Treatment of Tardive Dystonia Induced by Antipsychotics, Old and New.

OBJECTIVES: Tardive dystonia is a serious extrapyramidal side effect emerging after long-term treatment with antipsychotics, frequently with a deteriorating course, and unsatisfactory treatment. Presently, clozapine is used for the cotreatment of tardive dystonia and psychosis, at the cost of serious side effects. Apart from clozapine, there have been case reports describing positive effects of quetiapine on dystonic symptoms. Aim of the present study was to demonstrate the ameliorating effects of quetiapine on dystonic symptoms, in a sample of patients suffering from antipsychotic-induced tardive dystonia. METHODS: Quetiapine was administered to 16 consecutively enrolled stabilized patients with psychotic or mood disorders and tardive dystonia, replacing the "offending drugs," over a 3-month cross-tapering period. Target dose of quetiapine was set according to the defined daily dose of the received antipsychotic(s) at baseline, as reviewed by the World Health Organization Center of Drug Statistics Methodology, aiming at both maintenance of psychosis control and reduction of dystonic symptoms. RESULTS: Patients were found to have significant positive results in amelioration of dystonia (P < 0.001) over a 1-year period, without loss of antipsychotic efficacy. Reduction of dystonic symptoms with the use of quetiapine could be considered comparable with the positive effects of clozapine, with the additional advantage of relatively lacking serious side effects. CONCLUSIONS: Quetiapine may represent a valuable therapeutic choice for the treatment of tardive dystonia.

Sintomatología de las fases activa y prodrómica de la esquizofrenia paranoide de inicio en el joven y de inicio tardío / Active and prodromal phase symptomatology of young-onset and late-onset paranoid schizophrenia

Introducción: Se comparó a pacientes con esquizofrenia paranoide de inicio en el joven y de inicio tardío en lo relativo a la fase prodrómica y la fase activa del trastorno, con objeto de examinar la influencia que tenía la edad de inicio en la sintomatología de ambas fases de la enfermedad. Material y métodos: Examinamos a 88 pacientes consecutivos hospitalizados por esquizofrenia paranoide. Los valores de corte de la edad se establecieron en <30 años para el grupo de inicio en el joven y >=35 años en el grupo de inicio tardío. Los diagnósticos se hicieron de forma prospectiva, con el empleo de la entrevista clínica estructurada Structured Clinical Interview for DSM-IV-Patient Edition para los trastornos del Eje I (SCID-P). Se evaluó el tipo y la gravedad de la psicopatología en la fase activa mediante la aplicación de la entrevista clínica estructurada para la escala Positive and Negative Syndrome Scale (PANSS). Se efectuó un examen retrospectivo de los pacientes respecto a los síntomas prodrómicos iniciales, mediante la aplicación de la Structured Clinical Interview for DSM-III-R Patient Edition y una entrevista clínica respecto a otros síntomas adicionales. Se realizaron comparaciones con el empleo de las pruebas estadísticas de ji2 y de suma de rangos de Wilcoxon bilaterales. Resultados: El grupo de inicio en el joven se caracterizaba por la presencia significativamente mayor de síntomas prodrómicos negativos, y por una sintomatología negativa más intensa en la fase activa, en comparación con el grupo de inicio tardío. Las diferencias observadas fueron más prominentes en los pacientes varones. Conclusiones: La edad de inicio más avanzada de la esquizofrenia paranoide parece estar relacionada con una forma menos grave de la enfermedad, que se caracteriza por una menor intensidad de la sintomatología negativa, que se aprecia ya en la fase prodrómica del trastorno(AU)

Introduction: Young and late onset patients with paranoid schizophrenia were compared, regarding the initial prodromal and active phases of the disorder, in order to examine the influence of age of onset on the prodromal and active phase symptomatology of the disease. Materials and methods: We examined 88 consecutively hospitalized patients with paranoid schizophrenia. Age cutoff points were set at <30 years of age for the young, and >=35 years of age for the late onset group. Diagnoses were made prospectively, using the Structured Clinical Interview for DSM-IV-Patient Edition for Axis I disorders (SCID-P). Type and severity of psychopathology in the active phase were assessed by applying the Structured Clinical Interview for Positive and Negative Syndrome Scale (PANSS). Patients were retrospectively examined regarding their initial prodromal symptoms by applying the Structured Clinical Interview for DSM-III-R Patient Edition and clinical interviewing for additional symptoms. Comparisons were performed by applying the two-tailed Wilcoxon rank-sum and the chi-square statistical tests. Results: The young onset group was characterized by significantly more negative prodromal symptoms, and heavier negative symptomatology in the active phase, than the late onset group. Differences were more prominently shown in male patients. Conclusions: Older age of onset of paranoid schizophrenia appears to be related to a less severe form of the disease, characterized by less severity of negative symptomatology, already demonstrated in the prodromal phase of the disorder(AU)

[Active and prodromal phase symptomatology of young-onset and late-onset paranoid schizophrenia]. / Sintomatología de las fases activa y prodrómica de la esquizofrenia paranoide de inicio en el joven y de inicio tardío.

INTRODUCTION: Young and late onset patients with paranoid schizophrenia were compared, regarding the initial prodromal and active phases of the disorder, in order to examine the influence of age of onset on the prodromal and active phase symptomatology of the disease. MATERIALS AND METHODS: We examined 88 consecutively hospitalized patients with paranoid schizophrenia. Age cutoff points were set at <30 years of age for the young, and ≥35 years of age for the late onset group. Diagnoses were made prospectively, using the Structured Clinical Interview for DSM-IV-Patient Edition for Axis I disorders (SCID-P). Type and severity of psychopathology in the active phase were assessed by applying the Structured Clinical Interview for Positive and Negative Syndrome Scale (PANSS). Patients were retrospectively examined regarding their initial prodromal symptoms by applying the Structured Clinical Interview for DSM-III-R Patient Edition and clinical interviewing for additional symptoms. Comparisons were performed by applying the two-tailed Wilcoxon rank-sum and the chi-square statistical tests. RESULTS: The young onset group was characterized by significantly more negative prodromal symptoms, and heavier negative symptomatology in the active phase, than the late onset group. Differences were more prominently shown in male patients. CONCLUSIONS: Older age of onset of paranoid schizophrenia appears to be related to a less severe form of the disease, characterized by less severity of negative symptomatology, already demonstrated in the prodromal phase of the disorder.

Short stature, type E brachydactyly, exostoses, gynecomastia, and cryptorchidism in a patient with 47,XYY/45,X/46,XY mosaicism.

We report a 72-year-old male patient with a 47,XYY/45,X/46,XY mosaicism associated with short stature, exostoses, type E brachydactyly, gynecomastia, cryptorchidism, mild mental retardation, and a paranoid personality and conversion disorder. Since his prevalent cell line was 47,XYY (about 75%), our patient could be karyotypically classified as a case of 47,XYY syndrome. In view of the striking similarity of the clinical features of this case and those of a XYY case previously reported by Ikegawa et al (1992), it seems reasonable to suggest that these patients are representatives of a novel syndrome with a XYY karyotype.

Major depression and risk of depressive symptomatology associated with short-term and low-dose interferon-alpha treatment.

OBJECTIVE: The objective of this study is to identify early patients who are at-risk for major depression (MD) induced by interferon-alpha (IFN-alpha) and evaluate the response of depressive symptoms to antidepressants. METHODS: Thirty-six consecutive patients were treated with IFN-alpha. Psychiatric evaluations were performed prior to, and at 1 and 2 months after onset of therapy and upon completion of the study. Diagnoses were made according to DSM-IV criteria, and the severity of depressive symptoms was determined by the Hamilton Depression Rating Scale score (HDRSS). RESULTS: Of the 36 patients studied, 7 (19%) had MD before IFN-alpha treatment, 6 of which manifested a worsening of the depressive symptomatology during treatment. Of the remaining 29 patients, 9 (31%) developed MD during treatment. The median time required for the appearance or worsening of the depressive symptoms was 15 days (range 7-25). The median HDRSS before IFN-alpha in the 36 patients was 3 (range 1-20), whereas after 1 month of therapy, it was 10 (range 1-24; P=.000004). There was a strong positive correlation in the HDRSS before and 1 month after the initiation of treatment (r=.863). Of the 14 patients with a HDRSS of 1-2 before IFN-alpha treatment, only 1 (7%) developed MD, whereas of the 15 patients with a score >3, 8 (53%) developed MD. Antidepressants resulted in a decrease of the HDRSS to the IFN-alpha pretreatment values. CONCLUSION: One third of those treated with IFN-alpha developed MD. The HDRSS before treatment reveals the high- and low-risk patients for developing MD. Psychiatric evaluation should be performed prior to IFN-alpha treatment.

Enzyme replacement therapy in severe Fabry disease with renal failure: a 1-year follow-up.

We present here the course of clinical response of a 53-year-old haemodialysed Fabry patient who received recombinant human alpha-galactosidase A at a dose of 1 mg/kg every other week over a period of 1 year. The therapy was well tolerated by the patient, who revealed an impressive favourable cutaneous, gastrointestinal, neurological and psychiatric response and a dramatic improvement in his quality of life, but no improvement in cardiac and renal function.

Psychopathology and behavioural trends of children with accidental poisoning.

OBJECTIVE: To study the psychopathology of both young children with accidental poisoning and their mothers, measure the poisoned children's trends of behaviour and explore whether there is an association between parental smoking and poisoning in children. METHODS: The psychopathology of 150 poisoned and 150 matched control young children, and their mothers was studied according to DSM-IV criteria. Children's perceptions of behaviour were examined by a measure assessing internalizing and externalizing behaviour. RESULTS: Psychiatric disorders were by 4.3-fold more frequent in the poisoned than in the control children. Also, the study children exhibited higher levels in all aspects of behaviour. In the poisoned children's mothers the frequency of psychiatric disorders was threefold greater than in the control. Also, "parent-child relational problem" and "psychosocial and environmental problems" were more frequent in the study than the control groups. Smoking was more frequent in both parents of the poisoned than of the control children. CONCLUSIONS: Findings show that risk factors for accidental poisoning are localized on the children, their parents or may have a psychosocial-environmental origin. The presence of certain psychiatric disorders in young children (attention-deficit and disruptive behaviour disorders) or their mothers (anxiety, personality and mood disorders) requires the implementation of early measures for reducing the risk of poisoning.

Symptomatology of the initial prodromal phase in schizophrenia.

The initial prodromal symptoms in schizophrenia were studied in 100 DSM-diagnosed patients and 100 controls. The median number of symptoms in the patients and the controls was 8 (range 2-13) and 0 (range 0-5), respectively. Patients developed symptoms indicating social, occupational, and affective dysfunction, whereas the controls' symptoms included magical content and disturbance in mood. There were significant differences in the frequency of several symptoms appearing in the subtypes. Initial prodromal symptoms were classified into negative, positive-prepsychotic, and positive-disorganization categories. Patients with the disorganized subtype were more likely to have had negative symptoms in the prodromal state, and patients with the paranoid subtype were more likely to have had positive symptoms in the prodromal state. Observation of the course of symptoms from the prodromal to the psychotic state revealed that 58 percent of the symptoms showed increased intensity, 21 percent remained unchanged, 5 percent decreased, 3 percent evolved into other affective difficulties, 9 percent progressed into delusions, 1 percent progressed into hallucinations, and 3 percent disappeared. The Global Assessment of Functioning Scale showed that functioning is differentially affected among the subtypes even in the prodromal phase. These findings provide a better understanding of the initial prodromal state of schizophrenia, the signs and symptoms that best define it, and their prognostic significance.