Response after Infection-Associated Rise in Clozapine Levels in Treatment-Resistant Schizoaffective Disorder.

The clinical management of patients with treatment-resistant psychotic disorders is still challenging despite years of extensive research. If first-line antipsychotic treatment proves ineffective, clozapine is considered golden standard. Herein, we report on a patient with schizoaffective disorder that initially showed no response to treatment with clozapine and ECT and therefore reached a therapeutic dead end. After an unintentional exposure to supratherapeutic clozapine levels, related to a pneumonia, a significant and persistent reduction of psychotic symptoms occurred. The report suggests a careful reevaluation of the clozapine dose in cases of treatment-resistant psychotic disorders with failed trials of clozapine. Further increase of dose may prove efficacious, although side effects should be closely monitored. Research to determine the upper threshold of clozapine for antipsychotic efficacy is warranted.

Preserved emotional memory modulation in first episode psychosis.

Although patients with schizophrenia have severe memory impairments and emotional deficits, studies investigating emotional memory modulation (EMM) in schizophrenia show contradictory results, possibly due to methodological differences and small group size. We investigated whether impaired EMM is already present in First Episode Psychosis (FEP) and whether impairments in EMM are task or stimulus dependent. Forty-five FEP and thirty-seven Healthy Control (HC) male participants matched for age performed visual and verbal short-term (immediate recall) and long-term (after 24h recognition) memory tasks with neutral, negative and positive stimuli. On all tasks overall memory performance for FEP was significantly below that of HC. Although EMM varied by task and type of stimulus, none of the tasks showed a difference in EMM between FEP and HC. There were no differences between FEP and HC in the way emotion modulates different memory domains. This could mean that EMM is spared in the early course of schizophrenia.

Impairment of gaze-directed spatial coding in recent-onset schizophrenia.

Patients with schizophrenia show deficits in core cognitive functions as well as in social cognition. The aim of the present study was to test whether deficits in social cognition influence nonsocial, "cold", cognition. Thirty-five patients with recent-onset schizophrenia (SC) and 30 healthy controls (HC) performed a Simon task with social and simple geometric stimuli. We investigated whether the Simon effect, the slowing of reaction times produced by stimulus incongruities in the task-irrelevant spatial domain, differs between patients and healthy participants as a function of the social nature of the cues. The Simon effect was generated by a schematic drawing of human eyes (social cues) or rectangles (nonsocial cues). Overall, patients had longer reaction times than HC. In the eye-like condition, the Simon effect was significantly stronger for HC than for SC. In HC the Simon effect was significantly stronger in the eye-like than in the rectangle condition. In patients, the Simon effect did not differ significantly between both conditions. Thus, the influence of social cues was greatly reduced in the patient group. Current psychopathology or antipsychotic treatment did not influence results. The present study supports earlier findings of altered processing of schematic social cues in patients with schizophrenia, especially when gaze is task-irrelevant.