ABSTRACT
AIM: To study the effects of long-term use of clozapine on tear film stability and ocular surface tissue structure.METHODS: Case-control study was conducted on 45 patients(group 1)who were diagnosed with schizophrenia and treated with clozapine for 3.45±0.72a between March 2021 and December 2021. Another 45 healthy subjects(group 2)served as controls, whose demographic characteristics were similar to those of group 1. Patients' dry eye symptoms were investigated using OSDI questionnaire, tear secretion was detected by the Schirmer I test, ocular surface damage was assessed by the ocular surface staining score, and comprehensive ophthalmic examination was performed on all patients through LipiView ocular surface interferometer, ocular surface integrated analyzer, corneal confocal microscope and slit lamp photographic system.RESULTS: Slit-lamp photography showed diffuse grayish-white spot-like opacification in the corneal stroma of group 1, accompanied by brown star-like opacification in the center of the anterior capsule of the lens. OSDI scores were 38.00(31.50, 48.50)and 15.00(9.00, 19.50)in the two groups respectively. Schirmer test showed that the group 1 was 5.27±2.18mm/5min, while group 2 was 15.62±3.05mm/5min. Corneal fluorescein staining score: 4.00(2.50, 5.00)for group 1 and 1.00(0.00, 1.50)for group 2. The lissamine green staining score for the conjunctiva was 9.00(6.50, 10.00)and 3.00(2.00, 3.50)for the two groups, respectively. LipiView detected lipid layer thickness(LLT), suggesting that the results of group 1 and group 2 were similar, respectively 75.91±15.51 and 77.24±12.11nm; and the results were similar for the lid gland deficiency score, with 1.37±0.26 and 1.29±0.31 points, respectively. The mean tear meniscus height in group 1 was 0.13±0.06mm, which was lower than 0.23±0.04mm of group 2. Non-invasive breakup time(NIBUT)was 6.04±2.62 and 11.4±2.74s in group 1 and group 2 respectively. OSDI score, Schirmer Ⅰ test, ocular surface staining score, tear meniscus height and NIBUT were significantly different between the two groups(P<0.05). Confocal corneal microscopy suggested decreased corneal nerve fiber density with stromal layer inflammatory cell infiltration and pigmentation in group 1.CONCLUSION: The antipsychotic drug clozapine can induce dry eye with a range of ocular surface injuries such as corneal pigmentation, and patients who taking such drugs should be routinely examined by an ophthalmologist.
ABSTRACT
Se presenta el caso de un niño de un año de edad con neuroblastoma de localización en el mediastino posterior, que debutó con manifestaciones de Síndrome de Kinsbourne (opsoclonus, mioclonus), y que mejoró ostensiblemente después de la extracción quirúrgica del tumor. Se discute la frecuencia, localización, forma de presentación y tratamiento del síndrome.
The case of a 1-year old child with a neuroblastoma of posterior mediastinal location is presented. The initial manifestations were those of the Kinsbourne Syndrome (opsoclonus, myoclonus), which improved significantly after the surgical removal of the tumor. The frequency, location, form of presentation and treatment of the Kinsbourne Syndrome are discussed.
Subject(s)
Male , Humans , Infant , Neuroblastoma , Opsoclonus-Myoclonus Syndrome , ThoraxABSTRACT
Objective To explore the status of oxidative stress (OS) in the first-episode schizophrenia patients (FEP) and to examine the effects of antipsychotic drugs on oxidative stress of FEP. Methods The plasma total superox?ide dismutase (T-SOD), glutathione peroxidase (GSH-Px), catalase (CAT) and total antioxidant capacity (T-AOC) were measured in forty-seven FEP (case group) and forty-three healthy volunteers (control group) before and after treatment. Eighteen cases completed 6-week treatment with risperidone (risperidone group) and twenty-five cases completed 6-week treatment with olanzapine (olanzapine group). Results The activity of T-SOD and GSH-Px were lower (P0.05) in FEP compared to the control group. Risperidone and olanzapine significantly improved T-SOD and T-AOC, respectively (P0.05). Conclusion FEP has alterations of antioxidant enzymes, which may be related to the pathogenesis of schizo?phrenia. Antipsychotics risperidone and olanzapine may improve the oxidative stress in FEP.
ABSTRACT
OBJECTIVE:To provide reference for rational use of antipsychotic drugs in schizophrenia patients. METHODS:The general information and antipsychotic treatment information,which were extracted from the database of prior drug investigation in Mental Health Center of Hebei Province in 2002,2006 and investigation data in 2012 of 5014 schizophrenia patients,were ana-lyzed. RESULTS:Over time,the frequency of the first generation antipsychotic drugs decreased(P0.05). Over time,the proportion of inpatients receiving monotherapy decreased,while that of inpatients receiving combination treatment increased (χ2=18.682,P<0.01). CONCLUSIONS:The second generation antipsychotic drugs have gradually replaced the first generation antipsy-chotic drugs,and have became the leading drugs in the treatment of schizophrenia in Hebei province. The proportion of inpatients receiving combination treatment has increased,which is different from the domestic and foreign prevention and treatment guide-lines.
ABSTRACT
Objective To explore the working pattern for endocrinology clinical pharmacists participating in clinical drug treatment .Methods By participating in the treatment for a patient with diabetes and hyperprolactinemia and analyzing the cau‐ses of poor glycemic control and hyperprolactinemia ,clinical pharmacists proposed therapeutic regimen .Results The long‐term psychotropic medication may be one of the reasons why blood glucose of the patient was unsatisfactorily controlled .The patient with hyperprolactinemia may be associated with her longstanding use of paliperidone .The patient was recommended to consult a psychiatrist and switch to an alternative medication which does not cause hyperprolactinemia .Conclusion The active partici‐pation of clinical pharmacists during clinical drug therapy could improve the medication rationality and compliance of patients with drugs .
ABSTRACT
OBJECTIVE: This study examined the association between the brain-derived neurotrophic factor (BDNF) (Val66Met) polymorphism and the response to the addition of an atypical antipsychotic drug to a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) in treatment-refractory depression. METHODS: The study enrolled 64 patients meeting the Diagnostic and Statistical Manual of Mental Disorders-IV criteria for major depressive disorder who were treated with at least two courses of a single antidepressant, but who had Hamilton Depression Rating Scale (HAMD-17) scores > or =15 points that were reduced less than 50% over at least a 4-week treatment period. There were 24 males and 40 females (age range 27-68 years; mean+/-SD, 48+/-13 years). The patients' clinical improvement was evaluated using the HAMD-17. Patients with at least a 50% decrease in the HAMD-17 score were defined as responders. Serum BDNF levels were assayed using enzyme-linked immunosorbent assays and the presence of the BDNF (Val66Met) polymorphism was determined using the TaqMan genotyping assay. RESULTS: No correlation was found between the BDNF (Val66Met) polymorphism and a positive response to adding an atypical antipsychotic drug. No differences were observed in the changes in the serum BDNF levels and HAMD-17 scores between Val66Val and Met-carriers. In addition, in patients who experienced remission, the atypical antipsychotic drug was discontinued after at least 3 months of treatment and the patients were then followed for 1 year; 14 of 27 patients (52%) relapsed within 1 year. CONCLUSION: These results suggest that the BDNF (Val66Met) polymorphism is not associated with the response to the augmentation of a SSRI or SNRI with an atypical antipsychotic drug, and that the combination of an atypical antipsychotic drug and a SSRI or SNRI should be continued for 3 months or more in refractory depressed patients in the Japanese population.
Subject(s)
Female , Humans , Male , Asian People , Brain-Derived Neurotrophic Factor , Depression , Depressive Disorder, Major , Depressive Disorder, Treatment-Resistant , Enzyme-Linked Immunosorbent Assay , Norepinephrine , SerotoninABSTRACT
A student on aripiprazole (an atypical second generation antipsychotic drug) was admitted with deliberate overdose of the drug, and in the course of her hospital stay developed a clinical picture of mild neuroleptic malignant syndrome (NMS). She survived after supportive care. A brief review is included on the incidence of NMS secondary to aripiprazole overdose, and reveals an increasing incidence
ABSTRACT
OBJECTIVE: Schizophrenia, a devastating mental disorder, displays a wide range of cognitive impairments including attentional impairment. Prepulse inhibition (PPI), in which a startle response to a loud acoustic noise is reduced by a preceding auditory stimulus of a lower intensity, is impaired in schizophrenic patients and rats injected with apomorphine (APO) or phencyclidine (PCP) mimicking attentional deficits in schizophrenics. Here we examined therapeutic efficacy of a newly developed atypical antipsychotic compound (YKP1447;YKP) on PPI impairment induced by various doses of APO and PCP. METHODS: This study was composed of 3 experiments. YKP (0.5-15 mg/kg) or vehicle (VEH) was administered 15 min before the injection of APO (0.5 mg/kg, Exp1) or PCP (2.0 mg/kg, Exp2:1.5 mg/kg, Exp3). They were then tested for PPI in which a mix of startle stimulus and prepulse was presented. RESULTS: APO or PCP treatment effectively impaired PPI in tested animals (VEH/APO or VEH/PCP). Impaired PPI in APO group was reversed in animals that were pretreated with YKP (5-10 mg/kg) (Exp1). However YKP treatment was not effective in PCP group (Exp2-3). CONCLUSION: High concentration of YKP pretreatment had antipsychotic effect on APO-induced impairment in attentional function suggesting that the compound could potentially be used to treat cognitive impairment due to increased dopaminergic receptorbinding.
Subject(s)
Animals , Humans , Rats , Acoustics , Antipsychotic Agents , Apomorphine , Mental Disorders , Noise , Phencyclidine , SchizophreniaABSTRACT
OBJECTIVES: Vascular endothelial growth factor(VEGF), one of potent cytokines, and its receptors were related with various biological functions and pathological conditions. The purpose of this study was to investigate the changes of serum level of free VEGF, soluble VEGFR-1, and soluble VEGFR-2 after treatment with atypical antipsychotic drug in schizophrenia. METHOD: The schizophrenic patients were diagnosed with DSM-IV and were prospectively followed up for 4 and 8 weeks. Thirteen schizophrenic patients were evaluated their clinical assessment with serum levels of free VEGF, sVEGFR-1, sVEGFR-2, and positive and negative symptom scale(PANSS) at baseline, 4 weeks, and 8 weeks after treatment with atypical antipsychotic drug. Thirteen normal control subjects were recruited and matched with the patient group by age and sex. RESULT: The serum level of free VEGF(295.2+/-43.7pg/ml)and sVEGFR-2(8259+/-336.7) at baseline(before treatment) in schizophrenic patients were not significantly different, compared with the control group(199.0+/-28.8 and 8481+/-371.9) respectively. However, the serum level of sVEGFR-1(86.2+/-10.3, p<0.05) was significantly increased in the schizophrenic patients compared with the control group(59.0+/-6.4). After treatment with antipsychotic drug, the serum levels of free VEGF at 4 weeks(338.9+/-56.5) and 8 weeks(309.5+/-58.7) were not significantly, different compared with baseline. But the serum levels of sVEGFR-1 was significantly decreased at 8 weeks(57.3+/-6.3, p<0.05) after antipsychotic drug treatment. The serum levels of sVEGFR-2 were decreased at 4 weeks(7761+/-403.0, p<0.05) and 8 weeks(7435+/-333.5, p<0.05) compared with baseline. CONCLUSION: The decreased serum level of sVEGFR-1 and sVEGFR-2 might be affected by dopaminergic system which was influenced by antipsychotic drug.
Subject(s)
Humans , Cytokines , Diagnostic and Statistical Manual of Mental Disorders , Dopamine , Prospective Studies , Schizophrenia , Vascular Endothelial Growth Factor A , Vascular Endothelial Growth Factor Receptor-1 , Vascular Endothelial Growth Factor Receptor-2ABSTRACT
& executive function deficit could be reversible after treatment, and 3) medication might have a benefit in improving the cognitive functions in schizophrenia. Furthermore, the data supports that the better premorbid executive function was, the more favorable was the treatment response in schizophrenic patients. Finally, this study indicates that executive function might be an index of treatment improvement.
Subject(s)
Humans , Executive Function , SchizophreniaABSTRACT
Discovery of antipsychotic drugs provided us with a turning point which was regarded as a revolutionary event in psychiatry. The pathophysiology of psychotic disorders such as schizophrenia had not been unveiled until antipsychotic drugs were discovered. A clue to understanding the pathophysiology of psychotic disorders has been found through the investigation of the mechanism of action of antipsychotic drugs. It is natural outcome to have imperfect understanding of the pathophysiology of psychotic disorders, since their concepts has not been fully defined bioetiologically until now. This is the reason why antipsychotic drugs have limited effects in treating psychotic patients despite the use of them. Advances in molecular biology and neuroscience may unveil the neurobiological mechanisms of psychotic disorders and eventually provide enough information to develop new antipsychotic drugs. The serendipitous discovery of new drugs often creates opportunities for new directions in medical research. The study of the mechanism of action of new drugs may help refine scientific theories and develop newer and better drugs. Overcoming the psychotic disorders as well as cancers is one of the most difficult subjects that needs to be settled. In a sense that the antipsychotic drug was discovered by serendipity, reviewing the developmental history of antipsychotic drugs could be a meaningful way, as it could be a clue to solve the difficulties. History has always provided us with the wisdom to contemplate the future.
Subject(s)
Humans , Antipsychotic Agents , Molecular Biology , Neurosciences , Psychotic Disorders , SchizophreniaABSTRACT
OBJECTIVE: The development of metabolic disorders including diabetes mellitus and hyperlipidemia has been reported among schizophrenia patients treated with atypical antipsychotic drugs. The role of antipsychotic drugs in the development of this condition has not been proven yet. This study was conducted to investigate whether antipsychotic drugs that often induce weight gain influence glucose and lipid metabolism including insulin resistance and serum leptin level. METHODS: The study population consisted of 63 patients (all meeting DSM-IV criteria for schizophrenia), who were divided into 3 treatment groups: haloperidol (N=21), risperidone (N=21), and olanzapine (N=21) monotherapy, and 31 healthy control subjects. Fasting blood samples for glucose, insulin, leptin and lipids were analysed. In addition, insulin resistance (IR) was calculated through the homeostatic model assessment (HOMA) and body mass index (BMI) was also calculated. RESULTS: In patients receiving olanzapine, significant increases in BMI (p<0.01) and lipid profiles including LDL-cholesterol (p<0.05), triglyceride (p<0.01) and leptin levels (p<0.001) were found in comparison with the normal control group. A significantly higher degree of IR, as measured with the HOMA index, was found in patients receiving olanzapine than in patients receiving haloperidol (p<0.01) and risperidone (p<0.05), and in the normal control group (p<0.01). After removal of the impacts of BMI on the degree of HOMA-IR and serum leptin levels, the degree of HOMA-IR (p<0.05) and serum leptin levels (p<0.001) was also higher in patients receiving olanzapine than in the normal control group. CONCLUSION: The results of this study suggest that olanzapine has more significant influence on metabolic complications than haloperidol and risperidone and the characteristics of antipsychotic drug per se may be involved in the development of metabolic complication as well as weight change.
Subject(s)
Humans , Antipsychotic Agents , Body Mass Index , Diabetes Mellitus , Diagnostic and Statistical Manual of Mental Disorders , Fasting , Glucose , Haloperidol , Hyperlipidemias , Insulin , Insulin Resistance , Leptin , Lipid Metabolism , Risperidone , Schizophrenia , Triglycerides , Weight GainABSTRACT
OBJECT: We investigated the relationship between prolactin response to antipsychotics and clinical courses of psychotic symptoms and DAT gene polymorphisms. METHOD: Twenty-four acute psychotic inpatients completed the 12-week trial of risperidone. Serum prolactin, BPRS, ESRS and hyperprolactinemia-related symptoms were measured at baseline, 2, 4, 8 and 12 weeks after medication. The DAT gene polymorphisms were analyzed. RESULTS: The serum prolactin was significantly increased over time. According to the prolactin level at 2-week, the subjects were divided into the severe group(serum prolactin>60ng/mL, N=15) and the mild group (serum prolactin<60ng/mL, N=9). The prolactin levels of the mild group didn't increase beyond 60ng/mL throughout 12 weeks. Severe group had slower decrement of BPRS scores than those of mild group. Six females in severe group complained of irregular menstruations, but no female in mild group. Most patients had 10 allele of DAT gene. CONCLUSION: This study suggests that the magnitude of prolactin elevation at the 2-week of risperidone medication is correlated with severity of hyperprolactinemia throughout treatments. Our results did not show the relationship between prolactin responses and DAT gene polymorphisms.
Subject(s)
Female , Humans , Alleles , Antipsychotic Agents , Bipolar Disorder , Dopamine Plasma Membrane Transport Proteins , Dopamine , Hyperprolactinemia , Inpatients , Menstruation , Prolactin , Risperidone , SchizophreniaABSTRACT
There is a substantial variation in the treatment response and adverse reactions to antipsychotic drugs. Pharmacogenomics of antipsychotic drugs is to identify the gene(s) related with this variability in outcome to antipsychotic drugs. The genes considered to be related with the mechanism of action of antipsychotic drugs have been focused in this field, such as cytochrome P450, serotonin receptors, and dopamine receptors genes. Pharmacogenomic studies dealing with antipsychotic drugs have aimed to identify the association of these genes and drug response and adverse reactions. In this paper, the concept, methodological considerations, and future prospect of pharmacogenomics related with antipsychotic drugs will be addressed with extensive review of literatures.
Subject(s)
Antipsychotic Agents , Cytochrome P-450 Enzyme System , Pharmacogenetics , Receptors, Dopamine , Receptors, SerotoninABSTRACT
OBJECTIVES: Antibodies to stress proteins, which play a protective role against environmental stresses in a cell, might be related to the pathogenesis of schizophrenia. In this study, we examined antibodies to HSP70 and HSP90 in patients with schizophrenia before and after medication. Clinical variables such as age at onset, duration of illness, number of admission, and severity of symptoms according to immunoreactivity to HSP70 and HSP90 were also investigated in patients with schizophrenia. METHODS: IgG antibodies to HSP70 and HSP90 in 70 patients with schizophrenia and 83 normal controls were measured by ELISA. RESULTS: The levels of HSP70 and HSP90 antibodies were higher in the patients with schizophrenia than normal controls. Also, the frequencies of positive HSP70 and HSP90 antibodies were higher in the patients with schizophrenia, and their distribution was significantly associated with each other. The level of HSP70 antibody and frequency of positive HSP70 antibody decreased in the patients after medication. But, the level of HSP90 antibody and frequency of positive HSP90 antibody were not significantly changed after medication. The scores of symptom severity(brief psychiatric rating scale(BPRS)) were higher in the patients who showed positive HSP70 antibody. After medication, BPRS scores were not different between the positive and negative HSP70 antibody groups. Otherwise, the levels of HSP90 antibody were not related with BPRS scores and not changed after medication. CONCLUSION: Our results suggest that the antipsychotic drugs might affect the immunore-activity to HSP70 but not to HSP90 in the patients with schizophrenia.
Subject(s)
Humans , Antibodies , Antipsychotic Agents , Enzyme-Linked Immunosorbent Assay , Heat-Shock Proteins , Hot Temperature , HSP70 Heat-Shock Proteins , Immunoglobulin G , SchizophreniaABSTRACT
OBJECT: This study was performed in order to examine the correlation between acute neuroleptic-induced dystonic reactions and serum iron level. METHOD: Serum iron levels were measured in psychiatric inpatients who had developed acute neuroleptic-induced dystonia(N=41) and in control patients with no history of acute dystonic reactions(N=37). Serum iron levels were compared in acute dystonic inpatients before starting treatment with neuroleptics and after acute dystonic reaction. RESULTS: The patients exhibiting acute dystonic reactions had significantly lower serum iron levels than the patients without acute dystonic reactions. CONCLUSION: This result supports an association between low serum iron and the occurrence of neuroleptic-induced acute dystonic reactions.
Subject(s)
Humans , Antipsychotic Agents , Dystonia , Inpatients , IronABSTRACT
CV(bDAT) cell line, expressing dopamine transporter stably, has been established by transfection of CV-1 cells with bovine dopamine transporter cDNA. Using CV(bDAT) cells, the effects of various antipsychotic drugs on dopamine uptake were investigated. All of antipsychotic drugs tested, inhibited the [3>H]dopamine uptake into CV(bDAT) cells with IC50s in the low to mid micromolar, implying that antipsychotic drugs may produce overflow of dopamine in the synaptic cleft of dopaminergic neuron.