- |||||||||| Intellectual Disability With Perimenstrual Psychosis and Catamenial Catatonia: Diagnostic and Management Challenges (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_918;
Antipsychotics were discontinued, catatonia was treated with intravenous lorazepam and the residual cogwheel rigidity secondary to the intramuscular antipsychotics received in the emergency department for disorganized behavior was managed by intramuscular benztropine that afforded symptom relief...She was discharged on quetiapine 75 mg nightly...(3) Clinicians are encouraged to screen women for menstrual psychosis as the treatment is not confined to antipsychotics and the prognosis is satisfactory when adequately treated. In this poster, we aim to discuss the challenges of diagnosing and managing perimenstrual psychosis and catamenial catatonia in an intellectually disabled patient.
- |||||||||| risperidone / Generic mfg., lorazepam / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
Anti-NMDA Receptor Encephalitis in the Late Postpartum Period (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_892;
She subsequently developed catatonia, so risperidone was discontinued and lorazepam was initiated...Her encephalitis was treated with a five-day course of intravenous methylprednisolone...This case illustrates that anti-NMDAR encephalitis should remain in the differential diagnosis even if the symptom timeline is atypical. This poster will explore treatment options, disease course, and relapse rates of anti-NMDAR encephalitis in antepartum and postpartum patients.
- |||||||||| Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
Inpatient Hospital Course and 3 Month Follow-Up of Anti-NMDA Receptor Encephalitis: A Case Report and Literature Review (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_842;
She was discharged on a regimen of aripiprazole, clonazepam, benztropine, and hydroxyzine...She was started on a regimen of olanzapine, chlorpromazine, valproic acid, and lorazepam to manage her complex psychiatric symptoms and behaviors...She was discharged on tenofovir, valproic acid 1750mg total daily dose, and lorazepam 1mg nightly with plan for a second rituximab infusion 2 weeks after discharge and psychiatric follow up...From the case described above, it is evident that neuropsychiatric symptoms can persist greater than 3 months following initiation of immunologic treatment. The recurrence and relapse rate after the initial treatment remains unclear, which warrants clinical and research attention to study neuropsychiatric symptom persistence and effective neuropsychiatric treatment regimen for anti-NMDA receptor encephalitis.
- |||||||||| Comorbid Opioid Use Disorder in Body Dysmorphic Disorder (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_815;
It is interesting to note that only 6% of BDD patients had Opioid Use Disorder, but as this case demonstrates, can be a debilitating comorbidity that raises the risk for suicidality or hospitalization. However, little research has been done on the treatment of OUDs in patients with BDD or on the treatment of BDD in patients with an SUD, and this is an area of research that could benefit the modern population greatly.
- |||||||||| olanzapine / Generic mfg., lorazepam / Generic mfg.
Transient First-Episode Psychosis in an Adolescent With Recent Sars-Cov-2 Infection (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_788;
We also discuss the differences in neuropsychiatric presentations based on etiology, including multisystem inflammatory syndrome and toxic encephalitis. There is a paucity of literature examining these relationships, particularly in this patient population, emphasizing the need for further studies exploring the temporal relationship and pathophysiology of neuropsychiatric symptoms and SARS-CoV-2 infection in adolescents.
- |||||||||| trimethoprim/sulfamethoxazole / Generic mfg., lorazepam / Generic mfg.
An Unusual Case of Catatonia Onset From Acute UTI in a Patient With a History of Depression (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_735;
Patient was prescribed bactrim for a UTI the day before psychiatric admission...Objective screening with Bush Francis rating scale showed worsening of catatonia features in the presence of UTI symptoms. We explore this unique case to discuss the challenges and importance of managing complex catatonia features in patients
- |||||||||| lorazepam / Generic mfg., quetiapine / Generic mfg.
Acute Hyperactive Delirium Followed by Excited Catatonia: A Case Study (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_733;
It is possible for a patient with clinical improvement and resolution of acute hyperactive delirium to develop excited catatonia in a short time, so clinicians need to have a high index of suspicion especially among patients who have a history of catatonia. Given that hyperactive delirium alone responds excellent to antipsychotics while excited catatonia responds excellent to lorazepam IV, early diagnosis is of utmost important to adjust medications at the earliest time of noticing symptoms of excited catatonia.
- |||||||||| Seizalam (midazolam intramuscular) / Pfizer
A New Challenge for Midazolam: Treatment of Catatonia (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_729;
Her hospital course included psychotic behavior and agitation requiring restraints in addition to olanzapine, midazolam, and oral lorazepam...She eventually transitioned to scheduled oral lorazepam and haloperidol, which effectively treated her catatonia and psychosis...In the setting of high Bush-Francis scores and lack of established guidelines, we used midazolam to diagnostically evaluate and treat the patient, and then transitioned her to oral lorazepam. Implications - During a national shortage of parenteral lorazepam, the gold standard treatment for catatonia, we suggest a rapid-acting, affordable, accessible alternative treatment - IM midazolam proved an effective alternative to IV or IM lorazepam to assess for likelihood of a catatonia diagnosis and predict response to benzodiazepines - Future directions should include best practice guidelines for alternative management for catatonia other than lorazepam
- |||||||||| Posterior Reversible Encephalopathy Syndrome Presenting as Delirium With Psychosis/Agitation (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_700;
Implications - During a national shortage of parenteral lorazepam, the gold standard treatment for catatonia, we suggest a rapid-acting, affordable, accessible alternative treatment - IM midazolam proved an effective alternative to IV or IM lorazepam to assess for likelihood of a catatonia diagnosis and predict response to benzodiazepines - Future directions should include best practice guidelines for alternative management for catatonia other than lorazepam In the ED, she received labetalol and magnesium sulfate and was admitted to the OB/GYN service, which recommended an emergent cesarean section due to eclampsia and fetal malpresentation...She required intramuscular Haloperidol, Diphenhydramine, and Lorazepam, was placed in restraints, transferred to the ICU, and sedated with Dexmedetomidine...The case also speaks to the importance of differentiating primary postpartum psychosis from delirium, as the consequences of misdiagnosing delirium as postpartum psychosis can lead to delays in treating a delirious patient
- |||||||||| Challenges in Recognizing and Treating Prolonged Zolpidem Withdrawal: A Case Report (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_666;
The patient had abruptly discontinued multiple medications, including lorazepam, hydrocodone/acetaminophen, and tramadol, several days prior to admission...Clonazepam is suggested to have a better outcome for benzodiazepine GABA-ergic withdrawal, while diazepam is better for alcohol withdrawal...There is minimal literature on recognizing symptoms in the early and prolonged time course, complications, and treatment of zolpidem withdrawal. In this case, we provide a comprehensive overview of the importance of collateral material for critical patient information, allowing an extended time course for disease resolution, and interventions for GABA-ergic withdrawal due to zolpidem overuse.
- |||||||||| phentermine / Generic mfg.
A Case of Phentermine-Induced Psychosis: The Need for Caution for Drug-Drug Interactions (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_649;
Her psychiatric symptoms were stable with oral fluoxetine 60 mg daily, oral aripiprazole 2mg daily, oral amitriptyline 100mg at night, and oral lorazepam 1mg daily...Due to QTc prolongation oral trazodone 50mg daily was started instead of amitriptyline. Our case demonstrates the caution needs to be taken when prescribing phentermine not only for its neuropsychiatric side-effects but also for drug-drug interactions.
- |||||||||| bupropion / Generic mfg.
Unintentional Bupropion Overdose in a 13 Year Old Presenting as Psychosis (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_643;
Adolescents are at risk for both accidental and intentional overdose and present with more severe toxicity. Early recognition, a collaboratiive, multidisciplinary approach, and appropriate level of care based on symptomatology is required for its optimal management.
- |||||||||| Abilify Maintena (aripiprazole depot formulation) / Otsuka, Lundbeck
Treatment Success With LAI Aripiprazole in a Schizoaffective 84-Year-Old (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_640;
She had been trialed on multiple medications including sertraline, mirtazapine, buspirone, lorazepam, and aripiprazole...She presented to a specialized geriatric psychiatric clinic with elevated mood, irritability, delusions, rapid speech, verbal aggression, disorganized behaviors, decreased sleep, and grandiosity, on an ineffective regimen of oral daily risperidone... This case highlights that aripiprazole long-acting monthly injections can be effective and well tolerated in treating schizoaffective disorder in the geriatric population.
- |||||||||| olanzapine / Generic mfg.
Food and Drug Therapy: High-Dose Olanzapine and Family-Centered Exposure Intervention for Complicated and Refractory Psychosis in an Adolescent Male (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_602;
After this initial psychiatric hospitalization and a negative neurologic workup, the patient was started on benztropine twice daily for EPS and lorazepam three times daily for catatonia before arriving at our psychiatric facility...While family-based interventions have shown efficacy in treating adolescents with psychiatric conditions such as OCD and anxiety, this modality can also augment regimens for severe and refractory psychosis in adolescents in the acute inpatient setting before resorting to clozapine or ECT. This case highlights how combination pharmacotherapy and psychosocial modalities can significantly reduce resistant delusions and help progress adolescents with complicated psychosis towards earlier discharge.
- |||||||||| aripiprazole / Generic mfg.
Aripiprazole-Induced Neutropenia in a Patient With Early Psychosis Complicated by Catatonia (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_580;
She was ultimately discharged to a residential substance use treatment program. This poster presents a rare case of aripiprazole-induced neutropenia and explores a treatment strategy to successfully manage a complicated combination of medico-psychiatric syndromes and comorbidities.
- |||||||||| lorazepam / Generic mfg.
A Curious Case of Catatonia (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_574;
ECT is not available at our hospital and despite high doses of lorazepam, his presentation continued to fluctuate between stuporous, excited, and malignant states...We present a complex case of a patient with recurrent catatonia whose symptoms fluctuated between excited, stuporous, and malignant states that required 2 prolonged hospitalizations at different hospitals with complications including pneumonia, sepsis, intubation, rhabdomyolysis, ICU admission which required a multidisciplinary cooperation between psychiatry, neurology, ICU, and medicine, with enormous help from nursing. We will review the patient
- |||||||||| Caplyta (lumateperone) - Intra / Cellular Therapies
Use of Electroconvulsive Therapy (ECT) to Treat Delirious Mania in a 57-Year-Old Man (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_560;
We will review the patient Prior psychiatric medications included lithium, divalproex, ziprasidone, risperidone, lumateperone, lorazepam, diazepam, clonazepam, and benztropine...By the time of discharge the patient
- |||||||||| lorazepam / Generic mfg.
Understanding the Relationship Between Delirium and Catatonia in the Clinical Setting: A Case Report (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_559;
On day six, the patient was alert, oriented, and showing minimal signs of catatonia or delirium, albeit significant confusion over her hospital course. This case suggests a relationship between delirium and catatonia and brings attention to an issue that is fairly common in the clinical setting and may be under-recognized.
- |||||||||| lorazepam / Generic mfg.
Psychotic Manifestation of Complex Partial Seizure: A Case Report (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_540;
She responded well to a trial of Lorazepam...A high index of suspicion is needed for patients with atypical presentations of seizure disorders to properly manage and prevent future seizure episodes. Clinicians should be aware that seemingly psychiatric presentations may be manifestations of underlying seizure disorders.
- |||||||||| olanzapine / Generic mfg., lorazepam / Generic mfg.
LSD Induced Catatonia? A Case Report (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_519;
Clinicians should be aware that seemingly psychiatric presentations may be manifestations of underlying seizure disorders. Patient
- |||||||||| risperidone / Generic mfg., lorazepam / Generic mfg.
Excitatory Catatonia and First Episode Psychosis in a Child With Autism Spectrum Disorder (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_507;
Given high risk of mortality, it is imperative to have high clinical suspicion of excitatory catatonia in non-verbal patients with ASD who appear to have a significant change in baseline behaviors. Further research is needed to clarify the relationship between ASD, Psychosis and Catatonia.
- |||||||||| Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
A Case of Post-Covid-19 Anti-NMDA Receptor Encephalitis With Catatonic Features (Hall B Foyer, Exhibition Level Moscone South) - May 17, 2023 - Abstract #APA2023APA_490;
Although standard treatments such as steroids, IVIG, PLEX & Rituximab proved ineffective in this case, Lorazepam helped reduce symptoms. Therefore, we recommend that the Lorazepam trial should be considered in the setting of catatonia in post-Covid-19 anti-NMDA receptor encephalitis.
- |||||||||| lorazepam / Generic mfg.
Journal: Efficacy of a pre-specified timeline-based treatment protocol in children with acute repetitive seizures or seizure clusters. (Pubmed Central) - May 14, 2023
The first tier of treatment protocol focused on intravenous lorazepam, optimization of dose of existing anti-seizure medications (ASMs), and control of triggers like acute febrile illness, while second-tier focused on adding one or two additional ASMs, commonly used in cases with seizure clusters or status epilepticus...This pre-specified treatment protocol is safe and efficacious in controlling ARSs in cases with established epilepsy who are not critically sick. External validation from other parts of the world/centers and a more diverse epilepsy population are required before generalizing the protocol into clinical practice.
- |||||||||| BNC210 / Bionomics
A Phase 2, Double-Blind, Placebo-Controlled Study for BNC210, an Alpha7 Nicotinic Receptor Negative Allosteric Modulator (NAM) for the Acute Treatment of Social Anxiety Disorder (PREVAIL): Top-Line Efficacy and Safety Results (Salon 4) - May 9, 2023 - Abstract #ASCP2023ASCP_379;
Learning Objectives What is the mechanism of action of BNC210 in the treatment of social anxiety disorder? What are the top-line results of PREVAIL, a randomized, double-blind, placebo-controlled, 3-arm, parallel-group, multi-center Ph2 study?
- |||||||||| lorazepam / Generic mfg.
Clinical, Journal: Lorazepam use during clinical trials of adults with bipolar mania episodes. (Pubmed Central) - May 2, 2023
Intake enrollment was strikingly restricted only in placebo-controlled trials that used pretrial drug wash-out. Medication treatment conclusions from placebo-controlled, drug washout trials are not representative of clinical treatment for acute bipolar mania.
- |||||||||| Quantifying Benzodiazepine Effects Using Actigraphy: First Evidence from a Psychiatric Inpatient Cohort (Sapphire AB) - Apr 29, 2023 - Abstract #SOBP2023SOBP_312;
We found significant differences in activity at 2.6 -4.1h post-administration for Diazepam, 0.8 - 6.8h post-administration for Lorazepam (N=189/39) and 1.8 -7.5h post-administration for Clonazepam (N=121/9)...Detectable duration of BZD action is close to previous estimates. Sleep duration is not affected in an inpatient setting, while sleep fragmentation is reduced after Clonazepam administration.
- |||||||||| Spravato (esketamine intranasal) / J&J
Journal: Oral and Intranasal Ketamine Use in Treatment-Resistant Catatonia: A Clinical Case Report. (Pubmed Central) - Apr 29, 2023
She did not require acute hospitalization in the months that followed. CONCLUSIONS This case highlights a potential use of sublingual ketamine and esketamine nasal spray as a treatment option in patients with chronic catatonia when other treatment choices fail to be effective.
- |||||||||| Nitredon (nitrazepam) / Remedica
Preclinical, Journal: LC-Q-TOF/MS-based Fragmentation Behavior Study and In vitro Metabolites Identification of Nine Benzodiazepines. (Pubmed Central) - Apr 28, 2023
CONCLUSIONS This case highlights a potential use of sublingual ketamine and esketamine nasal spray as a treatment option in patients with chronic catatonia when other treatment choices fail to be effective. These experimental data add to our knowledge of the nine benzodiazepine drugs and their metabolism study, which could provide useful information and evidence of their in vivo metabolic profile prediction and help promote their monitoring in both clinical use and social/illegal abuse.
- |||||||||| Recentin (cediranib) / AstraZeneca
Trial completion date, Trial primary completion date, Monotherapy, Metastases: Sunitinib or Cediranib for Alveolar Soft Part Sarcoma (clinicaltrials.gov) - Apr 24, 2023
P2, N=34, Active, not recruiting,
These experimental data add to our knowledge of the nine benzodiazepine drugs and their metabolism study, which could provide useful information and evidence of their in vivo metabolic profile prediction and help promote their monitoring in both clinical use and social/illegal abuse. Trial completion date: Apr 2023 --> Mar 2024 | Trial primary completion date: Apr 2023 --> Mar 2024
- |||||||||| ceftriaxone / Generic mfg., clindamycin phosphate / Generic mfg., lorazepam / Generic mfg.
GROUP A STREPTOCOCCAL MENINGITIS : A CASE REPORT (E-Poster Area) - Apr 21, 2023 - Abstract #ESPID2023ESPID_646;
He presented an episode of generalized tonic clonic seizures which stopped after 2 doses of lorazepam (0.1 mg/kg)...Blood cultures and lumbar punction were taken, chest tube placed, and IV ceftriaxone (100 mg/kg q24h) treatment was started...Adjunctive therapy with IV clindamycine (20 mg/kg/day q8h) and IVIG (2g/kg) was immediately started...This case reminds us of the possibility of GAS meningitis without other foci of infection. This might be especially relevant in a context of raising concerns about iGAS in Europe.
- |||||||||| lorazepam / Generic mfg.
Psilocybin for the Treatment of Obsessive Compulsive Disorder (Salon 4) - Apr 15, 2023 - Abstract #ASCP2023ASCP_238;
Moreover, in the context of supervised clinical research, psilocybin was safe and well-tolerated, and reduced OCD symptoms to a greater extent than the active control lorazepam. Learning Objectives - to describe preliminary efficacy of psilocybin in the treatment of OCD; - to describe subjective experience during treatment and symptom change
- |||||||||| lorazepam / Generic mfg., metoclopramide / Generic mfg.
Gastric Electrical Stimulation as a New Treatment Modality for Rumination Syndrome () - Apr 6, 2023 - Abstract #AFMRSER2023AFMR_SER_36;
Her anxiety was addressed by Lorazepam and a tricyclic antidepressant...GES is effective in reducing nausea and vomiting in gastroparesis but there is essentially no data available that detail the efficacy of GES in patients without gastroparesis. This case is a unique example demonstrating that GES is a safe and effective treatment modality for intractable nausea and vomiting as well as potentially a new therapy for patients with severe RS.
- |||||||||| phenobarbital / Generic mfg.
Retrospective data, Review, Journal: Phenobarbital in Status epilepticus - Rediscovery of an effective drug. (Pubmed Central) - Apr 4, 2023
Thus, despite its decline in its popularity at least in Europe and North America, it should be considered a highly cost-effective treatment for early and established SE, not only in resource-limited settings. This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022.
- |||||||||| lorazepam / Generic mfg., midazolam hydrochloride / Generic mfg.
Clinical Pearls (Centennial III; Virtual) - Apr 2, 2023 - Abstract #AAPP2023AAPP_80;
Review first-line treatment options for autoimmune encephalitis. Identify the role of psychotropic medications and psychiatric pharmacists in acute and chronic management of autoimmune encephalitis.
- |||||||||| riluzole / Generic mfg., lorazepam / Generic mfg.
Catching Your Breath With ALS: A Rare Case of Bilateral Diaphragmatic Paralysis (Walter E. Washington Convention Center, Area G, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8642;
He required 1 mg lorazepam prior to imaging due to claustrophobia...He was diagnosed with ALS, started on riluzole, and maintained on AVAPS nightly.DISCUSSION Although the prevalence of diaphragmatic paralysis is unknown, unilateral diaphragmatic paralysis is more common...Diagnosis of bilateral diaphragmatic paralysis is confirmed when symptoms are consistent with inspiratory muscle weakness, bilateral elevated hemidiaphragms on chest x-ray, no movement of hemidiaphragms on sniff test, and evidence of reduced FVC and/or VC on PFT. Treatment is ventilatory support, invasive or noninvasive.
- |||||||||| lorazepam / Generic mfg., clonidine / Generic mfg.
Central Hypoventilation in a Child With SARS-CoV-2 Infection: A Diagnostic Challenge (Walter E. Washington Convention Center, Area H, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8273;
His course was complicated with apnea without respiratory distress followed by generalized tonic-clonic seizure aborted with lorazepam...Further work-up showed high prolactin and low growth hormone (GH) levels with poor response of GH to clonidine stimulation (Figure)... SARS-CoV-2 infection was the precipitating trigger in our patient
- |||||||||| Keytruda (pembrolizumab) / Merck (MSD)
Nonconvulsive Status Epilepticus Due to Thyroid Storm in a Patient With Lung Cancer on Pembrolizumab (Walter E. Washington Convention Center, Area K, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_8057;
Regarding his cancer, the patient completed three cycles of paclitaxel and carboplatin with partial response; Pembrolizumab was added on the second cycle...Patient was started on empiric antibiotic with Zosyn...Burch-Wartofsky point scale (BWPS) of 80 and patient was started on betablockers, methimazole, cholestyramine, and steroids...Seizures improved with levetiracetam and lorazepam, mental status returned to baseline, chemotherapy was held, and he was discharged...This case highlights the potential neurotoxicity of checkpoint inhibitors in patients with lung cancer. Prompt clinical recognition of NCSE and appropriate management of the underlying causes are paramount for patients.
- |||||||||| All That Wheeze Is Asthma, so Why Is My Primatene Mist Making My Asthma Worse? (Walter E. Washington Convention Center, Area A, Hall C (Lower Level)) - Mar 25, 2023 - Abstract #ATS2023ATS_7954;
Prompt clinical recognition of NCSE and appropriate management of the underlying causes are paramount for patients. It is inhaled epinephrine which is a potent alpha and beta receptor agonist...Post intubation, she had a seizure that responded to Ativan...She was discharged home on nifedipine XL (given her history of Raynaud
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