Actualización en enfermedad con cuerpos de Lewy / Update in Lewy body disease

La enfermedad con cuerpos de Lewy incluye 2 entidades que podrían ser consideradas variantes clínicas de una misma patología: la demencia con cuerpos de Lewy y la demencia en enfermedad de Parkinson. Con la finalidad de describir correctamente lo que sucede en la evolución de la enfermedad se divide el cuadro en etapa prodrómica y de demencia propiamente dicha. La primera está clínicamente representada por aquel período en el cual, si bien el paciente exhibe algunos signos y síntomas propios de la enfermedad, no reúne criterios de demencia. A pesar de ser difícil de definir y por carecerse todavía de contundentes datos clínicos y biomarcadores, se caracteriza principalmente por deterioro leve selectivo en función atencional ­ visuoespacial, trastorno del sueño REM y disautonomía‒. La segunda etapa está claramente caracterizada en los criterios de consenso del año 2005. Recientemente hemos publicado la validación de un instrumento llamado ALBA Screening Instrument, que permite diagnosticar con alta sensibilidad y especificidad la enfermedad aun en etapas tempranas y diferenciarla de otras patologías semejantes. La tomografía por emisión de positrones (PET) para transportador de dopamina es el procedimiento de referencia (gold standard) del diagnóstico. El tratamiento sintomático con anticolinesterásicos y neurolépticos atípicos favorece una buena evolución de la enfermedad y es fundamental tener en cuenta evitar medicamentos que pueden dañar gravemente a los pacientes como los anticolinérgicos y antipsicóticos típicos. Los avances en el diagnóstico y la difusión del impacto de esta enfermedad en la población contribuirán a generar mayores esfuerzos de investigación para hallar un tratamiento eficaz, preventivo o curativo o de ambas características. (AU)

Lewy body disease includes 2 entities that could be considered clinical variants of the same pathology: Dementia with Lewy bodies and Parkinson's disease Dementia. Two stages of the disease are described in this review, a prodromal stage and one of explicit dementia. The first one is clinically represented by that period in which, the patient exhibits some typical features of the disease, but not dementia criteria. Despite being difficult to define the prodromal stage and that strong clinical data and biomarkers are still lacking, there is evidence to characterize it mainly by mild selective impairment in attention and visuo-spatial function, REM sleep disorder and dysautonomia. The second stage is clearly characterized in the known consensus criteria of 2005. We have recently published the validation of an instrument called ALBA Screening Instrument which showed a high sensitivity and specificity for diagnosis of the disease even in the early stages. It´s useful to differentiate the disease from other similar pathologies. Positron Emission Tomography for dopamine transporter is the gold standard of diagnosis in life. Symptomatic treatment with anticholinesterases and atypical neuroleptics help patients in their evolution of the disease. Anticholinergics and typical antipsychotics are agents to avoid in the treatmen of the disease because can severely damage patients. Future advances in the diagnosis and dissemination of the knowledge of the disease will contribute to generate greater research efforts to find an effective preventive and / or curative treatment. (AU)

Successful Treatment of Intractable Hiccups with Benztropine / 대한소아신경학회지

In general, intractable hiccups are uncommon. Various drugs and interventions have been reported, but there is no consensus on the treatment of intractable hiccups. We report a patient with meningitis and rhombencephalitis who presented with intractable hiccups that were resolved following treatment with benztropine. A 17-year-old boy was admitted to another hospital with a two-week history of fever and headache. A cerebrospinal fluid (CSF) test showed an increased white blood cell (WBC) count (290/muL, monocytes 100%). He was diagnosed with meningitis and treated with ceftriaxone. Two days after admission, hiccups started and lasted for eight days, despite treatment with phenobarbital, diazepam, haloperidol, phenytoin, and chlorpromazine. He was transferred to our hospital for further evaluation and treatment. He was clinically diagnosed with rhombencephalitis based upon the findings of brain magnetic resonance imaging (MRI). The fever and headache disappeared one day later. However, the hiccups persisted, despite symptomatic treatment with chlorpromazine, gabapentin, and metoclopramide. The hiccups disappeared after one day of adding benztropine without relapse. Benztropine can be considered in the treatment of intractable hiccups.

New Onset Diabetic Ketoacidosis Associated with Quetiapine

New onset diabetes and diabetic ketoacidosis have been reported with administering atypical antipsychotics. Whereas clozapine and olanzapine are associated with a relatively high incidence of new onset diabetes and diabetic ketoacidosis, there are few case reports that have has been documented implicating quetiapine as the contributor to causing diabetes and diabetic ketoacidosis. I report here on a case of diabetic ketoacidosis that developed in a patient who was associated with quetiapine therapy. A 32-year-old woman with schizophrenia was transferred to the emergency room with diabetic ketoacidosis and vaginal bleeding. Seventeen months before this episode, she was hospitalized in an inpatient psychiatric institution and treated with quetiapine 1200mg, haloperidol 3mg, diazepam 5mg and benztropine 3mg with normal blood glucose levels. She had no personal and familial history of diabetes mellitus. She had no risk factors for diabetes mellitus and she also had no precipitating factor for diabetic ketoacidosis except for taking the atypical antipsychotic quetiapine. I believe that this case is the first case report of quetiapine associated diabetic ketoacidosis in Korea. Considering the unpredictability of hyperglycemia associated with quetiapine, monitoring the blood glucose should be part of the routine care when administering quetiapine.

A Case of Acute Dystonia Induced by Aripiprazole in a Patient with Tic Disorder / 대한정신약물학회지

An 8-year-old female with Tourette Disorder (TD) was treated with a daily oral dosage of 5 mg of aripiprazole, which did not significantly improve her symptoms. After treatment with 10 mg daily for 3 days, she experienced an acute episode of dystonia with facial muscle spasms, opisthotonus, and torticolis. All symptoms resolved after ingestion of a total of 2 mg of benztropine over 2 days. Previously, aripiprazole was considered to cause few anticholinrgic, antiadrenaline, or antihistamine effects or extrapyramidal symptoms. However, extrapyramidal symptoms have now been reported in patients with TD and in adolescent patients with other psychiatric disorders. We reviewed the literature, and to the best of our knowledge, this is the first report of a child TD patient with acute dystonia. Although the recommended treatment largely precludes acute dystonic reaction, aripiprazole has produced this reaction.

The Effect of Benztropine in Gustatory Hyperhidrosis: Two case report / 대한흉부외과학회지

Two patients with gustatory hyperhidrosis complaining of discomfort during usual activities were relieved of sweating by using anticholinergic benztropine. Herein, we report two cases of gustatory hyperhidrosis treated with benztropine.

Review of Sexual Dysfunction in Male Schizophrenics

OBJECTIVE: There are four possible explanations for the sexual dysfunction of schizophrenics. The first is the possibility or a real structural aspect. The second possibility is that sexual function changes secondary to the illness. The third possibility is that there are medical and sociocultural barriers to sexual expression for chronic schizophrenics. The fourth possibility is that sexual dysfunction due to antipsychotic medication. However, we didn't know the precise cause of sexual dysfunction in schizophrenics. Therefore, the purpose of this study was to explore the mechanism of illness itself and antipsychotics on sexual dysfunction in male schizophrenics. METHODS: The serum prolactin(PRL), testosterone(TST), and the plasma serotonin(5-HT) concentrations were measured by radioimmunoassay and high performance liquid chromatography method for 100 healthy male schizophrenics according to the DSM-IV. Concomitantly, the severity of psychotic symptoms using Clinical Global Impression(CGI), Brief Psychiatric Rating Scale(BPRS), Positive and Negative Syndrome Scale(PANSS), and the severity of side effects for antipsychotics using Extrapyramidal Side Effects Scale(EPSE), Anticholinergic Side Effects Scale(ACSE), the cognitive function using PANSS-Cognitive Function(PANSS-CF), Mini Mental State Exam-Korean(MMSE-K), and sexual dysfunction using Sexual Functioning Questionnaire(SFQ), Questionnaire for Sexual Dysfunction in Men were assessed. The PRL, TST and 5-HT levels of 50 healthy male controls who had no medical, neurological, and psychiatric illnesses were evaluated The sexual function using SFQ(items FGa, FNa) were also assessed. Furthermore, the correlation with age, education, religion economic status, age at onset, duration of illnesses, duration of admission. levels of PRL, TST, 5-HT, antipsychotic dosages, potency, benztropine total duration of medication, EPSE, ACSE, CGI BPRS, PANSS, PANSS-CF MMSE-K and sexual dysfunctions were identified in male schizophrenics. RESULTS: 1) The frequencies of sexual dysfunctions for schizophrenics(80%) were significantly(p<0.001) higher than those for controls(42%). The sexual dysfunctions according to sexual response cycle were low sexual desire '76% 'impairment of achieving erection '75%, 'impairment of maintaining erection'75%, 'impairment of obtaining orgasm'32%, 'impairment in the quality of orgasm'61%, 'impairment of quantity of ejaculate'44%, premature ejaculation'15%, and 'delayed ejaculation'50%. 2) The PRL, 5-HT levels of schizophrenics(28.5+/-20.6ng/ml, 298.5+/-89.1ng/ml) were significantly(p<0.001) higher than those of controls(10+/-5.6ng/ml, 169.2+/-37.8ng/ml), while the TST levels of schizophrenics(4.3+/-1.5ng/ml) and controls(4.5+/-1.2ng/ml) were not significantly different. The sexual dysfunctions of schizophrenics who had abnormal 5-HT levels(4.7+/-1.3 scores) were significantly(p<0.05) higher than those of who had normal 5-HT levels(3.8+/-1.6 scores) on item D7. 3) The sexual dysfunctions of unmarried schizophrenics were significantly(p<0.01 : p<0.05) higher than those of married schizophrenics(6.1+/-2.8 scores, 4.7+/-1.3 scores on item FGa : beta=-0.211 on item FNa). The sexual dysfunctions we positively correlated with the rise of 5-HT levels (r=0.209, p<0.05 on item D4 and r=0.241, p<0.05 on item D7), the higher age at onset(r=0.275, p<0.01 on item FNa : r=-0.202, p<0.05 on item FDa), the longer duration of illesses(r=0.237, p<0.05 on item D6), the longer duration of admission(r=0.234, p<0.05 on item D4 : r=0.328, p<0.05 on item D6), the longer total duration of medication(r=0.237, p<0.05 in item D6). However, age, education, religion, economic status, PRL, TST levels, antipsychotics dosage, potency, benztropine, ACSE, CGI, BPRS, PANSS, PANSS-CF, MMSE-K scores were not correlated with increased sexual dysfunctions. CONCLUSIONS: Male schizophrenics have significantly more sexual dysfunction to compare with controls. The high frequencies of sexual dysfunctions were low sexual desire and erectile disorder. The unmarried, higher age at onset, are longer duration of diseases were positively correlated with increased sexual dysfunctions. Also high 5-HT levels were positively correlated with increased sexual dysfunctions. This means that studies of plasma 5-HT levels, albeit questionable indicators of central 5-HT function, offer some additional support for the association of sexual dysfunction with excess 5-HT activity as primary pathology of schizophrenia. Our findings suggest that excess 5-HT activity seems to affect the patient's sexual function.

Comparison of Risperidone and Olanzapine Use in the Treatment of Inpatients with Schizophrenia / 대한정신약물학회지

OBJECTIVE: This retrospective study was designed to compare the drug usage patterns and clinical outcomes of patients who received either risperidone or olanzapine in a naturalistic setting at a university hospital. METHODS: Inpatients with schizophrenia given either risperidone or olanzapine, as a single oral antipsychotic drug during hospitalization were retrospectively investigated. Data on patients' age, sex, efficacy, duration of hospitalization, dosage, use of antiparkisonian drugs, cost of drugs, weight changes, and hepatotoxicity were collected. RESULTS: Sixty patients, 30 patients for each group, were evaluated. No significant differences were observed between groups for age, sex, the duration of hospitalization, the degree to the improvement of Global Assessment of Functioning and weight gain. The mean daily antiparkinsonian medication use expressed in benztropine equivalents was significantly lower (p<0.001) in the olanzapine group (0.8 mg+/-0.9) than in the risperidone group (2.2 mg+/-0.8). For risperidone, the mean daily dose and associated cost at discharge were 5.6 (+/-1.1)mg and 765.6 (+/-144.9) won per day, whereas those for olanzapine were 15.8 (+/-4.0)mg and 1884.2 (+/-470.9) won per day (p<0.001). A mild increase of liver enzymes was found in both groups. CONCLUSION: It appears from this study that both risperidone and olanzapine are relatively safe and effective in inpatients with schizophrenia. While olanzapine group shows a superior profile in the neurological side effects, risperidone group exhibits better profile in the daily cost of drug. Further controlled studies are recommended to confirm these findings.

A Case of Rabbit Syndrome

We report a case of rabbit syndrome in a 28-year-old man with chronic active epilepsy and mental retardation. He developed fine and rhythmic perioral involuntary movements with mild parkinsonism several months after he had been administered with neuroleptics. His movements had a rhythmic pattern consisting of 2-3 Hz with a resting period for 1- 2 seconds. They were remarkably reduced with benztropine. Parkinsonism also improved with benztropine.

Preliminary Study for the Effect of No-smoking on Antipsychotics, Benztropine and Propranolol Dosage for Re-admitted Psychotic Patients / 신경정신의학

This study was designed to investigate the effect of no-smoking on the pattern of medication for 30 re-admitted psychotic patents in the no-smoking(smoking-prohibited) ward, who had been admitted and medicated previously in the smoking (smoking-allowed) ward, in Wonju Christian Hospital, by comparing daily mean dosage of antipsychotics, benztropine mesylate, and propranolol administered in smoking state and in no-smoking state of the same patients. The results were as follows: 1) The mean hospital stay was reduced to 46.0 days in no-smoking ward compared to 61.1 days in smoking-allowed ward. This means mean admission period was reduced significantly(p<0.05) and over two thirds of all subjects experienced reduction of hospital stay from 2 days to 92 days. 2) A statistically significant difference was fecund in the dosage of antipsychotics in all subjects. Calculated in terms of chlorpromazine equivalent, the daily mean was 296.8+/-180.7mg in no-smoking state, and 395.0+/-232.2mg in smoking state(p<.01), 3) In schizophrenics(n=13), the daily mean dosage of benztropine mesylate was 0.56+/-.62mg in no-smoking state and 0.14+/-0.21mg in smoking state, showing a significant difference(p<.05). In bipolar group, the mean dosage in no-smoking ward was also smaller than in smoking ward, though not significant. 4) The difference of the daily mean dosage of propranolol between two states was not significant. In conclusion, in no-smoking state psychotic patients required less hospital stays and significantly lower dosage of antipsychotics, and the schizophrenics required significantly higher dosage of benztropine mesylate for extrapyramidal symptoms. The authors suggest that psychiatric patients should be encouraged to stop smoking and recommend that psychiatrists monitor smoking state of their psychotic patients for proper and efficient drug therapy.

The effect of benztropine messylate on haloperidol saliva level / 신경정신의학

No abstract available.

A double-blind study of amantadine sulfate versus benztropine mesylate in antipsychotic drug-induced extrapyramidal symptoms / 신경정신의학

No abstract available.