Brain atrophy and first episode psychosis in chronic cannabis use: case report

The question of harmful effects of cannabis and its etiological relation to psychotic disorders versus its potential medical benefits has never been more present and controversial as it is today. In our paper we present a young patient with first episode psychosis decompensation who admits heavy use of cannabis use over a long period of time on a daily basis. Through a routine differential diagnostics, CT brain scan revealed a diffuse cerebral atrophy unrelated to any specific neurological disorder. We would like to point out probable causality of heavy cannabis use with clinical presentation and observed morphological changes.The question of harmful effects of cannabis and its etiological relation to psychotic disorders versus its potential medical benefits has never been more present and controversial as it is today. In our paper we present a young patient with first episode psychosis decompensation who admits heavy use of cannabis use over a long period of time on a daily basis. Through a routine differential diagnostics, CT brain scan revealed a diffuse cerebral atrophy unrelated to any specific neurological disorder. We would like to point out probable causality of heavy cannabis use with clinical presentation and observed morphological changes

Diagnostics and Treatment of Person with First Episode Psychosis (FEP)

Koncept sekundarne prevencije ili rane intervencije primjenjiv je na sve duševne bolesti i poremećaje, a imajući u vidu često progresivan tijek bolesti kod psihotičnih poremećaja, posebno je važan za shizofreniju i poremećaje iz spektra shizofrenije. Sekundarne intervencije za cilj imaju modificiranje tijeka bolesti. Naime, rana detekcija, rano postizanje remisije, prevencija relapsa i postizanje funkcionalnog oporavka od bolesti moraju biti prioriteti u liječenju shizofrenije i poremećaja iz spektra shizofrenije.Early intervention in diagnostics and treatment of first episode psychosis (FEP) is of utmost importance and should be our priority. Psychotic disorders are often progressive and neurodegenerative. With early intervention we can modify outcomes, prevent damage, and achieve not only remission but functional recovery

Somatic Comorbidities in Psychiatric Patients.

Koncept somatskih bolesti koje bi bile odvojene od duševnih, koncept je koji šteti optimalnom liječenju naših bolesnika. Sve je više argumenata koji u kontekstu dijagnostike i liječenja dokazuju da je duševno nerazdvojno od tjelesnog.The concept of somatic illnesses that is separate from mental illness is a concept that harms the optimal treatment of our patients. There are more and more arguments showing that the mental is inseparable from the somatic in the context of diagnostics and treatment

Diagnostics and Treatment of Person with First Episode Psychosis (FEP)

Koncept sekundarne prevencije ili rane intervencije primjenjiv je na sve duševne bolesti i poremećaje, a imajući u vidu često progresivan tijek bolesti kod psihotičnih poremećaja, posebno je važan za shizofreniju i poremećaje iz spektra shizofrenije. Sekundarne intervencije za cilj imaju modificiranje tijeka bolesti. Naime, rana detekcija, rano postizanje remisije, prevencija relapsa i postizanje funkcionalnog oporavka od bolesti moraju biti prioriteti u liječenju shizofrenije i poremećaja iz spektra shizofrenije.Early intervention in diagnostics and treatment of first episode psychosis (FEP) is of utmost importance and should be our priority. Psychotic disorders are often progressive and neurodegenerative. With early intervention we can modify outcomes, prevent damage, and achieve not only remission but functional recovery

Venlafaxin Treatment of a Patient with Depression Disorder

U ovom radu pokušali smo prikazati tijek liječenja bolesnika koji je i u strukturi ličnosti pokazivao znakove i simptome mentalnog funkcioniranja po depresivnom tipu. Prema anamnestičkim i heteroanamnestičkim podacima smatrali smo da će lijek s poticanjem nekoliko transmitorskih sustava biti učinkovitiji u odnosu na težinu kliničke slike, kao i karakteristike strukture ličnosti koju smo pokušali u ovom radu što detaljnije opisati.This paper presents the progress in the treatment of a patient whose personal structure revealed the signs and symptoms of mental functioning in accordance with the depressive personality type. According to anamnestic and heteroanamnestic data, we thought that the medicine would be more effective with stimulation of several transmitter systems with regard to the clinical picture and personality structure characteristics, which have tried to describe in detail in the paper

INFECTION OR IDIOSYNCRATIC REACTION TO ANTIEPILEPTIC DRUGS?

Idiosyncratic reactions are serious, unpredicted adverse effects of antiepileptic drugs which are in use in psychiatry as mood stabilizers. Severe idiosyncratic reactions can manifest as systemic symptoms or Dress syndrome clinically manifested with increased body temperature, peripheral lymphadenopathy and potential one or multiple organ failure. We present a 36 years old patient, who was hospitalized for the first time in our hospital after he attempted suicide by hanging. Patient was diagnosed as Bipolar affective disorder, current episode depressive with psychotic features and high suicidal risk. At the time of admission he was taking olanzapine and venlafaxine. Psychopharmacs were cross titrated to clozapine, valproic acid and lamotrigine. Two weeks later, patient’s mood was stabilized but his somatic status worsened dramatically. He was forwarded to Clinic for Infective Diseases where he was diagnosed with severe sepsis. Dress syndrome, although initially suspected was not verified, but has to be taken into consideration in each patient prescribed with antiepileptic drugs

INFECTION OR IDIOSYNCRATIC REACTION TO ANTIEPILEPTIC DRUGS?

Idiosyncratic reactions are serious, unpredicted adverse effects of antiepileptic drugs which are in use in psychiatry as mood stabilizers. Severe idiosyncratic reactions can manifest as systemic symptoms or Dress syndrome clinically manifested with increased body temperature, peripheral lymphadenopathy and potential one or multiple organ failure. We present a 36 years old patient, who was hospitalized for the first time in our hospital after he attempted suicide by hanging. Patient was diagnosed as Bipolar affective disorder, current episode depressive with psychotic features and high suicidal risk. At the time of admission he was taking olanzapine and venlafaxine. Psychopharmacs were cross titrated to clozapine, valproic acid and lamotrigine. Two weeks later, patient’s mood was stabilized but his somatic status worsened dramatically. He was forwarded to Clinic for Infective Diseases where he was diagnosed with severe sepsis. Dress syndrome, although initially suspected was not verified, but has to be taken into consideration in each patient prescribed with antiepileptic drugs

INTEGRATED SPECIALIZED EARLY-COURSE PSYCHOSIS TREATMENT SERVICES - UNIVERSITY PSYCHIATRIC HOSPITAL VRAPCE MODEL

First episode of psychosis presents a critical period in terms of numerous associated risks, but also possibilities for effective therapeutic interventions. There is a continued focus on early interventions in prodromal states and early course of frank psychosis, aimed at ensuring faster remission, reducing relapses, achieving better long-term functioning, and preventing adverse outcomes linked to untreated psychosis and chronic psychotic disorders. A number of different specialized treatment models and services exist trying to close knowledge gaps and provide clinical interventions to first-episode psychosis (FEP) patients, but there is still no generally accepted standard of care informing our every-day practice. FEP and early-course psychosis specialized treatment model developed in 2004 in University Psychiatric Hospital Vrapce rests on integration of care across different organization units and clinical presentation acuity levels and patient needs (intensive care, FEP inpatient unit, FEP outpatient services including day hospital). Such integration of FEP services allows for flexible entry point on multiple levels, earlier structuring of therapeutic alliance for those requiring inpatient care, reduction of risks associated with FEP, quicker formation of long-term treatment plans, reduction of delay in accessing specialized services, and a more coordinated diagnostic process and recruitment of FEP patient population. Detailed evaluations of outcomes and comparisons with different treatment models are necessary in order to assess strengths and weaknesses of each specific model and inform modifications to current practice models

DIFFERENTIAL DIAGNOSIS OF PSYCHOTROPIC SIDE EFFECTS AND SYMPTOMS AND SIGNS OF PSYCHIATRIC DISORDERS

Diagnostic recognition and distinguishing of psychotropic side effects which are phenomenological Identical/similar to symptoms and/or signs of psychiatric disorders undergoing psychotropic treatment, is an integral element within the general diagnostic procedure. Unrecognising and undistinguishing of psychotropicinduced side effects from psychopathological phenomena and/or physical signs which are, according to relevant classification criteria, standard parts of psychiatric disorders, most frequently can cause increase the dose of the psychotropic medication, assigning of the unwarranted diagnoses, and/or addition of unnecessary medications. Some of the most frequent side effects that can be caused by the diagnostic difficulties and/or misjudgements of the phenomenological recognition and differentiating side effects from psychiatric symptoms and signs are: druginduced akathisia, intensive anticholinergic pharmacodynamic effects including delirium, neuroleptic induced Parkinsonism, paradoxically antidepressants-induced worsening or re-emerging depression, acute dystonia and tardive dyskinesia and others. In conclusion, differential diagnosis of these side effects requires careful evaluation based on clinical experience and knowledge