IntroductionAntidepressants can induce SIADH and it can be a serious complication. It is frecuently asociated with SSRIs (Selective Serotonin Reuptake Inhibitors) but this syndrome can be caused by another antidepressants, drugs and another causes can be involved.ObjectivesWe report the clinical course of an antidepressants induced SIADH with SSRIs and Mirtazapine and propose psychopharmacologic alternatives.MethodsWe describe the case of a 25 years old man, hypertensive in treatment with thiazides, polytraumatized as a result of a suicide attempt. The patient was treated with Sertraline and a SIADH occurred. Stopped Sertraline and diuretics and then, the patient was treated with Mirtazapine and Bisoprolol but hyponatremia was persistent. Then we use Trazodone and the sodium levels were normalized.ResultsHyponatremia is a potentially dangerous side effect of antidepressants and is not exclusive to SSRIs. Current evidence suggests a relatively higher risk of hyponatremia with SSRIs and venlafaxine, especially when combined with patient risk factors. In our case, the risk was increased by the polytrauma and thiazide diuretics. Although, according to the literature, the risk associated with mirtazapine is moderate, in our case, hyponatremia was persistent and sodium levels were normalized when stopped Mirtazapine and started Trazodone.ConclusionWe have to take into account risk factors associated with SIADH and modify them as far as possible. Trazodone could be an alternative treatment for patients with SIADH.

IntroductionOpioids modulate dopaminergic transmission in the pathophysiology of psychosis. Methadone, a pure agonist opioid synthetic contains a slightly higher potency, a longer lasting duration and reduced euphoric effect. Opiates may contain beneficial effects on psychosis. We report a case of psychosis after a complete opiate withdrawal.ObjectivesTo describe the possible antipsychotic effects of methadone on a patient who displays psychotic symptoms following the cessation of this treatment.MethodsX is a 35 year old female ex-heroin addict who came into the psychiatry emergency because of a psychomotor agitation episode. The patient reported delusions and impaired sensory perception with a behavioural change coincided with the cessation of methadone treatment.ResultsDuring admission, the patient’s condition consisted of injuries and erotomanic delusions partial structure. Furthermore, there were delusional interpretations of the environment and the presence of auditory and kinesthetich hallucinations. Behaviour was disorganised and affective blunting dominated. Neuroleptic treatment was prescribed and psychotic symptoms improved progressively.ConclusionsOpiate use in patients with psychosis has been linked to a reduction of psychotic symptoms and worsening in periods of abstinence. The caring of these patients should take into account these potential side effects, noting caution in times of detoxification or dose reduction that may exacerbate psychotic symptoms. Although the efficacy of methadone for the treatment of opioid dependence has been demonstrated, there remains insufficient specific scientific evidence in patients with schizophrenia and dual diagnosis. Therefore, it’s recommended that further research into this field of study is both required and necessary.

Introduction and objectivesDescription of a manic episode with psychotic symptoms in a patient by consumption of energy drinks.Aims and methodsLiterature review of the relationship between energy drink consumption and the possibility of suffering a manic episode and description of a clinical case.CaseThis case report describes a patient with no history of psychiatric interest suffers a manic episode with psychotic symptoms after consuming high amounts of energy drinks.Results and conclusionsTo my knowledge, this is one of the few cases that describe a manic episode in relation to the consumption of energy drinks, given this possibility, clinicians should consider asking about the consumption of energy drinks to young people without previous psychiatric history presenting a manic episode.