Shiatsu as an adjuvant therapy for schizophrenia: an open-label pilot study.

CONTEXT: Studies have suggested a possible role for shiatsu in treating a variety of mental and physical ailments. OBJECTIVE: To determine if shiatsu can provide clinical benefit to individuals diagnosed with schizophrenia. DESIGN: An open-label pilot study. SETTING: An inpatient psychiatric ward at Herzog Memorial Hospital, Jerusalem, Israel. PATIENTS: Twelve hospitalized patients with chronic schizophrenia. INTERVENTION: Shiatsu treatment provided in a course of eight 40-minute biweekly sessions over 4 weeks. MAIN OUTCOME MEASURES: All subjects were evaluated at baseline, 2 weeks, 4 weeks (end of treatment), and 12 weeks (followup). The tools used for assessment included the Clinical Global Impression (CGI), the Brief Psychiatric Rating Scale (BPRS), the Positive and Negative Syndrome Scale (PANSS), the Hamilton Rating Scale for Depression (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A), and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE). Side effects were measured using the Simpson-Angus Scale for Extrapyramidal Symptoms (SAS) and the Abnormal Involuntary Movement Scale (AIMS). RESULTS: On all scales of psychopathology and side effects, the subjects showed a statistically and clinically significant improvement by the end of treatment. This improvement was maintained at the 12-week follow-up. These findings, while encouraging, must be considered preliminary and require confirmation and cross-validation in larger-scale controlled studies.

Pilot controlled trial of D-serine for the treatment of post-traumatic stress disorder.

Enhancement of neurotransmission mediated at N-methyl-D-aspartate subtype of glutamate receptors (NMDAR) may be beneficial in post-traumatic stress disorder (PTSD). d-serine (DSR) is an endogenous full agonist at the NMDAR-associated glycine modulatory site. Twenty-two chronic PTSD outpatients were randomly assigned to participate in a 6-wk double-blind, placebo-controlled, crossover trial with 30 mg/kg x d DSR used as monotherapy or add-on pharmacotherapy. Outcome was assessed using the Clinician-Administered PTSD scale (CAPS), Hamilton Anxiety (HAMA) and Depression (HAMD) scales and the civilian version of the Mississippi Scale for Combat-Related PTSD (MISS). DSR treatment was well tolerated and resulted in significantly (p=0.03) increased DSR serum levels. Compared with placebo administration, DSR treatment resulted in significantly reduced HAMA (p=0.007) and MISS (p=0.001) scores and a trend (p=0.07) towards improved CAPS total scores. These preliminary findings indicate that NMDAR glycine site-based pharmacotherapy may be effective in PTSD and warrant larger-sized clinical trials with optimized DSR dosages.

Psychiatric manifestations in Turner Syndrome: a brief survey.

Turner Syndrome (TS) is a relatively common genetic syndrome in which a woman has a 45XO or 45XO/46XX mosaic karyotype. Although it is not associated with any psychiatric syndrome, several case reports in the literature describe a similar constellation of symptoms in TS that may represent a biologically-based entity. This article reviews existing case reports and seeks common characteristics among them, which may include mild psychosis with stress-precipitated onset, prominent mood features, and some features that may resemble organic disease.

Pfropfschizophrenia in the age of deinstitutionalization: whose problem?

BACKGROUND: The Kraepelinian concept of pfropfschizophrenia refers to the intertwined coexistence of mental retardation and schizophrenia. Patients with this syndrome are relatively treatment resistant and are often harmed by diverging policies and cost cuts within the framework of mental health care services. Thus, a better understanding of this syndrome has important practical implications. The multiple problems that these patients encounter in various educational and health care agencies and what questions need to be asked to better elucidate these patients' needs are assessed. DATA: Three case reports of adult long-term inpatients fulfilling the criteria for pfropfschizophrenia are presented. Their current mental status and illness histories are discussed in relation to hypothesized pathophysiological processes and current needs. LIMITATIONS: Small cohort, naturalistic study. CONCLUSIONS: Pfropfschizophrenia is a phenotypically heterogeneous syndrome. The chronology of the appearance of cognitive deficits and psychotic symptoms during the course of this disorder should be carefully assessed because it may reflect diverse pathophysiological processes, necessitating differentiated, specific treatment interventions.

D-serine efficacy as add-on pharmacotherapy to risperidone and olanzapine for treatment-refractory schizophrenia.

BACKGROUND: D-serine, a selective full agonist at the glycine site of N-methyl-D-aspartate glutamate receptor, might presently be the compound of choice for counteracting the hypothesized dysfunction of this receptor class in schizophrenia. Studies performed with Taiwanese patients indicate that D-serine significantly improves schizophrenia symptoms when used as adjuvant to conventional neuroleptics but not to clozapine. We assessed the efficacy and safety of D-serine adjuvant treatment for Occidental schizophrenia patients treated with newer atypical antipsychotics. METHODS: Thirty-nine risperidone- or olanzapine-treated schizophrenia patients participated in a double-blind, placebo-controlled, 6-week crossover trial with 30 mg/kg/day D-serine added to their antipsychotic medication. Measures of clinical efficacy and side effects were determined biweekly throughout the study. Clinical laboratory parameters and amino acid serum levels were monitored. RESULTS: D-serine administration induced increased serine serum levels (p < .001) and resulted in significant (p < .001) improvements in negative, positive, cognitive, and depression symptoms, as measured by the Positive and Negative Syndrome Scale. For approximately one third of the sample, D-serine treatment resulted in significant (>20%) reductions in Brief Psychiatric Rating Scale total scores. D-serine was well tolerated, and no detrimental changes in clinical laboratory parameters were noted. CONCLUSIONS: These findings 1) indicate that risperidone and olanzapine efficacy might be augmented with D-serine adjuvant treatment; 2) confirm D-serine efficacy against main schizophrenia symptom domains; and 3) warrant the assessment of D-serine antipsychotic monotherapy for this illness.

Placebo-controlled trial of lamotrigine added to conventional and atypical antipsychotics in schizophrenia.

BACKGROUND: Lamotrigine, a novel anticonvulsant drug having modulatory effects on glutamatergic neurotransmission, improves mood and cognition parameters in bipolar disorder. Recent studies suggest that when added to clozapine, lamotrigine treatment may result in significant positive symptoms reductions in schizophrenia. Similar effects were not observed in an open trial in which lamotrigine was used as adjuvant to nonclozapine antipsychotics. METHODS: Thirty-eight treatment-resistant schizophrenia inpatients receiving conventional and atypical antipsychotics enrolled in a 10-week, double-blind, placebo-controlled study, in which they were randomized in a 2:1 ratio to receive adjuvant treatment with lamotrigine, gradually titrated to a 400 mg/day dose, or placebo. Of these, 31 completed the trial. Measures of clinical efficacy and side effects were determined every other week. Serum levels of amino acids were assessed at the beginning and end of the study. RESULTS: In primary last observation carried forward analysis, no statistically significant between-group differences were observed; however, the completers' analyses revealed that lamotrigine treatment resulted in significant (p < or = .05) reductions in positive and general psychopathology symptoms, as measured by the Positive and Negative Syndrome Scale. No significant differences in lamotrigine effects were noted between conventional versus atypical antipsychotics. Lamotrigine treatment was well tolerated, and glutamate serum levels remained stable throughout the study. CONCLUSIONS: These preliminary findings 1) support the hypothesis that lamotrigine adjuvant treatment may improve positive symptoms and general psychopathology in schizophrenia, 2) suggest that beneficial effects may be achieved when lamotrigine is added to both conventional and atypical antipsychotics, and 3) warrant additional, larger scale trials.