- Email: [email protected]
P.6.041 Mental disorders in patients with Lyme disease
P6.
Other
The perfusion abnormalities were more promiueut in the severe OSAS group. Some ueuropsychological measures were found to be correlated with the perfusion iudices of the patients. In this prelimiuary study ouly oue patient who used coutiuuous positive air pressure (CPAP) therapy has showu remarkable improvement of the perfusion abnormalities that appeared in the temporal aud parietal regions. Conclusions: The results of this study support the fiudiugs of some previous reports iudicatiug that significant regional cerebral blood flow chauges aud ueuropsychological abnormalities are associated with obstructive sleep apnea syudrome. The detected perfusion deficits in this study were mainly related to the the parietal regions of the brain
mP6
040
Is the Brugada with antipsychotic treatment?
electrocardiogram and antidepressant
associated
S. Kouuas’, 0. Rouvali2, P. Dalli2, M. Efremidis’, S. Theodoropoulou2, F. Kardaras’ ’ “Evangelismos” General Hospital of Athens, 2nd Department of Cardiology, Drossia, Athens, Greece; 2”Evangelismos” General Hospital of Athens, Department of Psychiatry, Athens, Greece Purpose of the study: The Brugada syudrome is a rare clinical aud electrophysiologic entity cousistiug of sudden death from cardiac arrhythmias, associated with right bundle branch block aud unusual ST elevatiou in the right precordial leads @‘l-V3). The Brugada electrocardiographic patteru mimicked by overdose of cyclic autidepressauts, SSRIs but also therapeutic administration of ueuroleptics has beeu reported. Auother study showed a higher prevalence of the Brugada electrocardiogram among patients with cyclic autidepressaut overdose (15,3%) thau the expected oue in general populatiou (0,0550,1%). The purpose of our study was to assess the prevalence of the Brugada patteru among the ECGs of patients uuder therapeutic doses of autipsychotics aud autidepressauts. Methods: We studied 81 patients (43113 years old, 37 meu ~ 44 women) admitted to the Psychiatric Department of our General Hospital betweeu October 2002 aud February 2003. 42 patients (52,8%) suffered from affective disorders aud 38 patients (46,9%) from psychosis. 12 lead ECGs were obtaiuted at admission aud during the hospital stay. Summary-Results: A Brugada electrocardiographic patteru (type 3) was present in 1 of 81 admissions, a 40 year old mau with uo personal or familial history of cardiac disease, treated with haloperidol, veulafaxiue, lorazepame aud viperiden Physical examination, blood tests aud echocardiogram were uonnal. The patient uuderweut a procaiuamide test which did uot aggravate the Brugada electrocardiographic pattern Conclusions: The Brugada electrocardiographic pattern should be sought in patients uuder therapeutic doses of autipsychotics or autidepressauts. The exact prevalence of this patteru among psychiatric patients uuder treatment, the role of individual susceptibility aud its relationship to sudden death reported with such chrouic treatment requires f&her study to be clarified.
topics
m P6
041
s443 Mental
disorders
in patients
with
Lyme
disease
I. Ruduik’, R. Poplawska’, A. Szulc’, D. Juchuowicz’, B. Kouarzewska’ , A. Czeruikiewicz’ , I. Debowska2. ‘Medical Academy in Bialystok, Poland, Department of Psychiatry, Choroszcz, Poland; 2Mental Hospital, Department of Psychiatry, Choroszcz, Poland Introduction: Lyme Disease (Borreliosis) is a chrouic infectious disorder, affecting mauy iutemal orgaus. The pathogen of this disease is Borrelia burgdorferi. Eucephalopathy, depressive dosorders, panic attacks, chrouic fatigue, coufusiou aud some auorectic symptoms are the most common meutal disorders reported in patients with Lyme Disease, especially in chrouic phase of disease [ 11. The course of disorder is atypical (e.g. age of onset), uustable, chaugiug over time, aud symptoms usually respond to antibiotics, uot psychotropic ageuts. Poor perfonnauce in ueuropsychological tests aud positive serology could be helpful in establishing the filial diagnosis [2]. The purpose of this study was to establish the characteristics of meutal disorders in patients with curreut phase of disease aud in patients several years after diagnosis aud therapy with antibiotics. Material and methods: We examined 30 patients in a period of 2-6 years after ueuroborreliosis (group A) aud 123 patients with curreut symptoms of disease (group B), which included: 77 patieuts with chrouic arthritis, 20 with ueuroborreliosis, 26 with skill fonn of disease (erythema migraus), hospitalized in Department of Infectious Diseases in Bialystok, Poland, in 1998-99. The patients were assessed by battery of psychometric measures including: Miui Meutal State Examiuatiou QvIMSE), Hamilton Depression Rating Scale, Hamilton Anxiety Scale aud structured psychiatric iuterview made by 2 experienced psychiatrists, who established psychiatric diagnoses according to ICD-10 criteria. Results: In subjects with history of several years after ueuroborreliosis the diagnosis of meutal disorder was established in 63.3% of patients: 23.4% ~ cognitive disorders, 13.3% ~ anxiety disorders, 26.7% ~ depressive disorders. In patients with curreut symptoms of disease the psychiatric diagnosis was established: in patients with chrouic arthritis ~ cognitive disorders in 6.5% of patients, depressive disorders in 80.5% of patieuts, anxiety disorders in 5.2% of patients; in patients with ueuroborreliosis ~ cognitive disorders in 15% of patients, depressive disorders in 80% of patieuts, anxiety disorders in 5% of patieuts; in patients with skill fonn ~ anxiety disorders in 19.2% of patieuts, depressive disorders in 3.8% of patients. Conclusion: The most common meutal disorders found in patieuts with curreut disease were depressive aud cognitive disorders, especially in group with chrouic arthritis aud ueuroborreliosis. Several years after acute phase of ueuroborreliosis some cognitive, depressive aud anxiety disorders are persisted. Antibiotics aud psychotropic medication (autidepressauts, especially SSRI’ s) could be very helpful in maulaging meutal disorders occuriug in early aud late phase of Lyme Disease, but therapy should be introduced early, in proper doses aud in some cases used in a chrouic way. References [l]
[2]
Fallon BA, Nields JA, Parsons B, Liebowitz MR, Klein DF: Psychiatric Manifestations of Lyme Borreliosis. J Clin Psychiatry 1993; 54: 263261. Asch ES, Bujak DI, Weiss M, Peterson MG, Weinstein A: Lyme disease: an infectious and postinfectious syndrome. J Rheumatol 1994; 21: 454461.
Other
The perfusion abnormalities were more promiueut in the severe OSAS group. Some ueuropsychological measures were found to be correlated with the perfusion iudices of the patients. In this prelimiuary study ouly oue patient who used coutiuuous positive air pressure (CPAP) therapy has showu remarkable improvement of the perfusion abnormalities that appeared in the temporal aud parietal regions. Conclusions: The results of this study support the fiudiugs of some previous reports iudicatiug that significant regional cerebral blood flow chauges aud ueuropsychological abnormalities are associated with obstructive sleep apnea syudrome. The detected perfusion deficits in this study were mainly related to the the parietal regions of the brain
mP6
040
Is the Brugada with antipsychotic treatment?
electrocardiogram and antidepressant
associated
S. Kouuas’, 0. Rouvali2, P. Dalli2, M. Efremidis’, S. Theodoropoulou2, F. Kardaras’ ’ “Evangelismos” General Hospital of Athens, 2nd Department of Cardiology, Drossia, Athens, Greece; 2”Evangelismos” General Hospital of Athens, Department of Psychiatry, Athens, Greece Purpose of the study: The Brugada syudrome is a rare clinical aud electrophysiologic entity cousistiug of sudden death from cardiac arrhythmias, associated with right bundle branch block aud unusual ST elevatiou in the right precordial leads @‘l-V3). The Brugada electrocardiographic patteru mimicked by overdose of cyclic autidepressauts, SSRIs but also therapeutic administration of ueuroleptics has beeu reported. Auother study showed a higher prevalence of the Brugada electrocardiogram among patients with cyclic autidepressaut overdose (15,3%) thau the expected oue in general populatiou (0,0550,1%). The purpose of our study was to assess the prevalence of the Brugada patteru among the ECGs of patients uuder therapeutic doses of autipsychotics aud autidepressauts. Methods: We studied 81 patients (43113 years old, 37 meu ~ 44 women) admitted to the Psychiatric Department of our General Hospital betweeu October 2002 aud February 2003. 42 patients (52,8%) suffered from affective disorders aud 38 patients (46,9%) from psychosis. 12 lead ECGs were obtaiuted at admission aud during the hospital stay. Summary-Results: A Brugada electrocardiographic patteru (type 3) was present in 1 of 81 admissions, a 40 year old mau with uo personal or familial history of cardiac disease, treated with haloperidol, veulafaxiue, lorazepame aud viperiden Physical examination, blood tests aud echocardiogram were uonnal. The patient uuderweut a procaiuamide test which did uot aggravate the Brugada electrocardiographic pattern Conclusions: The Brugada electrocardiographic pattern should be sought in patients uuder therapeutic doses of autipsychotics or autidepressauts. The exact prevalence of this patteru among psychiatric patients uuder treatment, the role of individual susceptibility aud its relationship to sudden death reported with such chrouic treatment requires f&her study to be clarified.
topics
m P6
041
s443 Mental
disorders
in patients
with
Lyme
disease
I. Ruduik’, R. Poplawska’, A. Szulc’, D. Juchuowicz’, B. Kouarzewska’ , A. Czeruikiewicz’ , I. Debowska2. ‘Medical Academy in Bialystok, Poland, Department of Psychiatry, Choroszcz, Poland; 2Mental Hospital, Department of Psychiatry, Choroszcz, Poland Introduction: Lyme Disease (Borreliosis) is a chrouic infectious disorder, affecting mauy iutemal orgaus. The pathogen of this disease is Borrelia burgdorferi. Eucephalopathy, depressive dosorders, panic attacks, chrouic fatigue, coufusiou aud some auorectic symptoms are the most common meutal disorders reported in patients with Lyme Disease, especially in chrouic phase of disease [ 11. The course of disorder is atypical (e.g. age of onset), uustable, chaugiug over time, aud symptoms usually respond to antibiotics, uot psychotropic ageuts. Poor perfonnauce in ueuropsychological tests aud positive serology could be helpful in establishing the filial diagnosis [2]. The purpose of this study was to establish the characteristics of meutal disorders in patients with curreut phase of disease aud in patients several years after diagnosis aud therapy with antibiotics. Material and methods: We examined 30 patients in a period of 2-6 years after ueuroborreliosis (group A) aud 123 patients with curreut symptoms of disease (group B), which included: 77 patieuts with chrouic arthritis, 20 with ueuroborreliosis, 26 with skill fonn of disease (erythema migraus), hospitalized in Department of Infectious Diseases in Bialystok, Poland, in 1998-99. The patients were assessed by battery of psychometric measures including: Miui Meutal State Examiuatiou QvIMSE), Hamilton Depression Rating Scale, Hamilton Anxiety Scale aud structured psychiatric iuterview made by 2 experienced psychiatrists, who established psychiatric diagnoses according to ICD-10 criteria. Results: In subjects with history of several years after ueuroborreliosis the diagnosis of meutal disorder was established in 63.3% of patients: 23.4% ~ cognitive disorders, 13.3% ~ anxiety disorders, 26.7% ~ depressive disorders. In patients with curreut symptoms of disease the psychiatric diagnosis was established: in patients with chrouic arthritis ~ cognitive disorders in 6.5% of patients, depressive disorders in 80.5% of patieuts, anxiety disorders in 5.2% of patients; in patients with ueuroborreliosis ~ cognitive disorders in 15% of patients, depressive disorders in 80% of patieuts, anxiety disorders in 5% of patieuts; in patients with skill fonn ~ anxiety disorders in 19.2% of patieuts, depressive disorders in 3.8% of patients. Conclusion: The most common meutal disorders found in patieuts with curreut disease were depressive aud cognitive disorders, especially in group with chrouic arthritis aud ueuroborreliosis. Several years after acute phase of ueuroborreliosis some cognitive, depressive aud anxiety disorders are persisted. Antibiotics aud psychotropic medication (autidepressauts, especially SSRI’ s) could be very helpful in maulaging meutal disorders occuriug in early aud late phase of Lyme Disease, but therapy should be introduced early, in proper doses aud in some cases used in a chrouic way. References [l]
[2]
Fallon BA, Nields JA, Parsons B, Liebowitz MR, Klein DF: Psychiatric Manifestations of Lyme Borreliosis. J Clin Psychiatry 1993; 54: 263261. Asch ES, Bujak DI, Weiss M, Peterson MG, Weinstein A: Lyme disease: an infectious and postinfectious syndrome. J Rheumatol 1994; 21: 454461.