Quetiapine Therapy for Corticosteroid-Induced Mania
Notice bibliographique
Résumé
Dear Editor: Corticosteroids are routinely used for immunosuppression in patients who have received liver transplants (1). Mood symptoms and psychosis have long been documented as potential adverse effects of corticosteroid treatment (2). We report a case of corticosteroid-induced mania that followed a liver transplant and that resolved with quetiapine therapy. A white man, aged 52 years, was admitted for a liver transplant. The donor was his biological brother. Approximately 5 years previously, he had been diagnosed with hepatitis B and hepatitis C. He had no psychiatric history; however, his daughter had been diagnosed with bipolar disorder. After the transplant, the patient was given methylprednisolone 50 mg intravenously every 6 hours (4 doses) and then 40 mg intravenously for an additional 4 doses. Cumulatively, he received more than 250 mg of steroids before the onset of behavioural symptoms. On postoperative day 3, psychiatry was consulted because he was talking incessantly, preoccupied with hyperreligious themes, and making hypersexual comments. He claimed that he was a prophet and that he could speak different languages; his speech contained numerous neologisms. He was grandiose and claimed to posses spiritual powers that enabled him to sense different pleasant odours. He refused to divulge his name for security reasons. He had not slept for the last 2 days. He was not physically aggressive or agitated. The Young Mania Rating Scale (YMRS, 3) was used to assess symptom severity; his total score was 31, indicative of mania. On a mental status examination, he was poorly groomed and disrobed repeatedly, but he was awake, alert, cooperative, and oriented as to place, person, and time. He displayed pressure of speech and rambling speech with incoherent narration, neologisms, and loose associations. His mood was significantly elevated and euphoric. His thought content revealed grandiose delusions, ideas of reference, and hyperreligious themes. His attention, concentration, insight, and judgment were poor. The presumptive diagnosis was steroidinduced mania. A CT scan of the head on postoperative day 3 was unremarkable. He had a benign neurological examination; there was no evidence of infection; and laboratory values were within normal limits. The patient was started on quetiapine 25 mg at bedtime and 12.5 mg as needed twice daily. Within 10 hours of quetiapine therapy, his mental status gradually improved. His YMRS score was less than 5 at discharge. His thought process and concentration improved significantly. …
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,002 |
| Science ouverte | 0,002 | 0,000 |
| Intégrité de la recherche | 0,006 | 0,006 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».