SYMPOSIA

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