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SSRI Syndrome: A Review of Cases

Jimmy O. Ibikunle, M.D., Penn State College of Medicine, Department of Psychiatry, 500 University Drive, Hershey, PA 17033 1. Recognize constellation of signs and symptoms for diagnosis of serotonin syndrome. 2. Demonstrate understanding of pharmacokinetics pertinent in medication management with serotonergic agents. Serotonin syndrome is a toxic, potentially fatal hyperserotonergic state.(1) It has been reported at initiation, in overdose and combination of serotonergic agents. It also occurs in recreational substance abuse Sternbach’s diagnostic criteria(1) include autonomic, neuromuscular and cognitive symptoms and signs. Method: A retrospective chart review of toxicology consults at a university medical center for reported or suspected overdose and drug interactions involving at least one known serotonergic agent(2) was done. Individuals with substance intoxication and animal bites were excluded. Results: Of the 173 cases, over a 5-year period, 5 met criteria(1) for serotonin syndrome, constituting 2.89%. Mean age was 34.4. Four patients were female. One required ICU stay; others were discharged within 24 hours; all survived. Three cases occurred in the course of medication adjustments: switching from fluoxetine to trazodone, augmenting fluoxetine with Lithium and simultaneously increasing doses of fluoxetine and trazodone. Two cases involved intentional overdose: one with venlafaxine and the other with sertraline; the latter followed a recent switch to fluvoxamine. Cognitive symptoms were the most common initial presentation. Conclusion: Occurrence during medication changes supports an iatrogenic etiology. No cases involved a MAOI, notorious for its precipitant effect, and fluoxetine’s pharmacokinetics(2) suggests its predisposition. References: Sternbach H. The serotonin syndrome. American Journal of Psychiatry, 1991;148:705-13. Mills KC. Serotonin syndrome. American Family Physician, 1995;25:1475-82. Additional information from the author at...

Smoking during Pregnancy

Exposure to Tobacco During Pregnancy Affects Behavior in Newborns (The Nemours Foundation) According to a survey by the Centers for Disease Control and Prevention (CDC), more than 12% of women who gave birth during 1999 smoked during pregnancy. Smoking during pregnancy passes nicotine and other dangerous substances to the fetus and increases the risk of stillbirth, birth defects, low birthweight, sudden infant death syndrome (SIDS), and cancer. Maternal smoking has also been shown to affect the developing nervous system of the fetus. Researchers from Brown Medical School in Providence, Rhode Island, examined the effects of maternal smoking on a newborn’s body functions and behavior. Shortly after delivery in the hospital, the mothers of 56 full-term infants answered questions about their use of cigarettes during pregnancy and provided saliva samples to confirm their smoking or nonsmoking status. The mothers who smoked reported the number of cigarettes they smoked in a typical day of each trimester of pregnancy. Within 48 hours after birth, all of the infants underwent examinations of neurological and behavioral function, including tests for reflexes, central nervous system function, and visual function. In general, the infants who were exposed to tobacco were more excitable, had greater muscle tension, and showed other symptoms similar to infants going through drug withdrawal. Babies who had been exposed to tobacco needed to be picked up and touched more, and also showed more signs of physical stress in the central nervous system, gastrointestinal system, and visual system. The more cigarettes per day a mother smoked, the greater the effects on the newborn’s body functions and behavior. What This Mean to You: Smoking during...

Sleep Apnea in Children

Doctors Should Screen Kids for Snoring and Sleep Apnea Mon Apr 1,11:48 AM ET By Melissa Schorr NEW YORK (Reuters Health) – For the first time, the American Academy of Pediatrics (AAP) is recommending that doctors screen all children for snoring to determine if they might be at risk of obstructive sleep apnea, a temporary collapse of the upper airway that occurs during sleep. Symptoms of the condition include snoring, often with pauses, snorts or gasps as breathing temporarily stops and restarts. “Our hope is this will raise awareness of this condition among pediatricians so more children will be diagnosed,” AAP committee chair Dr. Carole L. Marcus, director of the pediatric sleep center at Johns Hopkins University in Baltimore, Maryland, told Reuters Health. During the past 3 years, the committee conducted a review of more than 2,000 medical journal articles to develop the first-of-their-kind guidelines on sleep apnea among children. While about 3% to 12% of youngsters snore, about 2% are thought to have obstructive sleep apnea syndrome. If left untreated, sleep apnea can cause significant health problems such as poor growth, neurological or behavioral problems, and in the most severe cases, heart problems. “People are familiar with this for adults, but don’t realize this is common in children because they look fine when they are awake,” Marcus noted. “People don’t think to bring up the condition of snoring.” However, the guidelines recommend that pediatricians should ask all children and their parents whether or not the child snores. Those who do snore should be further questioned on whether the snoring is continuous, causes the child to choke or gasp,...

To snoop or not to snoop in a child’s bedroom?

Sunday Patriot-News Front Page Story December 19, 1999 (Harrisburg, PA)– Parents must weigh issues of trust, curiosity, concern before searching, experts say. “Trust has everything to do with your child’s success and safety.” says Dr. Chris Petersen, a psychiatrist and assistant professor of psychiatry at Pennsylvania State University’s College of Medicine at the Hershey Medical Center.  “If you initiate damage of the trust by intruding into their life without reason, then that is a mistake.  If they’ve earned the trust and respect because of a level of responsibility, that should be respected, he says.   WARNING SIGNS Dr. Chris Petersen, a psychiatrist at Hershey Medical Center, cites these symptoms of teen depression: •Social withdrawal: A desire to remain isolated or restricted to a narrow peer group for weeks or months. •Isolation from peer group: Diminishing time and interaction with a previously close group of friends. •Symptoms of depression: ‘Irritability, anger and sadness, as well as boredom in situations they would not normally consider boring. •Deteriorating grades and work habits. •Frequent fighting, becoming abusive. • Maintaining poor personal hygiene. • Abusing alcohol or drugs. •Changing sleep habits and appetite. PARENTING ADVICE •The National, Parenting Center at www.tnpc.com. RECOMMENDED READING From George Schmidt, psychologist with the East Pennsboro Area School District. Both are by Anthony Wolf: •”Get Out of My Life … but first could you drive me and Cheryl to the Mall- Parent’s Guide to the Teenager.” • “It’s Not fair, Jeremy Spencer’s Parents Let Him Stay Up All...
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