And psychosis

Neurological symptoms result from demyelination of the spinal cord and are potentially irreversible. The symptoms and signs characteristic of a vitamin B 2 deficiency include paresthesis of the hands and feet, decreased deep-tendon reflexes, unsteadiness, and potential psychiatric problems such as moodiness, hallucinations, delusions, and psychosis. Neuropsychiatric disorders sometimes develop independently of the anemia, particularly in elderly patients. Visual loss may develop as a result of optic atrophy. 

BKCa The diversity of BKCa channels can be attributed to the assembly of pore-forming a subunit together with four different auxiliary subunits ((31 -(34). BMS-204352 has been identified as a BKCa channel opener for the treatment of acute ischemic stroke although it has also been shown as an M-channel activator. Therapeutic applications for channel openers include epilepsy, bladder overactivity, asthma, hypertension, and psychosis. Other known BKCa channel openers include NS-8, NS-1619, NS-4, and certain aminoazaindole analogs. 

Chap. 31), and during lactation. Levodopa is used cautiously in patients with cardiovascular disease, bronchial asthma, emphysema, peptic ulcer disease, renal or hepatic disease and psychosis. Levodopa and combination antiparkinsonism drugs (eg, carbidopa/levodopa) are classified as Pregnancy Category C and are used with caution during pregnancy and lactation. 

Investigation of the differences in crystal packing between (431) and (426) from comparison of their respective X-ray structures, revealed that (431) was more tightly packed than (442), reflected in their respective melting points of 235 and 170 °C. It was postulated that the absence of in vivo activity for (431) may be explained by the resultant reduction in water solubility and dissolution rate compared with (426). The comparatively high calculated polar surface area of (431) (122.5A ) compared with (426) (89.3 A ) was also proposed as a factor influencing the marked difference in bioavailability between the two related compounds. Compound (426) (SLV-319) is currently being developed with Bristol-Myers Squibb for the potential treatment of obesity and other metabolic disorders. Phase I trials for obesity were started in April 2004. Earlier Phase I clinical trials for the treatment of schizophrenia and psychosis, which commenced in April 2002, appear to have been abandoned. 

Ujike, H., Mitsumoto, S. Clinical features of sensitization to methamphetamine observed in patients with methamphetamine dependence and psychosis. Ann. N.Y. Acad. Sci. 1025 279, 2004. 

Perry E, Ballard C, Spurden D, Cheng A, Johnson M, McKeith I, Piggott M and Perry R (1998). Cholinergic systems in the human brain Psychopharmacology and psychosis. Alzheimer s Disease Review, 3, 117-124. 

The answer is b. (Hardmanr p 1158.) Isoniazid inhibits cell-wall synthesis in mycobacteria. Increasing vitamin B6 levels prevents complications associated with this inhibition, including peripheral neuritis, insomnia, restlessness, muscle twitching, urinary retention, convulsions, and psychosis, without affecting the antimycobacterial activity of INH. 

The answer is d. (Katzung, pp 404-A05) Vigabatrin can induce psychosis. It is recommended that it not be used in patients with preexisting depression and psychosis. 

Stepwise Approach to Management of Drug-Induced Hallucinosis and Psychosis in Parkinson s Disease... 

Antipsychotic medications have traditionally been used to treat disruptive behaviors and psychosis in AD patients. 

Both typical and atypical antipsychotics are effective in approximately 70% of patients with acute mania associated with agitation, aggression, and psychosis, and atypical antipsychotics are better tolerated. 

Delirium and psychosis may occur with high doses of FGAs or combinations of FGAs with AChs. 

Signs and symptoms of PCP intoxication include very unpredictable behavior, increased blood pressure, tachycardia, ataxia, slurred speech, euphoria, agitation, anxiety, hostility, and psychosis. At toxic doses, coma, seizures, and respiratory and cardiac arrest may occur. 

Brodaty H, Ames D, Snowdon 1 et al. (2003) A randomized placebo-controlled trial of risperidone for the treatment of aggression, agitation, and psychosis of dementia. 1 Clin Psychiatry 64(2) 134-143... 

Three tasks comprise the goals of the acute phase of treatment. First, an appropriate mood stabilizer must be chosen and safely initiated. Second, agitation and psychosis, if present, must be managed while waiting for the mood stabilizer to take effect. Third, the patient s sleep must be optimized. 

Management of Agitation and Psychosis. Like antidepressants, mood stabilizers do not work immediately. It often takes a week or longer for a mood stabilizer to reach a therapeutic level and exert its beneficial treatment effects. Meanwhile, one may have a labile, impulsive, and agitated patient on one s hands. Clearly, rapidly acting tranquilizing medications are needed at this juncture to calm an agitated patient. 

Loxapine (Loxitane). Loxapine is a medium potency antipsychotic, and it has several interesting features. First, it is chemically very similar to clozapine, the first of the atypical antipsychotics. In the test tube, loxapine actually behaves more like an atypical antipsychotic (more on that later), but when patients are treated with it, loxapine acts more like a traditional typical antipsychotic. A second point of interest is that loxapine is actually the major active metabolite of the antidepressant amoxa-pine (Ascendin). As a result, one can use a single medication (amoxapine) to treat both depression and psychosis. In practice, however, the use of what is essentially a fixed dose combination medication should be avoided. Using amoxapine does not allow separate adjustment of the antipsychotic and antidepressant, and most importantly, amoxapine is the only antidepressant associated with the risk of TD. 

Psychotic Disorders. Patient descriptions of flashback experiences occasionally resemble those of auditory or visual hallucinations. In addition, the numbing and affective restriction of PTSD can resemble the affective flattening of schizophrenia. Finally, some evidence indicates that those with chronic psychotic disorders such as schizophrenia are more vulnerable to trauma, creating the possibility of comorbid PTSD and psychosis. Flashbacks can be distinguished from hallucinations in that the sounds and visions described by a patient with PTSD during a flashback represent a reexperiencing of an earlier traumatic event. The content of the flashback, therefore, is either directly or indirectly tied to the trauma. 

The side effects of pemoline are similar to other stimulants but milder. The most common side effects are loss of appetite, nausea, and insomnia. Infrequent side effects include headache, dizziness, changes in mood, increases in blood pressure or pulse, and psychosis. 

Less frequent side effects of stimulants include euphoria, nervousness, irritability, headache, involuntary movements (tics), increased heart rate, and psychosis. If psychosis or tics develop, the patient s doctor should be notified immediately, and the medication should be stopped. Other side effects should also be reported and may necessitate a medication change. 

The behavioral and emotional complications of dementia such as agitation, depression, and psychosis are often the most troublesome aspect of the illness. They can alienate the family members who are trying to provide care and often lead exhausted families to institutionalize these patients whom they would otherwise prefer to keep at home. 

Atypical antipsychotics may be helpful in managing the delusions and agitated behavior that can accompany dementia. These medications, include risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), and olanzapine (Zyprexa). All antipsychotics, typical and atypical, appear to increase the risk of death in patients with dementia and psychosis. This appears as a warning in the package inserts of the newer drugs. A prudent approach is to discuss this risk with the caregiver, use the lowest effective dose, and monitor for effectiveness. 

Disulfiram is used as an adjunct in the management of alcohol dependence. It is contraindicated in patients with a history of cerebrovascular accident, cardiac failure, coronary artery disease, hypertension and psychosis. Side-effects that may be present include initial drowsiness and fatigue, nausea, vomiting, halitosis, reduced libido, psychotic reactions, allergic dermatitis, peripheral neuritis and hepatic cell damage. 

Severe intoxication has resulted in prostration, tachycardia, blood pressure flucmations, con-vulsive seizures, choreiform movements, and psychosis. Recovery may be complete, but permanent residual effects such as ataxia, optic atrophy, tremor, mental abnormalities, and footdrop have been reported. fti cases of fatal intoxication, typical autopsy findings include pulmonary edema, necrosis of the liver, nephritis, and degenerative changes in peripheral axons. ... 

Neuropsychiatric phenomena Patients have shown a variety of neuropsychiatric signs and symptoms including concentration disturbance, delusions, hallucinations, confusion, paranoia, and psychosis. 

Cognitive/Neuropsychiatric adverse events Use of zonisamide was frequently associated with the following CNS-related adverse events 1) Psychiatric symptoms, including depression and psychosis 2) psychomotor slowing, difficulty with concentration, and speech or language problems, in particular, word-finding difficulties and 3) somnolence or fatigue. 

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