A 23-year-old Japanese woman was brought to the emergency department about 6.5 h after taking liquid and later a half tablet purchased on the street. About 4.5 h prior to presentation, she displayed excited and disorganized behavior. On examination, she was not alert or oriented, with a Glasgow Coma Scale score of 13, did not answer any questions from doctors while smirking and looking around restlessly, and sometimes exhibited echolalia, imitating the speech of doctors. She was given intravenous infusion of fluid for 8 h, then discharged. Gas chromatography-mass spectrometry of urine revealed 5-methoxy-diisopropyltryptamine, 5-methoxy-N-methyltryptamine and an unidentified tryptamine. Identifying chemical products based solely on information of users is insufficient, and urinalysis is necessary in cases potentially involving designer drugs.

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BackgroundIdiopathic pulmonary arterial hypertension (IPAH) is a progressive and fatal cardiovascular disease if left untreated. In patients with IPAH with psychiatric illness or other complications, careful attention is required when administering medical therapies that may affect their hemodynamics. Patients suffering from IPAH who undergo anesthesia and surgery have a high mortality and morbidity rate. We describe the treatment of intractable psychiatric symptoms with electroconvulsive therapy (ECT) in a patient with IPAH.Case presentationA 23-year-old woman with IPAH and type I diabetes mellitus (DM) presented with malignant catatonia. Her heart function was classified as New York Heart Association (NYHA) class III. She required a rapid cure and ECT due to various psychiatric symptoms resistant to conventional medications. Pulmonary hypertensive (PH) crisis is the most concerning complication that can be induced by the sympathetic stimulation of ECT. To avoid PH crisis, we administered oxygen using a laryngeal mask and administered remifentanil for anesthesia. We also prepared standby nitric oxide for possible PH crisis, although it was ultimately not needed. With 14 ECT sessions, her malignant catatonia was ameliorated without physical complications.ConclusionECT is an acceptable option for the treatment of medication-refractory psychiatric disturbances in patients with IPAH, provided careful management is assured to prevent or address complications.

showed that treatment with bumetanide or placebo had no significant effect on BPRS score in patients, F(1, 24) = 0.062, P = 0.805. Similar to previous reports, 2 assessment of treated patients 2 months after bumetanide intake revealed that both bumetanide and placebo had no serious side-effects based on a prepared checklist.These study data have some limitations. First, the effect of bumetanide on patients with schizophrenia was not investigated on a specific symptom. Second, the dose of bumetanide 2 mg/day may be inadequate to show biological effects. Further studies are required to address these issues and to show the actual effect of bumetanide on schizophrenia. Fifteen patients (3 men and 12 women; age: 55.9 AE 13.9 years) receiving HBO 2 treatment for their underlying illnesses (maxillary osteomyelitis, n = 9; radiation injury, n = 2; spinal canal stenosis, n = 4) were recruited to this study after their informed consent was obtained. The anonymity of patients was preserved throughout the study. Sleep quality indices were calculated using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J), 3 the Epworth Sleepiness Scale (JESS), 4 the Visual Analog Scale (VAS), and actigraphy. Each of the 15 subjects was tested before starting the first HBO 2 treatment (pre) and after no more than five (short) treatments. Nine subjects were also tested after 20 (long) HBO 2 treatments. Statistical comparisons were performed using the Wilcoxon Signed Rank test. DISCLOSURE STATEMENTFollowing the short treatment, we observed an overall improvement in sleep indices, as indicated by significant improvements in the total PSQI-J score (pre: 7.7 vs short: 6.3, P = 0.041), in addition to significantly lower sleep onset latency (pre: 1.8 vs short: 1.1, P = 0.013), which was consistent with the actigraphy results (pre: 10.1 min vs short: 6.2 min, P = 0.016). Following the long treatment, we observed significant improvements in the total PSQI-J score (pre: 7.7 vs long: 5.0, P = 0.016), sleep quality (pre: 1.5 vs long: 0.9, P = 0.025), and daytime dysfunctions subscales (pre: 0.7 vs long: 0.3, P = 0.025), as well as in the total JESS score (pre: 8.3 vs long: 5.7, P = 0.037). We used the VAS to assess fatigue and pain, and observed a significant improvement in fatigue after both short (P = 0.009) and long HBO 2 treatments (P = 0.035), and in pain after the long treatment (P = 0.018) but not after the short treatment.With regard to the better sleep indices observed after the long treatments, we cannot exclude the possibility that this improvement is mediated by the alleviation of their original symptoms, primarily pain, rather than having a direct effect on sleep itself. However, the shorter sleep onset latency observed after the short treatment appears to be the immediate effect of HBO 2 treatment rather than an indirect effect, as the pain had not subsided in the short treatment period. Although this preliminary study is limited by the lack of a control group, our findings suggest that HBO 2 is a potential novel therapeu...