...experienced and reported in the previous literature. We hereby report two cases of exfoliative cheiltis successfully treated with topical tacrolimus and oral olanzapine. One of our two cases was refractory to almost all forms of treatments. Key words: exfoliative cheilitis; inflammation; olanzapine; tacrolimus Introduction Exfoliative cheilitis is a chronic inflammatory disease affecting vermilion border of lips with no specific etiology, although initially was thought to be associated with repetitive biting, sucking, licking or picking of lips. However later it was defined as a cyclic desquamation of the lips without the evidence of factitial sources of irritation such as lip licking or biting, infection or allergens as the primary etiology of the desquamation (1). Psychological/psychiatric problems like stress, anxiety, depression, obsessive compulsive disorders are known to be strongly associated with exfoliative cheilitis in the majority of previously reported cases (2)....
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...skin more sensitive to sunlight so use sunscreen to protect the skin. Provide a rationale for the use of this medication to the consumer. Olanzapine, an atypical anti-psychotic agent, is widely administered for the treatment of schizophrenia. It is effective in alleviating positive and negative symptoms of schizophrenia, with low occurrence of extrapyramidal side effects (Nahata, T., & Saini, T. R. 2008). This drug has been use for Daniel due his history of diagnosed with schizophrenia at the age of 19 years and currently displaying positive signs of schizophrenia, such symptoms of include hearing, seeing, sensing things that are not real and feeling unusually suspicious. Auditory hallucinations and paranoid delusions have found for example , he thinks that who were trying to ‘kill him’ and he was also suspicious of the neighbors and as a result had been isolating himself from everyone. In additional, before giving this drug it is important to check for his other health problem because sometimes he is taking ventolin puffer for his asthma because it may occur any other side effects due to his symptoms.This medication is suitable for him to use for reduce the psychosis and other symptoms previously showed to stop re-occurring. What are the side effects / adverse effects of this medication? And how will you manage these effects? Olanzapine depot injection usually uses for antipsychotic drug and suitable for Daniel’s symptom. The most common side effects of this drug is bodyweight...
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...also reported using amphetamines, heroine and cocaine in the past. He mainly uses cannabis regularly. He states that he is a binge drinker. Past Medical History MT has a history of Type 2 Diabetes and hypercholesterolaemia. He was also diagnosed with refractory schizophrenia and developed myopericarditis secondary to clozapine; he recovered after clozapine was ceased. Past Psychiatric History His first contact with mental health services for psychosis was in 1999 and was subsequently diagnosed with schizophrenia. At the time of his index offence, he had acute psychosis with religious, grandiose and persecutory delusions. Current Medications Drugs Dosage Frequency Indications Aripiprazole 25 mg Daily Atypical antipsychotic Olanzapine 7.5mg Nocte Atypical antipsychotic Aripiprazole maintane 400mg Every four weeks Atypical antipsychotic Lithium XR 900mg Twice daily Manic episode Benztropine 1mg Mane For dystonia due to side effects of antipsychotic medication Metformin XR 1g Twice daily Diabetes Gliclazide 40mg Nocte Diabetes Allergies Had an adverse drug reaction to clozapine, he developed a small pericardial effusion secondary to clozapine. Developmental and Personal History Family History MT denied a family history of mental illness or disorders. Childhood History MT was born in Tonga and states that there were no perinatal and obstetric complication during his mother’s pregnancy. There is no history of childhood psychiatric disorders. Adolescence...
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...of lithium are restlessness, dry mouth, and GI upset. Anticonvulsants Anticonvulsants are a type of mood-stabilizing medication used in Bipolar Disorder treatment. Examples of anticonvulsants include valproic acid (Depakene or Stavzor), divalproex (Depakote), and lamotrigine (Lamictal). It is found that the anticonvulsant asenapine (Saphris) can be helpful when treating mixed episodes. Common side effects of anticonvulsants are weight gain, dizziness, and sleepiness. It is rare, but certain anticonvulsants can cause skin rashes, blood disorders, or liver dysfunction. Antipsychotics Antipsychotic medications may offer help for patient who don’t respond to an anticonvulsant. Examples of antipsychotics include aripiprazole (Abilify), olanzapine (Zyprexa), risperidone (Risperdal), and quetiapine (Seroquel). Only one antipsychotic medication is approved by the Food and Drug Administration (FDA) to treat Bipolar Disorder: quetiapine. Side effects depend on the specific medication, but can include weight gain, sleepiness, tremors, blurred vision, and rapid heartbeat. Antipsychotic medication use also has the potential to affect memory and attention, and cause involuntary movements. Antidepressants Depending on unique Bipolar Disorder symptoms, may prescribe an antidepressant. However in some patient, antidepressants can trigger manic episodes. This could be cancelled out if taken together with a mood stabilizer medication. Older antidepressants, like tricyclic’s...
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...Do atypical antipsychotics cause sexual dysfunction??? INTRODUCTON I have chosen to focus on atypical antipsychotics and sexual dysfunction for my summative assignment as I am interested in this topic. I will explain the process of gathering information and relevant to my topic. I will then discuss the strengths and limitations of four chosen articles and explain its implication to practice. RATIONALE While on my Common foundation programme in an acute ward I attended a ward round for different patients. For confidentiality reasons the patients name is withheld to respects patient’s right to confidentiality (NMC, 2009). One of the service users raised a concern regarding his medication, when asked for the reasons, he expressed that the medication was affecting his sex life. I found this to be an interesting topic to explore evidence on sexual dysfunction as one of the side effects of antipsychotic. The American Psychiatric Association (1997) describes sexual dysfunction as “the inability to maintain erection to complete intercourse or sexual activity”. Sexual dysfunction can cause extreme difficulties in relationship and can lead to low self-esteem and depression (Kell & Dinsmore, 2008). The Oxford Dictionary for Nurses (2008) describes atypical antipsychotics as drugs that are used to treat severe mental disorders (psychoses) including schizophrenia, mania and anxiety in small dosages. SEARCH STRATEGY To find the information relevant for my topic I will use key...
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...For instance, A 2012 meta-analysis of combination therapy concluded an antipsychotic plus lithium is superior to lithium monotherapy for acute mania.34 Olanzapine plus fluoxetine is approved for BPD.38 The APA has recommended combination therapy for severe acute mania since 2002.39 For relapse prevention, lithium plus valproate has also been shown to be superior to valproate monotherapy.36 When monotherapy is partially effective or non-effective, combination therapy may have a theoretical advantage in efficacy where complementary mechanisms of action might have a synergistic, potentiating therapeutic effect, imparting some ability to treat a greater spectrum of symptoms.31,34 A potential safety advantage may be gained by allowing lower dosages that may be better-tolerated, though the introduction of multiple drugs generally increases risk of safety...
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...General Psychiatry William a. Kehoe, Pharm.D., m.a., FCCP, BCPS University of the Pacific stockton, california © 2009 American College of Clinical Pharmacy 1-281 General Psychiatry Learning Objectives: 1. Describe pharmacotherapeutic options for managing the following psychiatric problems: depression, bipolar disorder, schizophrenia, anxiety disorders, insomnia, and alcohol withdrawal. Describe the drugs used to treat the above disorders in terms of unique pharmacological properties, therapeutic uses, adverse effects, and cognitive and behavioral effects. Formulate a pharmacotherapeutic treatment plan when presented with a patient having depression, bipolar disorder, schizophrenia, an anxiety disorder, or insomnia. Discuss the treatment of substance abuse using alcohol abuse as a model. 4. 2. C. Theophylline. D. Pseudoephedrine. Which one of the following antidepressants would be least likely to cause drug-disease or drug-drug interactions for T.N.? A. Venlafaxine. B. Fluvoxamine. C. Phenelzine. D. Fluoxetine. Which one of the following periods represents the continuation therapy phase for T.N.’s depression? A. 6–12 weeks. B. 12–16 weeks. C. 6–12 months. D. 2−3 years. T.N. will be seen initially at monthly intervals to assess antidepressant therapy. Which one of the following instruments is a patient-completed measure of depressive symptoms that could be used to assess his response? A. Hamilton Rating Scale for Depression. B. Montgomery-Åsberg Depression Rating Scale...
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...Depression Paper Angie Marquez PSY 270 April 17, 2016 Depression Paper Most people have felt sadness at some point in their life. It is a normal reaction to the loss of a loved one or even just everyday life struggles. When these feelings of sadness start to last longer than a few days and begins to keep you from functioning normal it may be more than just sadness. Clinical depression is a treatable medical condition that many people experience in throughout life. Depression is considered a mood disorder. “Mood disorders are a category of illnesses that describe a serious change in mood” (Mental Health America, 2016). Other mood disorders include unipolar disorder and bipolar disorder. There are important differences between unipolar and bipolar such as how the illness makes people feel and behave and the difference in treatment (ULifeline, 2016). Bipolar disorder is a serious illness that involves one or more episodes of serious mania and depression (Mental Health America, 2016). Mania is when a person is feeling happy, confident, energetic and productive (ULifeline, 2016). During an episode of bipolar disorder a person can experience extreme mood swings. They can go from feeling happy and energetic to feeling sad and hopeless, sometimes with a period of a normal mood between the two extremes. There is no definite link between genetics and bipolar disorder but research does show that is tends to run in families (Mental Health America, 2016). Other causes of bipolar disorder...
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...Schizophrenia Schizophrenia is a severe and chronic brain disorder in which a person interprets actual reality abnormally. It is a mental disorder that makes it difficult to think clearly, have normal responses to emotions, act normal in a social setting, and tell the difference between their own interpretation of reality and actual reality. There are several types of Schizophrenia: paranoid, undifferentiated, disorganized, residual, and catatonic schizophrenia. The assumption is that schizophrenia is split or multiple personalities. Schizophrenia is defined as “split mind” but this references the disruption in normal balance of emotions and thinking. Schizophrenia is a chronic condition that requires lifelong treatment. Paranoid Schizophrenia is the most common type of Schizophrenia. It is when a person loses touch with reality. A person’s ability to function and think normally daily is altered more than during other types of schizophrenia. However, it includes fewer problems with concentration, memory, and/or lack of emotion. It is still a serious lifelong condition that can lead to many different complications. Doctors do not completely know what causes this disorder. Researchers have theories that it is caused by certain neural chemicals that are impaired and links have been found to abnormal regulation of the neurotransmitters dopamine and glutamate. Even though there is no specific known cause, there are risk factors that can increase the chances of being diagnosed...
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...doctors will help the patient in finding a long-term treatment. Medications include mood stabilizers, antipsychotics, antidepressants, antidepressant-antipsychotic and antianxiety. Mood stabilizers help control manic and hypomanic episodes. Examples of mood stabilizers are lithium (Lithobid), valproic acid (Depakene) and carbamazepine (Tegretol, Equetro and others). Antipsychotics are able to reduce, or sometimes eliminate, the distressing and disabling symptoms of psychosis, such as paranoia, confused thinking, delusions and hallucinations. Examples include olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel). Antidepressants help manage depressive episodes. Sometimes an antidepressant can trigger manic episode, so they are also prescribed with a mood stabilizer or an antipsychotic. An antidepressant-antipsychotic, the medication of Symbyax mixes both antidepressant fluoxetine and the antipsychotic olanzapine, giving the individual both the help of an antidepressant and an antipsychotic. Which works both as a depression treatment and a mood stabilizer. Lastly antianxiety medications help with anxiety and improve sleep. Benzodiazepines are the name of these antianxiety medications. Patients usually respond to the use of one treatment, if not combinations of treatments may be used to help to patient’s response. A case study from Zhang, Agius, & Zaman (2012) states “The patient is a 41-year-old self-employed gentleman, presenting with eight year history of depression...
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...Research by Ray, Chung, Murray, Hall, & Stein (2009) examined the risk of sudden cardiac death in those who took atypical and typical antipsychotic drugs. The typical drugs examined were Haloperidol and Thioridazine and the atypical, newer drugs were clozapine, olanzapine, quetiapine, risperidone. The study was divided between two cohorts- those on Tennessee Medicaid who were on antipsychotic drugs and the other cohort consisted of qualified nonusers of antipsychotic drugs but held an identical psychiatric record (Ray et al., 2009). The disease examined was a type of ventricular tachyarrhythmia called Torsades de pointes (TdP) in those who took atypical and typical antipsychotic drugs (Ray et al., 2009). Ventricular tachyarrhythmia is noted by an extended QT interval, which is the period where the heart recharges itself through a process called repolarization (Mayo Clinic, 2015). The extended QT interval in TdP involves both ventricles beating at a rapid rate, which results in less blood to the brain (Mayo Clinic, 2015). If there is a prolonged lack of blood to the brain, this can result in ischemia, hypoxia and death....
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...Abstract Introduction: Metabolic abnormalities, predominantly weight gain, are related with the use of Antipsychotic medications. Objectives: This paper will help us understand the underlying factors that cause metabolic and cardiovascular abnormalities; and to advice interventions that would help improve the condition of mental health consumers. Background: The review articles used in this paper shows a high linkage between metabolic and cardiovascular abnormalities with the use of Antipsychotic medications; which is one of the leading causes of mortality and morbidity among metal health consumers. Approach: Selective Article Reviews are being used. Findings and Implications: Metabolic and cardiovascular side effects such as weight gain, diabetes and hypertension are some of the risks of Antipsychotic drugs; however, there are other underlying factors that cause this such abnormalities such as genetic factors, lifestyle, and other medications. Hence, education, early monitoring and lifestyle modification is highly recommended. Conclusion: Atypical drugs are the frequently used treatment for mental disorders, particularly schizophrenia; but despite of its metabolic and cardiovascular side effects still it’s used is increasing. Therefore, early intervention and monitoring must be implemented, with the promotions of education, lifestyle and diet management. Introduction It is well known that psychotropic drugs, in general and antipsychotic...
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...Imipramine are usually prescribed only at night before bed to help improve sleep. They have less of an activating effect. TCAS can cause BP/dizziness, drowsiness, dry mouth, and weight gain. Consider Pregabilin if the above medications are contraindicated. 2nd Line – SNRI Venlafaxine Bicyclic - potent inhibitors of serotonin and norepinephrine reuptake and weak inhibitors of dopamine reuptake. Higher therapeutic window. * 75 mg/day PO divided q8-12hr initially; may be increased by ≤75 mg/day not faster than every 4 days * Moderate: Up to 225 mg/day PO divided q8-12hr Risk in overdose/cardiac/HTN Initiate in secondary care 3rd Line +/- Antipsychotic Dopaminergic blockade and regulation of receptor sensitivity. Olanzapine, Aripirazole Beta-blockers, such as propranolol (Inderal®), which is used to treat heart conditions, can prevent the physical symptoms that accompany certain anxiety disorders, particularly social phobia. MAOIs can react with SSRIs to produce a serious condition called “serotonin syndrome,” which can...
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...Anti-NMDA Encephalitis: A Novel Presentation of Schizophrenia Stephen A Belz B Pharm MPS The Prince Charles Hospital Pharmacy Department Rode Road, Chermside QLD 4032 ABSTRACT Background: It has been suggested that the modulation of dopamine is not the complete story when it comes to the pathophysiology of schizophrenia. Multiple other neurotransmitters have been linked to the condition such as NMDA & Serotonin. N-methyl D-asparate (NMDA) modulation has been used with success for a number of other conditions such as pain control and Alzheimer’s disease. Due to the high incidence of relapse and treatment failure of current therapies, it is vitally important that medical science looks further into the modulation of the other neurotransmitters involved. Aim: To report one case that illustrates a novel presentation of treatment resistant schizophrenia, that through extensive investigation produced a diagnosis of anti-NMDA antibody encephalitis. Clinical details and outcome: The patient had experienced extensive treatment for schizophrenia over at least 5 documented years at a number of institutions & hospitals with varying degrees of success. The patient’s presentation to TPCH resulted in the detection of Anti-NMDA antibodies leading to the diagnosis. Treatments used included immunomodulators and antipsychotics. Conclusions: After a prolonged admission, the patient was discharged back to her family substantially improved and is receiving maintenance immunoglobulin...
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...When most people think about the psychological disorder known as chizophrenia, many believe that this defines a person who portrays multiple personalities. However, this is not what schizophrenia is. Schizophrenia is a complex type of dementia, which means that people perceive voices and behaviors that do not necessarily exist. This research paper on schizophrenia will observe the disorder’s: symptoms, prevalence, causes and treatments. When observing a specific mental illness, the first step is to always investigate its symptoms. The symptoms of a mental illness are basic signs that a person with the disorder portrays. In schizophrenia, there are two main types of symptoms (and each of these types has a sub-type). The first are positive symptoms, in which a person is not aware of reality. These symptoms are easily distinguishable. The second are negative symptoms. Unlike positive symptoms, negative symptoms are harder to recognize for other people. These symptoms are simply emotions and behaviors that are absent in schizophrenic individuals, that are common in other people. The first sub-type of positive symptoms are hallucinations. This positive symptom characterizes an individual who hears, smells or feels something that is not actually there. The most common type of hallucination that people with schizophrenia experience is “voices”. These voices are heard in schizophrenic people’s imagination and are different from the internal voice that most people perceive. Unlike...
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