[Psychosis Associated with Herbal Products: Iatrogenic Delusional Disorder]. / Psicose Associada a Produtos de Ervanária: Perturbação Delirante Orgânica de Carácter Iatrogénico.

Metabolic, toxic or structural brain changes may present as psychotic symptoms. Organic delusional disorders are characterized by the presence of delusional ideas with evidence of brain dysfunction. Iatrogenesis may be a cause of this dysfunction. We present a case of neuropsychiatric symptoms, including delusional disorder, secondary to the use of herbal products. The patient's perception regarding the safety of natural products might result in an omission to report their use during clinical history taking, and thus its use should be actively questioned.

Sintomas psicóticos podem constituir a forma de apresentação de alterações estruturais, metabólicas ou tóxicas. As perturbações delirantes orgânicas são caraterizadas pela presença de ideias delirantes com evidência de disfunção cerebral. A iatrogenia pode ser uma causa desta disfunção. Apresentamos um caso de sintomas neuropsiquiátricos, incluindo perturbação delirante, secundária ao uso de produtos de ervanária. A noção de inocuidade associada a estes produtos origina que o consumo dos mesmos não seja referido espontaneamente pelo doente na recolha da história clínica, pelo que a sua utilização deve ser ativamente questionada.

Caffeine-induced psychiatric manifestations: a review.

The association between caffeine consumption and various psychiatric manifestations has long been observed. We present two cases that show the ability of caffeine to induce psychotic and manic symptoms, and we also review the extant literature on caffeine-induced psychiatric manifestations. On the basis of our own and others' findings, we suggest that caffeine may be related to not only de-novo psychotic or mood symptoms but also to aggravation of pre-existing psychotic or mood disorders. We therefore suggest that caffeine consumption among patients with mood or psychotic symptoms should be assessed carefully in clinical practice as part of routine psychiatric evaluations.

Abnormal auditory sensory gating-out in first-episode and never-medicated paranoid schizophrenia patients: an fMRI study.

Numerous electrophysiological studies have showed auditory sensory gating-out abnormalities in chronic schizophrenia with antipsychotic medication. Previous research has used functional magnetic resonance imaging (fMRI) with excellent spatial resolution to identify the neural substrates of sensory gating-out deficits revealing increased hemodynamic response in the hippocampus, thalamus and prefrontal cortex. However, such results obtained from medicated patients may be confounded by antipsychotic medication. The present study scanned 15 first-episode schizophrenia patients not yet receiving any medical treatment and 15 healthy controls matched in gender, age and education when they performed a sensory gating-out task adapted for fMRI. The symptoms of the patients were assessed with the positive and negative syndrome scale. Different from previous findings, the schizophrenia patients showed decreased activation in hippocampus and thalamus during sensory gating-out, compared with the normal controls. The results support the theory attributing abnormal sensory gating-out in schizophrenia patients to the dysfunction of hippocampus and thalamus.

Impact of tobacco smoking cessation on stable clozapine or olanzapine treatment.

OBJECTIVE: To examine the pharmacokinetic implications and potential clinical effects of tobacco smoking cessation in patients on stable clozapine or olanzapine treatment. DATA SOURCES: A literature search of MEDLINE (1950-November 2009) and EMBASE (1980-November 2009) was conducted using the search terms smoking, tobacco, cigarette, cannabis, smoking cessation, cytochrome P450, antipsychotic, clozapine, and olanzapine. In addition, reference lists from publications identified were searched manually. STUDY SELECTION AND DATA EXTRACTION: English-language articles and human studies were identified, yielding 111 returns. Articles that reported clinical outcomes following smoking cessation were selected. Pharmacokinetic data for these drugs were reviewed and articles that provided relevant background information were also included. DATA SYNTHESIS: Pharmacokinetic studies have demonstrated more rapid clearance of olanzapine and lower clozapine and norclozapine (desmethylclozapine) concentrations in smokers compared to nonsmokers. These studies also found that smokers require higher doses of these agents than nonsmokers. There are case reports of adverse clinical outcomes following smoking cessation in patients being treated with olanzapine and clozapine. Reports that included serum concentrations consistently found elevations following smoking cessation, and dosage reductions of 30-40% were required to achieve pre-cessation concentrations. Worsening psychiatric symptoms, somnolence, hypersalivation, extreme fatigue, extrapyramidal effects, and seizures have all been reported following smoking cessation in this patient group. CONCLUSIONS: Pharmacists need to be aware of potential risks associated with smoking cessation in patients stabilized on clozapine or olanzapine. Toxicity as a result of recent smoking reduction or cessation may be a reason for hospital admission. For hospitalized patients, pharmacists should obtain information concerning smoking status, including cessation attempts. Nonspecific signs and symptoms of elevated clozapine or olanzapine concentrations should be considered in relation to clinical status while the patient is hospitalized. Measurement of baseline serum clozapine concentrations and/or empiric dosage adjustment in patients expected to have a prolonged hospital stay with forced smoking cessation may be appropriate.

Successful treatment of polydipsia, water intoxication, and delusional jealousy in an alcohol dependent patient with clozapine.

The beneficial effect of clozapine on polydipsia and water intoxication in patients with schizophrenia has been demonstrated many times. The authors report a successful clozapine treatment of polydipsia, intermittent water intoxication, and delusional jealousy of an alcoholic. This is a rare case of clozapine treatment of a non-schizophrenic patient affected by polydipsia.

[Calcium balance and regulation in schizophrenic patients treated with second generation antipsychotics]. / Zaburzenia gospodarki wapniowo-fosforanowej u chorych na schizofrenie leczonych lekami przeciwpsychotycznymi II generacji.

UNLABELLED: Calcium balance and regulation play an important role in providing its normal plasma concentration. Hormonal regulation is mostly done by parathormone and vitamin D. Impaired balance may result in bone demineralization, decreased bone mineral density and cause osteopenia and osteoporosis. In patients with a diagnosis of schizophrenia it can be due to dietary and vitamin deficiencies, decreased sunshine exposure, as well as polydipsia and other reasons. There is no substantial data exploring the influence of second generation antipsychotics on calcium dynamics in schizophrenic patients. AIM: The aim of the study was to evaluate calcium and phosphate metabolism in patients with a diagnosis of schizophrenia treated with second generation antipsychotics in reference to a control group of healthy, non-medicated volunteers. METHOD: Participants in the study were 60 schizophrenic patients: 26 were treated with risperidone, 34 with olanzapine and 38 were healthy, non-medicated volunteers--the control group. Subjects were excluded for any medical condition or treatment known to alter calcium balance. Blood samples for analysis were fasting morning ones. The following parameters were measured: serum levels of ionized calcium and phosphate, serum levels ofparathormone and serum levels of 25-hydroxy-vitamin D3. Also a 24-hour urine sample was collected for the measurement of urinary calcium and phosphate. RESULTS AND CONCLUSION: There was no significant statistical difference between mean serum calcium and phosphate levels in schizophrenic patients and the control group and between patients treated with risperidone and those treated with olanzapine. 24 hour urine calcium and phosphate concentration was decreased in schizophrenic patients comparing to controls, but there was no difference between groups treated with risperidone or olanzapine.

Delírium y esquizofrenia: presentación de un caso clínico / Delirium and schizophrenia: a case report

No disponible

Attenuation of neuroleptic-induced extrapyramidal side effects by Kava special extract WS 1490.

We studied at 42 patients (17 female, 25 male) with different psychiatric diagnoses, who were pretreated by neuroleptics, the efficacy and tolerability of the Kava special extract WS 1490 on extrapyramidal side effects. In both patient and physician questionnaires as well as in the physician's global ratings, significant improvements were found for all extrapyramidal signs and symptoms recorded. The concomitant intake of WS 1490 was well tolerated by the patients. The findings of this observational study suggest that extrapyramidal side effects of neuroleptic drugs may be attenuated by Kava special extract WS 1490.

Who's that talking?

The case of a man aged 37, with symptoms suggesting paranoid schizophrenia is discussed. There was a rapid and sustained response to Kalium bromatum.

Psychosis and pregnancy: five cases of severely ill women.

An increasing number of patients with chronic mental disease are now integrated in society. As a consequence, women with severe psychiatric illness may become pregnant and wish to complete the pregnancy and to give birth to a child. The lack of sensation of reality in these patients and their social situation may result in particular problems in their treatment, and it may be necessary to admit them to a psychiatric ward before delivery. In this paper five cases of pregnant women with severe and chronic psychosis are described. These patients had many problems in common. Thus, they were all schizophrenics with very severe psychopathology, had poor understanding of their own situation, and lacked social networks. All the fathers were non-Danish. Coercion was used in all cases. To help women with severe mental illness to go through pregnancy and childbirth requires close collaboration between psychiatric and obstetric staff and social workers, and this should be organized in an institution with experience in the treatment of this type of patient.

[123I]IBZM SPECT in patients treated with typical and atypical neuroleptics: relationship to drug plasma levels and extrapyramidal side effects.

[123I]Iodobenzamide (IBZM) is an iodine-labeled dopamine receptor ligand and can be used to visualize brain D2 receptors in humans with single photon emission computerized tomography (SPECT). The ratio of striatal IBZM uptake to uptake in frontal cortex (ST/FC ratio) represents a semiquantitative measure of D2 receptor binding in the striatum. Our study sample included six patients treated with haloperidol (3.0-8.0 mg/day orally; one patient with an average of 0.9 mg/day intramuscularly), five patients with benperidol (9.0-15.0 mg/day orally) and nine patients treated with clozapine (200.0-600.0 mg/day orally). Typical neuroleptics (TNs) and atypical neuroleptics (ANs) were significantly different in their ST/FC ratios. The ST/FC ratios indicated that patients treated with benperidol exhibited the lowest ST/FC ratios, with increasingly higher ratios in patients on haloperidol or clozapine. We found a curvilinear relationship between the ST/FC ratios and the dose/kg body wt. of TNs and ANs on the basis of a dose-normalization according to Ki-values of the neuroleptic at D2 receptors and a weaker, but also curvilinear relationship between ST/FC ratios and normalized dosages according to clinically defined chlorpromazine equivalents. The specific uptake of IBZM did not correlate with the plasma levels of the TN haloperidol at the present dose range (0-12.4 ng/ml). For clozapine, a meaningful negative correlation between plasma levels and ST/FC ratio could be established. There was a negative continuous correlation between uptake of IBZM and extrapyramidal side effects, which is different from the threshold-based relationship between extrapyramidal side effects and IBZM uptake reported previously.

SPECT study of regional cerebral perfusion in neuroleptic-resistant schizophrenic patients who responded or did not respond to clozapine.

OBJECTIVE: The purpose of this study was to find predictive criteria for response to clozapine. METHOD: Single photon emission computed tomography studies of cerebral perfusion were done in 24 treatment-resistant schizophrenic patients while they were taking typical neuroleptics and again after they had been treated with clozapine for 6 months. Perfusion ratios of the subjects categorized as responders or nonresponders to clozapine and of the subjects in the two treatment conditions were compared. The ratios with significant between-group differences were compared to those from a normal database. RESULTS: Before clozapine, while taking neuroleptics, subjects who became responders to clozapine showed higher thalamic, left basal ganglia, and right prefrontal perfusion. Nonresponders to clozapine had lower prefrontal perfusion and responders had higher subcortical perfusion than subjects in the normal database. The subcortical perfusion of the responders decreased when they received clozapine. CONCLUSIONS: The study of cerebral perfusion may contribute to the prediction of response to clozapine.

Exorcism-resistant ghost possession treated with clopenthixol.

BACKGROUND: An Indian man now in Britain explained his criminal behaviour as episodic ghost possession. Traditional exorcisms failed to help. METHOD: A 'Western' diagnosis of dissociative state or paranoid schizophrenia was made. Treatment commenced using trifluoperazine and clopenthixol. RESULTS: The patient underwent remission during neuroleptic treatment, despite previous evidence of genuine possession. CONCLUSIONS: Many cultures give rise to apparently genuine cases of ghost possession. Neuroleptics may relieve symptoms of exorcism-resistant possession.