowledge of the individual P450 enzymes is important in the metabolism of individual drugs, together with an understanding of the patient's drug metabolizing ability. These factors may lead to more appropriate prescribing and further research into specific P450 enzymes responsible for metabolism of particular drugs, which remains unclear.

Computed tomographic findings in schizophrenia: relation with symptom dimensions and sex differences

OBJECTIVE

Loss of grey matter, a consistent finding in schizophrenia, is likely to be influenced by symptom heterogeneity and sex. This study was conducted to determine the extent and region of brain atrophy in schizophrenia and its relation to symptom syndromes and to patient sex.

DESIGN

Prospective study of consecutive patients.

SETTING

Psychiatric department of a general teaching hospital.

PATIENTS

Sixty-one consecutive patients (37 men and 24 women) admitted to hospital for acute exacerbation of schizophrenia, as diagnosed according to the DSM third edition, revised.

INTERVENTIONS

Computed tomographic examination of the head.

OUTCOME MEASURES

Diffuse atrophy and atrophy in the frontal and temporal regions and the sylvian fissure were rated using the CT Rating Scale for Schizophrenia. Ratings were contrasted between male and female subjects; relations between atrophy ratings and 3 symptom dimensions of schizophrenia were examined for male and female subjects separately.

RESULTS

Widening of the sylvian fissure was positively related to psychomotor poverty (r = 0.32, p < 0.01). There was a significantly stronger relation between diffuse atrophy and reality distortion in female than in male subjects. There was no sex difference in the atrophy rating in all regions of the brain, and this lack of sex difference was not related to age of onset, length of illness or age at the time of the CT scan.

CONCLUSION

The morphological changes in the brain on CT are no greater in men than in women with schizophrenia. Different mechanisms may be involved in producing reality distortion symptoms in men and women.