An open randomized pilot trial on the differential effects of aripiprazole versus risperidone on anhedonia and subjective well-being.

INTRODUCTION: Negative symptoms of schizophrenia often predict an unfavorable clinical outcome. Disturbed dopamine transmission in different brain parts may underlie different aspects of negative symptoms, and the effect of antipsychotics on them may also differ. This pilot study investigated the potentially therapeutic effects of the partial dopamine agonist aripiprazole on different negative symptoms. METHODS: This pilot study randomly assigned patients with schizophrenia (N=40) to either aripiprazole or risperidone. After 6 weeks of treatment, the severity of negative symptoms was determined by the PANSS. Subscales of self-report questionnaires were used to assess differences in initiative, anhedonia, social functioning and subjective well-being. RESULTS: Patients treated with aripiprazole showed a significant improvement on measures for anhedonia and subjective wellbeing. Negative symptoms in general, lack of initiative and social inhibition were also lower in the aripiprazole treated group, but without reaching statistical significance. DISCUSSION: According to this pilot study, aripiprazole appears to specifically improve anhedonia and subjective wellbeing compared to risperidone. This may be caused by a specific effect of aripiprazole on the limbic branch of the dopamine system. Future studies should replicate this finding with a larger sample size.

[Ischemic colitis without atherosclerosis?]. / Ischämische Kolitis ohne Arteriosklerose?

HISTORY AND CLINICAL FINDINGS: A 69-year-old woman, who was being treated for a bipolar affective psychosis, was admitted because of abdominal pain, emesis and bloody stool. EXAMINATIONS: Blood tests showed increased inflammation parameters. Ultrasound revealed a swollen intestinal wall. Coloscopy correlated with the ultrasound findings and demonstrated an ischemic colitis. The histological report at first corroborated this as the possible diagnosis. But angiography of the mesenteric vessels and duplex ultrasound of the cervical vessels were normal. COURSE AND THERAPY: The symptoms persisted under therapy with acetylsalicylic acid (100 mg daily), no food intake and intravenous fluids. The coloscopic picture and the laboratory tests remained unchanged. The findings did not normalize until most of the antipsychotic drugs, especially perazine, were discontinued. The angiographic and duplexultrasound results spoke against the initially suspected diagnosis of an ischemic origin, but for necrotizing colitis as an adverse effect of perazine. A second biopsy confirmed this explanation. CONCLUSION: A necrotizing colitis as an adverse effect of drugs can simulate an ischemic colitis on endoscopy and in a biopsy. Even if the clinical pattern is present possible adverse reaction to the medication should be considered. The diagnosis of a necrotizing colitis was postulated only after the course of the disease had been taken into account and, in particular, atherosclerosis had been excluded as a possible cause, and an adverse reaction to the medication had been considered.