Effective Treatment With Clozapine and Valproate for Refractory Schizophrenia-Like Psychosis After Cerebellar Hemorrhage

Almeida, Jaime; Serrao, Eva M.; Almeida, Andre Traça; Afonso, Joana

doi:10.1097/wnf.0b013e31821f4d91

Cited by 13 publications

(9 citation statements)

References 14 publications

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“…Nevertheless, the evidence which has accumulated from these detailed case descriptions shows that delusions mainly arise following right cerebral hemisphere damage. For example, of 16 published reports, which included 30 patients, 23 had unilateral right hemisphere lesions compared to 7 with bilateral or left‐sided hemisphere lesions or lesions elsewhere in the brain . Collectively, these case reports also suggest that delusions can arise following right hemisphere damage as a new event without a premorbid history of psychosis and without altered consciousness, as in delirium, or intellectual impairment, as in dementia.…”

Section: Poststroke Psychosismentioning

confidence: 97%

“…For example, of 16 published reports, which included 30 patients, 23 had unilateral right hemisphere lesions [8][9][10][11][12][13][14][15][16][17][18][19] compared to 7 with bilateral or left-sided hemisphere lesions or lesions elsewhere in the brain. [19][20][21][22] Collectively, these case reports also suggest that delusions can arise following right hemisphere damage as a new event without a premorbid history of psychosis and without altered consciousness, as in delirium, or intellectual impairment, as in dementia.…”

Section: P Os Ts Trok E Psychos Ismentioning

confidence: 99%

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Organic psychosis: The pathobiology and treatment of delusions

Joyce

2018

CNS Neurosci Ther

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Organic or secondary psychosis can be seen in diverse conditions such as toxic/metabolic disorders, neurodegenerative disease, and stroke. Poststroke psychosis is a rare phenomenon, but its study has significantly contributed to the understanding of delusion formation. The evidence from case studies of patients with focal strokes shows that delusions develop following unilateral damage of the right hemisphere. The majority of patients with right hemisphere stroke do not develop delusions however, and advanced neuroimaging analysis has elucidated why this symptom develops in only a small proportion. Lesions of the right lateral prefrontal cortex or lesions with connectivity to this area correlate with delusional beliefs in this subgroup. Studies of patients with primary psychosis, for example schizophrenia, or under the influence of the psychotogenic drug ketamine, also show abnormal function of this area in relation to the severity of their abnormal beliefs. The conclusion of these studies is that the right lateral prefrontal cortex is 1 hub in a neural network which includes the basal ganglia and limbic system and receives inputs from midbrain dopamine neurones. In patients with schizophrenia, or at risk of psychosis, dopamine is dysregulated and evidence suggests that faulty dopamine signaling is the precursor of delusion formation. It is therefore likely that the mechanism of delusion formation is the same in both primary and secondary psychosis. This is consistent with the mainstay of treatment of both conditions being antipsychotic medication. However, antipsychotic medication in people with cerebrovascular disease should be avoided if at all possible. This is because epidemiological studies have found that antipsychotic use is associated with an increased risk of stroke and will thus compound the possibility of a further cerebrovascular accident.

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Section: Poststroke Psychosismentioning

confidence: 97%

Section: P Os Ts Trok E Psychos Ismentioning

confidence: 99%

Organic psychosis: The pathobiology and treatment of delusions

Joyce

2018

CNS Neurosci Ther

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“…No medication is food and drug administration (FDA) approved for post-stroke psychosis. One case report discussed improvement in symptoms with the combination of clozapine and divalproex, however, another study remains mechanistically (therapeuticpathway target) inconclusive [13,14]. More clinical studies and longitudinal therapeutic investigations are needed to address the gaps discussed in this case report.…”

Section: Discussionmentioning

confidence: 90%

Dilemma of Treating Psychosis Secondary to Stroke

Agrawal¹,

Verma²,

Vatsalya³

et al. 2021

Cureus

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Post-stroke psychosis is prevalent and disabling with increased mortality risk. Treatment for post-stroke psychosis is limited in this staggering medical concern. The most commonly used medications are antipsychotics, however, the risk for stroke increases further with the use of antipsychotics. Furthermore, interventional clinical studies have not been carried out to test the efficacy and safety of antipsychotics in the management of post-stroke psychosis. We present a case of post-stroke psychosis to highlight the risks faced by these patients in terms of daily function and safety concerns and the challenges encountered in treatment due to poor response to the conventional antipsychotics; and so calling attention to early diagnosis and improved treatment options. More clinical investigations are needed to address the pathology associated with the clinical presentation and exploring the pharmacotherapies to improve efficacy and safety of treatment for post-stroke psychosis.

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“…Treatment suggestions are limited with case reports. There are case reports in the literature reporting that clozapine and valproic acid (Almeida et al 2011) risperidone (Ferreira et al 2017), fluvoxamine and chlorpromazine (Rocha et al 2014), and fluoxetine and risperidone (Duggal 2005) yielded positive results.…”

Section: Treatmentmentioning

confidence: 99%

İnme Sonrası Nöropsikiyatrik Sorunlar

Gençer¹,

Hocaoğlu

2019

Psikiyatride Güncel Yaklaşımlar

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Stroke is the most frequent and significant reason of disability in society. The underlying basic pathophysiological mechanisms of stroke are infarct and hemorrhage. 20% of patients that had a stroke became dependent. Dementia, depression, anxiety disorder, mania, psychosis, pathological emotions, apathy and catastrophic reactions constitute challenging clinical presentations that occur after stroke. In this review, current data about epidemiology, etiology, clinic and treatment of psychopathologies that occur in poststroke period will be discussed. Özİnme toplumdaki en sık yeti yitimi nedeni olarak göze çarpan bir hastalıktır. İnmenin altında yatan temel patofizyolojik süreçler enfarkt ve hemorajidir. İnme geçiren hastaların %20'si bağımlı hale gelmektedir. Demans, depresyon, anksiyete bozukluğu, mani, psikoz, patolojik emosyonlar, apati ve katastrofik reaksiyon, inme sonrasında klinisyenlerin karşılaştıkları zorlu psikiyatrik tabloları oluşturmaktadır. Bu derlemede, inme sonrası dönemde görülen psikopatolojilerin epidemiyoloji, etyoloji, klinik ve tedavileri konusunda güncel gelişmeler perspektifinde elde edilen veriler paylaşılacaktır.

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Effective Treatment With Clozapine and Valproate for Refractory Schizophrenia-Like Psychosis After Cerebellar Hemorrhage

Cited by 13 publications

References 14 publications

Organic psychosis: The pathobiology and treatment of delusions

Organic psychosis: The pathobiology and treatment of delusions

Dilemma of Treating Psychosis Secondary to Stroke

İnme Sonrası Nöropsikiyatrik Sorunlar

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