Pašilytė, Agnė

Substance use is a significant trigger for psychosis, with about 25% of first-episodes being substance-induced. Tobacco, alcohol, cannabis, and cocaine use disorders are three times more prevalent in schizophrenia patients. Substance-induced psychotic disorders can persist for days or weeks and are often linked with paranoid schizophrenia. Coexisting substance use disorders complicate diagnosis, treatment, and patient outcomes. Case presentation: A 25-year-old male was brought in after attempting to kills his mother with a knife during a psychomotor agitation episode. Orientation could not be assessed, he lacked verbal contact and insight into his own condition. At times he remained motionless with his eyes closed or became agitated, suggesting active psychopathology. Since the age of 17, he has been dependent on alcohol and psychoactive substances: MDMA, marihuana, psilocybin, amphetamine, methamphetamine, cocaine, crack. His condition has been deteriorating for about 3.5 years. For several months, his mother has noticed her son acting strangely or inadequately, frequently speaking off topic, showing personality changes, telling odd stories, or sometimes stopping communication altogether. Psychological examination revealed: slowpaced, disturbed, undirected, lacking insight thinking with low abstraction and poor generalization forming capabilities. He has been previously admitted with paranoid schizophrenia diagnosis, but does not take his prescribed Olanzapine (10 mg twice daily). Discussion: Differentiating substance-induced psychosis from primary mental illnesses like schizophrenia is challenging. Long-term use of psychoactive substances can trigger or worsen psychotic episodes, with about 25% of first-episodes being substance-induced. Substance use can mask early symptoms of schizophrenia, delaying diagnosis and complicating treatment. Poor medication adherence dramatically raises the risk of severe psychotic episodes, relapses, and violent behaviour. Effective management requires integrated treatment, family support, medical supervision to reduce the burden of dual-diagnosis illnesses. Substance use with psychosis can mask or mimic endogenic psychiatric disorders, complicating diagnosis and treatment. This case highlights the need for integrated care: medical management, psychosocial support, and substance cessation to improve patient stability and and lessen burdens on patients and healthcare system.

Schizophrenia in pediatric and adolescent populations is rare but severe, with a prevalence of 0.33–0.75%. Early-onset schizophrenia (EOS), diagnosed before 18, often involves more significant cognitive, emotional, and social impairments than adult-onset cases. This report presents a case of a 24-year-old female with treatment-resistant schizophrenia (TRS) and endocrine complications, emphasizing the complexities of her care and management. The patient’s mental health challenges began at 15 and manifested as depressive symptoms as well as generalized anxiety. At age 17, the patient was diagnosed with paranoid schizophrenia due to progressive symptoms. Various antipsychotic medications, including risperidone, aripiprazole, and olanzapine, proved insufficient, leading to the introduction of clozapine. Despite clozapine effectiveness in stabilizing her mental health, it caused significant side effects, such as metabolic syndrome, amenorrhea, and elevated prolactin levels. These issues were managed by adding metformin into her treatment plan. Despite occasional relapses and challenges, including weight fluctuations, hallucinations, dellusions, her condition stabilized enough to allow her to pursue academic goals and maintain social functionality. Treatment-resistant schizophrenia, particularly in young females, poses unique challenges. Clozapine remains main treatment in such cases, although its side effects often require additional interventions. Identification of TRS early led to start treatment quickly. As a result, the first administration of clozapine resulted in a positive change in the patient's condition and showed rapid recovery. This case also highlights the importance of managing antipsychotic-induced endocrine complications with additional therapies like metformin and underscores the necessity of a multidisciplinary approach in addressing the interplay of mental and physical health. It is very important to identify TRS early, and start treatment as soon as possible. This case shows the significance of personalized, multidisciplinary care in managing TRS, especially in younger patients. By addressing both psychiatric symptoms and systemic side effects, tailored interventions can significantly enhance quality of life and functional outcomes.

Įvadas. Antibiotikų, ypač fluorchinolonų, sukelti psichiatriniai šalutiniai poveikiai, tokie kaip nerimas, psichozė ir depresija, tampa vis aktualesne problema dėl jų plataus vartojimo. Didžiausia rizika kyla vyresnio amžiaus pacientams anamnezėje turintiems psichikos sutrikimų. Siekiant užtikrinti saugų gydymą, būtina didinti sveikatos priežiūros specialistų informuotumą ir atidžiai stebėti pacientų būklę terapijos metu. Tikslas. Peržiūrėti naujausią literatūrą ir klinikinius atvejus, susijusius su psichiatrijos simptomais, dažniausiai susijusiais su fluorochinolonais. Medžiaga ir metodai. Literatūros peržiūra atlikta naudojant PubMed, Google Scholar ir Cochrane duomenų bazes. Įtraukimo kriterijai: publikacijos anglų kalba per pastaruosius 10 metų. Iš viso į peržiūrą įtraukta 52 tinkamos studijos. Rezultatai. Studijos parodė ryšį tarp fluorchinolonų ir psichiatrijos simptomų, ypač nerimo, psichozės ir kognityvinių sutrikimų. Psichiatrijos šalutiniai poveikiai pasireiškė 2-11% pacientų, ypač vyresnio amžiaus ir turintiems ankstesnių psichiatrijos sutrikimų. Pasiūlyti mechanizmai apima GABA receptorių moduliaciją, mitochondrinį toksiškuną ir mikrobiomo pokyčius. Simptomai dažnai išnyksta nutraukus vaisto vartojimą, tačiau kai kuriais atvejais buvo reikalingas gydymas antipsichotikais ar hemodialize. Išvados. Fluorchinolonai gali sukelti psichozinius simptomus, ypač vyresnio amžiaus pacientams arba pacientams, turintiems su CNS susijusių sutrikimų. Reikia atlikti daugiau tyrimų giliau ištirti patologinius mechanizmus bei nustatyti biomarkerius jautriems pacientams. Kol kas rekomenduojama atsargiai skirti fluorchinolonus pažeidžiamoms grupėms.

Introduction: Irritable Bowel Syndrome (IBS) is a prevalent gastrointestinal disorder marked by abdominal discomfort or pain and irregular bowel habits. It is classified into four subtypes – IBS-C (constipation-predominant), IBS-D (diarrhea-predominant), IBS-M (mixed-type), and IBS-U (unclassified). IBS is influenced by both gastrointestinal and psychological factors. Research has highlighted the significant role of the bi-directional gut-brain axis system in regulating symptoms of IBS and exacerbating comorbid conditions like anxiety and depression. However, affective symptoms and anxiety themselves can also cause or exacerbate the symptoms of IBS. Aim: The aim of this narrative literature review is to explore the role of affective and anxiety symptoms in the development and clinical outcomes of different subtypes of irritable bowel syndrome and provide an overview of the newest scientific literature. Methodology: A narrative literature search, review and analysis were conducted using the computerised databases - PubMed, Google Scholar and ScienceDirect in December 2024. The following keywords and their combinations were used to identify relevant scientific publications: Irritable bowel syndrome, IBS, IBS subtypes, anxiety, depression, bipolar disorder, gut-brain axis. Inclusion criteria: full text, peer-reviewed scientific publications, published in English, not older than 10 years, scientific publication types included – clinical trials, controlled clinical trials, randomized controlled trials, metaanalyses, systematic reviews and reviews. A total of 74 full-text publications were reviewed. Descriptive analysis was performed to summarize the findings. Results: Affective and anxiety disorders are more prevalent in IBS patients than in the general population. The IBS-M subtype shows higher anxiety rates, while IBS-M and IBS-C are more likely to exhibit increased depressive symptoms. Patients with depression have a 2.4-fold higher risk of developing IBS, and they are nearly twice as likely to experience new-onset IBS. Anxiety increases the risk of IBS by 1.53 times and is strongly associated with more frequent and severe gastrointestinal symptoms, especially in IBS-C and IBS-D subtypes. The connection between IBS and bipolar disorder (BD) remains unclear, with some studies suggesting an association and others finding no consistent link.

Introduction: According to recent research, inflammation may play a major part in mood disorders. Peripheral proinflammatory mediators have been shown to be elevated in bipolar disorder (BD) and other mood disorders, and BD risk is higher in those with systemic autoimmune diseases[1]. These processes may enhance the blood-brain barrier's permeability, making the brain more susceptible to brain-reactive autoantibodies and other immune components that can result in mental symptoms[2].

Introduction: Cannabis remains the most prevalent drug worldwide, with an estimated 219 million users in 2021 (or 4.3% of all adult people worldwide). Globally, one in every 17 persons reported using drugs in 2021, which is 23% higher than ten years prior. According to the World Drug Report in 2021 5,3% of 15-16 year olds globally reported using cannabis within the previous year[1]. Psychosis remains as a major public health concern as a potential side effect of cannabis use[2]. Numerous studies indicate that individuals who use cannabis regularly run a higher chance of developing psychosis[2]. Most importantly, greater cannabis usage is linked to increased psychological symptoms in people under the age of 25, particularly in those who are already predisposed to or vulnerable to such effects[3]. that beeing, a family history of psychosis[4].

Introduction: ADHD is a neurodevelopmental condition marked by hyperactivity, lack of attention, and impulsiveness. As first diagnosis or persistence of symptoms is also observed in adulthood, previously thought to be a disorder only occurring in childhood and resolved by adolescence, it now includes adults too. Adult ADHD is linked to subpar day-to-day functioning and usually goes together with other psychiatric disorders such as substance abuse, depressive or bipolar disorders. [1] This tends to be the reason, why these patients usually show worse functioning in everyday life and why ADHD can be deceptive. It can often be misdiagnosed as anxiety, depression or even schizophrenia spectrum disorders. [2] Moreover, associations with some inflammatory and autoimmune medical conditions are recently being reported. Two of the most significant ones being atopic immunological diseases (AID) asthma and atopic eczema. [3]

Introduction: In recent decades, numerous innovative treatments for treatment resistant depression (TRD) have been invented, most notably low-dose ketamine infusion and repeated transcranial magnetic stimulation (rTMS)(1). The purpose of this research is to compare the effect of severe depression symptoms of patients undergoing low – dose ketamine infusion versus rTMS therapy.

Introduction: It has been repeatedly demonstrated that ketamine rapidly and effectively reduces depression in people who are resistant to therapy (TRD). Is ketamine as safe and effective as the electroconvulsive treatment (ECT) that is now available is a crucial question(1),(2). Methodology: This review aims to present recent findings regarding ECT and ketamine as a potential treatment option for depression.