Presentation
CONCLUSION: This study suggests that oral risperidone may be a safe option for acute agitation in patients presenting to the ED with alcohol intoxication. Copyright © 2017 Elsevier Inc. All rights reserved. [ncbi.nlm.nih.gov]
Entire Body System
- Abdominal Obesity
obesity (i.e. abdominal circumference above 90th percentile). [em-consulte.com]
Cardiovascular
- Orthostatic Hypotension
Monitoring of orthostatic vital signs should be considered in elderly patients for whom orthostatic hypotension is a concern. [pdr.net]
CV: tachycardia, chest pain, orthostatic hypotension, prolonged QT interval. EENT: rhinitis, sinusitis, pharyngitis, abnormal vision. GI: constipation, nausea, vomiting, dyspepsia, abdominal pain, anorexia. Metabolic: weight gain. [glowm.com]
Elderly patients exhibit a greater tendency to orthostatic hypotension, careful titration with monitoring of orthostatic vital signs should be considered. [drugs.com]
Musculoskeletal
- Motor Restlessness
These include dyskinesias such as repetitive, involuntary, and purposeless body or facial movements, Parkinsonism (cogwheel muscle rigidity, pill-rolling tremor and reduced or slowed movements), akathisia (motor restlessness, especially in the legs, and [library.neura.edu.au]
These disorders include akathisia (motor restlessness), dystonia (abnormal muscle tone), and tardive dyskinesia (involuntary and repetitive movements). [ncbi.nlm.nih.gov]
This may include withdrawal symptoms or extrapyramidal symptoms such as muscle contractions, motor restlessness, rigidity, slowness of movement, tremor and irregular jerky movements. [tabletwise.com]
At each visit, the primary clinician inquired about health problems, intercurrent illness, and concomitant medications and administered a 32-item questionnaire concerning energy level, muscle stiffness, motor restlessness, bowel and bladder habits, sleep [nejm.org]
Psychiatrical
- Anhedonia
It has been extensively evaluated in both relapsed and remitted patients and appears sensitive to change. 6.7.2.4 Scale for the Assessment of Negative Symptoms ( Andreasen 1981 ) The SANS assesses affective blunting, alogia, avolition/apathy, anhedonia [doi.org]
A low score indicates less severity. 6.5.2.3 Scale for the Assessment of Negative Symptoms ‐ SANS ( Andreasen 1983 ) This six‐point scale gives a global rating of the following negative symptoms: alogia, affective blunting, avolition‐apathy, anhedonia‐asociality [dx.doi.org]
Neurologic
- Seizure
After the dosage was titrated to 6 mg/d, she experienced generalized seizure attacks. [ncbi.nlm.nih.gov]
Stop taking and see physician NOW: Seizures. Related Reading What is Risperidone? Tardive dyskinesia Heterocyclic antidepressants Click below to find more related articles on Risperidone. [psyweb.com]
If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911. [medlineplus.gov]
- Agitation
BACKGROUND: Acute agitation in the setting of alcohol intoxication is commonly encountered in the Emergency Department (ED). [ncbi.nlm.nih.gov]
Risperidone is a widely accessible antipsychotic that can be used to manage psychosis-induced aggression or agitation. Objectives: To examine whether oral risperidone alone is an effective treatment for psychosis-induced aggression or agitation. [cochrane.org]
These trials have important limitations: patients typically had received antipsychotic drugs for years, even though the presence of psychosis or agitation at the initiation of therapy had not been clearly established; the response of psychosis and agitation [nejm.org]
- Akathisia
Patients with comorbid tic disorders had the poorest rate of response and highest rate of akathisia. [ncbi.nlm.nih.gov]
The most common adverse reactions that were associated with discontinuation from clinical trials (causing discontinuation in >1% of adults and/or >2% of pediatrics) were nausea, somnolence, sedation, vomiting, dizziness, and akathisia” (see package insert [aap.org]
>10% Somnolence (40-45%) Insomnia (26-30%) Agitation (20-25%) Anxiety (10-15%) Headache (10-15%) Rhinitis (10-15%) Fatigue (18-31%) Parkinsonism (28-62%) Akathisia (5-11%) Increased appetite (4-44%) Vomiting (10-20%) Drooling ( Urinary incontinence (5 [reference.medscape.com]
- Stupor
The general head space of risperidone is often described as one of sleepiness, emptiness, apathy, stupor and catatonia. The specific cognitive effects can be broken down into several components which progressively intensify proportional to dosage. [psychonautwiki.org]
CNS depression Sun exposure: increased risk of photosensitivity Patient monitoring ☞ Closely monitor neurologic status, especially for mood changes or suicidal ideation, neuroleptic malignant syndrome (high fever, sweating, unstable blood pressure, stupor [medical-dictionary.thefreedictionary.com]
Workup
QT, RR, ST Intervals
- Prolonged QT Interval
BACKGROUND: Numerous structurally unrelated drugs, including antipsychotics, can prolong QT interval and trigger the acquired long QT syndrome (aLQTS). All of them are thought to act at the level of KCNH2, a subunit of the potassium channel. [ncbi.nlm.nih.gov]
Bradycardia, electrolyte imbalance, use with other drugs that prolong the QT interval, or congenital prolongation of the QT interval can increase risk for occurrence of this arrhythmia. • Drug has an antiemetic effect in animals; this may occur in humans [glowm.com]
People taking other medicines that can increase the risk of a 'prolonged QT interval' (see end of factsheet for examples). [netdoctor.co.uk]
QT interval Tardive dyskinesia Thrombotic thrombocytopenic purpura (TTP) Sleep apnea syndrome Urinary retention Blood and lymphatic system disorders: Anemia, granulocytopenia Cardiac disorders: Tachycardia, sinus bradycardia, sinus tachycardia, atrioventricular [reference.medscape.com]
Treatment
RESULTS: PANSS scores before treatment were comparable between treatment groups. On days 7, 15, 30, and 60 of the treatment, the differences between two treatment groups became evident. [ncbi.nlm.nih.gov]
Prognosis
Dual diagnosis can have an adverse effect on treatment and prognosis of SMI. [ncbi.nlm.nih.gov]
Tomotaka Suzuki, Masayuki Takase, Toshihiro Moriyama, Hiroyuki Watanabe, Toyoaki Hirata, Makoto Asano and Masaomi Iyo, Impact of dopamine supersensitivity psychosis in treatment-resistant schizophrenia: An analysis of multi-factors predicting long-term prognosis [doi.org]
Etiology
The etiology and treatment options of IGM remain controversial. Previous case reports have suggested that hyperprolactinemia may be associated with IGM. [ncbi.nlm.nih.gov]
There were no significant differences in respect to age, gender, stage of disease, etiologies of delirium and sum of etiologies. [scielo.isciii.es]
Gynecomastia in German soldiers: etiology and pathology. GMS Interdiscip Plast Reconstr Surg. DGPW; 2012; 1: Doc 03. doi:10.3205/iprs000003 [CrossRef]. Shores LE. [healio.com]
Cambridge, Cambridge University Press Stein L, Wise CD. (1971): Possible etiology of schizophrenia: progressive damage to the noradrenergic reward system by 6-hydroxydopamine. [dx.doi.org]
Epidemiology
Principle mechanisms underlying venous thromboembolism: Epidemiology, risk factors, pathophysiology and pathogenesis. Respiration 2003;70:7-30. [ PUBMED ] 3. Anderson FA Jr., Spencer FA. Risk factors for venous thromboembolism. [jmhhb.org]
Performance of comorbidity scores to control for confounding in epidemiologic studies using claims data. Am J Epidemiol 2001 ; 154 : 854 -64. 20. ↵ Romano PS, Roos LL, Jollis JG. [dx.doi.org]
Barbui, New EMA report on paliperidone 3-month injections: taking clinical and policy decisions without an adequate evidence base, Epidemiology and Psychiatric Sciences, 10.1017/S2045796016001025, 26, 3, (231-233), (2016). [doi.org]
Diagnosis, Epidemiology and Management of Mixed States in Bipolar Disorder. CNS Drugs, Vol. 29, Issue. 9, p. 725. CrossRef Google Scholar Berger, Michael Lewitzka, Ute and Seemüller, Florian 2015. Akutbehandlung manischer Episoden. [cambridge.org]
Epidemiology of Delirium. Dement Geriatr Cogn Disord 1999; 10(5): 315-318. [ Links ] 3. Lipowski ZJ. Delirium in the elderly patient. N Engl J Med 1989; 320(9): 578-582. [ Links ] 4. Bond SM, Neelon VJ, Belyea MJ. [scielo.isciii.es]
Pathophysiology
Pathophysiological mechanisms implicated in the development of AEP in our patient seem to be associated with eotaxin and serotonin eosinophilic-specific chemoattracting action, through the serotoninergic action of risperidone. [ncbi.nlm.nih.gov]
Precise pathophysiologic understanding of the hematologic side effects of antipsychotics is lacking, although different mechanisms of action have been proposed. 3 Possible mechanisms when a patient is taking clozapine or olanzapine include: • direct toxic [mdedge.com]
Principle mechanisms underlying venous thromboembolism: Epidemiology, risk factors, pathophysiology and pathogenesis. Respiration 2003;70:7-30. [ PUBMED ] 3. Anderson FA Jr., Spencer FA. Risk factors for venous thromboembolism. [jmhhb.org]
Prevention
Routine physical and laboratory examinations may prevent silent disease progression. [ncbi.nlm.nih.gov]
This announcement marks another step forward in our strategic, comprehensive, and effective approach to fraud prevention. We can all be encouraged by the actions that have been taken – and the results we’ve obtained – in recent years. [justice.gov]
Lamotrigine, olanzapine, and quetiapine have bimodal efficacy in preventing both mania and depression, although lamotrigine’s efficacy is more robust in preventing depression and olanzapine’s efficacy is greater in preventing mania. [doi.org]
Researching Advancements in Cancer Vaccines Cancer vaccines can be used either in the prevention or the treatment of cancer. [news-medical.net]