Læknablaðið : fylgirit - 01.08.2003, Síða 67

POSTERS / 27TH NORDIC PSYCHIATRIC CONGRESS I
Hannover, Germany, Hannover Medical School, Carl-Neuberg-Str.l, 30625 Hanno-
ver, Germany. Stefan Kropp, MD, Clinical Psychiatry and Psychotherapy, Medical
School Hannover, Germany.
mziege999@yahoo. com
Weight gain occurs during treatment with drugs of different chemi-
cal structures and is an important problem when patients are
treated with antipsychotics. The clinical relevance of drug-induced
weight changes is due to increased rates of morbidity and reduced
treatment compliance. Regarding the underlying causes, the impor-
tant role of neurotransmitter systems has been discussed since
decades. Understanding of the regulation of appetite and weight
has made major progress, particularly in the last decade. In this con-
text, the discovery of leptin was crucial. In addition to the neuro-
endocrine systems, weight gain induced by psychotropic agents
might also involve immune modulators. The majority of studies
dealing with antipsychotic-induced weight gain hypothesize that
there is a limited period of weight gain. In contrast we suggest that
psychotropic drugs, especially novel antipsychotics, appear to cause
long-term weight gain. Risperidone 4mg/dailv caused 42 kg weight
gain over a period of four years in a patient with schizophrenia. The
present poster discusses the possible mechanisms of long term
weight gain and shows strategies to minimize or to counteract
weight gain induced by novel antipsychotics. Although numerous
psychotherapeutic approaches are available, they are only of
limited usefulness in severely ill psychiatric patients. Fortunately, a
number of promising pharmacological approaches have been intro-
duced during the last years, but so far there is no clinical data on the
usefulness and safety of such drugs.
P - 28 Thursday 14/ 8, 14:00-15:00
ls phototherapy useful in treatment of anorexia patients?
Janas-Ko/ik Malgorzala. MD. PhD. Dcpartment and Clinic of Psychiatry and
Psychotherapy, Silesian Medical University, Ziolowa 45/47, PL 40-635 Katowice.
Poland. Irena Krupka-Matuszczyk. Marek Krzystanek, Jan Szymszal, Ewa
Augustyniak.
nialgorzala.janas-kozik@psychialria.pl
Phototherapy was introduced by N. Rosenthal as a treatment of
seasonal affective disorder. Phototherapy synchronizes biological
rhythms of humans and increases serotoninergic transmission in a
brain [1]. Anorexia nervosa (AN) is a disorder with a putative in-
crease of serotoninergic activity. Characteristic symptoms of AN
are aberrant eating behavior, a desire to lose weight and fear of be-
coming obese. The theoretical assumption that phototherapy may
improve symptoms of AN has never been explored before.
Tlie aim of the study was to assess an influence of phototherapy
on body mass changes in AN patients during a 6 weeks of treat-
ment.
Twenty-six female AN patients aged from 12-22 years were the
examined group. Nine patients were treated with phototherapy and
17 were a control group. Every subsequent week of treatment the
body mass index (BMI) and BMI changes were calculated and de-
pressive symptoms assessed using Hamilton rating scale.
BMI increases in each of the examined groups were observed
(p<0,001). There were no statistically significant differences be-
tween BMI increases in the examined groups. AN patients with de-
pressive symptoms showed improvement after 6 weeks (p=0.028).
Phototherapy may be considered effective in treatment of depres-
sive symptoms in AN.
References
1. Metzger JY, Berthou V, Perrin P. Sichel JP. Phototherapy: clinical and
therapeutic evaluation of a 2-year experience. Encephale 1998; 24: 480-5.
2. Ericsson M., Poston II WSC. Foreyt JP. Common biological pathways in eating
disorders and obesity. Addict Behav 1996; 21: 733-43.
P - 29 Thursday 14/8,14:00-15:00
Neuroleptic malignant syndrome and serotonin syndrome
in critical care
Kcnncth R. Kaufimm. MD, MRCPsych, Professor of Psychiatry, UMDNJ-Robert
Wood Johnson Medical School, 125 Paterson Street, Suite #2200, New Brunswick,
New Jersey 08901, USA. Michael J Levitt, Jagadeeshan Sunderram.
kaiifmakr@umdnj.edu
Background: Neuroleptic malignant syndrome (NMS) and seroto-
nin syndrome (SS) are two medical emergencies associated with
psychotropics. Differentiation and treatment are complex, especi-
ally when features of both are present and the patient has taken
both serotonergic and neuroleptic agents.
Aims: Create an algorithm for complex cases with mixed features in
the critical care setting.
Methods: Retrospective case analysis with literature review.
Results: 23-year-old white female was admitted following a poly-
drug overdose of venlafaxine, topiramate, divalproex sodium,
risperidone, and carbamazepine. Upon presentation, the patient
was afebrile, normotensive but tachycardic with WBC 12000, CPK
523, valproic acid level 122, carbamazepine level 39, and ammonia
113. She was intubated for airway protection, initiated on L-carni-
tine 250mg IV q8h, and managed with supportive care. On the third
day of admission temperature rose to 103.7 and physical examina-
tion revealed 4+ reflexes with sustained clonus and increased upper
and lower extremity rigidity. Cyproheptadine and dantrolene were
initiated for presumptive SS and concomitant NMS. With persisting
symptoms and rising CPK levels to 1033, the diagnosis of NMS was
more evident. Bromocriptine was initiated and cyproheptadine was
discontinued. Clinical improvement was noted with normalizing
CPK. She was extubated on day 10 and confirmed a polydrug over-
dose, depression and agreed to inpatient psychiatric transfer.
Conclusions: Initial management should include intubation for air-
way protection, IV hydration, benzodiazepines, and monitoring for
vital signs and laboratory values. Aggressive intervention for NMS
and SS is indicated with a combination of cyproheptadine and
dantrolene. If clinical features persist with CPK levels greater than
1000, bromocriptine should be included.
P - 30 Thursday 14/8,14:00-15:00
Placebo controlled crossover trial with repetitive
transcranial magnetic stimulation in major depressive
illness: Double-blind crossover study
Anna L Þórisdóttir'. Ómar Hjaltason^, Ómar fvarsson^, Sigurjón B. Stefánssoni
'Department of Neurology and ZDepartment of Psychiatry, Landspitali University
Hospital, Iceland
annahho@landspitali.is
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