Suicidality and psychotic episodes after starting aripiprazole: two case reports.

Switching antipsychotic medication must be done carefully to ensure patient safety and a successful response. Here, we present two major psychotic decompensations that occurred following a switch to aripiprazole in two patients with schizophrenia. Mr. X was treated with paliperidone and experienced residual anxiety. Thus, a switch to aripiprazole was planned with risperidone and a gradual decrease in paliperidone. Initially, an increase in aripiprazole resulted in remission of his residual symptoms. However, two weeks later, he presented an anxiety relapse with persecutory ideas which required hospitalization. Mr. Y, who was treated for many years with risperidone, presented with a treatment resistant psychotic episode. A switch to aripiprazole enhanced his clinical condition. Despite the initial improvement, soon after discharge from the hospital, the patient presented psychotic symptoms requiring home intervention. Ultimately, the patient in the midst of a delusional recrudescence, had killed himself when the health care team arrived. A strong dopamine antagonist may lead to the development of dopaminergic upregulation. The addition of a partial agonist to these hypersensitive neurotransmitter pathways could explain these episodes. We agree with previous reports and recommend careful management when switching from strong dopamine antagonists to aripiprazole.

Conscious recollection in autobiographical memory: an investigation in schizophrenia.

Whether or not conscious recollection in autobiographical memory is affected in schizophrenia is unknown. The aim of this study was to address this issue using an experiential approach. An autobiographical memory enquiry was used in combination with the Remember/Know procedure. Twenty-two patients with schizophrenia and 22 normal subjects were asked to recall specific autobiographical memories from four lifetime periods and to indicate the subjective states of awareness associated with the recall of what happened, when and where. They gave Remember, Know or Guess responses according to whether they recalled these aspects of the event on the basis of conscious recollection, simply knowing, or guessing. Results showed that the frequency and consistency of Remember responses was significantly lower in patients than in comparison subjects. In contrast, the frequency of Know responses was not significantly different, whereas the frequency of patients' Guess responses was significantly enhanced. It is concluded that the frequency and consistency of conscious recollection in autobiographical memory is reduced in patients with schizophrenia.

Reduced levels of specific autobiographical memories in schizophrenia.

Autobiographical memory is intrinsically related to the self and personal identity. This study investigated whether both personal episodic memory and semantic memory are impaired in schizophrenia, a disease characterized by an abnormal personal identity. Personal episodic memory and personal semantic memory were investigated in 24 patients with schizophrenia and 24 normal subjects using an autobiographical fluency task and an autobiographical memory inquiry. Autobiographical memory scores and the proportion of specific memories were lower in patients with schizophrenia than in normal subjects. The deficit of personal episodic and semantic memory, as assessed by the autobiographical memory inquiry and the autobiographical fluency task, respectively, was most apparent after the onset of clinical symptoms. Schizophrenia is associated with an impairment of both personal episodic and semantic memory and with a reduction of specific autobiographical memories. Those impairments are consistent with the existence of an abnormal personal identity in patients with schizophrenia.