Pezhman Hadinezhad, Hamzeh Hosseini,
Volume 12, Issue 0 (Case Supplement 2021)
Abstract
Background: Zolpidem is a non-benzodiazepine drug, approved by FDA for sleep induction. Zolpidem is thought to be a safer drug than benzodiazepines (BZD) because of no evidence of abuse or dependence potential, but several case reports of zolpidem abuse and dependence have been published along with a small number of cases demonstrating seizures after sudden zolpidem withdrawal.
Case presentation: A 32-year-old unmarried woman suffering from major depressive disorder had been taking zolpidem for insomnia for more than 1 year. She began to take zolpidem alone without mixing other kinds of hypnotics, and 50 mg of zolpidem used to be initially effective in treating her insomnia. In some days the dose increased up to 100 mg per day. In the end, she had to discontinue zolpidem abruptly because she could not afford it anymore. After 2 days, she suddenly showed facial spasm, mouth opening, tonic-clonic seizure, and loss of consciousness for about 1-2 minutes. Post-ictal confusion with clouded consciousness, psycho-motor retardation, persisted in 1 day. EEG in wakefulness revealed intermittent, generalized, diffused alpha wave and diffused sharp waves, and suggested seizure waves in the patient.
Conclusion: Our case suggested that the potential of zolpidem dependence and withdrawal seizure are also present in the Iranian population. The female-gender, high dosage and long-term use of zolpidem might be risk factors for the development of adverse effects.
Pezhman Hadinezhad, Hamzeh Hosseini,
Volume 13, Issue 1 (Winter 2022)
Abstract
Background: Selective serotonin reuptake inhibitors (SSRIs) have proven more problematic in terms of some side effects than the original clinical trials suggested. Sertraline may displace warfarin from plasma proteins and may increase the prothrombin time. The aim of this study was to report a rare case of the sertraline- induced severe anal pain and rectal bleeding without concurrent of taking any other drugs including non-steroidal anti-inflammatory drugs (NSAIDs).
Case Presentation: Here we report a case of a 31-year old married man who referred to a psychiatrist with depressive disorder and started to take sertraline up to 400 mg daily, thereafter the patient reported severe anal pain and bleeding. Other etiologies of this side effect were evaluated with Naranjo evaluation scale and rolled out. The patient did not report any anal pain or bleeding after eight months of stopping sertraline.
Conclusion: Reported from sertraline, the psychiatrists must be more cautious when prescribing sertraline and monitor the patient properly for a long time to ensure these rare adverse effects and complications do not happen.
Pezhman Hadinezhad, Javad Setareh, Parisa Adimi Naghan,
Volume 14, Issue 1 (Winter 2023)
Abstract
Background: Kleine-Levin syndrome (KLS) is a rare sleep disorder with at least two episodes of hypersomnia coincidence with at least one cognitive, eating, perceptive and disinhibited symptoms and normal inter-episodes. These symptoms are not explained by another sleep, medical, neurological, psychiatric disorders and substance or drug use.
Case Presentation: Here we report a young female with personality disorder and obsessive-compulsive disorder who had KLS. Her symptoms appeared in the past 1.5 years ago, while she had an episode of hypersomnia lasting for 5 days. She had 4 attacks; each one lasted up to 2-7 days. We found that overriding KLS symptoms on underlying main psychiatric or personality disorders complicates diagnosis. All neurological examinations during episode and further investigation were in normal range.
Conclusion: We suggest that taking a complete history and mental state examination in the episode and inter episode phase helps to diagnosis both KLS and comorbid psychiatric disorders.
