5 research outputs found
DULOXETINE-RELATED PANIC ATTACKS
Side-effects arising on the grounds of antidepressant administration pose as a substantial obstacle hindering successful
depressive disorder treatment. Side-effects, especially those severe or those manifested through dramatic clinical presentations such
as panic attacks, make the treatment far more difficult and shake patientsā trust in both the treatment and the treating physician.
This case report deals with a patient experiencing a moderately severe depressive episode, who responded to duloxetine
treatment administered in the initial dose of 30 mg per day with as many as three panic attacks in two days. Upon duloxetine
withdrawal, these panic attacks ceased as well. The patient continued tianeptine and alprazolam treatment during which no
significant side-effects had been seen, so that she gradually recovered.
Some of the available literature sources have suggested the possibility of duloxetine administration to the end of generalised
anxiety disorder and panic attack treatment. However, they are outnumbered by the contributions reporting about duloxetine-related
anxiety, aggressiveness and panic attacks. In line with the foregoing, further monitoring of each and every duloxetine-administered
patient group needs to be pursued so as to be able to evaluate treatment benefits and weigh them against risks of anxiety or panic
attack onset
VENLAFAXINE WITHDRAWAL SYNDROME
Dual-action antidepressants serotoninānorepinephrine reuptake inhibitors (SRNIs) are widely used to treat depression. Owing to
its efficiency and safety, venlafaxine holds a prominent place in this group of depressants. Abrupt venlafaxine discontinuation
involves a high risk of withdrawal syndrome. Mechanism of its development is similar to that of selective serotonin reuptake
inhibitors (SSRIs), but of higher intensity. Venlafaxine withdrawal symptoms may include several somatic symptoms as well as
several psychiatric symptoms. In some cases, symptoms may look like a stroke. A treatment option is re-inclusion of venlafaxine or a
SSRI antidepressant.
The paper presents the case of a 70-year-old patient who discontinued of her own accord to take venlafaxine, which she had been
taking regularly at a daily dose of 225 mg for more than a year. A few hours after taking the last dose, withdrawal syndrome
occurred with severe symptoms resembling a stroke. The patient was examined by a neurologist and the CT and laboratory
parameters showed no irregularities. Diagnosis was made after psychiatric observation. Venlafaxine, 150 mg per day, was
prescribed, the symptoms disappeared relatively quickly, and the patient fully recovered.
Withdrawal syndrome is a real risk for each venlafaxine treated patient. The possibility of its occurrence should be always kept
in mind and patients should be timely informed about it. In this way, the risk of venlafaxine withdraw syndrome could be reduced,
unnecessary stress to patients prevented and the costs of medical treatment lowered
PERFORMANCE ASSESSMENT TOOL FOR QUALITY IMPROVEMENT IN HOSPITALS (PATH): FIRST EXPERIENCES IN CROATIA
PATH (Performance Assessment Tool for Quality Improvement in Hospitals), projekt Regionalnog ureda Svjetske zdravstvene organizacije (SZO) za Europu pruža bolnicama sveobuhvatan i standardiziran alat za vrednovanje vlastitih rezultata i razvoj mjera za unapreÄenje kvalitete. Program PATH pokrenut je 2008. godine i u Hrvatskoj, a od 2009. godine provodi se u bolnicama koje su se dobrovoljno odluÄile u njega ukljuÄiti. U ovom radu prikazujemo prva iskustva probne faze uspostavljanja programa PATH, utemeljena na podacima koji su prikupljani u 22 hrvatske bolnice. Analiza prvih rezultata upozorila je na postojanje izraženih razlika meÄu bolnicama, koje su se na primjeru postotka carskih rezova kretale od najmanje 1,1% do najviÅ”e 21,4% zabilježenih carskih rezova u pojedinim bolnicama tijekom razdoblja prikupljanja podataka. Stopa smrtnosti infarkta miokarda kretala se od 1,9 do 21,4%, dok se smrtnost moždanog udara kretala od 12,5 do 45,5%. NajviÅ”i postotak prijavljenih ubodnih ozljeda za lijeÄnike iznosio je 16,2% osoblja tijekom jedne godine, 6,1% za medicinske sestre i 4,6% za spremaÄice. Ovo istraživanje upuÄuje na postojanje mnogih problema i ograniÄenja u prikupljanju pokazatelja na bolniÄkoj razini, njihovoj analizi i stvaranju preporuka za unapreÄenje kvalitete koje se moraju uzeti u obzir prilikom usporedbe bolnica na nacionalnoj ili meÄunarodnoj razini.PATH (Performance Assessment Tool for Quality Improvement in Hospitals), a project of the World Health Organization (WHO) for Europe offers hospitals a comprehensive and standardized tool (a set of indicators) to evaluate their own performance and development of measures for quality improvement. PATH Program was launched in Croatia in 2008, and it was conducted in 2009 in hospitals that have voluntarily decided to be involved. Here we present the results of the first phase of pilot experience of establishing the program, based on data collected in 22 Croatian hospitals. Analysis of the first results indicated the existence of marked differences among the hospitals that have taken the example of the percentage of cesarean sections ranging from 1.1% to 21.4%. The mortality rate of myocardial infarction ranged from 1.9 to 21.4%, while the mortality of stroke ranged from 12.5 to 45.5%. The highest percentage of needle-stick injuries reported for physicians was 16.2% of entire hospital staff in one year, 6.1% for nurses and 4.6% for the supportive staff. The result suggests the existence of many problems and limitations in data collection at hospital level, limitations in their analysis and creates recommendations for quality improvements, which must be taken into account when hospitals are compared on the national or international level
VENLAFAXINE WITHDRAWAL SYNDROME
Dual-action antidepressants serotoninānorepinephrine reuptake inhibitors (SRNIs) are widely used to treat depression. Owing to
its efficiency and safety, venlafaxine holds a prominent place in this group of depressants. Abrupt venlafaxine discontinuation
involves a high risk of withdrawal syndrome. Mechanism of its development is similar to that of selective serotonin reuptake
inhibitors (SSRIs), but of higher intensity. Venlafaxine withdrawal symptoms may include several somatic symptoms as well as
several psychiatric symptoms. In some cases, symptoms may look like a stroke. A treatment option is re-inclusion of venlafaxine or a
SSRI antidepressant.
The paper presents the case of a 70-year-old patient who discontinued of her own accord to take venlafaxine, which she had been
taking regularly at a daily dose of 225 mg for more than a year. A few hours after taking the last dose, withdrawal syndrome
occurred with severe symptoms resembling a stroke. The patient was examined by a neurologist and the CT and laboratory
parameters showed no irregularities. Diagnosis was made after psychiatric observation. Venlafaxine, 150 mg per day, was
prescribed, the symptoms disappeared relatively quickly, and the patient fully recovered.
Withdrawal syndrome is a real risk for each venlafaxine treated patient. The possibility of its occurrence should be always kept
in mind and patients should be timely informed about it. In this way, the risk of venlafaxine withdraw syndrome could be reduced,
unnecessary stress to patients prevented and the costs of medical treatment lowered
DULOXETINE-RELATED PANIC ATTACKS
Side-effects arising on the grounds of antidepressant administration pose as a substantial obstacle hindering successful
depressive disorder treatment. Side-effects, especially those severe or those manifested through dramatic clinical presentations such
as panic attacks, make the treatment far more difficult and shake patientsā trust in both the treatment and the treating physician.
This case report deals with a patient experiencing a moderately severe depressive episode, who responded to duloxetine
treatment administered in the initial dose of 30 mg per day with as many as three panic attacks in two days. Upon duloxetine
withdrawal, these panic attacks ceased as well. The patient continued tianeptine and alprazolam treatment during which no
significant side-effects had been seen, so that she gradually recovered.
Some of the available literature sources have suggested the possibility of duloxetine administration to the end of generalised
anxiety disorder and panic attack treatment. However, they are outnumbered by the contributions reporting about duloxetine-related
anxiety, aggressiveness and panic attacks. In line with the foregoing, further monitoring of each and every duloxetine-administered
patient group needs to be pursued so as to be able to evaluate treatment benefits and weigh them against risks of anxiety or panic
attack onset