Biological Profile and Cardiovascular Risk in Patients Receiving Neuroleptics at the Psychiatric Department of the University Hospital Center of Brazzaville

Several studies report the problem of cardiovascular tolerance of treatments with neuroleptics, given the important number of morbidities in patients with mental illnesses. This preliminary work aimed to describe the epidemiological and biological profile of patients taking neuroleptics and followed in the psychiatry department of Brazzaville University Hospital, from the angle of cardiovascular risk. Fifty (50) patients (17 men and 33 women), with a mean age of 33.9 10.7 years, were included. Epidemiological data (sex, age, tobacco or alcohol consumption) were collected on pre-established survey forms. Biochemical (total cholesterol, HDL-c, triglycerides and atherogenicity index) and inflammatory parameters (ultra-sensitive CRP, troponin I and NT-ProBNP) were investigated using enzymatic and indirect immunofluorescence technical, respectively. The results obtained showed that 54% of patients were obese, 94% were non-smokers, and 12% had high blood pressure. 10% of patients had high total cholesterol levels and 90% had HDL cholesterol levels below 60 mg/dl. Triglycerides and atherogenicity index were significantly elevated in relation to Body Mass Index (BMI). Ultrasensitive CRP was elevated in 38% of patients. In conclusion, this study revealed an association between lipid parameters (triglycerides and atherogenicity index) in relation to BMI in patients taking neuroleptics followed in the Psychiatry Department of University Hospital Center of Brazzaville.

The Use of Atypical Neuroleptics in Drugs Management in Fann’s Psychiatry Department

Background and Objectives: Neuroleptics have revolutionized pharmacological management in psychiatry. The advent of atypical neuroleptics constitutes a major turning point in this therapeutic challenge. The objective of our study was to determine the prescription of these atypical neuroleptics in Fann’s psychiatry department. Methodology: It was a descriptive retrospective cross-sectional study that involved 223 patients hospitalized in the psychiatry department of Fann Hospital during the period from January 2015 to December 2017. Results: Our study shows a majority prescription of classic neuroleptics in combination Haloperidol-Chlorpromazine 53% and 14% in monotherapy and a prescription of atypical neuroleptics at 4%. They are prescribed in combination with the classics at 4%. Conclusion: These results show a still low prescription of atypical neuroleptics which raises questions about the availability and affordability of such drugs, but also about prescription habits in the context of developing country.

Successful management of delirium with dexmedetomidine in a patient with haloperidol-induced neuroleptic malignant syndrome:A case report

BACKGROUND We report a case of lorazepam-induced agitated delirium treated with haloperidol,which in turn triggered the onset of neuroleptic malignant syndrome(NMS).The latter condition,a medical emergency,was effectively treated with medical treatment and dexmedetomidine,a versatile and highly selective shortacting alpha-2 adrenergic agonist with sedative-hypnotic and anxiolytic effects.CASE SUMMARY A 65-year-old man with a history of bipolar disorder presented to the emergency department with severe abdominal discomfort after binge eating.During his hospital stay,he received intravenous lorazepam for insomnia.On the next day,he became delirious and was thus treated with seven doses(5 mg each)of haloperidol over a 48 h period.Signs of NMS(hyperthermia,rigidity,myoclonus of upper limbs,impaired consciousness,tachypnea,and dark urine)became apparent and haloperidol was immediately suspended and brisk diuresis was initiated.On intensive care unit admission,he was confused,disoriented,and markedly agitated.Dexmedetomidine infusion was started with the goal of achieving a Richmond Agitation-Sedation Scale score of-1 or 0.NMS was resolved gradually and the patient stabilized,permitting discontinuation of dexmedetomidine after 3 d.CONCLUSION Dexmedetomidine may be clinically helpful for the management of NMS,most likely because of its sympatholytic activity.

Atypical Neuroleptic Malignant Syndrome: Pitfalls and Challenges in the Delirious Substance Abuser

Introduction: A rare and atypical form of Neuroleptic Malignant Syndrome (NMS) can be a deceptive and life threatening condition if not diagnosed properly in acute and critical care settings. Methods: The management of a patient presenting with atypical NMS without prominent rigidity, but with extensive rhabdomyolysis after the administration of haloperidol and ziprasidone is described in this report. Results: Prompt recognition of atypical features of NMS was managed by intensive care unit admission, supportive care and pharmacotherapy, leading to a complete resolution of the syndrome and a favorable outcome verified by laboratory findings. Conclusion: Early stages and atypical features of NMS may be variable in presentation and clinical course. The absence of muscle rigidity may not rule out NMS. A strong clinical suspicion based on clinical history is crucial for early diagnosis and treatment. Termination of dantrolene therapy may not be necessary during rhabdomyolysis and elevated aminotransferase levels.

Dendritic and spine alterations in areas 9 and 17 in schizophrenia and Huntington chorea and the role of neuroleptic exposure

Recent morphological studies in schizophrenia suggest atrophic changes in the neuropil of the prefrontal cortex. Most recently, we showed a schizophrenia-associated decrease in MAP2 in schizophrenia, which we believed is not due to neuroleptic exposure. MAP2 is a very important protein in the assembly of micro-tubule in neurons;therefore, it plays a major role in neuronal processes like dendrites, spines and synapses. Additionally, recent studies from our lab showed decreases in dendrites in area 32 and area 9. In this study we examined the dendrites and spines in area 9 and 17 to determine if neuroleptic drugs play a role. Huntington’s patients take neuroleptics similar to schizophrenics;therefore, by comparing the two groups to controls we can determine if neuroleptics play a role in the deficits reported in schizophrenia. Our results showed a significant decrease in both basal dendrites and spines for both layers III and V in area 9 in schizophrenia compared to controls. The Huntington’s brains, on the other hand, showed no significant difference compared to controls. In area 17, there was also no significant difference when comparing the three groups. The data suggest that neuroleptic drugs may not be responsible for the changes observed in schizophrenia.

Re-Challenge with Clozapine after Neuroleptic Malignant Syndrome and Seizure in a Patient with Di-George Syndrome: Case Report and Review of Literature

Background: Individuals with 22q11.2DS, a genetic subtype of Schizophrenia, respond as well to clozapine as those with other forms of Schizophrenia. It has been reported that serious and rare adverse events like seizures, and myocarditis have been associated with clozapine treatment in this population. To the best of our knowledge, the incidence of neuroleptic malignant syndrome (NMS) as an adverse effect of antipsychotic use in patients with this disorder has not yet been reported. Aim: In this article, we discuss a case of clozapine-induced NMS and subsequent re-challenge in a patient with 22q11.2DS-associated schizophrenia. The aim of this study is to accumulate scientific data about rare presentations, and serve as a major educational tool, and highlight the unique challenges faced when using clozapine in a patient with DiGeorge Syndrome. Methods: This is a descriptive case report of a patient encountered in the inpatient unit which includes retrospective review of the patient’s electronic medical record and a literature review of antipsychotic medications-induced NMS. Conclusion: This study demonstrates a successful re-challenge with clozapine after the patient developed NMS and seizures during the initial treatment and also highlights how, in addition to drug level monitoring, considering pharmacogenetic testing early in treatment might help minimize adverse drug reactions in individuals with known genetic disorders such as 22q11.2DS.

CASE REPORT OF NEUROLEPTIC MALIGNANT SYNDROME WITH RISING BLOOD SUGAR

Objective To report one case of neuroleptic malignant syndrome （NMS） with raising blood sugar. Methods The patient was studied clinically with biochemistry, white blood cells, psychiatric symptoms, and creatine phosphokinase （CPK） observations. Results The male patient with a history of taking antipsychot- ics more 30 years and his age of onset was about 20 years. He had severe muscular rigidity, altered consciousness and autonomic disturbance associated with elevation of serum CPK levels （max 3755 U/ L ） and leucocytosis （max 13.3 × 10^9/L）, especially granular leukocytosis（ max 90% ） and lymphocytopenia （rain 8% ）. In addition, high blood sugar emerged along with the variation of white blood cells （ max 9. 0 mmol/L）. Conclusion The manifestations of the patient was in conformity with those of the NMS. The patient had catatonic signs such as mutism, drinking difficulty, etc. and excess of saliva. Developmental observation with CPK and white blood cells is able to reveal the severity level of NMS. Raising blood sugar should be also monitoring item.

Slow and Steady: The Cautious Use of Neuroleptics in a Patient with Andersen-Tawil Syndrome

Long QT syndrome (LQT) is a disease of cardiac repolarization caused by alterations in the transmembrane potassium and sodium currents. This results in prolongation of the QT interval on electrocardiography (EKG) and can result in torsade de pointes and sudden cardiac death. We present a case of a patient who has Anderson Tawil syndrome;a congenital long QT syndrome, with a history of cardiac arrhythmias who developed acute paranoid schizophrenia that was refractory to treatment with non-QT-prolonging drugs and required institution of neuroleptics to control her psychiatric symptoms.

Atypical neuroleptic properties of l-stepholidine -Electrophysiological and behavioral studies

Intravenous administration of l-stepholidine (SPD), a dopamine (DA) receptor antagonist, in-creased the firing rate of DA neurons located in the ventral tegmental area (VTA) and substantia nigra pars compacta (SNC) in both anaesthetized and paralyzed rats. However, with the increase of dose, SPD selectively inhibited the fir-ing activity of DA neurons in the VTA but not in the SNC. The inhibition was reversed by the DA agonist apomor-phine (APO), suggesting that it may be via the mechanism of depolarization inactivation (DI). In rats, chronic admin-istration of SPD for 21 d dose-dependently decreased the number of spontaneously active DA neurons in the VTA, of which effect was reversed by APO (i. v. ). In contrast, the same treatment failed to affect the population of DA neu-rons in the SNC. Similarly, the acute treatment of SPD also decreased the number of spontaneously firing DA neurons in the VTA, but not in the SNC. SPD per se only induced very weak catalepsy. Its catalepsy which was not in pro-portion to dosage was only observed in the dose range of 10-40 mg/kg and lasted 15 min. SPD effectively antago-nized the APO (2 mg/kg, i.p. )-induced stereotypy. The above-mentioned results suggest that SPD selectively inacti-vates the DA neurons in the VTA not in the SNC. SPD may associate with a low incidence of extrapyramidal side-ef-fects and may be ranked as a promising compound for searching for a new kind of atypical neuroleptics.

Tinospora cordifolia attenuates antipsychotic drug induced hyperprolactinemia in Wistar rats

Objective: To evaluate the anti-hyperprolactinemic effect of methanolic extract of Tinospora cordifolia against antipsychotic/neuroleptic drug induced hyperprolactinemia. Methods: A total of 48 Wistar albino rats were chosen in the study. To induce hyperprolactinemia, haloperidol at 5 mg/kg/day was intraperitoneally administered for 16 continuous days and sulpiride at 20 mg/kg/day was administered intraperitoneally for 28 continuous days. Methanolic extract of Tinospora cordifolia at 200 mg/kg/day and 400 mg/kg/day were administered orally 30 min before administration of haloperidol and sulpiride for 16 and 28 days, respectively. Then, we had evaluated prolactin, dopamine and antioxidant status in the treatment group as compared to haloperidol and sulpiride. Results: There was a significant (P<0.05) increase in serum prolactin level and decrease in dopamine level in the haloperidol and sulpiride treated animals. However, methanolic extract of Tinospora cordifolia significantly (P<0.05) decreased serum prolactin level and increased brain dopamine level. Further, superoxide dismutase and catalase level were also decreased significantly in the haloperidol and sulpiride treated groups as compared to those of the control group and the antioxidant status was restored significantly on treatment with methanolic extract of Tinospora cordifolia. Furthermore, methanolic extract of Tinospora cordifolia also reduced total leukocyte count, and increased red blood cell count and hemoglobin concentration. In addition, the spleen did not show signs of infection or inflammation in the experiments. Conclusions: Methanolic extract of Tinospora cordifolia has a significant anti-hyperprolactinemic effect which may be attributed to neuroprotective and antioxidant effects of its signature constituents like stepharanine.

Procalcitonin interest to assess a septic state inducing the death

In this prospective study, we evaluated the use of PCT when collecting the body which was carried out. The chosen cut-off was set at 10 ng/mL because at this level, the PCT was associated to a multiorgan failure attributable to a septic shock.For 90 cases, two groups were stratified by their final diagnosis: 33 of for non violent deaths and 57 of violent deaths. There was no significant elevation of procalcitonin rate (PCT) in the group of violent deaths. We noted 6 elevations of PCT rate above 10 ng/mL for non violent deaths (15.4%) and in 3 cases there wasan evidence for an infectious context (recent anti- infectious treatments, chemotherapy in progress).Control of CRP performed on blood samples found initial elevations above 10 mg/L in 3 of the 6 cases (including 2 of 3 cases associated with an infectious context). There is no evidence of PCT rate increase for intermediate PMI (post mortem interval), long PMI and undefined PMI. This study found a PPV (positive predictive value) and clinical specificity of 100% for a cut-off set at 10 ng/mL. By taking this threshold, no significant PCT increase was observed in presence of death cases related to a violent origin as well as a fatal multiorgan failure due to malignant hyperthermia syndrome induced by neuroleptic use. The PCT appears to remain stable over time and whatever the conservation conditions of the body.

Dantrolene in the Treatment of Refractory Hyperthermic Conditions in Critical Care: A Multicenter Retrospective Study

Purpose: To examine the use of intravenous dantrolene in hospitalized patients. Materials and Methods: Medical Records of patients treated with intravenous dantrolene between 2007 and 2012 at 6 teaching hospitals were reviewed. Temperature, muscle rigidity, creatine kinase levels, and mortality were assessed in association with dantrolene use. Results: Twenty-five patients received intravenous dantrolene, 9 patients with neuroleptic malignant syndrome (NMS), 8 with hyperthermia due to sepsis, 4 with NMS and sepsis, 2 for malignant hyperthermia (MH), and 2 with hypermetabolic syndrome associated with juvenile diabetic ketoacidosis. Dantrolene was administered as a bolus of 1 - 3 mg/kg. Core temperature decreased after dantrolene administration in all groups but significant only for MH, NMS cases (Pre 102.3 ± 0.9&degF vs. Post 99.5 ± 0.9&degF;p Conclusion: Dantrolene was associated with reductions in temperature and rigidity in hyperthermia of diverse origins in patients admitted to Intensive care settings.

Management of Venous Priapism: Experience of Sylvanus Olympio University Hospital in Lomé(TOGO)

Objective: To study the diagnostic, etiological, therapeutic and evolutionary aspects of patients received at the Sylvanus Olympio Hospital in Lomé for venous priapism. Patients and Methods: A cross sectional study, over 5 years (2012-2016), of 27 cases of low flow priapism treated at the Chu Sylvanus Olympio in Lomé. Results: The mean age of the patients was 28.14 years ± 8.6. The average time of consultation was 106 hours (04 days 10 hours) ± 208.02. In our study, 4 (14.81%) patients consulted before the 6th hour and 20 (74%) patients consulted after the 24th hour. The blood count required in all patients revealed a case of chronic myeloid leukemia. Hemoglobin electrophoresis resulted in 23 (85.1%) cases of sickle cell disease. The management was medico-surgical. After an average follow-up of 11 months, erectile function was evaluated in 18 patients, and erectile dysfunction was noted in 10 (55.5%) patients.