CLINICAL AND GENETIC FEATURES OF PERSONALIZED ANTIPSYCHOTIC THERAPY OF PATIENTS WITH PARANOID SCHIZOPHRENIA OF THE KAZAKH ETHNIC GROUP IN THE REPUBLIC OF KAZAKHSTAN.

The problems of schizophrenia therapy occupy a leading place in both foreign and domestic clinical psychiatry. The paper presents the results of a study to identify reliable biomarkers for predicting antipsychotic therapy of patients with paranoid schizophrenia of the Kazakh ethnic group in the Republic of Kazakhstan, conducted within the framework of the project: "National program for the introduction of personalized and preventive medicine in the Republic of Kazakhstan" IRN ОР12165486. The effectiveness and tolerability of antipsychotic drugs used in the treatment of paranoid schizophrenia in the Republic of Kazakhstan according to clinical treatment protocols are analyzed. Gender and age-specific dynamics in the clinic of paranoid schizophrenia in antipsychotic therapy in persons of Kazakh ethnicity are described. Certain genetic features of representatives of the Kazakh ethnic group have been identified, which can influence the effectiveness and tolerability of antipsychotic drugs, which determines the basis of an innovative approach to personalized therapy of paranoid schizophrenia in patients of the Kazakh ethnic group in the Republic of Kazakhstan.

Long-acting injectable paliperidone palmitate induced severe cutaneous allergic reaction in a patient with first episode delusional disorder tolerating oral paliperidone regimen: a case report.

BACKGROUND: Paliperidone is a second-generation antipsychotic agent that is effective in the treatment of schizophrenia and schizoaffective disorder as well as an adjunct to mood stabilizers and antidepressants for bipolar and depressive disorders. Paliperidone is available in both oral and injection forms. Here we report an unexpected case of cutaneous allergic reaction induced by paliperidone long-acting injection (LAI) following oral tolerance. CASE PRESENTATION: A 55-year-old man with first episode delusional disorder was treated with paliperidone tablets with tolerance. On day seven he received the paliperidone LAI and developed an allergic reaction in minutes including flushing of the face, widespread urticaria with mild airway constriction. The allergic symptoms were relived following the administration of antihistamine within several minutes. CONCLUSION: The allergic reaction that occurred post administration of the paliperidone LAI but not the oral tablets suggest it is likely due to the excipients in the formulation of the LAI rather than paliperidone itself. This case highlights the necessity of monitoring allergic reactions in psychiatric patients when converting from oral to LAI format of paliperidone.

An Australian study of delusional disorder in late life.

OBJECTIVES: There is a paucity of available research to guide clinical practice in delusional disorder (DD), particularly in late life. This study aimed to evaluate antipsychotic use and treatment outcomes in patients with DD aged 65 years and older. Secondarily, we sought to examine associated clinical features and socio-demographic variables. DESIGN AND SETTING: This descriptive study reviewed all consecutive cases of DD referred to an Australian old age psychiatry service over a 12-year period. Fifty-five patients were assessed in the inpatient and/or community setting, with data verified from a review of all individual medical records. MEASUREMENTS: Data were collected with respect to antipsychotic use, outcomes, and clinical features. Socio-demographic variables of DD cases were compared to a non-matched comparison group (n=278) and an age and gender matched comparison group with a 1:1 ratio (n=55). RESULTS: The predominant type of DD was persecutory (87%). Non-prominent hallucinations were experienced by 18%, and depressive symptoms occurred in 22%. There was a statistically significant association between having DD and social isolation (χ2= 11.04 (DF=1) p<0.001; McNemar's test p<0.001). Atypical antipsychotic medication was prescribed in 32 cases, with follow-up permitted in 51 of the 55 cases (mean duration 36.6 months). Sustained recovery occurred in 20%, and improvement in an additional 35% of the study sample. Four patients subsequently developed dementia, and two developed mild cognitive impairment. CONCLUSIONS: Clinical improvement, including sustained recovery, occurred in more than half of those with late life DD. The majority of those who improved (96%) received atypical antipsychotics.

EVALUATION OF THE EFFICACY OF ATYPICAL ANTIPSYCHOTIC DRUGS AND PSYCHOTHERAPY IN PATIENTS WITH PARANOID SCHIZOPHRENIA BASED ON THE DURATION OF REMISSION.

Duration of remission (DR) is the equivalent of the risk of re-hospitalization, which is considered as evidence of unsuccessful completion of the prescribed treatment. The evidence of DR informativeness as a criterion for effectiveness of prescriptions is distribution of DR values among patients with re-hospitalization during the observation period. The aim of the study is to analyse the duration of remission as a criterion for the effectiveness of prescribing atypical antipsychotic drugs and psychotherapy for patients with paranoid schizophrenia. 4 groups of patients were formed: the study group No. 1 includes patients who received atypical antipsychotic drugs; the study group No. 2 includes patients who received atypical antipsychotic drugs and psychotherapeutic cortrection (PC); the control group No. 1 includes patients receiving typical antipsychotic drugs; the control group No. 2 includes patients who received typical antipsychotic drugs and PC. The total number of examined patients was 164 people, the average age was 29.25±13.5 years, the number of patients with a diagnosis of paranoid schizophrenia was 118, with a diagnosis of acute polymorphic psychotic disorder with symptoms of schizophrenia - 46. The average duration of the disease was 2.7±2.1 years. The statistical tobit model made it possible to objectify the results of the effectiveness of the combination of antipsychotic drugs, psychotherapy, and DR by the studied patients. We used the tobit model to test the power of hypotheses, i.e., the possibility of this model to determine the existing differences in the effectiveness of the compared treatment methods (Rosenbaum and Rubin, 1983; Wooldridge, J.M., 2012). The effectiveness of the treatment was evaluated by indicators of duration of the remission period by the patients and the risk of re-hospitalization due to disease relapse. We observed a clear dynamic of some patients to re-hospitalization during the observation period with the highest hospitalization rates in the first 100 days. Evidence of the tests powers was a clear prevalence of cases of re-hospitalization by the patients taking typical antipsychotic drugs (44 cases) compared with those among patients receiving atypical ones (12). There was a clear predominance of cases of prolonged remission by the patients who took atypical antipsychotic drugs (70) compared with those who received typical ones (38) among 108 of censored ones. It was determined that patients who took typical and atypical antipsychotic drugs entered remission with the same period, but its quality was different. It was found that the indices of DR by prescription of atypical antipsychotic drugs and PC were significantly higher compared with those of typical antipsychotic drugs - the integral difference in DR per patient was 140 days. The risk of re-hospitalization due to prescription of atypical antipsychotic drugs decreases on average by 87.8% compared with prescription of the typical ones, that is, prescription of atypical antipsychotic drugs significantly increases DR compared with prescription of typical antipsychotic drugs.

Oral Isotretinoin for the treatment of Aripiprazol-induced acneiform rash.

Acneiform rash is a commonly reported side effect to certain types of medications, including antipsychotic agents. Its clinical presentation consists mainly of papulopustular lesions. Other types of lesions, such as nodular or cystic, can also be observed. Body distribution of the lesions follows a similar pattern to acne vulgaris. Depending on the severity of the case, drug-induced acne may be treated in different ways. In mild cases, the use of topical antibiotics and retinoids in combination is usually effective. With more severe forms, it may be necessary to add oral antibiotics, such as tetracyclines, but a good response is not always achieved. Identification of the drug responsible for the side-effect is mandatory in refractory eruptions. Herein, we present the case of an Aripiprazole-induced acneiform rash successfully treated with oral Isotretinoin. The treatment was effective and well tolerated and there was no need to discontinue the psychopharmacological medication. This is the first study to report this modality of treatment.

Sertindole: EEG Analysis, Tolerability, and Clinical Efficacy.

INTRODUCTION: One of the common side effects of antipsychotic drugs is excessive sedation. The treatment with antipsychotics often manifests as an increase in slow wave activity in electroencephalography (EEG). The aim of this study was to analyze EEG recordings of patients treated with a non-sedative antipsychotic drug sertindole with regard to its adverse effects and clinical efficacy. PATIENTS AND METHODS: EEG recordings of 45 patients (27 females, mean age 30.1±8.7 years) with schizophrenia were analyzed. EEG recordings were categorized based on abnormalities severity. The clinical efficacy was rated on the Clinical Global Impression Scale. RESULTS: Abnormalities from mild to moderate were found in 29% of the group. Clinical improvement was observed in 80% of patients. Sedation/daytime sleepiness was present in 7% of patients. Other side effects were prolongation of QTc (11%, severe 4%), insomnia (9%), extrapyramidal symptoms (7%), and heart palpitations (2%). CONCLUSIONS: Patients treated with sertindole do not show side effects similar to those found during treatment with other antipsychotic drugs. Increased slow wave activity in EEG and sedation were absent in the majority of the investigated patients.

[Delusional depression : Diagnostics, phenomenology and therapy]. / Die wahnhafte Depression : Diagnostik, Phänomenologie und Therapie.

Depressive delusion is the key symptom of psychotic depression also known as major depressive disorder with psychotic features (ICD-10: F 32.3). Delusional topics are limited to guilt, impoverishment and hypochondria. Kurt Schneider described these as being the three primordial fears of human beings. Psychotic depression is distinguished by the particular severity and frequency of the episodes of illness as well as by increased suicidal tendencies. Although one in five patients with a major depression experiences psychotic symptoms, this condition is all too easily overlooked and the appropriate therapy is not initiated. Here we use case histories to illustrate some of the obstacles to diagnosis arising from the difficulty of identifying delusions hidden in a person's experience of depression, life history and personality. A targeted active exploration of these difficulties is significant taking into account the observable symptoms and not only the subjectively experienced symptoms. A phenomenological approach is chosen to explore the matter of depressive delusion and to investigate the interaction of delusion and affect and the special importance of anxiety for the genesis of delusion. In accordance with the current treatment recommendations and against this background, it is proposed that the pharmacological strategy should be supplemented by the use of benzodiazepines more often than has it has been in the past.

Paroxysmal Perceptual Alteration: Drug-Induced Phenomenon or Schizophrenic Psychopathology?

Brief and repetitive episodes of perceptual changes, termed paroxysmal perceptual alteration (PPA), have been described in association with antipsychotic treatment. We report a case of paranoid schizophrenia who had such perceptual changes akin to PPA for 15 years, which was not related to antipsychotic treatment. There was a rapid resolution of PPA after treatment with low-dose clonazepam.

Olanzapine as a possible replacement choice for paliperidone-induced Pisa syndrome: a case report.

OBJECTIVE: The aim of this paper is to present a case of paliperidone-induced Pisa syndrome and provide treatment experience. METHOD: The case report is combined with a review of the literature. RESULTS: A 37-year-old man had been diagnosed with paranoid-type schizophrenia for about 10 years. He received three-month treatment of paliperidone extended release (ER) at 6 mg per day, but showed a progressively Pisa-like physical position. We initially added an anticholinergic drug, but saw no improvement. The paliperidone ER was replaced by olanzapine at 10 mg per day, and the Pisa-like symptom improved after 1 month of the drug replacement. CONCLUSIONS: We propose olanzapine as a possible replacement choice for patients with paliperidone-related Pisa syndrome.

Antipsychotic response in delusional disorder and schizophrenia: a prospective cohort study.

INTRODUCTION: Scientific evidence focused on the treatment response in delusional disorder (DD) patients is scarce, and the findings are controversial. Our goal was to compare the antipsychotic response at the 12-week followup between patients diagnosed with DD and patients diagnosed with schizophrenia and to identify potential response dimensions. METHODS: A prospective, observational, cohort study with 12-week follow-up was conducted with DD and schizophrenia patients matched for sex, age and cumulative years of disease. The following scales were assessed: Positive and Negative Syndrome Scale (PANSS; 5-factors), Personal and Social Performance Scale (PSP), Clinical Global Impression Scale (CGI), and Columbia-Suicide Severity Rating Scale (C-SSRS). Treatment response was defined as a ≥30% reduction in the total PANSS score. Linear and logistic regression models were used to investigate the potential predictive value of psychopathological variables for the antipsychotic response. RESULTS: Response percentages in DD and schizophrenia were 61.5% and 69.2%, respectively. The duration of untreated psychosis, antipsychotic dosage, and diagnosis did not predict antipsychotic response. In the whole sample, improvement in positive symptoms was significantly associated with the clinical global improvement (p=0.006), explaining almost 20% of the variance in the model. Within the DD group, improvement in cognitive symptoms explained 30% of the variance in clinical global improvement. CONCLUSIONS: Both response percentages and required antipsychotic doses were similar between DD and schizophrenia. Changes in positive symptoms were associated with clinical global improvement in the entire sample, and improvement in cognitive symptoms was correlated with global improvement exclusively in DD.

[PSYCHOEDUCATIONAL PROGRAM AS A WAY OF CORRECTING MOTIVATIONAL COMPONENTS IN PATIENTS WITH PARANOID SCHIZOPHRENIA WITH ABDOMINAL OBESITY].

The aim of the study was to investigate the influence of motivational and targeted psychoeducational programs designed for patients with paranoid schizophrenia with abdominal obesity. We observed 34 women aged 18-42 with continuous-flow type paranoid schizophrenia. All patients had a concomitant abdominal obesity, which developed secondarily after long-term administration of second generation antipsychotic medications (at least 1 year). Based on clinical-psychopathological and psychometric methods of assessment and on the analysis of Treatment Satisfaction Questionnaire we have developed modules for psychoeducational programs. Based on the results of the treatment we conclude that the application of psychoeducational programs is an effective component of complex treatment of patients with paranoid schizophrenia. Abdominal obesity should be regarded as an important and the main side effect of long-term therapy with atypical antipsychotic medications. It has a marked negative effect on subjective assessment of patients and decreases the level of their mental and social adaptation. This factor should be the basis for the formation of re-socialization and compliance-oriented actions.

Paranoid delusional disorder follows social anxiety disorder in a long-term case series: evolutionary perspective.

Social anxiety disorder (SAD) patients may have self-referential ideas and share other cognitive processes with paranoid delusional disorder (PDD) patients. From an evolutionary perspective, SAD may derive from biologically instinctive social hierarchy ranking, thus causing an assumption of inferior social rank, and thus prompting concerns about mistreatment from those of perceived higher rank. This naturalistic longitudinal study followed four patients with initial SAD and later onset of PDD. These four patients show the same sequence of diagnosed SAD followed by diagnosed PDD, as is often retrospectively described by other PDD patients. Although antipsychotic medication improved psychotic symptoms in all patients, those who also had adjunctive serotonin-specific reuptake inhibitors for SAD had much more improvement in both psychosis and social functioning. From an evolutionary perspective, it can be conjectured that when conscious modulation of the SAD social rank instinct is diminished due to hypofrontality (common to many psychotic disorders), then unmodulated SAD can lead to paranoid delusional disorder, with prominent ideas of reference. Non-psychotic SAD may be prodromal or causal for PDD.

Clozapine-induced acute interstitial nephritis.

Acute interstitial nephritis is a common cause of acute kidney injury. Acute interstitial nephritis is most commonly induced by drug although the cause may also be infective, autoimmune, or idiopathic. Although eosinophilia and eosinophiluria may help identify this disease entity, the gold standard for diagnosis remains renal biopsy. Prompt diagnosis is important because discontinuation of the culprit drugs can reduce further kidney injury. We present a patient with an underlying psychiatric disorder who was subsequently diagnosed with clozapine-induced acute interstitial nephritis. Monitoring of renal function during clozapine therapy is recommended for early recognition of this rare side-effect.