Medicamentsen-ligne vous propose les traitements dont vous avez besoin afin de prendre soin de votre santé sexuelle. Avec plus de 7 ans d'expérience et plus de 90.000 clients francophones, nous étions la première clinique fournissant du
acheter cialis original en France à vente en ligne et le premier vendeur en ligne de Kamagra dans le monde. Pourquoi prendre des risques si vous pouvez être sûr avec Medicamentsen-ligne - Le service auquel vous pouvez faire confiance.
Blackwell Munksgaard 2005
A psychotic episode associated with the AtkinsDiet in a patient with bipolar disorder
talcum powder, and ﬂooding the apartment withwater from his bathtub, resulting in the collapse of
Studies have suggested that a ketogenic diet is
the ceiling of the apartment downstairs. The time
beneﬁcial for epilepsy, both in adults (1) and in
course of the patient’s diet and symptoms is
children (2). As antiseizure medications have
proved to be eﬀective treatment for bipolar
At presentation to the hospital, the patient’s
disorder, the question has arisen whether the
weight was recorded as 189 pounds. Mood was
ketogenic diet, or other diets, may be eﬀective in
irritable and expansive. Thought process was
the treatment of bipolar disorder (3). Dietary
rambling and tangential. Thought content included
omega-3 fatty acids have been found to lengthen
somatic preoccupation and delusions with religious
remissions in bipolar disorder (4). But in one study
references. He was not oriented to day or date.
that examined the eﬀect of the ketogenic diet on
He was placed on a regular diet, and treated with
bipolar disorder in valproate-resistant patients, no
a continuation of his preadmission medications.
eﬀect was found (5). We describe the case of a
His weight increased rapidly, his mood stabilized,
patient with bipolar disorder maintained on val-
and his delusions gradually improved until his
proic acid, who developed mania shortly after
One possible connection between diet and the
The patient is a 54-year-old veteran who ﬁrst
development of mania in this patient is a relation-
developed bipolar disorder in the mid-1990s. His
ship between ketosis and valproate metabolism.
most recent psychiatric admission was in October2001. Discharge psychiatric medications weredivalproex, 1.5 g total per day, clonazepam, 1 mgat HS, and quetiapine, total daily dose 700 mg.
From October 2001 until June 2003, the patient
had no psychiatric complaints recorded by hiscaseworker with the exception of mild anxiety. On
June 12, 2003, the patient told his caseworker that
he started the Atkins diet. On June 25, the patient
reported that he was not sleeping well, and
clonazepam was increased to 1.5 mg. On July 10,
because of continued insomnia, his divalproex was
increased to 2 g/day. On July 22, the patient’s
family voiced concerns over his increasingly bizarrebehavior and paranoia. On July 24, the patient had
multiple somatic complaints, and on July 30, he
complained of multiple odors and was hyperverbal.
A total of 25 mg of diazepam/day was added to his
Fig. 1. Patient weight and severity of manic symptoms prior to
medication regimen. On August 8, the caseworker
admission. Symptoms were recorded from notes made by the
noted that money was missing from the patient’s
patient’s caseworker. Shaded area represents the period of the
bank account. The patient continued to refuse
patient’s diet. Symptom severity was divided on a 6-pointscale: 1 ¼ stable mood; 2 ¼ some complaints of anxiety;
hospital admission until August 12, when he was
3 ¼ insomnia; 4 ¼ bizarre behavior with intact reality testing;
evicted after covering the entire apartment in
5 ¼ disorientation, primarily to date; and 6 ¼ severe psychosis.
branched-chain fatty acid that is metabolized both
1. Sirven J, Whedon B, Caplan D et al. The ketogenic diet for
by glucuronization and oxidation. There is signif-
intractable epilepsy in adults: preliminary results. Epilepsia
icant variation in the pattern of valproate metab-
olism within and between individuals (6). The
2. Vining EP, Freeman JM, Ballaban-Gil K et al. A
oxidative pathway occurs within the mitochondria
multicenter study of the eﬃcacy of the ketogenic diet.
Arch Neurol 1998; I55: 1433–1437.
and is subject to auto-induction (7) and is capable
3. El-Mallakh RS, Paskitti ME. The ketogenic diet may have
of complete metabolism of valproate via beta
mood-stabilizing properties. Med Hypotheses 2001; 57:
oxidation to carbon dioxide and ketone bodies
(8). During low-carbohydrate diets or starvation,
4. Stoll AL, Severus WE, Freeman MP et al. 3 Fatty
gluconeogenesis is stimulated through multiple
acids in bipolar disorder: a preliminary double-blind,placebo-controlled trial. Arch Gen Psychiatry 1999; 56:
mechanisms, including increased mitochondrial
transport of fatty acids, resulting in the formation
5. Yaroslavsky Y, Stahl Z, Belmaker RH. Ketogenic diet in
of ketones. It is conceivable that the stimulation of
bipolar illness. Bipolar Disord 2002; 4: 75.
fatty acid transport and metabolism by dietary
6. Kreher U, Darius J, Wien F. Establishing individual
changes could lower plasma levels of valproate.
metabolite patterns for patients on valproate therapy. EurJ Drug Metab Pharm 2001; 26: 99–107.
An alternative explanation in the present case is
7. McLaughlin DB, Andrews JA, Hooper WD, Cannell GR,
that metabolic conditions related to the diet
Eadie MJ, Dickinson RG. Apparent autoinduction of
contributed directly to the development of mania,
valproate beta-oxidation in humans. Br J Clin Pharmacol
independently of changes in the plasma level of
valproate. Mania has been precipitated in Muslim
8. Silva MF, Ruiter JP, Overmars H et al. Complete beta-
oxidation of valproate: cleavage of 3-oxovalproyl-CoA by
bipolar patients by changes in Ôsocial rhythmÕ
a mitochondrial 3-oxoacyl-CoA thiolase. Biochem J 2002;
is observed (9). Elevation of mood has been
9. Kadri N, Mouchtaq N, Hakkou F, Moussaoui D.
reported in obese patients during low-calorie,
Relapses in bipolar patients: changes in social rhythm? Int
limited-carbohydrate diets, whether or not ketosis
J Neuropsychopharmacol 2000; 1: 45–49.
10. Rosen JC, Gross J, Loew D, Sims EA. Mood and
develops (10). Mood changes during fasting may
appetite during minimal-carbohydrate and carbohydrate-
be related to changes in neuroendocrine function
supplemented hypocaloric diets. Am J Clin Nutr 1985; 42:
In summary, the close temporal relationship
11. Michalsen A, Schneider S, Rodenbeck A, Ludtke R,
between the initiation of the Atkins diet by this
Huether G, Dobos GJ. The short-term eﬀects of fasting onthe neuroendocrine system in patients with chronic pain
patient and the subsequent development of mania
syndromes. Nutr Neurosci 2003; 6: 11–18.
suggests a relationship between diet and bipolardisorder. Further studies are necessary to elucidate
this relationship, as well as to investigate the eﬀects
of dietary changes on the metabolism of valproic
Department of Psychiatry and Behavioral Medicine
Medical College of Wisconsin8701 Watertown Plank RoadMilwaukee, WI 53226, USA
PODER LEGISLATIVO LEY N° 1015 QUE PREVIENE Y REPRIME LOS ACTOS ILICITOS DESTINADOS A LA LEGITIMACION DE DINERO O BIENES EL CONGRESO DE LA NACION PARAGUAYA SANCIONA CON FUERZA CAPITULO I DISPOSICIONES GENERALES Artículo 1°.- Ambito de aplicación. La presente ley: a) regula las obligaciones, las actuaciones y los procedimientos para prevenir e impedir la u
SDP:s invandringspolitiska arbetsgrupps rapport Grundlinjen i SDP:s invandringspolitik . 3 Centrala förslag i rapporten . 3 Förord. 7 1 Finland blir internationellt. 9 2 En behärskad arbetskraftsinvandring är målet . 11 2.3 Bibehåll tillgångsprövningen . 13 2.4 Det vilda hyrarbetet måste tämjas, skatterna till Finland . 14 2.6 Arbetstagarnas rättigheter bör stärkas i Europeiska