Open Access Case Study

Severe Weight Loss and Emaciation Following Topiramate Administration

Mohammad Abu-Hegazy, Abdallah M. Almarzoogi, Sultan M. Almarzoogi, Waseem Marei M. Marei

International Neuropsychiatric Disease Journal, Page 1-4
DOI: 10.9734/INDJ/2017/35961

Topiramate is an antiepileptic drug, used also for prevention of an episodic migraine. Its effects include sodium-channel-blocking activity, enhancement of cerebral GABA concentrations and antagonism of AMPA/kainate receptors, which leads to a decreased glutamate-mediated excitation. It is documented to possess weight reducing properties. It attenuates appetite through mechanisms that remain to be elucidated. Severe weight loss is not reported in the literature. We investigated one patient with severe weight loss (40.2% loss) resulted in emaciation and found that the implicated drug was topiramate. This notion was confirmed when we discontinued the implicated drug (Topiramate) as the patient regained his weight again to the previously recorded levels. Conclusion: Severe weight loss up to emaciation may occur after topiramate administration, Topiramate can be used to counteract the weight gain effect of antipsychotics, long acting topiramate preparation alone or in combination with long acting phentermine can be used to treat morbid obesity.

Open Access Original Research Article

Efficacy and Tolerability of Aripiprazole in a Nigerian Cohort with First-episode Psychosis: A Post-marketing Survey

S. O. Olotu, I. O. Agbonile, J. O. Omoaregba, B. O. James

International Neuropsychiatric Disease Journal, Page 1-10
DOI: 10.9734/INDJ/2017/34977

Background: Individuals with first episode psychoses often discontinue pharmacotherapy due to poor symptom remission and/or intolerable side effects. Aripiprazole has been reported to show good efficacy with low side effect profiles in Caucasians. No studies have been conducted to assess its effectiveness and tolerability in a Nigerian population hence the need for this study.

Methods: A post marketing surveillance was conducted involving patients with first episode psychosis presenting to a regional tertiary psychiatric facility in Nigeria. Participants were titrated through a dose range of 10-30 mg of aripiprazole depending on response or tolerability and followed up over a 12 week period. Assessments at baseline, at 2, 6, and 12-weeks post recruitment were done to rate severity of psychopathology (CGI, PANSS), side effects (MSAS), functioning (GAF), and medication adherence (MARS).

Results: Of fifty patients completing the study (49.5% drop-out rate), we observed significant improvements at 12 weeks compared to baseline in symptom remission (p<0.001), clinician rating of improvement (p<0.01), and psychosocial functioning (p<0.001). There were no significant changes compared to baseline as regards medication adherence, extra pyramidal side effects (p=0.23), fasting blood sugar (p=0.67) and fasting cholesterol (p=0.57)

Conclusion: Aripiprazole may be effective and tolerable among individuals with first episode non-affective psychoses presenting at a tertiary psychiatric facility in Nigeria.

Open Access Original Research Article

Prevalence of Hepatic Encephalopathy and Its Precipitating Factors in CLD Cirrhotic Patients

Anam Khalid, Amna Afsar, Mohammad Mohsin Arshad, Ammarah Ghafoor, Sadaf Khalid, Shayan Saleem

International Neuropsychiatric Disease Journal, Page 1-7
DOI: 10.9734/INDJ/2017/35563

Objectives of Study: Hepatic Encephalopathy is a spectrum of neuropsychiatric abnormalities in patients with acute or chronic liver dysfunction, after exclusion of brain disease. It is characterized with intellectual impairment, personality changes, and a depressed state of consciousness. This study is underwent to study the clinical profile, important precipitating factors and outcome of hepatic encephalopathy in hospitalized CLD patients.

Methods: Cross-sectional, observational descriptive study which was undergone at Chaudhry Hospital, Gut and Liver Center, Gujranwala, Pakistan, on a sample size of 145 hospitalized CLD patients, out of which 92 with Hepatic Encephalopathy during August 2016 to December 2016. Data was analyzed by SPSS v22.0 and the results are expressed as counts and percentage.

Results: Prevalence of hepatic encephalopathy in CLD patients is 63.4% with average age of patients above 40 years and 60% male predominance. The main precipitating factor for hepatic encephalopathy is underlying infection 57% (n=52) and upper gastrointestinal bleed 29% (n=27). The most common comorbidity is diabetes mellitus i.e. 62% (n=57). The main cause for CLD is hepatitis B and C related liver cirrhosis in our study. Among 92 patients, 42% (n=39) presented in grade 2 hepatic encephalopathy followed by 30% (n=27), 19.5% (n=18) and 8.5% (n=8) in grade 3, 1 and 4 respectively. Among 92 patients, 73% (n=67) got discharged after a stay of 5 ±2 days and 27% (n=25) expired. Among 25 expired patients, 71% (n=17) with Child-Pugh Score class C.

Conclusion: The prevalence of HE is more than 60% and main precipitating factor for hepatic encephalopathy is underlying infection. Diabetes mellitus is important co-morbidity factor observed in more than half of the patients. Majority of the patients present in grade 1 have good outcome. Expiry rate is higher in patients presenting with grade 3 and 4 hepatic encephalopathy and with Child-Pugh Score of class C.

Open Access Original Research Article

Transition of Service Users from Child to Adult Mental Health Clinic in Lagos Nigeria

Oluyemi Ogun, Increase Ibukun Adeosun, Grace Ijarogbe, Moshudat Bello-Mojeed

International Neuropsychiatric Disease Journal, Page 1-7
DOI: 10.9734/INDJ/2017/36129

Adolescence is a potentially stressful period characterised by various developmental changes. Disruption in provision and utilisation of mental health services during the transition from adolescence to adulthood has dire implications on clinical outcomes. There is dearth of data on the transition of service users from child to adult mental health services in Africa. This study determined the rate and correlates of drop out from treatment during the transition from child and adolescent clinic to the adult out-patient clinic at a public mental health care facility in Nigeria.  Using a retrospective cohort study design, clinical records of adolescent patients transferred to the adult clinic of a public psychiatric hospital after attaining adulthood were reviewed. Relevant clinical and socio-demographic data were documented in a pro-forma and analysed with SPSS 16.  More than a third (37.1%) of the cohort dropped out of treatment during transition from the child and adolescent clinic to the adult clinic.  Factors associated with disengagement from services during the transition period included male gender (p= 0.004), age <19 years at implementation of transfer (p<0.001) and previous traditional or spiritual treatment in the pathway to care (p= 0.015). On regression analysis, male gender (p=0.003), traditional or spiritual pathway to care (p=0.004) and transfer from child clinic before 19 years (p<0.001) were independently associated with drop-out from follow-up after transition to the adult clinic. The findings highlight the need for interventions targeted at minimising disruption in mental health service utilisation during transition from adolescence to adulthood. The transition process should be customised to address the specific and peculiar mental health needs of each adolescent.

Open Access Original Research Article

Cognitive Impairment among Elderly Patients Presenting with Fall Injury in Orthopaedic Clinics in South Western Nigeria

Fisayo Elugbadebo, Olusegun Baiyewu

International Neuropsychiatric Disease Journal, Page 1-8
DOI: 10.9734/INDJ/2017/36582

Background: Falls are a major cause of morbidity and mortality in the elderly and are associated with cognitive impairment. In this study, we described the association of mild cognitive impairment and dementia with number of falls among elderly patients presenting with fall injury in 2 hospitals in Southwestern Nigeria.

Materials and Methods: This is a cross sectional descriptive study of seventy older adults presenting with fall injury at the Orthopaedic clinics in Ibadan, South Western Nigeria. Cognitive status of participants was assessed using Mini Mental State Examination (MMSE), Animal Fluency Test, Delayed Word Recall, Stick Design Test. Functioning was assessed by Instrumental Activity of Daily Living scale, severity of dementia by Clinical Dementia Rating scale (CDR).

Results: The prevalence of dementia and mild cognitive impairment among the participants was 22.9% and 14.3% respectively. There was a linear correlation between number of falls and scores on the MMSE (r = -0.68) and CDR scale (r = 0.59) (P= .05). Participants with dementia were more likely to have more than one fall (OR: 3.74, CI: 1.14 -12.33). Those who had more than one fall in the previous 12 months had lower scores in all the neurocognitive test when compared to those with single fall.

Conclusion: Since mild cognitive impairment and dementia were identified among these group of older adults and dementia was associated with multiple falls, attention to these problems could help reduce the risk of subsequent fall injury and possible morbidity and mortality.