Friday, June 3, 2016

A Case Report of Psychosis in a Patient of Myxedema: Myxedema Madness

Hypothyroidism is one of the most important causes of organic psychosis and sometimes can be missed. There are some cases showing extreme degree of hypothyroidism leading to psychiatric illnesses like mania, depression and psychosis. In present case, a 21year old well-functioning female developed hypothyroidism initially with symptoms of Myxedema which was undiagnosed for 2 years. She had psychotic features after 2 years in form of hallucinatory behavior, poor self-care, persecutory and referential delusions, episodes of violent behavior and suicidal attempts. Thyroid supplementation was given in therapeutic dose but there was no improvement in her clinical profile. It was decided by experts to add antidepressant and antipsychotic medicines. Patient had marked improvement. She started talking with family, her aggression subsided. Only persecutory delusion and memory impairment persisted so doses of antipsychotic medicine was gradually built up. 

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Administration of Vasoconstrictor, But Not Volume Expander Prevents Maternal Hypotension During Spinal-Epidural Anesthesia For Elective Cesarean Section

Administration of vasoconstrictor preventing maternal hypotension after combined spinal-epidural , anesthesia(CSEA) in elective cesarean section patients.A total of 240 full-term, single pregnancy women, undergoing elective cesarean section in CSEA were included. Multiple linear regression analysis was used to identify major contributing factors for maternal hypotension from 18 independent variables. The model was set as ╬▒entry= 0.05, ╬▒remove = 0.15, and condition index <15. The incidence of hypotension from different combinations of vasoconstrictors for hypotension prevention were calculated and compared, then correlated with pH and base excess in neonatal umbilical venous blood, as well as 1 and 5 min Apgar score, using one-way ANOVA. p<0.05 was considered to be significant difference. Continuous dosage of phenylephrine decrease incidence of maternal hypotension after CSEA for elected cesarean section.

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