Clinical Schizophrenia and Related Psychoses最新文献

Aggressive behaviour represents a challenge in the treatment of patients with schizophrenia, being often associated with clinical predictors of severity of illness such as poor insight, psychotic re-exacerbation, concomitant substance misuse or comorbidity with personality disorders. As psychotic relapses and consequent risk of aggressive behaviour are often associated with a poor compliance, purpose of the present manuscript is to give an overview of the available data about the use of depot antipsychotics for the management of violence in patients with schizophrenia. A research in the main database sources has been conducted to identify relevant papers about the topic. Few studies (most of them retrospective and with small sample sizes) have investigated the effectiveness of depot antipsychotic for the treatment of aggressive behaviour in schizophrenia. Aripiprazole depot appears to be promising for the management of aggressive behaviour of subjects with schizophrenia, however data about its efficacy in the long-term are absent and lack of evidence prevents the recommendation of this compound for the treatment of aggressiveness in subjects affected by schizophrenia. In addition, there is not sufficient evidence to conclude that a specific depot antipsychotic may have a better efficacy on aggressive behaviour of patients affected by schizophrenia. Prospective comparative studies (e.g. with oral clozapine and aripiprazole depot) are needed to assess the real clinical advantage of the use of depot antipsychotic versus oral alternatives for the prevention of violent behaviour in schizophrenia.

Background: Chilaiditi's sign is defined as the interposition of bowels between the liver and the right diaphragm. When the patient is symptomatic due to the intestinal obstruction, the case is referred to as Chilaiditi's syndrome.

Objective: To emphasize the importance of accurate diagnose of Chilaiditi's syndrome in patients with psychotic disturbances.

Method: A 46 years old male was admitted to our department suffering from a constant epigastric and right upper quadrant pain with radiation to the right shoulder. The pain started 10 hours before the admission of the patient and was accompanied with vomiting. Patient has a history of schizophrenia and intellectual disability. He was in a stimulatory situation and unable to give any information about his state of health.

Results: Patient was afebrile, tachycardic and laboratory results were normal. The chest and abdomen x-ray showed the Chilaiditi's sign. With the ultrasound procedure the case of the pneumoperitoneum was excluded. A conservative treatment with IV fluid hydration, pain management, diet modification, laxatives and enemas, was used. After a week of hospitalization, the patient felt well, having proper diet and regular evacuations and at the Chilaiditi's sign was no more observed.

Discussion: The etiology of the Chilaiditi's syndrome is multifactoral and it has been reported that it is associated with psychotropic medication and intellectual disability.

Conclusions: The diagnosis of the syndrome is vital in order to avoid unnecessary and dangerous surgical interventions. Only few publications of a Chilaiditi syndrome in patients with psychosis are cited in the literature.

Background: Treatment-resistant schizophrenia patients frequently need to be managed with clozapine. However, noncompliance is in-part due to complaints of sedation, fatigue, and low energy. There is little literature reporting on the effectiveness and safety of using stimulants to treat clozapine-induced sedation. We report three cases of treatment-resistant schizophrenia where methylphenidate was used to address these common side-effects.

Methods: To evaluate the effectiveness and safety of psychostimulants in treatment-resistant schizophrenia, we reviewed 3 extensively documented cases of clozapine-induced sedation treated with methylphenidate for over 2 years, in addition to reviewing the literature on this topic.

Results: All 3 patients reported improvements in energy and fatigue, along with decreased sedation, while treated with methylphenidate for 27, 30, and 32 months respectively. Clozapine doses ranged between 325mg and 500mg daily; methylphenidate doses ranged between 2.5mg of the immediate-release and 72mg daily of the extended-release formulation. There was no reported or observed increase in psychotic symptoms resulting from treatment with methylphenidate.

Conclusion: Methylphenidate may be safe and effective in the management of clozapine-induced sedation in treatment-resistant schizophrenia. Large scale, placebo-controlled, double-blind trials are needed to further validate the safety and efficacy of methylphenidate as treatment for clozapine-induced sedation.

Patients with schizophrenia have higher rates of adverse childhood experiences (ACEs) than the general population, and those who suffered multiple traumatic experiences have a higher prevalence of positive symptoms, poorer social functioning and more suicidal ideations and behavior. The current study aims to determine the prevalence of ACEs in a female patient sample with schizophrenia. An observational descriptive cross-sectional study was conducted. Participants included 50 female patients older than 18 years, with schizophrenia. Semi-structured interviews and the Adverse Childhood Experiences Questionnaire were conducted. We observed that 90% experienced at least one ACE. Most (52%) suffered 4 or more ACEs. A high prevalence of emotional abuse and neglect was found and a significant relationship between patients who suffered multiple ACEs and the presence of suicidal behavior and persistent auditory hallucinations.

Although recognized as a feature of schizophrenia since the time of Kraepelin, motor disorders have received relatively little attention, particularly as regard their phenomenology. This is particularly the case in the English-speaking literature, where 'automaticity', mutism, and autonomic instability, have been emphasized among the features of catatonia at the expense of more complex behaviors and mannerisms. The possible relationship between the content of thinking disorders, such as hallucinations and dereistic thinking, and involuntary and semi-voluntary movement disorders, has been little noted. That such gestures might have "intentionality", or meaning, has not been considered. The case is presented of an adolescent who developed involuntary movements which seemed to have meaning in reference to his interests. The thought content, phenomenology, and brain abnormalities underpinning catatonia merit further study.

Objectives: To report the finding of psychosis in a patient with Davidoff-Dyke-Masson Syndrome.

Method: Case report.

Conclusions: Right-sided hemiatrophy may be an addition to the list of neuro-developmental and structural cerebral anomalies associated with psychotic disorders including schizophrenia.

Background: While clozapine (CLZ) is the most effective antipsychotic drug for schizophrenia treatment, it remains underused. In order to understand the barriers of frequent blood draws for white blood cell counts (WBCs) and clozapine levels, we developed a psychiatrist survey and began an integrative approach of designing a point-of-care device that could eventually have real-time monitoring with immediate results.

Methods: We ascertained barriers related to CLZ management and the acceptance of possible solutions by sending an anonymous survey to physicians in psychiatric practice (n=860). In parallel, we tested CLZ sensing using a prototype point-of-care monitoring device.

Results: 255 responses were included in the survey results. The two barriers receiving mean scores with the highest agreement as being a significant barrier were patient nonadherence to blood work and blood work's burden on the patient (out of 28). Among nine solutions, the ability to obtain lab results in the physician's office or pharmacy was top ranked (mean±sd Likert scale [4.0±1.0]). Physicians responded that a point-of-care device to measure blood levels and WBCs would improve care and increase CLZ use. Residents ranked point-of-care devices higher than older physicians (4.07±0.87 vs. 3.47±1.08, p<0.0001). Also, the prototype device was able to detect CLZ reliably in 1.6, 8.2, and 16.3 μg/mL buffered solutions.

Discussion: Survey results demonstrate physicians' desire for point-of-care monitoring technology, particularly among younger prescribers. Prototype sensor results identify that CLZ can be detected and integrated for future device development. Future development will also include integration of WBCs for a complete detection device.

So far, demographic variables have not consistently been found to predict clinical response to antipsychotics. This study examines some differences in response to ziprasidone, which has been shown to be effective, with a better metabolic side effect profile, but was little used in New York State Hospitals. The aim was to study state hospital patients switched to ziprasidone. The results led to questions about different responses in different groups. Subjects from state hospitals who needed a change of antipsychotic participated in this open-label, 8-week trial of up to 240-mg ziprasidone. Analyses included comparisons of the very different results from two sites. Of the 36 study subjects, 12 terminated early. The 17 outpatients from Buffalo, who were older and on lower doses of antipsychotics pre-study, improved significantly. The 19 inpatients from the Bronx, overall younger and on higher pre-study doses, barely changed. Improvements in PANSS total score were significantly associated with older age, greater baseline severity, and lower doses of antipsychotics pre-study. The subjects improved on metabolic parameters. The results suggest that ziprasidone may be just as effective as previous antipsychotics taken by these severely mentally ill patients, and with fewer metabolic side effects. Note: The study described here includes a dosage of ziprasidone that has not been approved by the U.S. Food and Drug Administration (FDA). The FDA has approved daily doses of ziprasidone no greater than 100 mg PO bid.