- |||||||||| lorazepam / Generic mfg.
Review, Journal: Efficacy of Transcranial Direct-Current Stimulation in Catatonia: A Review and Case Series. (Pubmed Central) - May 17, 2022
The results indicate that tDCS, in addition to symptomatic pharmacotherapies such as lorazepam, seems to effectively reduce catatonic symptoms...However, the specific efficacy of tDCS in catatonia remains to be demonstrated in a randomized controlled trial. The development of therapeutic alternatives in catatonia is of paramount importance.
- |||||||||| lorazepam / Generic mfg.
Journal: A Case Report of Scrupulosity Presenting as Catatonia in a Patient With Both OCD and OCPD. (Pubmed Central) - May 12, 2022
Administration of lorazepam successfully treated these presenting symptoms...The patient's history and presentation supported the idea that her hyper-religiosity stemmed not from bipolar disorder or psychosis, as previously thought, but rather from a subtype of obsessive-compulsive disorder referred to as scrupulosity. This report summarizes the characteristics of scrupulosity and discusses this potentially deceptive mimic of more commonly seen conditions.
- |||||||||| lorazepam / Generic mfg., midazolam hydrochloride / Generic mfg., haloperidol / Generic mfg.
Journal: Midazolam with Haloperidol versus Lorazepam with Haloperidol for Agitation: Effect on Emergency Department Lengths of Stay. (Pubmed Central) - May 6, 2022
Although nonpharmacologic interventions such as verbal de-escalation and patient engagement are first-line interventions for acute agitation, parenteral medications are often required to ensure safety and facilitate patient care. There is no consensus recommendation on pharmacologic agents for acute agitation, however emergency clinicians have historically utilized an anti-psychotic, benzodiazepine, and/or antihistamine - as monotherapy or in some combination..
- |||||||||| lorazepam / Generic mfg.
Review, Journal: Catatonia: Back to the future of the neuropsychiatric syndrome. (Pubmed Central) - May 6, 2022
In recent years, new therapeutic alternatives such as non-invasive transcranial magnetic stimulation have emerged. In this review we propose several initiatives to promote the dissemination and knowledge of catatonia in the clinical setting.
- |||||||||| lorazepam / Generic mfg.
Journal: Crossing State Lines: Ethical and Clinical Considerations in Treating a Child With Catatonia. (Pubmed Central) - May 6, 2022
In this review we propose several initiatives to promote the dissemination and knowledge of catatonia in the clinical setting. The combination of lorazepam and electroconvulsive therapy (ECT) is a safe and effective treatment for catatonia in both adults and children, although the body of literature pertaining to children remains limited...No abstract available
- |||||||||| gabapentin / Generic mfg.
Gabapentin is an Effective Adjunct Medication for Benzodiazepine Withdrawal (Palomino Ballroom 4-10) - May 6, 2022 - Abstract #ASCP2022ASCP_148;
Gabapentin reduces the amount of benzodiazepine administered during the hospital stay. Accreditation Post-Test Question Post-Test Question Which medication is effective for treating benzodiazepine withdrawal patients?
- |||||||||| memantine / Generic mfg.
When Being Antagonistic Is a Good Thing: Using Memantine as Salvage Therapy for Catatonia From NMDA-Receptor Encephalitis () - May 5, 2022 - Abstract #APA2022APA_1128;
Memantine was later uptitrated to 5 mg twice a day - while lorazepam was weaned down - with continued improvement in catatonic symptoms...First, catatonia has a medical etiology in up to 46% of cases (Stern 2018), and this rate increases with age and level of care (Oldham 2018)...In turn, many clinicians are hesitant to prescribe memantine for such cases, with scant evidence to refute this. This is a unique case that demonstrates memantine’s utility and safety profile in cases of NMDA-R encephalitis-induced catatonia through a patient who was falsely assumed to have a primary psychiatric illness due to demographic factors.
- |||||||||| lorazepam / Generic mfg.
The Sound of Silence: Cognitive Biases and Socioeconomic Barriers Leading to Delayed Diagnosis of Metastatic Cancer () - May 5, 2022 - Abstract #APA2022APA_1099;
A lorazepam challenge was equivocal...Her case also highlights anchoring bias that led to delays in diagnosis due to repeated attribution, by both family and healthcare system, of her symptoms to depression. If social determinants of health and cognitive biases are not addressed, patient safety and outcomes may be negatively affected, especially in marginalized patient populations.
- |||||||||| Nihilistic Delusions and ECT for Psychotic Depression: A Case Report of Severe Decompensation in the Setting of the COVID-19 Pandemic () - May 5, 2022 - Abstract #APA2022APA_992;
Per family, she regularly used methamphetamine, heroin, and marijuana...Multiple medications were trialed over the 2 month inpatient stay, including zydis, depakote, risperidone, ativan, klonopin, etc., with little therapeutic response...While we may not know the answers on how to overcome these impacts, it is crucial that these issues be discussed so cases like Ms. X’s will end in improved outcomes.
- |||||||||| Neuropsychiatric Manifestations of COVID-19: A Case Report () - May 5, 2022 - Abstract #APA2022APA_990;
We present a case of a 32 y/o Hispanic female, with no PPHx and PMHx of Diabetes Mellitus Type 1 & a positive COVID-19 infection, who initially presented to the ER, brought in by ambulance, due to an overdose of 20 metformin pills...It was recommended that the patient be started on Seroquel 25 mg PO & Melatonin 6 mg PO at bedtime to assist with sleep...Keppra and Ativan were given for the management of seizures...However, it soon became apparent that SARS-CoV-2 was a catalyst to the development of the neuropsychiatric manifestations. This case goes to prove that practicing clinicians should maintain a low threshold of suspicion of neuropsychiatric manifestations when dealing with patients with a history SARS-CoV-2.
- |||||||||| lorazepam / Generic mfg., haloperidol / Generic mfg.
First Do No Harm: Optimizing Medication Use in a Psychiatric Emergency Room to Minimize Morbidity. () - May 5, 2022 - Abstract #APA2022APA_922;
Conclusions : The use of safe and effective pharmacological interventions is one of several important steps in managing agitation and maintaining staff and patient safety in the psychiatric ER. Through the development of a structured initiative, we were able to significantly reduce the prescribing of medications which can impart significant morbidity on our patients.
- |||||||||| lorazepam / Generic mfg., escitalopram / Generic mfg.
Catatonia and Severe Schizophrenia in a 12-Year-Old With a Rare Genetic Mutation () - May 5, 2022 - Abstract #APA2022APA_851;
This case illustrates the detailed management of rare early-onset catatonia and schizophrenia in a 12-year-old boy. Interestingly, it is the first case of these psychiatric disorders in a pediatric patient with progressive cognitive decline associated with a genetic mutation of unknown clinical significance.
- |||||||||| olanzapine / Generic mfg., lorazepam / Generic mfg.
A Case of Ayahuasca-Induced Psychosis () - May 5, 2022 - Abstract #APA2022APA_735;
· Ayahuasca is commonly used in South America for shamanic rituals and ceremonies, and it may produce “mystical experiences”. · It is important to reevaluate these symptoms after the acute intoxication.
- |||||||||| Too Much Too Little Too Late: Chronic Hypercalcemia and Sudden Antidepressant Withdrawal as Risk Factors for Late Onset Mania () - May 5, 2022 - Abstract #APA2022APA_701;
However, due to decreased need for sleep of two to three hours a night, patient was switched to olanzapine 10 mg with lorazepam 2 mg at bedtime...Without a holistic approach, a patient’s manic symptoms may remain refractory to antipsychotic treatment since the underlying cause may be left unaddressed. In this poster, we discuss the laboratory algorithm for assessing hypercalcemia as well as abrupt SSRI dose decreases or discontinuation as risk factors for late onset mania.
- |||||||||| lorazepam / Generic mfg., memantine / Generic mfg.
To Exercise the Right to Exorcise? A Non-Canonical Case of Catatonia () - May 5, 2022 - Abstract #APA2022APA_696;
He improved after a lorazepam trial and was transferred for consideration of ECT...Memantine was subsequently initiated and BFCRS scores dropped to 10... Psychiatrists should be cognizant of the need for informed consent around religious practices and special consideration should be given to any proposed intervention for a patient who cannot provide consent.
- |||||||||| lorazepam / Generic mfg., thyroxine / Generic mfg.
Thyroid Trouble: Catatonia, Delirium, and Severely Elevated TSH () - May 5, 2022 - Abstract #APA2022APA_692;
Additionally, endocrinology recommended levothyroxine 50mcg daily, and three days of methylprednisolone 1000mg daily was started...The aberrant lab results, exam findings, worsening mental status, declining alertness, and multi-organ failure raised concerns for catatonia and/or delirium secondary to hypothyroidism, myxedema coma, or Hashimoto’s encephalopathy. The goal of this poster is to highlight the importance of working with our endocrinology colleagues and identifying thyroid disease as not only a cause of depression and anxiety but also as a potential cause of catatonia, severe altered mental status, multi-organ failure, and death.
- |||||||||| lorazepam / Generic mfg., quetiapine / Generic mfg.
The Mask of Psychiatric Disorders: A Case of Acute Inflammatory Demyelinating Polyneuropathy in Postpartum Psychosis and Bipolar I Disorder () - May 5, 2022 - Abstract #APA2022APA_678;
Here we report a unique case in which a patient was diagnosed with postpartum psychosis and bipolar 1 disorder in addition to paraparesis secondary to AIDP. When confronted with a patient demonstrating a myriad of psychiatric symptoms, behavioral disturbances, and neuropathy, a clinician must persist with essential medical workup and collaborate with other services to consider the possibility of a general medical condition such as AIDP which can become life threatening.
- |||||||||| The Importance of Competent Cultural Care in Psychiatry: When Psychosis, Substance Misuse and Culture Collide () - May 5, 2022 - Abstract #APA2022APA_675;
While en route to the hospital with emergency medical services, he was given Haldol 5 mg, Benadryl 50 mg, and Ativan 2 mg (unknown route of administration) due to combative behavior...With the use of a Spanish translator, the patient explained he had been walking for four days and was using both alcohol and methamphetamine...Throughout hospitalization, the patient was treated aggressively with diazepam for alcohol withdrawal, and each day, he was able to provide a clearer history...This case highlights the importance of not only speaking to patients in their native language to more adequately get thorough histories, but also stresses the importance of understanding cultural aspects of patients (in this case the strong belief in Santa Muerte) and the importance of teasing cultural ideologies apart from primary psychotic symptoms and substance use intoxication or withdrawal. There is a deficiency in publications involving Santa Muerte in relation to psychosis and substance use, so this aims to bring awareness to this cultural ideology in its interaction with mental health as well.
- |||||||||| ketamine / Generic mfg.
Spill the Tea on 5-HT: A Case of Recurrent Serotonin Syndrome in the Setting of Ketamine and ECT () - May 5, 2022 - Abstract #APA2022APA_646;
The etiology of SS was thought to be her antidepressants (duloxetine & mirtazapine), which were held...She responded to lorazepam and supportive measures...The burgeoning use of ketamine in ambulatory settings makes it necessary to elucidate the risks, which we discuss further. More research is needed into the mechanisms of ketamine and ECT, specifically how the combination of these treatments influence 5-HT.
- |||||||||| lorazepam / Generic mfg.
Restoring Power: Dynamic Evolution of Catatonia in the Context of Cerebral Venous Sinus Thrombosis and Hemorrhagic Infarction—a Case Presentation () - May 5, 2022 - Abstract #APA2022APA_624;
Subsequent lorazepam titration, heparin administration, and additional medication trials did not produce clinical improvement over the next six weeks...Thus, ruling out CVST may be an appropriate part of the neuromedical workup for presentations of secondary catatonia, especially when not responsive to other mobilizing interventions. Our case demonstrates catatonia in the context of CVST, a phenomenon sparsely described in the literature that could potentially be a rare contributor to catatonic motor behavior.
- |||||||||| risperidone / Generic mfg., olanzapine / Generic mfg., lorazepam / Generic mfg.
Psychiatric Comorbidities in Infectious Diseases () - May 5, 2022 - Abstract #APA2022APA_607;
Thus both the literature and the aforementioned case indicate that physicians must maintain a high degree of suspicion for an infectious process as a potential underlying cause of novel or re-emergent psychosis. However, this remains an open hypothesis and should be explored further.
- |||||||||| lorazepam / Generic mfg., diazepam / Generic mfg.
Onset of Benzodiazepine Withdrawal Catatonia During Electroconvulsive Therapy for Treatment-Resistant Depression () - May 5, 2022 - Abstract #APA2022APA_581;
Prior to admission, she had been taking 30 mg of diazepam daily for greater than ten years for anxiety, with prior unsuccessful attempts to taper due to intolerable increases in anxiety...Her catatonia symptoms improved in response to a lorazepam challenge of 2 mg, and the catatonia symptoms continued to improve on lorazepam 2 mg three times a day while continuing to receive ECT...We review the current literature behind benzodiazepine withdrawal catatonia, including proposed pathophysiological mechanisms and general treatment guidelines. Although this report features just one case, our hope is that this information will enable clinicians to consider catatonia on the differential whenever benzodiazepines are tapered–even in patients already receiving a course of ECT–particularly when there is a history of long-term benzodiazepine use.
- |||||||||| Trintellix (vortioxetine) / Lundbeck, Takeda
New Onset Panic Disorder Following an Infection With COVID-19 () - May 5, 2022 - Abstract #APA2022APA_570;
Despite the fact that the patient has been already on psychiatric medications (Gabapentin, Lorazepam, Amitriptyline and Escitalopram), in order to control her new condition, the medications were gradually tapered and changed to a different class of medications (Olanzapine and Duloxetine). Other case report studies with panic disorder onset following COVID-19 infection have also had positive outcomes with patients taking Vortioxetine (9), Paroxetine (10) and Sertraline (11).
- |||||||||| lorazepam / Generic mfg., quetiapine / Generic mfg., ziprasidone / Generic mfg.
Management of Acute Mania in Patients With COVID-19 on Medical Floors: Pearls and Pitfalls () - May 5, 2022 - Abstract #APA2022APA_539;
Conclusion Managing patients with acute mania on medical floors is difficult under normal circumstances, and if that patient has COVID-19, the balance of appropriately treating the patient for their psychiatric condition while mitigating risk of infection of others becomes even more precarious. We propose utilizing rational aggressive polypharmacy when managing acute manic patients with COVID 19 on medical floors.
- |||||||||| risperidone / Generic mfg., lorazepam / Generic mfg.
Long Post-Covid Psychosis: A Case Report () - May 5, 2022 - Abstract #APA2022APA_536;
In our case, such a presentation may have been a combination of a family history of autoimmunity, psychosocial stressors, and COVID-19 infection. We review the connections between pathogens and psychosis and review the major proposed etiologies of post viral psychosis including the mechanism of post-viral autoimmunity, which may have played a role in our case.
- |||||||||| lithium carbonate ER / Generic mfg.
Lithium and Its Side Effects, a Case Study () - May 5, 2022 - Abstract #APA2022APA_533;
He was initially started on Lithium over 30 years ago after experiencing an episode of paradoxical increased agitation when he took one dose of Ativan...At the time of this report, this patient has begun tapering off of Lithium and on an upward titration of Lamictal, off label, for the target symptom of irritability. Treatment goals for this patient include complete discontinuation of Lithium to avoid any further renal insult, regaining of his ability to concentrate his urine with resolution of Lithium induced nephrogenic diabetes insipidus, normalization of parathyroid stimulating hormone and secondarily normalization of calcium metabolism.
- |||||||||| Lennox-Gastaut Syndrome: A Case Report and Literature Review () - May 5, 2022 - Abstract #APA2022APA_525;
Therefore, it is important to understand the complexity in trying to provide symptomatic relief to LGS patients. Despite seeing the majority of cases lead to moderate - to - severe cognitive impairment within the first 5 years, targeting LGS and its surrounding neurocognitive problems individually and holistically, can improve the lives of the patients, but also in the lives of their families.
- |||||||||| Informed Consent as a Barrier to Electroconvulsive Therapy in the Management of an Incapacitated Patient With Malignant Catatonia () - May 5, 2022 - Abstract #APA2022APA_508;
At the OSH, she initially received olanzapine and quetiapine for confusion and agitation...Antipsychotics were held, and she was started on lorazepam then diazepam for concern of catatonia versus neuroleptic malignant syndrome...Legislation around emergent ECT for malignant catatonia should be evaluated to decrease barriers in facilitating lifesaving treatment. Conclusion Emergent ECT should be considered in patients with malignant catatonia, even when patients are unable to consent and have no alternate decision makers.
- |||||||||| lorazepam / Generic mfg., levetiracetam / Generic mfg.
Blue Lotus-Associated Epilepsy and Amnesia in Active Duty Servicemember () - May 5, 2022 - Abstract #APA2022APA_383;
Blue Lotus is easily obtained, undetectable by routine drug screen, and has the potential to provoke seizures, retrograde amnesia, and akathisia in an otherwise young and healthy individual. Recognizing these devastating drug complications is critical for medical providers to provide appropriate care.
- |||||||||| lorazepam / Generic mfg.
A Case on Cannabis Induced Catatonia () - May 5, 2022 - Abstract #APA2022APA_327;
Case We discuss a case describing a 19-year-old female with no past medical or psychiatric history who was admitted and treated with IV lorazepam for catatonia...Recommendations are needed in regards to safe levels of cannabis consumption in order to tailor treatment approaches and prevent the chances of cannabis-induced catatonia. All of these modifications, are therefore, crucial in the implementation, specifically of, cannabis-induced catatonia, or substance-induced catatonia, into the DSM-V.
- |||||||||| A Case of Recurrent Intentional Foreign Body Ingestion and Psychogenic Nonepileptiform Seizures in a Forensic Patient () - May 5, 2022 - Abstract #APA2022APA_323;
For a preliminary diagnosis of unspecified depression and ongoing insomnia, he was started on sertraline 50 mg daily as he refused mirtazapine...This is demonstrated by the patient’s ability to have two additional ingestion episodes despite continuous one-to-one monitoring. Reimagining patient care settings that can better handle acute medical and psychiatric disease, in coordination with a multidisciplinary approach, may be cost-saving and could holistically improve the care of these complex patients [5].
- |||||||||| Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
A Case of Chronic Hashimoto Encephalopathy With Delayed Treatment Due to Psychiatric Symptoms () - May 5, 2022 - Abstract #APA2022APA_319;
However, over the next several months she presented several times with worsening manic and psychotic symptoms including elevated mood, flight of ideas, increased speech rate, decreased need for sleep, excessive spending, grandiose delusions, and paranoia and was diagnosed with bipolar disorder and started on lithium, olanzapine, and lorazepam though ultimately only improved after index course of electro-convulsive treatment (ECT)... This case highlights the importance of proper diagnosis and treatment of chronic Hashimoto encephalopathy despite underlying psychiatric symptoms.
- |||||||||| Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
“Say What?” Hashimoto’s Encephalopathy and Anti-NMDA Receptor Encephalitis in a 16-Year-Old Presenting With Dysarthria () - May 5, 2022 - Abstract #APA2022APA_313;
She was treated with several days of high dose steroids and olanzapine for unusual behaviors and insomnia with initial improvement in symptoms and was discharged home at her family’s request to continue treatment in the outpatient setting...She was then treated with IVIG and rituximab in addition to lorazepam for catatonia...Fortunately, our team was able to establish a good rapport with her family, and ultimately, they followed up with members of our team for two years until she moved to college. The importance of cultural competency will be woven into the content of our discussion throughout the poster as it pertains to the work up and the treatment of altered mental status.
- |||||||||| morphine sulphate / Generic mfg., lorazepam / Generic mfg.
Journal: Adult Medical Cannabinoid Use and Changes in Prescription Controlled Substance Use. (Pubmed Central) - Apr 30, 2022
Unadjusted analyses did not find significant changes in either morphine equivalents (p=0.81) or lorazepam equivalents (p=0.980), and patients similarly received relatively low doses of THC (2.32 mg/day) and CBD (2.24 mg/day). Findings demonstrated minimal to no change in either opioids or sedative hypnotics over the 6 months of medical cannabis use but may be limited by low retention rates, external generalizability, and an inability to account for nonprescribed substance use.
- |||||||||| lorazepam / Generic mfg., haloperidol / Generic mfg.
Retrospective data, Journal: Efficacy of Combination Haloperidol, Lorazepam, and Diphenhydramine vs. Combination Haloperidol and Lorazepam in the Treatment of Acute Agitation: A Multicenter Retrospective Cohort Study. (Pubmed Central) - Apr 26, 2022
Findings demonstrated minimal to no change in either opioids or sedative hypnotics over the 6 months of medical cannabis use but may be limited by low retention rates, external generalizability, and an inability to account for nonprescribed substance use. Both the B52 and 52 combinations infrequently required repeat agitation medication; however, the B52 combination resulted in more oxygen desaturation, hypotension, physical restraint use, and longer length of stay.
- |||||||||| olanzapine / Generic mfg., lorazepam / Generic mfg., clozapine / Generic mfg.
Journal, Real-world evidence: Maintenance Therapy of Psychosis Spectrum Disorders in a Real-World Setting: Antipsychotics Prescription Patterns and Long-Term Benzodiazepine Use. (Pubmed Central) - Apr 26, 2022
The highest rate of long-term AP co-prescription was found for BZD (in 42.7% cases, average 6-months daily dose of 2.8 ± 2.7 mg lorazepam equivalents) and anticholinergics (33.6%). Existing appropriately designed interventions aiming to safely switch the inappropriate therapeutic regimens, i.e. very high prevalence of long-term AP polypharmacy and non-rational BZD co-prescription, should be implemented in the region of Western Balkans.
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