Higher than recommended dosages of antipsychotics in male patients with schizophrenia are associated with increased depression but no major neurocognitive side effects: Results of a cross-sectional pilot naturalistic study.

INTRODUCTION: The current small pilot naturalistic cross-sectional study assesses whether higher dosages of antipsychotics are related to a satisfactory outcome concerning symptoms of schizophrenia but also to a worse outcome in terms of adverse events and neurocognitive function. MATERIAL AND METHODS: 41 male stabilized hospitalized schizophrenic patients were assessed by PANSS, Calgary Depression Rating Scale, UKU and Simpson-Angus Scale and a battery of neurocognitive tests. Medication and dosage was prescribed according to clinical judgement of the therapist. RESULTS: Clinical variables and adverse events did not differ between patients in the recommended vs high dosage groups. Higher dosage correlated with depressive symptoms but there was no correlation with neurocognitive measures except for impaired concentration. DISCUSSION: Results suggest that it is possible to achieve a good clinical response in refractory patients by exceeding recommended antipsychotic dosages at the price of depression and possible mild isolated concentration deficits but not other neurocognitive or extrapyramidal adverse events. Currently clinicians prefer first-generation antipsychotics when high dosages are prescribed, but considering the more favorable adverse effects profile of newer agents, it is important to study higher dosages of these agents and to test whether they should be preferably given when high dosages are necessary.

Unusual morphological pattern and distribution of the ansa cervicalis: a case report.

Ansa cervicalis presents great anatomic variability regarding its origin and formation, the number of its roots and its distribution, as well. In the current case, we report an aberrancy in the form and distribution of ansa cervicalis' branches to the infrahyoid muscles and the sternocleidomastoid muscle, which is unique, since, to the best of our knowledge, a similar case has not been recorded in the literature. During regular dissection, we detected that the ansa cervicalis' loop, which was formed underneath the superior belly of the omohyoid muscle, provided a branch for the sternothyroid muscle, from which two recurrent rami were arisen. These two rami joined together forming an unusual triangular nerve formation. The neural trunk formed by the union of the aforementioned two rami perforated the inferior belly of the omohyoid muscle and afterwards was directed towards the ipsilateral sternocleidomastoid muscle. The awareness of such an unusual variability to the surgeons of the head and neck region would be of great importance, since it is crucial not to damage the ansa cervicalis or its branches in order to prevent any possible phonation disorders. Additionally, ansa cervicalis is proved to be extremely useful in the re-innervation of the larynx following paralysis of the recurrent laryngeal nerve.