[Relationship between clozapine plasma levels and withdrawal symptoms]. / Relación entre los síntomas de discontinuación y los niveles plasmáticos de clozapina.

Discontinuation of clozapine and an attempt to change his medication to sertindol has led to serious psychotic and somatic symptoms in an schizophrenic patient treated with clozapine for five years, however after readministration of clozapine these symptoms rapidly disappeared. To further analyse the case we have developed an HPLC method for the measurement of plasma levels of clozapine and its main metabolite N-desmethyl clozapine in order to monitor the plasma levels of clozapine and to correlate with the clinical symptoms. The present results confirmed that after discontinuation of clozapine no measurable amount of drug or its main metabolite were present in the plasma of the patient. The correlation between the plasma levels of clozapine and the changes in the clinical state of the patient confirmed that the patient's severe psychotic and somatic symptoms were the result of discontinuation of clozapine treatment. The clozapine plasma concentration of the patient reported here was low (100 ng/ml) compared to the generally accepted plasma levels for antipsychotic action of clozapine (350 ng/ml), however the somatic and psychotic clozapine withdrawal symptoms rapidly and completely disappeared.

Relación entre los síntomas de discontinuación y los niveles plasmáticos de clozapina / Relationship between clozapine plasma levels and withdrawal symptoms

La suspensión del tratamiento con clozapina en un intento de introducir sertindol en un paciente esquizofrénico en tratamiento en los últimos 5 años produjo un cuadro intenso de síntomas somáticos y psíquicos, que desaparecieron por readministración de clozapina. Con el fin de analizar la relación entre los niveles plasmáticos de clozapina y su metabolito principal norclozapina con el cuadro clínico, se desarrolló un método por cromatografía líquida de alta resolución (HPLC). Los resultados demuestran que la sintomatología coincide con la desaparición de los niveles plasmáticos de clozapina y su metabolito, y la recuperación con el aumento de éstos. Las concentraciones plasmáticas de clozapina encontradas fueron inferiores a las establecidas como necesarias para la acción antipsicótica de clozapina (350 ng/ml), sin embargo con esta concentración (100 ng/ml) los síntomas tanto psíquicos como somáticos desaparecieron. El presente caso documenta la relación entre la sintomatología de discontinuación de clozapina y los niveles plasmáticos del fármaco y su metabolito principal (AU)

Clozapine withdrawal symptoms after change to sertindole in a schizophrenic patient.

A 30-year-old male patient with paranoid schizophrenia was on clozapine therapy for more than five years. Discontinuation of clozapine and an attempt to change his medication to sertindole has led to serious psychotic and somatic symptoms. After readministration of clozapine the psychotic symptoms rapidly disappeared. The patient was monitored by BPRS and PANSS positive and negative scale. Also clinical and labor parameters of the patient were monitored. The change of his medication from clozapine to sertindole was unsuccessful. This case report suggests that although atypical antipsychotics may be generally different from the classical neuroleptic drugs, there are also significant differences among the atypical antipsychotic drugs in their effects on the receptors of the central nervous system. Therefore the change of clozapine to another atypical antipsychotic medication in the clinical practice should be cross-tapered and the symptoms of withdrawal closely monitored.

Ageing and problems in differential diagnosis of psychoorganic syndromes.

Depressive syndrome was investigated in 132 psychiatric and neurologic patients by Zung's self-rating depression scale. The dexamethasone suppression test (DST) was carried out in 62 patients. Visual evoked potentials (VEP) (stimulation with flash (F-VEP) and pattern (P-VEP)), serum levels of LH, FSH, prolactin, ACTH, estradiol and cortisol were measured in 15 female patients between 85 and 94 years of age. Abnormal DST results indicated depression rather than dementia. P-VEP latencies correlated with cognitive symptoms, while F-VEP latencies correlated with affective symptoms. Gonadotropin levels were lowered in senility in comparison with the climacteric period of life. Depressive, anxious, cognitive, anorexic, sexual and disturbed diurnal mood changes syndromes could be separated by factor analysis. The severity of the cognitive depressive syndrome correlated negatively with estradiol serum levels. The total scores of Zung's self-rating depression scales correlated positively with ACTH and negatively with FSH serum levels.

[Successful electroconvulsive treatment of a schizophrenic patient suffering from severe hemophilia A]. / Súlyos haemophilia A-ban szenvedö schizophreniás beteg szövödménymentes elektroshock kezelése.

Experiences obtained with the electroconvulsive treatment of a schizophrenic patient suffering from severe haemophilia A are reported. No haemorrhagic complications were observed. According to our experiences electroconvulsive therapy can be applied also in severe haemophilia A if satisfactory replacement therapy can be ensured. Similar case has not been found in the literature.

Intellectual function in muscular dystrophies.

Intellectual function was studied in 28 boys with Duchenne dystrophy, 12 patients with facioscapulohumeral-type and 10 patients with limb-girdle-type muscular dystrophy. A definite relationship between intelligence level and the type of muscle disease was found. The more severe the genetic damage manifested by the rapidity of progression of muscular dystrophy the more definite the affection of the CNS manifesting as mental deficit. The factors influencing the level and structure of intelligence seem to exert their effect before the manifestation of muscle lesions.