SYMPOSIA
SYMPOSIA
SYMPOSIA
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Poster Presentations<br />
[PP-116] Ref. No: 261<br />
Fluoxetine induced hypomanic shift in a bulimic patient: A case report<br />
Mustafa Özten, Atila Erol<br />
Department of Psychiatry, Sakarya University, Faculty of Medicine, Sakarya, Turkey<br />
E-mail: drozten@yahoo.com<br />
In the psychopharmacological treatment of bulimia nervosa (BN), antidepressants have a positive effect on mood and reduce the related<br />
preoccupation with body weight and the number of binge eating episodes. Research with antidepressants such as imipramine, desipramine,<br />
trazodone, phenelzine, amitriptyline and mianserin has been conducted to investigate their efficacy in the treatment of bulimia. A higher dose<br />
of the fluoxetine (60 mg/day) was shown to be effective in BN and has received FDA approval. Comorbidity of eating disorders with mood,<br />
anxiety, and substance use disorders is common. The presence of additional psychiatric disorders impairs compliance with treatment and makes<br />
treatment difficult by increasing severity and chronicity. The treatment of bulimia nervosa with fluoxetine is adversely affected by the presence<br />
of a mood disorder. High dose fluoxetine should be used for BN to be effective, but these high doses may increase the risk of a manic shift.<br />
When using fluoxetine in patients with a history of bipolar mood disorder (BiPMD) or a positive family history of BiPMD, clinicians need to be<br />
careful because of the possibility of a manic shift. There is not any developed algorithm for psychopharmacological treatment with comorbidity<br />
of BiPMD and BN; generally the use of agents that have a positive effect on both disorders is recommended, although such a medication is not<br />
available. Negative effects on weight gain or other negative interactions of mood stabilizers in BN, makes it difficult to use them. Like other<br />
antidepressants SSRIs may also cause a manic shift. The use of antidepressant doses of fluoxetine for mood and anxiety disorders are known to<br />
carry a risk for a manic or hypomanic shift. Hence, detailed examination of cases, where there is history of mood disorder or family history of mood<br />
disorder, is recommended. Using high dose fluoxetine in BN also increases the possibility of manic or hypomanic shifts. The use of fluoxetine 60<br />
mg in a patient with BN caused a hypomanic shift, even though there was no history of bipolar disorder or a positive family history. A review of<br />
the treatment demonstrated that 60 mg of fluoxetine did not result in a significant decrease in symptoms and adequate treatment response.<br />
Retrospectively inadequate response to the treatment was associated with the presence of comorbid BiPMD.<br />
Key words: Bulimia nervosa, fluoxetine, hypomania, mania<br />
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S194<br />
[PP-117] Ref. No: 262<br />
Schizophrenia and Mega Cisterna Magna: A case report<br />
Semra Karayılan, Atila Erol<br />
Department of Psychiatry, Sakarya University Faculty of Medicine, Sakarya, Turkey<br />
E-mail: skryln@gmail.com<br />
The cerebellum, which is known in general as an organ to control coordination, balance, and fine motor movements, has been demonstrated<br />
to have an important role in cognitive functions by using anatomical and functional imaging methods. The anomaly of mega cisterna magna<br />
is one of the various lesions of the posterior fossa which can influence cerebellar functions like cerebellar hypoplasia/agenesis, vermis<br />
hypoplasia/agenesis, Dandy-Walker malformation or variant, persistent Blake’s pouch, arachnoid cyst, Joubert syndrome, and tumors of the<br />
posterior fossa. Mega cisterna magna (MCM) is a developmental malformation of the posterior fossa, where morphologically the vermis and<br />
cerebellar hemispheres are intact. Associated structural brain anomalies are common with mega cisterna magna and especially, MCM may<br />
be a component of the Dandy-Walker variant (with cerebellum hypoplasia) or Dandy-Walker syndrome (with cerebellum agenesia). Our<br />
knowledge about the relationship between this anomaly and psychiatric disorders is limited to very few case reports available. In this article,<br />
we report a case of schizophrenia associated with mega cisterna magna. A 35-year-old married patient (house wife, graduated from primary<br />
school) was brought to our clinic by her relatives with complaints of disorganized and inappropriate speech, strange behavior, and fear of<br />
people. She had auditory and visual hallucinations and delusions of reference and persecution. Up to five months ago she had no psychiatric<br />
or neurological symptoms or history. Her symptoms began with social isolation, decrease of self-care, and positive psychotic symptoms.<br />
Neurological examination and EEG examination were normal, but mega cisterna magna was discovered in her cranial magnetic resonance<br />
imaging scan. The patient was treated with risperidone 6mg/day for four weeks and was discharged after remission of psychotic symptoms.<br />
The prevalence and prognostic significance of MCM has not been defined completely yet. Memory and verbal fluency were found to be lower<br />
in cases of mega cisterna magna than in controls. Schizophrenic patients are known to have problems of memory and verbal fluency, too.<br />
The role of the cerebellum in schizophrenia has been highlighted by Andreasen’s hypothesis of ‘cognitive dysmetria’. This hypothesis suggests<br />
S194 Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org