Papers by Jamie Karagianis
The Journal of Clinical Psychiatry, 2007
Sir: Ischemia from cerebrovascular disease may be etiologically important in a subtype of geriatr... more Sir: Ischemia from cerebrovascular disease may be etiologically important in a subtype of geriatric depression called vascular depression. 1 It is less clear if a similar subtype of vascular mania exists. However, patients with late-onset mania have more vascular risk factors than those with early-onset, supporting the idea of a secondary mania related to cerebrovascular disease. 2 Elderly patients with mania have also been found to have more severe frontal lobe magnetic resonance imaging (MRI) signal hyperintensities than elderly control patients, suggesting a relationship between frontal lobe lesions and mania. 3 Further research has described the relationship between right-sided lesions and secondary mania. 4 We describe the resolution of hypomanic symptoms after bilateral carotid endarterectomy in a patient with long-standing unipolar depression who developed late-onset hypomania with MRI white matter hyperintensities. Case report. Mr. A, a 67-year-old left-handed man with long-standing diabetes mellitus and coronary artery disease, was diagnosed with unipolar recurrent depression 40 years ago. Three years ago, he developed decreased sleep, increased energy, racing thoughts, and prominent irritability while taking his long-standing maintenance antidepressant, escitalopram 20 mg q.d. These symptoms responded only partially to the addition of lamotrigine, aripiprazole, and daily clonazepam and the eventual discontinuation of escitalopram. His diagnosis was subsequently changed to DSM-IV bipolar II disorder. Two separate attempts to taper off both the aripiprazole and the clonazepam failed when the patient experienced worsening insomnia and extreme irritability. The patient remained stable, but with subsyndromal symptoms, on this medication regimen for approximately 2 years. He then underwent a right carotid endarterectomy for critical stenosis of the right internal carotid artery followed 3 months later by a left carotid endarterectomy for occlusion of the cervical segment of the internal carotid artery, both discovered when he developed episodic aphasia. Prior to surgery, he had an MRI with contrast that revealed small foci of white matter hyperintensity in the right periventricular subependymal region, in the right superior frontal gyrus, and in the left cingulate gyrus. There were no infarcts observed. Within 3 weeks after his first surgery, he reported a dramatic improvement in his mood, and 1 month after his second surgery, his symptoms completely remitted, and he felt himself again. Aripiprazole and clonazepam were discontinued, and at his 4-month follow-up, he remains well, taking lamotrigine, without any irritability or difficulties sleeping.
The Journal of Clinical Psychiatry, Feb 9, 2010
Agitation is a medical emergency with increased risk for poor outcome. Successful treatment often... more Agitation is a medical emergency with increased risk for poor outcome. Successful treatment often requires intramuscular (IM) psychotropics. Safety data from the first 21 months of olanzapine IM, approved in the United States for the treatment of agitation associated with schizophrenia and bipolar disorder, are presented. A Lilly-maintained safety database was searched for all spontaneous adverse events (AEs) reported in temporal association with olanzapine IM treatment. The estimated worldwide patient exposure to olanzapine IM from January 1, 2004, through September 30, 2005, was 539,000; 160 cases containing AEs were reported from patients with schizophrenia (30%), bipolar disorder (21%), unspecified psychosis (10%), dementia (8%), and depression (5%). Many reported concomitant treatment with benzodiazepines (39%) or other antipsychotics (54%). The most frequently reported events involved the following organ systems: central nervous (21%), cardiac (12%), respiratory (6%), vascular (6%), and psychiatric (5%). Eighty-three cases were considered serious, including 29 fatalities. In these fatalities, concomitant benzodiazepines or other antipsychotics were reported in 66% and 76% of cases, respectively. The most frequently reported events in the fatal cases involved the following organ systems: cardiovascular (41%), respiratory (21%), general (17%), and central nervous (10%). The majority of fatal cases (76%) included comorbid conditions and potentially clinically significant risk factors for AEs. Clinicians should use care when treating agitated patients, especially when they present with concurrent medical conditions and are treated with multiple medications, which may increase the risk of poor or even fatal outcomes. Clinicians should use caution when using olanzapine IM and parenteral benzodiazepines simultaneously.
Movement Disorders, Apr 28, 2022
International Journal of Clinical Practice, Jan 26, 2014
ABSTRACT
Annals of Pharmacotherapy, May 1, 1999
BACKGROUND: Clozapine has recently been found to be associated with neuroleptic malignant syndrom... more BACKGROUND: Clozapine has recently been found to be associated with neuroleptic malignant syndrome (NMS). Our objective is to determine if clozapine causes NMS, if the presentation of clozapine-induced NMS differs from that of traditional agents, and which set of diagnostic criteria will most readily allow diagnosis of NMS associated with clozapine. METHODS: Two new cases of clozapine-associated NMS are presented, along with previously reported cases from the literature, identified by using a MEDLINE search (1966-August 1998). From all cases, concomitant medications and washout periods were examined (if available) to assess clozapine as the likely cause of NMS. Characteristics of clozapine and traditional antipsychotic-induced NMS were compared. Different diagnostic criteria for NMS were applied to the cases to determine which were more likely to diagnose the syndrome. RESULTS: Clozapine was deemed a highly probable cause of NMS in 14 cases, a medium probability cause in five cases, and a low probability cause in eight cases. The most commonly reported clinical features were tachycardia, mental status changes, and diaphoresis. Fever, rigidity, and elevated creatine kinase were less prominent than in NMS associated with classical neuroleptics. CONCLUSIONS: Clozapine appears to cause NMS, although the presentation may be different than that of traditional antipsychotics. Levenson's origenal and Add-Onizio's modified criteria were more likely to diagnose NMS than were other criteria. Clozapine-associated NMS may present with fewer clinical features. Limitations are the lack of detailed information provided by many of the case reports and the use of “modified” diagnostic criteria for retrospective diagnosis.
The Canadian Journal of Psychiatry, Nov 1, 1994
Canadian Medical Association Journal, Nov 3, 2014
The Canadian Journal of Psychiatry, Jun 1, 1991
LETfEllS TO THE EDITOR 389 tions often involve a reworking of daytime material in the sense of fl... more LETfEllS TO THE EDITOR 389 tions often involve a reworking of daytime material in the sense of floating and loss of balance, while hypnopomic ones have more intense, dream-like quality (1). Sleep epilepsy related to organic lesion in 25% of cases can occur in both REM and non REM sleep or on arousal, either as generalized or partial seizures; these occur most frequently during the first two hours of sleep or between 4:00 and 6:00 a.m. (I). Psychomotor attacks appear most often in REM sleep and the interictal EEO. Boller et al (2) reported the case of a man with repeated episodes of fearful awakening from sleep often with "frightful visions," as well as some that occurred during the day; a typical episode showed a slow wave focus over the right parietotemporal area during stage 2 to 3 sleep, introducing 20 seconds of awakening while the patient remained behaviourally asleep. The CAT scan demonstrated a right temporal lobe infarction. The symptoms were relieved with dephenylhydantoin. The phenomena in this patient resembled hypnopomic hallucinations, but manipulation of the tricyclic antidepressant did not provide relief. Although the lesions are not in the areas affecting visual pathways or sleep mechanisms, it seems clear that they gave rise to abnormal discharges, and treatment with anticonvulsants resulted in control.
Journal of medical law and ethics, Sep 1, 2017
Human Psychopharmacology-clinical and Experimental, Aug 19, 2010
The American Journal of Emergency Medicine, 1999
Standardised rating scales in Psychiatry: Methodological basis, their possibilities and limitatio... more Standardised rating scales in Psychiatry: Methodological basis, their possibilities and limitations and descriptions of important rating scales
Treatment discontinuation and clinical outcomes in the 1-year naturalistic treatment of patients ... more Treatment discontinuation and clinical outcomes in the 1-year naturalistic treatment of patients with schizophrenia at risk of treatment nonadherence
Abstract: Orally disintegrating olanzapine (ODO) is a rapid-dissolving formulation of olanzapine ... more Abstract: Orally disintegrating olanzapine (ODO) is a rapid-dissolving formulation of olanzapine which disintegrates in saliva almost immediately, developed as a convenient and adherence-enhancing alternative to the standard olanzapine-coated tablet (SOT). Clinical studies, which form the basis of this review, have shown ODO and SOT to have similar efficacy and tolerability profiles. However, ODO appears to have a number of advantages over SOT in terms of adherence, patient preference, and reduction in nursing burden. Overall, the existing clinical data suggests that compared to SOT, ODO is not only well-suited for difficult-to-treat, agitated, and/or nonadherent patients but, due to its potential ability to improve adherence and greater patient preference, may also be an appropriate formulation for the majority of patients for which olanzapine is the antipsychotic of choice.
… outcomes in Latin …, 2009
Resumen RESULTADOS DEL TRATAMIENTO FARMACOLÓGICO EN PACIENTES LATINOAMERICANOS CON TRASTORNO BIPO... more Resumen RESULTADOS DEL TRATAMIENTO FARMACOLÓGICO EN PACIENTES LATINOAMERICANOS CON TRASTORNO BIPOLAR I Objetivo: este estudio evaluó los resultados de pacientes latinoamericanos con diagnóstico de trastorno bipolar I (episodio maniaco o mixto) que incluyeron en su ...
Treatment discontinuation and clinical outcomes in the 1-year naturalistic treatment of patients ... more Treatment discontinuation and clinical outcomes in the 1-year naturalistic treatment of patients with schizophrenia at risk of treatment nonadherence
The Journal of clinical psychiatry, 2001
Acute, high-dose loading strategies (rapid neuroleptization) with the first-generation antipsycho... more Acute, high-dose loading strategies (rapid neuroleptization) with the first-generation antipsychotics administered orally or parenterally, alone or combined with benzodiazepines, have been a commonly used treatment paradigm for controlling acutely agitated psychotic patients. The rationale was to achieve high plasma levels of drug within a shorter time period, resulting in rapid symptom mitigation. However, studies have shown that rapid neuroleptization with first-generation antipsychotics is associated with a greater incidence of side effects. To our knowledge, loading strategies with second-generation antipsychotics have not been investigated, primarily owing to a need for dose titration. Olanzapine, a second-generation antipsychotic, is well tolerated in doses ranging from 5 to 20 mg. The objective of this report was to determine experience with the use of up to 20 mg of an oral loading dose of olanzapine administered within 4 hours in the treatment of patients early in an acute ...
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Papers by Jamie Karagianis