Antonio E. Di Rosa

Quetiapine and clozapine in parkinsonian patients with dopaminergic psychosis.

ObjectiveThis study aimed to compare the efficacy and safety of quetiapine and clozapine in parkinsonian patients with dopaminergic psychosis in a randomized, open-label, blinded-rater, parallel group trial. MethodsForty-five patients with Parkinson disease (PD) and psychosis induced by antiparkinsonian drugs were randomly assigned to receive either quetiapine or clozapine. The duration of the trial was 12 weeks. Forty patients, 20 in each treatment group, completed the study. The final dose of quetiapine (mean ± SD) was 91 ± 47 mg/d and that of clozapine 26 ± 12 mg/d. The severity of psychosis was assessed using the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impression Scale–Severity Subscale (CGI-S). The Unified Parkinson’s Disease Rating Scale (UPDRS) III was used to assess motor conditions during the study period. The Abnormal Involuntary Movement Scale (AIMS) was performed to evaluate dyskinesias. ResultsForty patients, 20 on clozapine and 20 on quetiapine, completed the study. The psychopathologic state improved significantly (P < 0.001) from baseline in both treatment groups. No differences were found between clozapine and quetiapine at any assessment time. Motor conditions remained unchanged after clozapine and quetiapine. Dyskinesias decreased significantly (P < 0.05) in both groups. Side effects were mild, generally transient, and well tolerated. ConclusionsQuetiapine and clozapine appear equally efficacious for treatment of dopaminergic psychosis in patients with PD.

The effect of mirtazapine augmentation of clozapine in the treatment of negative symptoms of schizophrenia: a double-blind, placebo-controlled study

The development of therapeutic strategies to effectively treat negative symptoms remains one of the primary goals in the treatment of schizophrenia. Mirtazapine is the first of a new class of dual action compounds, the noradrenergic and specific serotonergic antidepressants (NaSSa), whose activity is related to the enhancement of noradrenergic and serotonergic transmission by a presynaptic &agr;2 antagonism and postsynaptic 5-HT2 and 5-HT3 antagonism, respectively. This study was a 8-week double-blind, randomized, placebo-controlled trial of 30 mg adjunctive mirtazapine to clozapine therapy in 24 patients with DSM-IV schizophrenia. The main finding at the end of the trial was a significant reduction on the Scale for the Assessment of Negative Symptoms (SANS) total scores in the mirtazapine group compared to placebo (P<0.01) with a significant improvement on the SANS subscales avolition/apathy and anhedonia/asociality. The Brief Psychiatric Rating Scale total score at week 8 showed superiority of mirtazapine over placebo. These findings suggest a potential role for mirtazapine as an augmentation strategy in the treatment of negative symptoms of schizophrenia.

Olanzapine augmentation of paroxetine-refractory obsessive-compulsive disorder

The aim of the present study was to investigate the effect of adjunctive olanzapine in patients with obsessive-compulsive disorder (OCD) refractory to paroxetine. Twenty-one patients unresponsive to treatment with paroxetine, administered for at least 12 weeks at the dose of 60 mg/day, participated to a 12-week open-label, add-on trial with olanzapine (10 mg/day). The psychopathological state was evaluated by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and by Clinical Global Impression (CGI). Three patients did not complete the 12-week adjunctive treatment with olanzapine. In the 18 completers, the mean Y-BOCS score decreased significantly from 27.1+/-4.0 at baseline to 20.1+/-3.9 at final evaluation (P<.001). Seven patients (38.9%) were rated as responders at final evaluation. Steady-state plasma concentrations of paroxetine were not modified during olanzapine coadministration. The drug combination was generally well tolerated and initial sedation and weight gain were the most frequent unwanted effects. Our findings confirm the results of previous studies and indicate that the addition of olanzapine to ongoing treatment with serotonin reuptake inhibitors (SRI) may be beneficial in some patients unresponsive to SRI monotherapy.

Levetiracetam in tardive dyskinesia.

Objectives: The aim of this study was to evaluate the effect of levetiracetam on tardive dyskinesia (TD), which is known to be a major limitation of chronic antipsychotic drug therapy, particularly with conventional antipsychotics. Methods: Sixteen patients suffering from chronic psychosis with TD were enrolled consecutively. Levetiracetam was given in gradually increasing doses, starting with 125 twice a day until the best clinical benefit was achieved (mean dosage, 2290 mg; range, 1000-3000 mg). Tardive dyskinesia was assessed using the Abnormal Involuntary Movement Scale at baseline and after 1 month and 3 months of treatment with levetiracetam. Results: Compared with baseline, there was a significant improvement in the Abnormal Involuntary Movement Scale score after 1 month still present after 3 months (P < 0.001). All patients well tolerated levetiracetam, except one who dropped out of the trial after the first 2 weeks owing to excessive drowsiness. Conclusions: The results of this open-label observational study suggest that levetiracetam is a well-tolerated drug and effectively controls TD.

Loperamide overdose-induced catatonia: potential role of brain opioid system and P-glycoprotein

Objective Catatonic features are observed in several psychiatric illnesses but can also be found following substance misuse. Loperamide is an anti-diarrhoeal medication that acts on opioid receptors in the intestine, reducing peristalsis. It is normally unable to pass through the intestinal wall or the blood–brain barrier; however, high dosages can in fact induce the effects on the central nervous system. Case report We describe the case of a 20-year-old man who presented with severe catatonia following excessive intake of loperamide, fully remitted with lorazepam. Conclusion We speculate on a possible increase of loperamides bioavailability after overdose owing to reduced expression and functioning of P-glycoprotein.

Neuroepidemiological Survey on Sicilian Population

This research was designed as a pilot study in order to determine the feasibility and the reliability of a major door-to-door neuroepidemiological survey to be performed in the near future in 3 Sicilian towns with a total population of 30,000 inhabitants. 1,601 subjects were investigated by means of a questionnaire for the prevalence of stroke, epilepsy, parkinsonian syndromes, peripheral neuropathies, intracranial neoplasm and migraine. This preliminary study proved to be a good starting point, but some difficulties were identified in the questionnaire, in data collecting instruments and in diagnostic criteria.

Drug-induced parkinsonism: prevalence, clinical features and follow-up study in three Sicilian communities

Sirs: As part of a neuroepidemiological study, designed to evaluate the prevalence of the common neurological disorders in three Sicilian communities, we previously investigated the prevalence of Parkinsons disease (PD) and other types of parkinsonism including drug-induced parkinsonism (DIP) [15]. We now present a 4-year follow-up of the patients diagnosed as having DIP during this previous prevalence survey in order to obtain information on the natural history of this disorder. The general methodology of the prevalence survey has been reported elsewhere [14, 15]. In brief, the study was carried out in three Sicilian municipalities: Riposto, Catania province; Santa Teresa Riva, Messina province; and Terrasini, Palermo province. The total population on prevalence day (1 November 1987) consisted of 26,692 subjects. We were able to interview 24,496 people. Cases of parkinsonism were ascertained through a door-to-door two-phase approach. Phase one consisted of the administration of a questionnaire and of a brief neurological examination performed by medically trained people; subjects who screened positive at phase 1 were entered into phase 2, which consisted of a complete standardized neurological examination performed by board-certified neurologists. Parkinsonism was diagnosed when two of four cardinal signs were present: rigidity, bradykinesia, resting tremor and impaired postural reflexes. I f a subject was treated with antiparkinsonian drugs, only one of these signs was sufficient for the diagnosis. Among patients fulfilling these criteria, DIP was defined as a syndrome following the use of neuroleptics (phenothiazines, butyrrophenones, etc.) or other antidopaminergic drugs (metoclopramide, alphamethyldopa, flunarizine, etc.) in the 6 months preceding onset of symptoms and with a negative history for symptoms of parkinsonism preceding the use of the drug. The general practioners of all patients affected by DIP were contacted and discontinuation (whenever possible) of the drug inducing parkinsonism was suggested.

Iron status in schizophrenic patients with acute neuroleptic-induced dystonic reactions

1. Serum iron parameters were measured in a group of schizophrenic patients who had developed acute neuroleptic-induced dystonia (N = 17) and in control patients with no history of extrapyramidal disorders (N = 16). No differences were found between the two groups for iron, ferritin or transferrin levels. 2. Iron status was estimated in 44 schizophrenic patients starting treatment with high-potency neuroleptics before and after 3 weeks of medication. In the 6 patients developing dystonia serum iron levels as well as other iron parameters did not differ from the values observed in the remaining 38 patients either on admission or after neuroleptic treatment. In each group the haematological profile was not modified by neuroleptic medication. 3. These results do not support an association between low serum iron and the occurrence of neuroleptic-induced dystonic reactions.

PSYCHOLOGICAL DIFFERENCES IN AMATEUR AND COMPETITIVE SKIERS

The mean personality scores based on responses to the Adjective Check List by 28 competitive skiers were compared with those for 32 amateurs to evaluate psychological characteristics of both groups (ages ranged from 18 to 26 years). Analysis gave significant differences only for six of 37 scales. In comparison with amateurs, competitors showed more need for achievement, dominance, endurance, exhibition, self-confidence and a more positive Ideal Self.