Are Second-Generation Antipsychotics Useful in Tardive Dystonia?

OBJECTIVE: To review the current evidence on the effectiveness of second-generation antipsychotics (SGAs) in the treatment of tardive dystonia (TDt) and give recommendations for treatment. METHODS: Medline/PubMed/Psyclit/Embase database searches were conducted in January 2015, and a manual review of references within the retrieved articles was done. All articles in English and those that had English abstracts and dealt with treatment of TDt were included. RESULTS: Our search and review yielded a total of 88 reports (none of them a controlled trial) involving 145 patients treated with one of the 5 SGAs. Clozapine has the maximum number of published reports (52 reports involving 90 subjects, whereas there were 36 reports involving 55 subjects treated with other SGAs, including olanzapine, risperidone, quetiapine, aripiprazole, and perospirone). CONCLUSIONS: The available evidence points to the effectiveness of clozapine as monotherapy and in combination with clonazepam for the treatment of TDt. When clozapine is not an option, olanzapine and quetiapine are reasonable alternatives. Given the lack of controlled trials, future focus should be on conducting randomized, placebo-controlled, multicenter, collaborative controlled clinical trials of several years' duration.

Efficacy of extended-release divalproex combined with "condensed" dialectical behavior therapy for individuals with borderline personality disorder.

BACKGROUND: Borderline personality disorder (BPD) is a significant psychiatric illness for which medication treatments are still being explored. The goal of this study was to assess divalproex extended release (ER) vs placebo for patients receiving dialectal behavior therapy (DBT). METHODS: Patients with BPD received 4 weeks of "condensed DBT." Those with Symptom Checklist-90 (SCL-90) scores >150 after this treatment were then randomly and blindly assigned to placebo or divalproex ER for 12 weeks. Repeated measures analysis of variance utilizing last observation carried forward was used to assess the results. RESULTS: Seventeen participants completed the full assessment. Two patients had a significant decrease in SCL-90 in the first 4 weeks, leaving 15 patients for the medication phase of the trial. There were no significant differences between the participants assigned to divalproex ER compared with placebo. However, there was a significant improvement in both groups from baseline to endpoint (P = .001). CONCLUSIONS: The response of 2 of 17 participants in the first 4 weeks prior to medication may point to a practice strategy in approaching outpatients with BPD. Although the patients had a decrease in symptoms during the study, there was no advantage observed for divalproex ER and DBT over placebo and DBT.

Appendectomy for appendicitis in patients with schizophrenia.

BACKGROUND: Anecdotal evidence suggests that schizophrenia patients who require surgery have a high rate of adverse outcomes. We searched the Department of Veterans Affairs national datasets to determine the clinical course of schizophrenia patients with appendicitis who underwent appendectomy. METHODS: The Patient Treatment File (the nationwide inpatient database for the Department of Veterans Affairs) and the Beneficiary Identification and Records Location System were searched to identify all patients with International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes for schizophrenia or schizoaffective disorder diagnosed with appendicitis during fiscal years 1995 to 1999. Computer-based information was supplemented with chart-based data. We sought data on six common preoperative risk factors and 25 specific adverse outcomes, including death. RESULTS: There were 55 patients identified. The mean age was 49, and 96% were men. The median time from symptom onset to diagnosis of appendicitis was 3 days. A history of substance abuse was obtained in 16 (29%). Disruptive behavior was documented in 16 (29%). Restraints were used in 9 (9%). The appendix was perforated in 36 (66%) and gangrenous in 9 (16%). Thirty-one (56%) had > or = 1 complication; there were 2 in-hospital deaths (4%). CONCLUSIONS: This is the first report on this topic in the medical literature. Appendicitis is typically diagnosed late in schizophrenic patients. Adverse patient behaviors are frequent. The complication and death rates are high.

Psychiatric epidemiology in cross-cultural perspective: a review.

Advances in psychiatric research have reestablished the importance of psychiatric community epidemiological studies. Psychiatric epidemiological surveys that used the same standardized diagnostic interview and classification system in different parts of the world were reviewed. The lifetime prevalence for any psychiatric morbidity ranged from 21 to 65%. The prevalence of psychiatric disorders was higher than that in the first- and second-generation community surveys. The relevance of these findings to clinical practice, public health, and the directions for future epidemiological research are discussed.

Delusion of pregnancy in males: a case report and literature review.

Delusions of pregnancy in males are bizarre delusions that are rare in occurrence. Variables in characterization of such delusions include organic factors, neuroendocrine abnormalities, sexual identity confusion, misinterpretation of mechanical factors, and wishes for another baby. In this report we describe a persistent delusion of pregnancy in a 43-year-old man with chronic schizophrenia in the background of poor sexual adjustment.

Neuroleptic malignant syndrome and psychotic illness.

A typical case of NMS and its successful treatment with bromocriptine is described. The authors noticed an inverse relationship between the process of recovery from NMS and the pre-existing psychotic illness.

The syndrome of irreversible lithium-effectuated neurotoxicity (SILENT).

Though the acute complications of lithium toxicity involving the central nervous system have been known for more than 70 years, it is only recently that the longlasting sequelae of lithium intoxication have come to be discussed at length; about fifty-five cases have been reported so far. The acronym SILENT (Syndrome of Irreversible Lithium-Effectuated Neurotoxicity) has been coined recently to denote these sequelae. The present report describes the typical profile of SILENT (persisting cerebellar dysfunction) and suggests measures to decrease the incidence of this potentially serious condition, for which no definitive treatment is available.