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Given the published data linking prucalopride with serotonin syndrome, its anxiolytic and antidepressant effects in animal models, and its effect on blood-brain barrier permeability we suspect that prucalopride - likely in combination with escitalopram - precipitated this patient's first manic episode. We queried a drug-drug interaction database, Lexicomp Drug Interactions, for the four medications patient was taking on admission (escitalopram, dicyclomine, prucalopride, tamsulosin). Despite these medication changes, the patient continued to have symptoms of acute mania, including global insomnia, euphoric mood, and grandiose delusions. [Extracted from the article]

Depression presents a wide canvas for considering some approaches, issues, and problems in the study of major categories of mental illness in the context of current behavioral andmolecular neurobiology. The study of depression encompasses multiple interactions among psychiatry, neurology, and neuroscience, as well as interactions with a host of other disciplines. This paper considers issues from an American perspective and discusses topics including historical aspects of the ways humanity has struggled with depression; the growth of approaches, and the "wars" in psychiatry in the middle of the 20th century between different ideologies; the development of psychiatry as a behavioral science inclusive of many disciplines; current diagnostic systems such as the Diagnostic and Statistical Manual ofMentalDisorders (DSM-5) of theAmericanPsychiatricAssociation, and the ICD-10Classification ofMental andBehavioralDisorders of theWorldHealth Organization; the efforts to delineate subtypes of depression; the search for new neurobiological and behavioral targets in the context of the National Institute of Mental Health's Research DomainCriteria framework; and examples of potential future discoveries and disciplines thatmay ultimately improve treatment. [ABSTRACT FROM AUTHOR]

Objectives Individuals with bipolar disorder have high rates of other medical comorbidity, which is associated with higher mortality rates and worse course of illness. The present study examined common predictors of medical comorbidity. Methods The Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study (Bipolar CHOICE) enrolled 482 participants with bipolar I or bipolar II disorder in a six-month, randomized comparative effectiveness trial. Baseline assessments included current and lifetime DSM- IV- TR diagnoses, demographic information, psychiatric and medical history, severity of psychiatric symptoms, level of functioning, and a fasting blood draw. Medical comorbidities were categorized into two groups: cardiometabolic (e.g., diabetes, hyperlipidemia, and metabolic syndrome) and non-cardiovascular (e.g., seizures, asthma, and cancer). Additionally, we looked at comorbid substance use (e.g., smoking and drug dependence). Results We found that 96.3% of participants had at least one other medical comorbidity. Older age predicted a greater likelihood of having a cardiometabolic condition. Early age of onset of bipolar symptoms was associated with a lower chance of having a cardiometabolic condition, but a greater chance of having other types of medical comorbidity. Additional predictors of other medical comorbidities in bipolar disorder included more time spent depressed, less time spent manic/hypomanic, and longer duration of illness. Medications associated with weight gain were associated with low high-density lipoprotein and abnormal triglycerides. Conclusions There appears to be a substantial medical burden associated with bipolar disorder, highlighting the need for collaborative care among psychiatric and general medical providers to address both psychiatric and other medical needs concomitantly in this group of patients. [ABSTRACT FROM AUTHOR]

Objective The aim of the present case report is to describe a potential interaction between valproic acid and oxcarbazepine that resulted in hepatic injury. Methods We report the case of a 46-year-old man with schizoaffective disorder who was cross-titrated from valproic acid to oxcarbazepine because of liver injury. Results Initiation of oxcarbazepine four days after stopping valproic acid produced a significant elevation in liver enzymes that normalized with oxcarbazepine discontinuation and did not reappear with its reintroduction five days later. Conclusions Our findings suggest that a longer washout period or another agent should be considered when transitioning from valproic acid to oxcarbazepine. [ABSTRACT FROM AUTHOR]