Adjunctive treatment with risperidone in clozapine-resistant schizophrenia: a case report and review.

OBJECTIVES: Long-term studies show that 47% to 63% of schizophrenic patients treated with clozapine fail to respond after 12 years of treatment. Such high rates of resistance justify the growing interest in therapeutic strategies based on enhancing the effect of clozapine with other antipsychotics. The combination of clozapine and risperidone in the treatment of partial responders to clozapine has been one of those receiving most interest from research. METHODS AND RESULTS: The present work reports the case of a 26-year-old man, diagnosed with schizophrenia who, after treatment with clozapine at appropriate doses over 12 weeks without observable response, showed a marked and sustained improvement after the addition of risperidone to the clozapine treatment. We also present a detailed review of publications related to the therapeutic combination of clozapine and risperidone in clozapine-resistant schizophrenia. CONCLUSIONS: Despite the contradictory nature of the published data, our results are in support of other work reporting that treatment with a combination of clozapine and risperidone, apart from being well tolerated, may constitute an effective alternative in this type of patient. Nevertheless, there is a need for further, controlled studies, with larger samples, with a view to drawing definitive conclusions and making specific recommendations.

Monotherapy with reboxetine in amphetamine withdrawal syndrome.

Amphetamine withdrawal can induce a condition with the symptoms of major depression. We report the case of a 46-year-old woman with antecedents of abuse of amphetamines and amphetamine derivatives from age 16 to age 41, who in the 5 years since withdrawal presented recurrent depression resistant to treatment. She was treated with maximum doses of selective serotonin reuptake inhibitors and lithium, but there was no remission of symptoms. On being treated with reboxetine, a selective noradrenaline reuptake inhibitor, euthymia was achieved, without negative after effects. Several studies have shown that noradrenaline plays an important role in the modulation of the response to amphetamines. The findings in this case suggest that reboxetine may constitute an interesting alternative for the treatment of amphetamine withdrawal syndrome (AWS).

Combined treatment with amisulpride in patients with schizophrenia discharged from a short-term hospitalization unit: a 1-year retrospective study.

OBJECTIVE: Antipsychotic monotherapy is considered as the reference standard in the pharmacological treatment of schizophrenia. Nonetheless, there is a large rate of studies showing polypharmacy with antipsychotics as more frequent than would be expected attending experts' recommendations. The objective of this study is to describe polypharmacy with antipsychotic regimen in patients with schizophrenia discharged with amisulpride from the short-term hospitalization unit. METHODS: We have analyzed the prescription of psychotropic drugs upon discharge of 52 patients with schizophrenia or schizoaffective disorder who were discharged with amisulpride from January to December 2005. Variables were included to describe the following treatments: antipsychotic (drug and dose), benzodiazepine, and anticholinergic drugs. Sociodemographic and clinical variables were also collected. RESULTS: In the group treated with 2 antipsychotics, the most frequently used common combination was with a classic antipsychotic in depot formulation. Patients (17.5%) were prescribed to another 2 antipsychotics in addition to amisulpride, being the most common combination with a second generation antipsychotic, and a classic or depot antipsychotic. CONCLUSIONS: The results of our study show that the use of amisulpride as an adjuvant can be a suitable therapeutic strategy for patients with schizophrenia resistant to treatment and for the rapid control of symptoms in schizophrenic patients with acute episodes. However, its clinical use does not have to be reserved exclusively for patients with resistant schizophrenia to clozapine.

Inverse correlation between insulin-like growth factor (IGF)-binding protein-5 and IGF-I and II during postnatal development of the anterior pituitary gland.

BACKGROUND: The insulin-like growth factor (IGF) system is important for pituitary development and control, with each member of this axis having a specific temporal and spatial expression. Because IGF-binding protein-5 (IGFBP-5) is one of the most highly expressed binding proteins in the anterior pituitary (AP), it might be of special importance in this gland. OBJECTIVE: The purpose of this study was to examine the temporal relationship between the expression of the IGFs and IGFBP-5 in the AP during postnatal development. DESIGN AND METHODS: Quantitative reverse transcription polymerase chain reaction was used to study the mRNA levels of these proteins in the AP of male and female rats at 10, 20, 30, 40 and 60 days of age. RESULTS: The highest mRNA levels of IGF-I and II occurred at 10 and 20 days of age with a dramatic decrease at 30 days (p < 0.0001). IGF-I, but not IGF-II, mRNA levels increased again during adulthood (60 days). The pattern of IGFBP-5 mRNA was inversely expressed, with maximum values occurring at 40 days. IGF-I mRNA levels were higher in males at 10 days, but higher in females at 20 days. The expression of IGF-II was higher in males both at 10 and 20 days. IGFBP-5 gene expression was higher in females at 40 days. CONCLUSION: The dramatic changes in the expression of IGF-I, IGF-II and IGFBP-5 throughout postnatal development suggest that these factors play important roles in the development of this gland and that their actions are highly interrelated.