Ketamine for depressive symptoms: A retrospective chart review of a private ketamine clinic.

Background: There is currently no published evidence demonstrating the effectiveness and safety of subanaesthetic doses of ketamine, when administered intravenously as an adjunct treatment for depressive symptoms, in a real world setting in South Africa. Aim: This retrospective chart review reports the clinical response (change in Patient Health Questionnaire - 7 score) to an initial infusion series of ketamine added to usual treatment, and the pattern of its subsequent maintenance use, for depressive symptoms. Setting: A private ketamine clinic in Hilton, KwaZulu-Natal. Methods: The medical records of all patients who attended a private ketamine clinic between August 2019 and 31 May 2021 were retrospectively analysed. Depression symptoms were evaluated using the Patient Health Questionaire-9 (PHQ-9) administered immediately before and 24 h after each treatment. Response was defined as a score decrease of more than 50%. Results: Among the 154 patients who received ketamine infusions for depression, 67 completed a six infusion initial series, with a response rate of 60.6% and remission rate of 32.4%. Of the 154, 50% no longer experienced any suicidal ideation after treatment and adverse events were uncommon, with 6.2% of infusions requiring intervention for adverse events, mostly nausea. In addition, 48.5% of those who completed the initial series continued to receive maintenance infusions, with no evidence of escalating use or abuse. Conclusion: Incorporating intravenous ketamine into the existing treatment regimens at a private clinic was associated with reduced acuteness of depression severity and suicidal ideation. This approach appeared safe and tolerable, showing no signs of abuse or dependence. Contribution: This is the first known naturalistic study reporting on ketamine use for depressive symptoms in South Africa.

Neurological Soft Signs, Spontaneous and Treatment Emergent Extrapyramidal Syndromes in Black Africans With First Episode Schizophrenia.

Background: Very little is known about the relationship between spontaneous and treatment-induced motor syndromes in Africans with first episode schizophrenia. Objective: We investigated the association between spontaneous NSS and EPS, with treatment-induced EPS in a homogenous sample of Black Africans with first episode schizophrenia. Methods: We examined Xhosa (South Africa) and Yoruba (Nigeria) patients, using the Neurological Evaluation Scale and extrapyramidal symptoms scale before and at 3 months after exposure to low dose flupenthixol decanoate. Pearson's correlations and Linear regression models, controlling for duration of untreated psychosis (D.U.P) and premorbid adjustments, were used in examining associations. Results: Among 99 participants in the baseline sample, 91 (91.8%) and 20 (20.2%) had at least one definite NSS and EPS, respectively, before exposure to antipsychotics. Treatment-induced EPS were recorded in 34 (38.6%). Spontaneous EPS was associated with treatment-emergent Akathisia in participants with a longer D.U.P (r = 0.75, ß = 0.70, p = 0.008). This association was specific for Parkinsonism (r = 0.75, ß = 0.85, p = 0.008) and dyskinesia (r = 0.75, ß = 1.70, p = 0.008). Conclusion: Similar to previous findings for tardive dyskinesia in studies implementing longer-term follow-up, spontaneous EPS may also predict short-term antipsychotic-induced EPS such as akathisia. These results may be important for early identification of patients at risk of treatment-induced Akathisia-linked psychomotor agitation in first episode schizophrenia.

The 2nd Schizophrenia International Research Society Conference, 10-14 April 2010, Florence, Italy: summaries of oral sessions.

The 2nd Schizophrenia International Research Society Conference, was held in Florence, Italy, April 10-15, 2010. Student travel awardees served as rapporteurs of each oral session and focused their summaries on the most significant findings that emerged from each session and the discussions that followed. The following report is a composite of these reviews. It is hoped that it will provide an overview for those who were present, but could not participate in all sessions, and those who did not have the opportunity to attend, but who would be interested in an update on current investigations ongoing in the field of schizophrenia research.

First-episode psychosis: an update

Interest in the subject of first-episode psychosis has increased considerably in the last two decades. At present; a number of centres around the world focus on early identification and intervention in people with psychotic disorders. Researchers have focused particularly on people who are possibly experiencing the prodromal phase of the illness in the hope that; by instituting appropriate early intervention; the outcome of schizophrenia will be improved. Patients with first-episode psychosis present with different symptom domains that should be taken into account when planning treatment. Most patients initially respond to treatment; however; there is a high rate of relapse within a few years. It is therefore important that we continue to seek improved relapse prevention strategies. There has also been a resurgence of interest in psychosocial risk factors for the development of schizophrenia in the recent literature. We review the literature on first-episode psychosis and highlight the significant findings

The relationships between depression and remission in first-episode psychosis.

This study assessed changes in depressive symptoms over time in 57 patients with first-episode psychosis, and investigated the relationships of these symptoms during the acute psychotic episode and the post-psychotic period with treatment outcome. Assessment instruments included the Calgary Depression Scale (CDS) and the Positive and Negative Syndrome Scale (PANSS). For the evaluation of treatment outcome, recently proposed operational remission criteria were used. PANSS factor analysis identified a depression/anxiety factor (PANSSD/ A) at baseline, which separated into "pure" depression (PANSS-D) and anxiety (PANSS-A) factors at 24 months. There were strong correlations between the CDS and the PANSS-D/A, PANSS-D and PANSS-A scores at baseline, but at 24 months significance was lost between CDS and PANSS-A. Compared to non-remitters, patients who achieved remission had significantly higher baseline CDS scores, but depressive symptoms resolved with antipsychotic treatment. Non-remitting patients had relatively low baseline CDS scores, but their depressive symptoms persisted throughout the study. These findings suggest that depressive symptoms in the acute psychotic episode differ from those in the post-psychotic period in terms of their phenomenology, temporal relationship to psychosis, and treatment response.