Category: Medication - Beyond The Body

Beyond The Body

Benzodiazepines and PTSD

10/11/2016

Benzodiazepines are a type of medication which fall under the sedative-hypnotic class, and work by enhancing the activity of the neurotransmitter GABA. While benzos are most well-known for their sedating and anxiolytic effects, they have been used in the treatment of those with seizures, alcohol withdrawal, for anesthesia purposes, as well as for insomnia and mental health issues like anxiety (particularly in the short term).

Interestingly from a historical perspective, benzos were also the original treatment for PTSD, and were thought to be beneficial in treating PTSD symptoms rapidly, particularly anxiety and trouble sleeping. While statistics range from 30% to upwards of 74% of those with PTSD being treated with benzodiazepines of some kind, there is growing evidence that suggests that these medications are not effective in treating the core symptoms of PTSD (i.e. hyperarousal, dissociation, and avoidance).

In addition, studies have also suggested that use of benzodiazepines for those with PTSD may be in fact be harmful with risks that far outweigh the benefits. The studies below suggest that we should be very cautious in prescribing benzos for PTSD due to the high rates of comorbid substance use disorders (a serious risk given the tolerance/withdrawal associated with these meds), in addition to suggestions that benzos may in fact worsen overall severity of PTSD, depression and treatment outcomes for those who are affected.

To learn more, check out these articles:
https://www.ncbi.nlm.nih.gov/pubmed/26164054
http://www.ptsd.va.gov/…/newsl…/research-quarterly/v23n4.pdf

Think Like A Psychiatrist - On A Mood Stabilizer, But Develops Odd Gait, Incontinence and Cognitive Impairment

8/3/2016

Put your knowledge and skills to the test with the case of Mr. X, a 67yo male, who presents with new-onset cognitive impairment, gait disturbance, dyskinesia, and urinary incontinence of 2 months duration. Mr. X now requires assistance with most ADLs including ambulation.

In terms of psychiatric history, he was diagnosed with ‪‎bipolar‬‪ ‎depression‬ 8 years ago, and has since been effectively treated with ‪valproic acid‬ and venlafaxine. Serum valproic acid level is within the therapeutic range.

What work-up would you order? What diagnosis or differential diagnosis are you considering?

"Treated with a mood stabilizer, he becomes incontinent and walks oddly" by Kumari S, Sridhar R, and Rao M (Current Psychiatry).

A New Antipsychotic May Help Improve Medication Compliance and Relapse Rates

7/4/2016

Health Canada announced early last week that they have approved a new ‪‎antipsychotic‬ medication for the treatment of ‪‎schizophrenia‬ in adults.

The medication is called Invega Trinza (aka paliperidone palmitate), a new version of the drug Invega Sustenna, which has already been out on the market for some time. Psychiatrists are hopeful regarding the impact Invega Trinza may have on the care of their patients and specifically their medication compliance and risk of relapse, as it is an injection that need only be administered four times a year, rather than on a monthly schedule in its old form.

"Adherence to medication is often a challenge for Canadians living with schizophrenia, with not taking medication as prescribed as the most common cause of relapse. Studies have shown that within the first five years of treatment, up to 80 per cent of people with schizophrenia had experienced one or more relapses. Each relapse can result in a reduced response to treatment, putting continued symptom control even further out of reach.

"Relapse prevention is a critical part of disease management and recovery-focused care for people living with schizophrenia," says Dr. Philip Tibbo, Director, Nova Scotia Early Psychosis Program in Halifax. "The unique dosing of INVEGA TRINZA can offer patients long-term symptom control. This could help to significantly reduce the risk of relapse over time."
For more information about this new medication, check out the links below:

Think Like A Psychiatrist - Manic After A Cruise

4/7/2016

Put your knowledge and skills to the test with the case of Mr. K, a 36 year old male, who presents to the ER with his wife, with new symptoms of elevated mood and self-esteem, decreased sleep, increased speech, racing thoughts, distractibility and increased goal-directed activity. They report that these symptoms began 10 days ago after they returned home from a cruise vacation.

Mr. K has no past psychiatric medication or recent substance use. His family history is significant for a brother who had a single manic episode and past suicide attempt in his adolescence. Mr. K is employed at a biotechnology company, where he does shiftwork, however since returning from his cruise, he has been unable to go to work due to his current symptoms.

Mr. K does not take any regular medications however, he reports using scopolamine for motion sickness on the cruise, and his wife tells you that she believes this may have led to his developing mania.

What would you say to Mr. K and his wife? What is Mr. K's diagnosis? How would you treat his manic symptoms?

"Manic After Taking A Vacation" by Embay Tan (Current Psychiatry).

Psych In The News - Week 75

9/6/2015

Catch up on all the news related to mental health and psychiatry from last week!

Think Like A Psychiatrist - A Case of Lip Smacking & Tongue Rolling

9/3/2015

Put your knowledge and skills to the test with the case of Ms. X, a 65 year old woman, with a long-standing history of ‪bipolar disorder "characterized by psychotic mania and severe suicidal depression." Ms. X's symptoms have been well managed with a combination of aripiprazole, trazodone and citalopram. However, due to change in her insurance coverage, Ms. X learns that aripiprazole will no longer be covered and so she requests a different medication. She is subsequently switched to quetiapine.

At her follow-up visit a few weeks later, Ms. X is noted to have a euphoric mood, decreased sleep, flight of ideas, and paranoia. She is also observed by her psychiatrist to be smacking her lips and rolling her tongue quite frequently.

What is the cause of Ms. X's involuntary movements? How would you manage this patient?

"A medication change, then involuntary lip smacking and tongue rolling" by Apeksha Shah, Shivam Dubey and Piyush Das (Current Psychiatry)

Psych In The News - Week 71

7/19/2015

Catch up on all the news related to psychiatry and mental health from last week!

Psych In The News - Week 70

7/12/2015

Catch up with all the news related to mental health and psychiatry from last week!

Psych In The News - Week 69

7/5/2015

Catch up with all the news related to mental health and psychiatry from last week!

Health-Boosting Lithium?

6/30/2015

Many have heard of lithium‬, but did you know that it was thought to have curative and health-boosting effects long before it was found to be useful for psychiatric conditions like bipolar disorder? In this interesting read "Should We All Take a Bit of Lithium?", the author reviews the history of lithium including lithium-enriched water springs being a popular health destination in the 19th century, to its use in the famous soda 7Up. Touching on more recent studies, the author also points out the benefits that lithium has with regards to the brain including decreasing the rates of suicide‬ and having positive impacts on the health and resiliency of our neurons.

"One could make a case that lithium is the Cinderella of psychotropic medications, neglected and ill used. Reported by an Australian psychiatrist, John Cade, in 1949 to be an effective treatment for bipolar disorder (it was approved as a drug by the Food and Drug Administration in 1970) its efficacy in mood disorders and suicide prevention has been documented as well as or better than virtually any other psychotropic medication. But it retains a grim and undeserved reputation, perhaps because it was originally associated in the public mind with serious mental illness and because, like many medications, lithium can have serious side effects if not monitored properly. As a psychiatrist, I can tell you that because of its stigma, lithium as a medication is a hard sell to patients with serious mood disorders who could clearly benefit from treatment. But there are undoubtedly other reasons for its neglect. Pharmaceutical companies have nothing to gain from this cheap, ubiquitous element."