1/50. Asymptomatic pancreatitis associated with clozapine.Besides the well-known adverse effects of clozapine, such as granulocytopenia, tiredness and hypersalivation, acute pancreatitis is known to be a very rare complication of the drug. In the literature a total of five case reports have been published so far. We report a case of asymptomatic pancreatitis subsequent to clozapine treatment at therapeutic doses in a 38-year-old male patient with chronic paranoid-hallucinatory schizophrenia. The patient was rehospitalized after an acute exacerbation of the psychosis subsequent to an attempt to change medication on an outpatient basis. Treatment with clozapine was initiated again. During phases of progressively increasing the clozapine dose, serum levels of amylase and lipase were increased; after maintaining daily doses of clozapine of 300 mg and/or 600 mg the pancreatic enzymes normalized quickly within a few days. The patient did not report any pancreas-related complaints, nor did specific diagnostic studies produce any indicative result, only a minor thickening of the head and body of the pancreas in the ultrasound. It is assumed that the phenomenon of subclinical, asymptomatic pancreatitis during increasing dosage of clozapine occurs more often than previously supposed. The monitoring of serum amylase levels during slow increase in clozapine is recommended; if leukocytosis or eosinophilia is present, the possibility of even a subclinical and asymptomatic pancreatitis should be considered.- - - - - - - - - - ranking = 1keywords = schizophrenia (Clic here for more details about this article) |
2/50. psychotropic drugs in acute intermittent porphyria.Acute intermittent porphyria is one of a group of metabolic diseases called the porphyrias that may lead to symptoms of the central nervous system during an acute exacerbation. Certain drugs such as barbiturates are known to precipitate attacks of acute intermittent porphyria, but unfortunately there is little information regarding the safety of many psychotropic drugs in this disorder, especially the newer antidepressants and atypical antipsychotics. We report a case of an elderly patient with acute intermittent porphyria who was treated with a variety of psychotropic agents for a severe depression with psychotic features. Although many of the agents did not improve the psychiatric status of the patient, all the drugs were tolerated without precipitating an episode of acute intermittent porphyria. To our knowledge, this is the first report of the safe use of sertraline, venlafaxine, olanzapine, risperidone, clozapine, buspirone, trazodone, lorazepam, and clonazepam in a patient with documented acute intermittent porphyria. Our report also supports the safety of trifluoperazine. Although response and sensitivity to drugs may vary greatly among patients with this disorder, clinicians may want to consider the possibility of the above drugs to treat psychiatric symptoms in patients with acute intermittent porphyria.- - - - - - - - - - ranking = 1.5736233953468keywords = psychotic (Clic here for more details about this article) |
3/50. clozapine in the treatment of neuroleptic-induced blepharospasm: a report of 4 cases.BACKGROUND: blepharospasm, the forcible closure of eyelids, is an infrequent consequence of neuroleptic treatment that, when severe, can interfere with the ability to walk, drive, or work. Like tardive dyskinesia, blepharospasm can be disfiguring and aesthetically distressing, contributing to the increased stigmatization of patients. case reports: We report 4 patients with DSM-IV schizoaffective disorder, paranoid schizophrenia, or chronic undifferentiated schizophrenia who developed neuroleptic-induced blepharospasm. In all patients, blepharospasm remitted without the reemergence of psychosis within 3 to 5 months of treatment with clozapine, 100-200 mg/day. CONCLUSION: The results suggest that clozapine may successfully treat neuroleptic-induced blepharospasm without the reemergence of psychosis in patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder.- - - - - - - - - - ranking = 3keywords = schizophrenia (Clic here for more details about this article) |
4/50. Treatment of self-mutilation with olanzapine.BACKGROUND: Self-mutilation or dermatitis artefacta is a facet of a much broader spectrum of factitial disease. Three nonpsychotic patients with self-mutilation are presented in this article who were successfully treated with low dose olanzapine when all other modalities of therapy had failed, including trials with numerous antidepressants and antipsychotics. OBJECTIVE: The patients were simultaneously evaluated and treated by a dermatologist and a psychiatrist who run the psychodermatology or consultation-liaison clinic based at McMaster University. After dermatologic conditions had been excluded as a cause of the clinical findings, olanzapine was prescribed on a trial basis due to its low risk of parkinsonian side-effects and its antihistaminic properties. CONCLUSIONS: The excellent clinical response of the patients can be attributed to the low side-effect profile of the drug but also to the anti-impulsive effect which stems not only from antihistaminic properties but also from its antidopamine and serotonin-blocking action.- - - - - - - - - - ranking = 1.5736233953468keywords = psychotic (Clic here for more details about this article) |
5/50. Progression of postictal to interictal psychosis.PURPOSE: To describe a case series of patients with both postictal psychosis (PIP) and chronic interictal psychosis (IIP). methods: We retrospectively reviewed the records of 43 patients with PIP from a comprehensive epilepsy center to find evidence of both PIP and IIP in the same patient. RESULTS: Six (13.9%) of the 43 patients met all the criteria for both PIP and IIP. Five of our six patients had multiple documented PIPs before they became chronically psychotic. The range of length of time between PIP and IIP was 7 to 96 months. Postictal and interictal psychotic behavior was similar or identical in five of six cases. CONCLUSIONS: The results of this study suggest a progression from PIP to IIP: there is a similarity between the symptoms of the two psychoses, a history of multiple PIPs before the first IIP, and a period of months to years between PIP and IIP onset.- - - - - - - - - - ranking = 1.5736233953468keywords = psychotic (Clic here for more details about this article) |
6/50. comorbidity of parkinsonism and schizophrenia in a patient treated with clozapine.clozapine is the least likely anti-psychotic to induce extrapyramidal symptoms (EPS). We present a surprising case of a woman schizophrenic patient treated with clozapine suffering from EPS. Single photon emission computed tomography (SPECT) revealed a low density of presynaptic dopamine transporters in our patient's brain. A comorbid diagnosis of Parkinson's disease in schizophrenia was confirmed in this way. This helped us to find a proper therapeutic strategy for our patient.- - - - - - - - - - ranking = 5.7868116976734keywords = schizophrenia, psychotic (Clic here for more details about this article) |
7/50. Recurrent neuroleptic malignant syndrome in a man with mild mental handicap.A case of recurrent neuroleptic malignant syndrome (NMS) occurring in a 29-year-old man with mild mental handicap and a superadded psychotic disorder is described. The case illustrates a number of unusual features such as recurrent episodes and resolution with administration of intravenous procyclidine. The possibility of NMS occurring in people with mental handicap, who have a high level of neuroleptic drug prescription, must be borne in mind.- - - - - - - - - - ranking = 0.78681169767338keywords = psychotic (Clic here for more details about this article) |
8/50. The clinical efficacy of maintenance electroconvulsive therapy in a patient with a mild mental handicap.A 32-year-old chronically relapsing depressed male patient with a mild mental handicap had tried different forms of pharmacotherapy which were either not tolerated or failed to prevent recurrences of episodes of psychotic depression. The use of maintenance ECT as the mainstay of the therapeutic regime led to a marked consistent clinical improvement.- - - - - - - - - - ranking = 0.78681169767338keywords = psychotic (Clic here for more details about this article) |
9/50. Olanzapine for recurrent aggression in a patient with temporal lobe epilepsy who had temporal lobectomy.We report the case of a patient with epilepsy who had interictal severe affective aggression, and whose epilepsy significantly improved (but not aggression) after successful temporal lobectomy. Olanzapine significantly improved these aggressive episodes refractory to neurosurgery and previous pharmacological treatments including antipsychotics, anticonvulsants/mood stabilizers and benzodiazepines.- - - - - - - - - - ranking = 0.78681169767338keywords = psychotic (Clic here for more details about this article) |
10/50. neurosyphilis and schizophrenia.neurosyphilis continues to present in atypical forms, leading to erroneous diagnoses by physicians and psychiatrists. This patient, with a previous history of psychosis, presented in a catatonic state with rhabdomyolysis and renal failure. A subsequent breakdown was thought to be schizophrenic until unusual features led to a reassessment and discovery of neurosyphilis which was treated with penicillin and resulted in a remarkable clinical recovery.- - - - - - - - - - ranking = 4keywords = schizophrenia (Clic here for more details about this article) |
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