Contributions
Type: Publication Only
Background
Among the side effects of the drugs from the group of antifungal agents voriconazole are the mental disorders by different psychopathological registers.
Aims
The aim was to study the typology of mental disorders and therapeutic approaches in the event of psychosis in patients with hematological diseases complicated by fungal infection, during the application of voriconazole.
Methods
There were studied 15 patients with various hematological diseases (AML, ALL, MM, AA) by the clinical method in the period from 2006 to 2014, in which observed the development of mental disorders during therapy with voriconazole in connection with invasive fungal infections (aspergillosis, candidiasis)
Results
Of the 15 patients, 11 demonstrated hallucinatory syndrome. Development hallucinosis in most cases within 1-2 days underwent almost stereotypical dynamics - the formation of psychopathological disorders began with demonstrations insomniac disorders (violation of falling asleep, frequent awakenings), joined by vivid nightmares with disturbing content, accrued unexplained anxiety, persistent daytime (4 patients of the 11 alarm combined with hypothymia (depressed mood). Then, against the clear consciousness and stored criticism, manifest verbal perceptual deception by type of acoasma (hiss, scratches) or elementary functional hallucinations (addressed to the patient isolated words or phrases arising on a background of real sounds of medical equipment or personnel speech), which gradually became more complicated. With closed eyes formed visual hallucinatory disorders that were in the nature of sensuous vividness, and were represented by a set of bright, moving images of people and (rarely) animals of normal size or reduced. It is noted high involvement of the patient in what is happening - 'people' were talking among themselves and with the patient, 'commented' his actions and thoughts. There was not noted the increasing of anxiety on the background of experienced by patients deceptions of perception.
In 4 patients, hallucinatory disorders are not formed and mental disorders limited by insomniac, anxiety disorders and hypothymia and had more short-term character than in the previous group of patients.
Described disorders in patients persisted for 6 ± 2 days on average.
Formation of described psychopathological disorders occurred on the background of significant somatogenic asthenia caused by severe hematologic malignancies and its complications (including infectious origin) and intoxication by chemotherapeutic agents. In the history of the patients showed no manifest psychopathological disorders.
Treatment of mental disorders in the studied patients was phased. The aim of the first phase was psychosis reduction, the second – the support treatment to prevent relapse of psychotic disorders.
Preference was given to intravenous administration of psychotropic drugs (in most cases – through a central venous catheter) that correspond to the guidelines for the management of patients with haematological diseases.
In hallucinatory disorders the main therapeutic intervention focused on the first stage; the treatment have a short duration and include the use of butyrophenone antipsychotics (haloperidol 10 mg / day). In necessary of the rapid sedation or relief the anxiety / insomniac disorders diazepam was administered in therapeutic scheme (20 mg / day).
Summary
During the application of voriconazole the mental disorders may occur (most often formed hallucinatory syndrome) that require psychopharmacological correction.
Keyword(s): Fungal infection, Hematological malignancy, Treatment, Voriconazole
Session topic: Publication Only
Type: Publication Only
Background
Among the side effects of the drugs from the group of antifungal agents voriconazole are the mental disorders by different psychopathological registers.
Aims
The aim was to study the typology of mental disorders and therapeutic approaches in the event of psychosis in patients with hematological diseases complicated by fungal infection, during the application of voriconazole.
Methods
There were studied 15 patients with various hematological diseases (AML, ALL, MM, AA) by the clinical method in the period from 2006 to 2014, in which observed the development of mental disorders during therapy with voriconazole in connection with invasive fungal infections (aspergillosis, candidiasis)
Results
Of the 15 patients, 11 demonstrated hallucinatory syndrome. Development hallucinosis in most cases within 1-2 days underwent almost stereotypical dynamics - the formation of psychopathological disorders began with demonstrations insomniac disorders (violation of falling asleep, frequent awakenings), joined by vivid nightmares with disturbing content, accrued unexplained anxiety, persistent daytime (4 patients of the 11 alarm combined with hypothymia (depressed mood). Then, against the clear consciousness and stored criticism, manifest verbal perceptual deception by type of acoasma (hiss, scratches) or elementary functional hallucinations (addressed to the patient isolated words or phrases arising on a background of real sounds of medical equipment or personnel speech), which gradually became more complicated. With closed eyes formed visual hallucinatory disorders that were in the nature of sensuous vividness, and were represented by a set of bright, moving images of people and (rarely) animals of normal size or reduced. It is noted high involvement of the patient in what is happening - 'people' were talking among themselves and with the patient, 'commented' his actions and thoughts. There was not noted the increasing of anxiety on the background of experienced by patients deceptions of perception.
In 4 patients, hallucinatory disorders are not formed and mental disorders limited by insomniac, anxiety disorders and hypothymia and had more short-term character than in the previous group of patients.
Described disorders in patients persisted for 6 ± 2 days on average.
Formation of described psychopathological disorders occurred on the background of significant somatogenic asthenia caused by severe hematologic malignancies and its complications (including infectious origin) and intoxication by chemotherapeutic agents. In the history of the patients showed no manifest psychopathological disorders.
Treatment of mental disorders in the studied patients was phased. The aim of the first phase was psychosis reduction, the second – the support treatment to prevent relapse of psychotic disorders.
Preference was given to intravenous administration of psychotropic drugs (in most cases – through a central venous catheter) that correspond to the guidelines for the management of patients with haematological diseases.
In hallucinatory disorders the main therapeutic intervention focused on the first stage; the treatment have a short duration and include the use of butyrophenone antipsychotics (haloperidol 10 mg / day). In necessary of the rapid sedation or relief the anxiety / insomniac disorders diazepam was administered in therapeutic scheme (20 mg / day).
Summary
During the application of voriconazole the mental disorders may occur (most often formed hallucinatory syndrome) that require psychopharmacological correction.
Keyword(s): Fungal infection, Hematological malignancy, Treatment, Voriconazole
Session topic: Publication Only