Relationship of Estrogen to Extrapyramidal Symptoms in Female Schizophrenic Patients

OBJECTIVE: It has been thought that estrogen has neuroleptic like effect in women schizophrenic patients. This study aimed to investigate neuroleptic side-effects severity in women with schizohrenia and to investigate their putative association with variations in sex steroids over menstrual cycle. Based on the estrogen theory, The author hypothesized that parkinsonian side-effects would be exacerbated when estrogen levels were high. METHOD: 26 schizophrenic women were assessed using the ESRS(Extrapyramidal Symptom Rating Scale) and estrogen analysis. Tests were conducted twice, in the mid luteal and mid follicular phase. RESULT: It was hypothesized that high level of estrogen would lead to an exacerbation of parkisonian side-effects but the results indicated that parkinsonian side effects decreased overall when estrogen levels were high. This effects were more marked for the group taking typical neuroleptics than those taking atypical neuroleptics. CONCLUSION: The results of this study suggest that estrogen and progesteron may reduce the severity of neuroleptic indeced extrapyramidal side effects over menstrual cycle in women with schizophrenia. It was concluded that estrogen has different effects on dopamine dynamics in the mesolimbic and mesostriatal pathways according to estrogen, progesteron, catecol estrogen, prolactine.

Risperidone-Induced Mania in Psychoses / 신경정신의학

Risperidone is one of a new class of atypical antipsychotic drug that combines potent dopamine(D2) and serotonin(5-HT2) receptor antagonist properties. In the last few years, there have been several report of risperidone-induced manic symptoms during treatment of schizoaffective disorder or schizophrenia. We report three cases of mania developed in two schizophrenia patients and one amphetamine-induced psychotic disorder which appear to have been precipitated by rispendone. This inducing effect might be attributed to its ability to block postsynaptic 5-HT2 receptors, a property that distinguishes it self from other antipsychotic agents. The blocking of serotonin receptors by risperidone may create a perceived depletion of serotonin similar to that seen in affective disorder and lead to mania. Therefore, we should be cautions in the treatment of psychotic disorder with risperidone.

The Effect of Cyproheptadine Treatment in Neuroleptic Induced Akathisia / 신경정신의학

OBJECTIVE: Neuroleptic Induced Akathisia(NIA) often occurs in neuroleptic treated patients. Cyproheptadine, an antiserotonergic agent, was used to treat neuroleptic induced akathisia. METHOD: In an open trial 21 neuroleptic-treated patients with akathisia were administrated Cyproheptadine(16mg/day) over 4 days. Assessment of akathisia was evaluated using Barnes' rating scale(BAS) for neuroleptic induced akathisia. The degree of depression and psychosis were assessed by brief psychiatric rating scale(BFRS) and Hamilton rating scale for depression(HAM-D). RESULT: Most patients(20 of 21) with neuroleptic induced akathisia(NIA) showed improvement under the treatment of cyproheptadine. There was no aggravation of psychosis or depression during the treatment. Symptoms of akathisia aggravated when cyproheptadine was discontinued. CONCLUSION: Cyproheptadine may be useful in the treatment of neuroleptic induced akathisia(NIA).