The Journal of clinical psychiatry
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Clozapine, an atypical neuroleptic with unique clinical and preclinical properties, represents a potentially valuable addition to the psychopharmacopeia. Its development and use have been limited by its higher frequency, compared with other pharmacologic treatments, of the potentially fatal side effect of agranulocytosis. ⋯ No patient had hematologic reactions to treatment with psychotropic agents before or after clozapine treatment. These findings, along with other work in progress, suggest that clozapine's granulocytoxic effects are produced by a highly specific immune-mediated mechanism.
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A case of agitated delirium secondary to bilateral occipital cerebral infarctions in a cancer patient was refractory to trials of large doses of intravenous psychotropic agents, but continuous intravenous infusion of haloperidol controlled agitation rapidly and safely. A total haloperidol dose of 600 mg/day was used without complications. Haloperidol by continuous infusion should be considered in the management of severe, refractory agitation in patients who are medically ill.
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Case Reports
Mood-related obsessive-compulsive symptoms in a patient with bipolar affective disorder.
The authors present a case of coexisting obsessive-compulsive disorder (OCD) and bipolar affective disorder in which the obsessive-compulsive symptoms disappeared during episodes of mania and reappeared during periods of depression. Although patients with coexisting bipolar disorder and OCD are relatively rare, careful study of those patients may increase our understanding of the complex relationship between obsessive-compulsive symptoms and mood. Abnormalities in serotonergic neurotransmission have been postulated in both affective disorders and OCD and may provide important clues to the pathophysiology of OCD.
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Psychogenic habit cough--a condition that can be debilitating if it extends over a period of years--has been described in both pediatric and adolescent populations, but not in adults. The authors review the cases of 4 adult patients with this condition, review the available pediatric/adolescent literature, and make suggestions for the direction of future research. In some cases, psychogenic habit cough in adults can be successfully treated with a combination of psychotherapy, relaxation therapy, and speech therapy.