Olfactory Reference Syndrome: a case report

Olfactory reference syndrome (ORS) is a psychiatric condition characterized by the false belief that an individual emits an offensive or foul odour from their body. It causes lot of embarrassment and social impairment to these patients. Treatment options include antidepressants and antipsychotics. Here we present a case of Olfactory Reference Syndrome who responded to combination of antipsychotics and antidepressant.

Switching Antipsychotics to Blonanserin in Patients with Schizophrenia: An Open-label, Prospective, Multicenter Study

OBJECTIVE: This study was performed to investigate the efficacy and tolerability of blonanserin in schizophrenic patients who were previously treated with other antipsychotics but, due to insufficient response, were switched to blonanserin. METHODS: A total of 52 patients with schizophrenia who were unresponsive to treatment with antipsychotic monotherapy or combination therapy were recruited into this 12-week, open-label, prospective, multicenter study. Patients were switched to blonanserin from their existing antipsychotics over a maximum 2-week tapering-off period. Efficacy was primarily evaluated using the 18-item Brief Psychiatric Rating Scale (BPRS). Assessments were performed at baseline, and at weeks 1, 2, 4, 8, and 12. RESULTS: Switching to blonanserin resulted in a significant decrease in the mean total score on the BPRS from baseline (56.8 ± 9.4) to week 12 (42.1 ± 13.8, p < 0.001). The most common adverse events were extrapyramidal symptoms (n = 12, 23.1%), insomnia (n = 10, 19.2%), and emotional arousal (n = 6, 11.5%). Overweight or obese patients (body mass index ≥ 23 kg/m2, n = 33) who switched to blonanserin exhibited significant weight loss from 75.2 ± 9.3 kg at baseline to 73.5 ± 9.2 kg at week 12 (p = 0.006). The total cholesterol (baseline, 236.1 ± 47.6 mg/dl; endpoint [week 12], 209.9 ± 28.0 mg/dl; p = 0.005) and prolactin levels (baseline, 80.0 ± 85.2 ng/ml; endpoint [week 12], 63.2 ± 88.9 ng/ml; p = 0.003) were also significantly improved in patients with hypercholesterolemia or hyperprolactinemia. CONCLUSION: The results of the present study suggest that switching to blonanserin may be an effective strategy for schizophrenic patients unresponsive to other antipsychotic treatments.

Determination of 9 Residual Organic Solvents in Blonanserin by Headspace Gas Chromatography / 中国药房

OBJECTIVE:To establish a method for the determination of 9 residual organic solvents in blonanserin as methanol, alcohol,isopropyl alcohol,acetonitrile,dichloromethane,hexane,ethyl acetate,tetrahydrofuran and methylbenzene. METHODS:Headspace gas chromatography was adopted. The determination was performed on DB-624 capillary column using temperature pro-gramming. The inlet temperature was 150 ℃,and flame ionization detector was used with temperature of 250 ℃. High purity nitro-gen was used as carrier gas with flow rate of 2.8 mL/min. The split ratio was 1:1,and headspace sample size was 1 mL. Head-space heating temperature was 90 ℃,and equilibration time was 35 min. RESULTS:The linear ranges of methanol,alcohol,iso-propyl alcohol,acetonitrile,dichloromethane,hexane,ethyl acetate,tetrahydrofuran and methylbenzene were 6-1500 μg/mL(r=0.9998),10-2500 μg/mL(r=0.9999),10-2500 μg/mL(r=0.9998),0.82-205 μg/mL(r=0.9994),1.2-300 μg/mL(r=0.9995), 0.58-145 μg/mL(r=0.9994),10-2500 μg/mL(r=0.9999),1.44-360 μg/mL(r=0.9996),1.78-445 μg/mL(r=0.9995),respec-tively. The limits of quantitation were 17.71,6.02,3.17,7.45,1.53,0.69,0.93,1.01,0.22 μg/mL;the limits of detection were 5.89,1.90,1.05,2.48,0.51,0.23,0.31,0.33,0.07 μg/mL,respectively. RSDs of precision and stability tests were all lower than 3.0%,and isopropanol was found in repeatability test (RSD=2.1%). The average recoveries ranged 96.67%-102.66%(RSD=1.9%,n=9),96.00%-101.83%(RSD=1.9%,n=9),97.17%-101.50%(RSD=1.4%,n=9),96.97%-102.44%(RSD=2.2%,n=9),95.83%-103.33%(RSD=2.5%,n=9),95.83%-100.28%(RSD=1.9%,n=9),98.17%-101.25%(RSD=1.0%,n=9),96.55%-102.30%(RSD=1.9%,n=9),96.30%-102.22%(RSD=1.8%,n=9),respectively. CONCLUSIONS:The method is simple,rapid,accurate and suitable for simultaneous determination of 9 residual organic solvents in blonanserin as methanol,alco-hol,isopropyl alcohol,acetonitrile,dichloromethane,hexane,ethyl acetate,tetrahydrofuran and methylbenzene.

Neuroprotective effects of blonanserin on H2O2-induced injury in PC12 cells / 天津医药

Objective To explore neuroprotective effects of blonanserin on H2O2-induced injury in PC12 cells. Meth?ods PC12 cells were divided into four groups:control group (C group), H2O2-treated group (H group), blonanserin pretreat?ed group (B group) and positive control group (vitamin E- pretreated, E group). The effects of different concentrations of blonanserin (0, 5, 10, 20, 40, 80 and 160 μmol·L-1) on cell proliferation in PC 12 cells were observed. MTT assay was used to detect the cell activity of different groups. The apoptotic rates of different groups were measured by TUNEL assay. The mor?phological changes were observed using inverted microscope and Hoechst 33258 staining. The superoxide dismutase (SOD) vi?ability and malondialdehyde (MDA) levels were detecded by biochemical methods in four groups. Results The appropriate concentration of blonanserin (0-20 μmol·L-1) can promote the growth of PC12 cells. Comparing with the C group, the apoptot?ic rate and MDA level were increased in group H, while the cell viability and the SOD viability were decreased obviously ( P<0.05). Compared with H group, the cell viability, SOD viability were significantly increased, while the MDA level and apoptotic rate were decreased (P<0.05). Conclusion Blonanserin shows neuroprotective effect on H2O2-induced injury in PC12 cells.

Blonanserin Augmentation of Atypical Antipsychotics in Patients with Schizophrenia-Who Benefits from Blonanserin Augmentation?: An Open-Label, Prospective, Multicenter Study

OBJECTIVE: The purpose of this study was to investigate the efficacy and tolerability of atypical antipsychotics (AAPs) with augmentation by blonanserin in schizophrenic patients. METHODS: aA total of 100 patients with schizophrenia who were partially or completely unresponsive to treatment with an AAP were recruited in this 12-week, open-label, non-comparative, multicenter study. Blonanserin was added to their existing AAP regimen, which was maintained during the study period. Efficacy was primarily evaluated using the Positive and Negative Syndrome Scale (PANSS) at baseline and at weeks 2, 4, 8, and 12. Predictors for PANSS response (≥20% reduction) were investigated. RESULTS: The PANSS total score was significantly decreased at 12 weeks of blonanserin augmentation (-21.0±18.1, F=105.849, p<0.001). Moreover, 51.0% of participants experienced a response at week 12. Premature discontinuation of blonanserin occurred in 17 patients (17.0%); 4 of these patients dropped out due to adverse events. The patients who benefited the most from blonanserin were those with severe symptoms despite a treatment with a higher dose of AAP. CONCLUSION: Blonanserin augmentation could be an effective strategy for patients with schizophrenia who were partially or completely unresponsive to treatment with an AAP.

Effect of isopropyl myristate on the viscoelasticity and drug release of a drug-in-adhesive transdermal patch containing blonanserinEffect of isopropyl myristate on the viscoelasticity and drug release of a drug-in-adhesive transdermal patch containing blonanserinretain-->

The purpose of this study was to investigate the effect of isopropyl myristate (IPM), a penetration enhancer, on the viscoelasticity and drug release of a drug-in-adhesive transdermal patch containing blonanserin. The patches were prepared with DURO-TAK87-2287 as a pressure-sensitive adhesive (PSA) containing 5% (/) of blonanserin and different concentrations of IPM. Anrelease experiment was performed and the adhesive performance of the drug-in-adhesive patches with different concentrations of IPM was evaluated by a rolling ball tack test and a shear-adhesion test. The glass transition temperature () and rheological parameters of the drug-in-adhesive layers were determined to study the effect of IPM on the mechanical properties of the PSA. The results of therelease experiment showed that the release rate of blonanserin increased with an increasing concentration of IPM. The rolling ball tack test and shear-adhesion test showed decreasing values with increasing IPM concentration. The results were interpreted on the basis of the IPM-induced plasticization of the PSA, as evidenced by a depression of the glass transition temperature and a decrease in the elastic modulus. In conclusion, IPM acted as a plasticizer on DURO-TAK87-2287, and it increased the release of blonanserin and affected the adhesive properties of the PSA.

One-Year Follow-Up of Serum Prolactin Level in Schizophrenia Patients Treated with Blonanserin: A Case Series

In our previous study, a prolactin elevation was more frequently in risperidone than in blonanserin; however, it was more often in blonanserin than in olanzapine. Therefore, while a rate of PRL rising is low to moderate, hyperprolactinemia is a considerable adverse effect in the blonanserin treatment. In this study, to examine detailed characteristics of hyperprolactinemia of blonanserin, we analyzed the prolactin data in six schizophrenic patients who were switched to blonanserin from other antipsychotics and followed for one year. As a result, blonanserin dose was clearly associated with serum prolactin level. The average prolactin level was almost normal when the mean blonanserin dosage was 8.0 mg/day. Regardless of the dose decrease of blonanserin, there were no remarkable changes in symptoms and social functions. Based on our findings, we conclude that low dose blonanserin medication may be useful for schizophrenia maintenance treatment without hyperprolactinemia and a high rate of relapse.

Simultaneous determination of blonanserin and its metabolite in plasma by LC-MS/MS / 中国药学杂志

OBJECTIVE: To establish an LC-MS/MS method for simultaneous determination of blonanserin and its metabolite blonanserin C in the plasma of healthy volunteers. METHODS: After adding saturated aqueous solution of sodium bicarbonate as the basification reagent, blonanserin and blonanserin C were extracted from plasma by ethyl acetate-dichloromethane (4;1). Then blonanserin and blonanserin C were determined by LC-MS/MS using blonanserin B and blonanserin D as internal standards respectively. Separation was carried on an Agilent Eclipse plus C18 column(4.6 mm×150 mm, 5 μm)with a mobie phase of acetonitrile-0.005 mol·L-1 ammonium formate aqueous solution containing 0.1% formic acid (87;13) at the flow rate of 0.5 mL·min-1. The column temperature was set at 40°C. ESI source was applied and operated in positive ion mode. Quantitative determination was performed using selective reaction monitoring (SRM) at m/z 368.2→297.2 for blonanserin, m/z 396.3→297.2 for blonanserin B, m/z 340.2→297.1 for blonanserin C and m/z 356.2→313.3 for blonanserin D. RESULTS: Blonanserin and blonanserin C showed good linearity in the range of 10-2000 ng·L-1(r2=0.997). The extraction recoveries for blonanserin and blonanserin C were more than 93.5% and 74.5% respectively, while the intra-day and inter-day RSDs were lower than 9.0% and 16.4% respectively. CONCLUSION: The method is simple, rapid, accurate and sensitivie for simultaneous determination of blonanserin and blonanserin C in human plasma, which can be applied to the clinical pharmacokinetic study and therapeutic drug monitoring of blonanserin.

Pharmacokinetics of blonanserin and its main metabolite after multiple-dose administration in Chinese healthy volunteer / 中国药学杂志

OBJECTIVE: To study the pharmacokinetics of blonanserin and its main metabolite in Chinese healthy volunteers after multiple-dose administration. METHODS: Twenty Chinese healthy volunteers were randomly divided to two groups and given 4 mg blonanserin twice daily (bid) and 8 mg blonanserin once daily (qd) for 7 d, respectively. HPLC-MS/MS was used to determine the plasma concentrations of blonanserin and its metabolite N-desethyl blonanserin. The pharmacokinetic parameters were calculated by DAS software. RESULTS: The main pharmacokinetic parameters of blonanserin and its metabolite after multiple-dose administration of 4 mg bid were as follows; pav were (327.75±83.83) and (200.38±67.75) ng · L-1; tmax were(1.48±0.69) and (4.15±2.16) h; t1/2 were(12.98±3.35) and(18.68±4.90) h; AUCSS were (3933.00±1005.96) and(2404.56±813.03) ng · h · L-1; AUC0-∞ were (8160.18±2173.64) and (7730.84±1732.06) ng · h · L-1. CONCLUSION: The inter-individual variation of the pharmacokinetic parameters of blonanserin is very large and therapeutic drug monitoring of blonanserin will be needed during clinical therapy.

Blonanserin-induced Mood Alteration in Schizophrenia and Schizoaffective Disorder: Two Cases

We report two outpatients, one with schizophrenia and one with schizoaffective disorder, who developed manic or hypomanic episodes following the initiation of blonanserin during the course of treatment. Blonanserin is a novel antipsychotic that acts as a 5-HT and D2 receptor antagonist. Both patients developed hypomanic episodes within 2 weeks of receiving a small dose (6-8 mg) of blonanserin, and one patient later developed full-blown mania; both episodes ended within 1 month of discontinuing blonanserin. The mood alteration observed in these cases suggests a possible antidepressant effect of blonanserin; thus, clinicians should monitor mood changes when administering this antipsychotic.

A Case of Blonanserin-Induced Mania in Schizophrenia / 대한정신분열병학회지

Schizophrenia is a psychiatric disease which requires a long term treatment. Thus, patient's therapeutic compliance can be very crucial to the disease's prognosis. Moreover, the adverse effects of drugs are also important to determine the patient's therapeutic compliance. The atypical antipsychotic drugs have been improved in the way to strengthen therapeutic effects and to reduce adverse effects. Blonanserin, an atypical antipsychotic, is a selective serotonin-dopamine agonist which blocks the dopamine D2/D3 receptors and serotonin 5-HT2A receptor. Blonanserin is well known to include parkinsonism, akathisia and insomnia. In this case report, Blonanserin treatment was given to patients who admitted to the closed ward due to psychotic symptoms such as idea of reference, persecutory delusion, auditory hallucination and blunted affect. The patients showed manic symptoms including elated mood, talkativeness, hyperactivity after the increase of Blonanserin dose up to 24 mg. Such manic symptoms were improved after Blonanserin dose was decreased to 16 mg. Many researches have reported newly-evoked manic/hypomanic episodes in schizophrenic patients after the use of atypical antipsychotics such as Risperidone, Olanzapine and Ziprasidone. However, there is no report of Blonanserin-induced manic/hypomanic episode. Therefore, further study is necessary to evaluate the manic/hypomanic episodes which are thought to be the adverse effects of Blonanserin.

A Case of Blonanserin-Induced Mania in Schizophrenia / 대한정신분열병학회지

Schizophrenia is a psychiatric disease which requires a long term treatment. Thus, patient's therapeutic compliance can be very crucial to the disease's prognosis. Moreover, the adverse effects of drugs are also important to determine the patient's therapeutic compliance. The atypical antipsychotic drugs have been improved in the way to strengthen therapeutic effects and to reduce adverse effects. Blonanserin, an atypical antipsychotic, is a selective serotonin-dopamine agonist which blocks the dopamine D2/D3 receptors and serotonin 5-HT2A receptor. Blonanserin is well known to include parkinsonism, akathisia and insomnia. In this case report, Blonanserin treatment was given to patients who admitted to the closed ward due to psychotic symptoms such as idea of reference, persecutory delusion, auditory hallucination and blunted affect. The patients showed manic symptoms including elated mood, talkativeness, hyperactivity after the increase of Blonanserin dose up to 24 mg. Such manic symptoms were improved after Blonanserin dose was decreased to 16 mg. Many researches have reported newly-evoked manic/hypomanic episodes in schizophrenic patients after the use of atypical antipsychotics such as Risperidone, Olanzapine and Ziprasidone. However, there is no report of Blonanserin-induced manic/hypomanic episode. Therefore, further study is necessary to evaluate the manic/hypomanic episodes which are thought to be the adverse effects of Blonanserin.

Blonanserin: New Serotonin-Dopamine Antagonist / 대한정신약물학회지

Blonanserin is a newly developed agent which is approved for the treatment of schizophrenia in Japan and Korea. This agent has high affinity to dopamine D2 receptor and serotonin 5-HT2A receptor. Blonanserin was as effective as risperidone in the treatment of schizophrenia, and showed greater efficacy in negative symptoms than haloperidol. Blonanserin was well tolerated in both the short- and long-term studies, and the frequency and intensity of EPS is generally similar with risperidone. For other side effects, blonanserine seems to have better safety profiles compared with other atypicals, and showed less prolactin elevation than risperidone. These findings suggest that blonanserin is useful in the treatment of schizophrenia.